Scholars Symposium 2024: Pharmacy

Effectiveness of Selected Flavonoids at Pancreatic Lipase Inhibition

by Lauren Fleming (Undergraduate), Seth Campbell (Undergraduate), Price Amber (Undergraduate), Amber Haney (Undergraduate), Faith Nyatichi (Undergraduate), Bernard Addo (Undergraduate), Denise Jean-Louis (Faculty)

Pancreatic lipase is an enzyme that is commonly targeted for the treatment of obesity.14 Inhibition of pancreatic lipase slows down the breakdown and absorption of fats, in turn reducing the chance of obesity.2 Objective: To determine whether apigenin, fisetin, luteolin, quercetin, and genistein are more or less effective at inhibiting pancreatic lipase than orlistat (positive control, FDA-approved medication to treat obesity). Methods: We utilized a fluorescence assay employing 4-methylumbelliferyl oleate as a fluorogenic substrate. Results: Quercetin and fisetin have lower IC50 values, implying a lower concentration is needed to achieve inhibition of pancreatic lipase. This indicates that quercetin is more potent at inhibiting pancreatic lipase than the other flavonoids. On the other hand, genistein has the highest IC50, which implies a higher concentration is required to inhibit pancreatic lipase. This implies that of the compounds tested, genistein is the least potent at inhibiting pancreatic lipase. Apigenin and luteolin have moderate potency in inhibiting pancreatic lipase, as indicated by the slightly higher IC50 values. Discussion: There is a correlation between the structures of the flavonoids and their inhibition activity. Of the flavonoids tested, quercetin and fisetin are the flavonoids with the highest pancreatic lipase inhibition; their structures are hydroxylated on the B ring. Luteolin and apigenin are not hydroxylated on the B-ring and inhibit pancreatic lipase to a lesser extent.

Perceptions of Pharmacist-led Pharmacogenomic Services in a Pediatric Behavioral Health Clinic: Provider and Staff Perspectives

by Judah Brammer (Undergraduate), Nathan Gibson (Undergraduate), Cameron Lee (Undergraduate), Halley McClain (Undergraduate), Samantha Woodrich (Undergraduate), Michele Dodds (Undergraduate), Justin Cole (Faculty), Robert Bechtol (Faculty)

Background: Pharmacogenomics (PGx) is the study of the influence of genetic variation on drug response with the aim of increasing the efficacy and safety of current and future treatments. The application of pharmacist-led pharmacogenomics to everyday patient care has the potential to revolutionize how medication therapies are selected and optimized; however, implementation of these services has been slower than desired, despite clinical data suggesting many benefits. Studies support the clinical value of pharmacogenomic services in children with behavioral health conditions; however, there is a gap in evaluating the humanistic outcomes of these services. There has been minimal research validating whether pharmacist-led pharmacogenomic interventions are valued by health care providers of children with behavioral health diagnoses. The overall purpose of this research was to explore the value of pharmacist-provided pharmacogenomic services in the pediatric population while also incorporating the perceptions that providers have about PGx counseling. The Objectives of the project were to: (1) describe the key components and structure of a pharmacist-led pharmacogenomic education service in an ambulatory pediatric behavioral health program and (2) explore provider and staff perceptions of the counseling services. Methods: A descriptive case study was conducted to evaluate key components of a pharmacist-led PGx education program and provider and clinic staff perceptions of the PGx counseling services in a pediatric behavioral health clinic, Rocking Horse Community Health Center. The providers and staff included primary care physicians, collaborating psychiatrists, nurse practitioners, and nurses at the clinic responsible for treating pediatric patients for behavioral health issues, ordering pharmacogenomic testing, and referring patients to the pharmacist. Data was collected via personal interviews and observational checklists. Interviews were approximately 30-60 minutes in length using Microsoft Teams. Observational and demographic data were gathered using RedCap and analyzed using SPSS. Interview data was transcribed and independently coded manually in Word by two members of the research team. A third member was involved to review the codes and resolve any discrepancies. Theme statements were created to explore the provider and staff perceptions of the pharmacist-led PGx education program and services at the clinic. Results and Conclusions will be presented at the research symposium.

Rendezvous with Death: Preparing Future Pharmacists for Death and Dying Experiences

by Kayleigh Conaway (Undergraduate), Rachel Massey (Undergraduate), Tyler Wisse (Undergraduate), Robert Bechtol (Faculty), Stephanie Tubb (Faculty), Emily Laswell (Faculty)

Background: There is a growing need for end-of-life care (EOLC) training for pharmacists due to a growing elderly population; however, there has been a deficiency in this type of training nationally. An internal analysis of Cedarville University School of Pharmacy (CUSoP) faculty, students, and alumni was conducted and concern was expressed that students are not prepared to face EOLC in practice based on traditional lecturing alone. Based on these results, an educational intervention for third-year student pharmacists was developed. The Objectives of the project were to (1) assess if an educational intervention can improve student pharmacist preparedness to face EOLC, and (2) to assess students’ perceived ability to provide support to patients and families in EOLC, Methods: Third-year pharmacy students (N=33) participated in an EOLC educational intervention, which focused on providing pharmacist perspectives on death and dying in practice and applying practical communication tools to a patient case. The intervention consisted of two sections: a pharmacist panel and a branched narrative application activity. Pre- and post-surveys were used to collect demographic information from students and responses to a modified Lazenby’s End of Life Care Survey. Using SPSS 29.0.1, demographic items were analyzed using descriptive statistics while the pre-post data was analyzed for differences with the Wilcoxon sign-rank test. Results and Conclusions will be presented at the research symposium.

Cost Savings of Vasopressin Reformulation

by Luke O'Brien (Undergraduate), Will Hadley (Undergraduate), karis Kulp (Undergraduate), Lena Pokwo (Undergraduate), McKenzie Grinalds (Faculty), Nathanael Smith (Faculty)

Background: Vasopressin is a guideline-directed second-line vasopressor and recommended adjunct therapy for septic shock after norepinephrine for additional blood pressure control. When vasopressin was successfully patented in 2014, the halt of generic production resulted in an exponential price increase. As a result, the cost of Vasopressin continued to soar over the next four years, making it difficult for hospitals to afford this medication. Over the duration of this study, the cost of one Vasostrict 20 units per 10mL multi-dose vial was $1,730.48. When a patient needs only a partial bag, the remaining vasopressin in the bag is wasted. Since studies have found cost savings by decreasing the package size of similar medications, Miami Valley Hospital began compounding vasopressin in smaller doses of 20 units per 100 mL bags, reduced from 40 units per 250 mL. Methods: This retrospective analysis reviewed 190 charts of patients receiving vasopressin between April 2019 and August 2019. All the encounters occurred after the hospital had switched to compounding the 20-unit bags of vasopressin. The count of bags dispensed from the central pharmacy was verified to determine how many patients received an odd number of bags. When a patient received an odd number of bags, it indicated a situation in which 20 units of vasopressin would have been wasted under the previous formulation. Results: Of the 190 encounters in the study, an even number of bags were received by 88 (46%), while an odd amount was received by 102 (54%). From this, it was calculated that the intervention saved an average of $933.91 per encounter and at least $176,500.00 over the 127-day span of these encounters. The cost of vasopressin per vial remained constant until December 2020; by extrapolating to then from the end of this study, an estimated $678,239.15 was saved over 16 months. Conclusion: This study demonstrates the value of waste reduction through more precise dispensing. Future research could focus on qualitative measures to determine the potential effect on patient outcomes or pharmacy workload to find how this precision can best be optimized.

Comparison of the Outcomes of Direct Oral Anticoagulants (DOACs) to Warfarin in Post-Watchman Patients

by Micah Eisman (Undergraduate), Hudson Wellin (Undergraduate), Justin Merrick (Undergraduate), Reenet Maliel (Undergraduate), Daniel Kelly (Undergraduate), Nathanael Smith (Faculty)

Background: Warfarin has been the gold standard in years past for preventing thromboembolic events following a left atrial appendage occlusion device implant. Direct Oral Anticoagulants (DOACs) have been utilized more recently; however, there is minimal research on safety and efficacy, as well as predictor variables for prescribing DOACs in this setting. Methods: This is a retrospective chart review with the primary objective to compare the frequency of major bleeding of post-Watchman implant patients prescribed either warfarin or DOACs over the forty-five-day, post-implantation period. The secondary objectives were to assess other outcomes, such as stroke, other thrombotic complications, or peri-device leak, and to describe predictor variables for prescribing warfarin versus DOACs in post-Watchman implant patients. The patient cohort date range was from January 2018 to December 2021. All patients who received a Watchman implant at Kettering Health Network during this time that did not meet exclusion criteria were included. Bilirubin values were used to evaluate liver function for patients. Results: A total of 579 patients were included, with 82 (14.7%) prescribed warfarin and 461 (82.8%) receiving a DOAC for post-implant anticoagulation. For the primary objective, DOACs demonstrated no statistically significant difference as compared to warfarin (p=0.533). Additionally, no statistically significant difference was demonstrated regarding thrombotic events and peri-device leaks (p= 0.884 and p= 0.571, respectively). Bilirubin demonstrated a statistically significant difference between groups (p=0.029). Conclusion: In conclusion, DOACs appear to be non-inferior to warfarin as it relates to bleed, thrombus, and peri-device leak in the setting of post-Watchman device implantation. Patients who were previously on one anticoagulant were more likely to remain on the same anticoagulant following the procedure. However, though not statistically significant, if a patient had anticoagulants switched following the procedure, it trended towards an increased likelihood for a switch from warfarin to a DOAC rather than from a DOAC to warfarin. In patients with decreased liver function, as demonstrated by an elevated bilirubin, warfarin was more likely to be initiated.

Prescribers' Adherence to Infection  Prophylaxis Guidelines in a Community  Oncology Center

by Alea Anthony (Undergraduate), Ashley Bortlein (Undergraduate), Jillian Norriss (Undergraduate), Jillian Patrick (Undergraduate), HollyAnne Hickey (Undergraduate), Lauryn Gibson (Undergraduate), Bethany Sibbitt (Faculty)

Guidelines clearly outline the prophylactic measures prescribers should take to prevent infections in their patients with cancer. One of the leading causes mortality in cancer patients is microbial infection. Adhering well to evidence-based guidelines improves both cost outcomes for healthcare systems and health outcomes for patients. Current guidelines available today: NCCN, AGIHO/DGHO, MASCC/ISOO, ACS, and ASCO/IDSA. OBJECTIVE 1: To assess prescriber adherence to antimicrobial guidelines in low- to medium-risk patients with cancer. ● Null Hypothesis of Objective 1: Prescribers are adherent to antimicrobial prophylaxis guidelines (greater than 80% prescribing practices). ● Alternative Hypothesis of Objective 1: Prescribers are not adherent to antimicrobial prophylaxis guidelines (less than or equal to 80% prescribing practices). OBJECTIVE 2: To assess the incidence of microbial infections in low- to medium-risk patients with cancer. ● Null Hypothesis of Objective 2: There is not an increased incidence of infections in low- to medium-risk patients with cancer who did not receive antimicrobial prophylaxis compared to those who did. ● Alternative Hypothesis of Objective 2: There is an increased incidence of infections in low- to medium-risk patients with cancer who did not receive antimicrobial prophylaxis compared to those who did. A retrospective chart analysis was utilized to assess infection prophylaxis in low- to medium- risk cancer patients at Kettering Health Cancer Center following IRB approval. Patients’ charts were reviewed from the electronic medical record to assess prescriber adherence to prophylaxis guidelines as well as incidence of infection in the patient.

Burden of Untreated Sexually Transmitted Infections in the United States:  A Systematic Review

by Abigail Facemyer (Undergraduate), Houston Purcell (Undergraduate), Destany Ripley (Undergraduate), Shawn Scarberry (Undergraduate), Benjamin Tarwater (Undergraduate), Stephanie Tubb (Faculty), Juanita Draime (Faculty)

The purpose of this study is to determine the financial and clinical burdens of untreated sexually transmitted infections (STIs) in the United States. A systematic review was conducted to determine the financial and clinical burden of untreated sexually transmitted infections (STIs) in the United States.

The Effects of Antiseizure Medications in the Development of Atherosclerotic Cardiovascular Disease: A Scoping Review

by Jacob Thomas (Undergraduate), Elizabeth Nansikombi (Undergraduate), Noelle Straka (Undergraduate), Libby Ezell (Undergraduate), Nathanael Smith (Faculty), Mckenzie Grinalds (Faculty)

Objectives: To determine the impact of enzyme-inducing antiseizure medications (Ei-ASMs) on cardiovascular (CV) biomarkers, atherosclerotic cardiovascular disease (ASCVD), and cardioembolic-related outcomes along with additional gaps in the literature.

Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, PubMed, ProQuest Nursing & Allied Health, Cochrane, Web of Science, and CINAHL databases were searched using ASM and CV-related keywords. Inclusion criteria were adults age 18 years and older, specific CV biomarkers, ASCVD outcomes, and ASM monotherapy or polytherapy. Exclusion criteria were acute treatment of seizures; status epilepticus; dietary therapy or surgery only; non-epilepsy indications for ASMs; and non-human studies. Using Covidence, full-text review was separated into a two-step process. Two researchers screened article abstracts for inclusion and exclusion criteria, and two researchers conducted the full-text screening. Discrepancies were resolved by another researcher. Data was extracted via an excel spreadsheet.

Results: Of the 1,783 studies screened, 43 were included. We included 32 articles for research question 1, 11 articles for research question 2, and one article for research question 3. For research question 1, most included articles reported results pertaining to total cholesterol (TC, 24/32, 75%), high-density lipoprotein (HDL, 24/32, 75%), and low-density lipoprotein (LDL, 22/32, 69%). For research question 2, most included articles reported outcomes pertaining to myocardial infarction (8/11, 73%), other indications (8/11, 73%), and CVD-related mortality (7/11, 64%). For research question 3, one included article enrolled subjects at high risk for CV events. For research question 4, there are various gaps in the literature specifically regarding limited studies reporting outcomes for non-lipid biomarkers and peripheral vascular disease and cardioembolic outcomes. For all these gaps, more research is needed to determine the impact of Ei-ASMs.

Conclusions: Most included articles reported TC, HDL, and LDL levels or MI and CVD-related mortality. Next steps will be to evaluate results to determine the impact of Ei-ASMs. More research is needed to be able to assess the impact of Ei-ASMs on other biomarkers and ASCVD and cardioembolic outcomes.

Therapeutic Potential for Andrographolide in Patients Across Many Disease States

by Thomas Bonifield (Undergraduate), Luke Evans (Undergraduate), Temi Ladipo (Undergraduate), Joshua Ford (Undergraduate), Melissa Beck (Undergraduate), Denise Jean-Louis (Faculty), Samson Amos (Faculty)

Andrographolide is a diterpene plant product derived from Andrographis paniculata and which has been used in traditional Chinese medicine. This scoping review aimed to identify human diseases for which andrographolide may provide therapeutic benefit and any adverse effects noted in the studies. Twelve studies were evaluated, demonstrating varying levels of efficacy in several disease states including multiple sclerosis, diabetes and several respiratory illnesses.

The Growth Inhibitory Effects of Sulforaphane on Glioblastoma Cell Lines

by Princess Eziolise (Undergraduate), Lauren Gabor (Undergraduate), Logan Grove (Undergraduate), Brandon Tieu (Undergraduate), Elizabeth Williams (Undergraduate), Denise Jean-Loius (Faculty), Samson Amos (Faculty)

Glioblastoma (GBM) is known to be the most common and aggressive brain tumor in adults. Despite new therapies, GBM outcomes have not changed. Grade IV GBM is characteristically heterogeneous at both cellular and molecular levels. Studies have shown that sulforaphane (SFN) is a promising substance for inducing apoptosis and cell proliferation in GBM cells. Our objective is to determine the effects of SFN on cell viability in GBM cell lines. METHODS: GBM cells were seeded at 1x104 cells per well in a six-well plate. A cell counting assay was used to determine the percentage of viable cells. The cell viability was determined using a CytoSmart Technologies cell counter. Images were captured using a NIKON eclipse microscope to assess the biological effect of SFN on GBM cell morphology. An MTT assay was used to measure GBM cell proliferation under increasing concentrations of SFN. Cell proliferation was measured with a spectrophotometer. The mean +/-SEM was calculated and a bar graph was plotted using GraphPad Prism version 9. RESULTS: Our findings indicated that treating GBM cells with SFN decreases cell proliferation, induces cell cycle arrest, and induces apoptosis. GBM cells treated with 80 micrograms of SFN had a death rate of>70% and <30% viable cells, compared to the control group of 90% viable cells and 10% dead cells. Treating GBM cell lines with SFN decreased the number of colonies formed. This is especially seen in the cell lines treated with 80 micrograms of SFN. MTT assay shows that treating cells with SFN decreases cell proliferation drastically. After forty-eight hours, the cell proliferation decreased by 50%, and after seventy-two hours, the cell proliferation decreased by 75%. CONCLUSION: SFN decreased cell proliferation proportional to the concentration used. Higher concentrations also showed a higher cell death rate than lower concentrations, proving that SFN induces apoptosis. The MTT assay demonstrated that cell proliferation decreased significantly between 48 and 72 hours of SFN treatment. Future research is needed to determine the signaling pathway through which SFN induces changes in GBM (essential survival proteins).

The Effects of Gingko Biloba and Apixaban on Bleeding Time in Rats

by Lynette Bailey (Undergraduate), Ira Vanmatre (Undergraduate), Nicholls Joshua (Undergraduate), Joshua Peeler (Undergraduate), Melissa Beck (Undergraduate), Elisha Injeti (Faculty)