The Arnold & Marie Schwartz College of Pharmacy and Health Sciences,

Long Island University, Brooklyn, New York

Friday, June 21, 2013

7:30 AM – 4:00 PM

2013

This educational program is sponsored by the New York State Council of Health-system Pharmacists (NYSCHP) who is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmaceutical education. This program is approved for 0.6 CEU(s) (6 contact hour). Statements of Continuing Pharmaceutical Education Credit will be mailed to those participants who complete the entire evaluation form at the conclusion of the session. These statements will be mailed 30 days after receipt of the completed evaluation forms. Payments to NYSCHP are not deductible as charitable contributions for federal income tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code (i.e., ordinary, necessary business expenses; miscellaneous itemized deduction).

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EIGHTH ANNUAL NEW YORK CITY REGIONAL PHARMACY RESIDENCY CONFERENCE

Arnold & Marie Schwartz College of Pharmacy Long Island University

Brooklyn, New York

In Collaboration with the New York City and Royal Counties Societies of NYSCHP

Friday, June 21, 2013 7:00 AM– 8:00 AM Registration, Exhibits, Continental Breakfast HS Lobby

(Courtyard side) 8:00 AM – 8:15 AM Welcoming Address HS-107 David Taft, PhD, Dean The Arnold and Marie Schwartz College of Pharmacy 8:15 AM – 9:15 AM Guest Speaker:

Now That I’ve Got Such a Great Job, HS-107 Why Do I Hate It So Much?

John Lasky, JD Senior Vice President, Human Resources The Brooklyn Hospital Center, Brooklyn, NY

9:15 AM – 10:15AM Keynote Presentation:

Computerized Technologies to Mitigate Medication Error HS-107 and Adverse Drug Event Risk John Manzo, PharmD, FASHP

Director, Clinical Applications/Pharmacy NYU Langone Medical Center, Information Technology New York, New York

10:15 AM – 10:30 AM Break & Room Set-up (AV) HS Lobby 10:30 AM – 12:30 PM Platform Presentations HS107/118/121

Pratt 120 & 121 12:30PM – 1:30PM BBQ LUNCHEON COURTYARD (12:30 PM to 1:00 PM for Preceptors and Program Directors) 1:00 PM – 1:30 PM Preceptor and Program Director HS 118 Town Hall Meeting & Preceptor Development 1:30PM – 3:35 PM Platform Presentations HS107/118/121

Pratt 120 & 121

3:35 PM – 4:00 PM Presentation of Teaching Certificates, HS-107 Program Conclusion & Raffle

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Applying for Continuing Education Credits

Go to: www.healthsystemce.org Choose: “Member Login” Use the email address that your NYSCHP materials are delivered to. Choose the course and verify your attendance.

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New York City Regional Residency Conference RESIDENTS’ PLATFORM PRESENTATIONS

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Session I - Room 1 – HS107 Moderator: Shan Wang Evaluator: Rebecca Deoras, Kin Huie

Cardiology/Medicine 10:30 AM USE OF ASPIRIN AND STATINS FOR THE PRIMARY PREVENTION OF MYOCARDIAL INFARCTION

AND STROKE IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS Tae Eun Park, Pharm.D./PGY2 Infectious Diseases Pharmacy Resident/SUNY Downstate Medical Center, Brooklyn, NY [2]

10:50 AM IMPACT OF PHARMACIST-PROVIDED EDUCATION ON HEART FAILURE READMISSION: A PILOT STUDY Helene Maltz, B.S., Pharm.D., PGY-2 Internal Medicine Pharmacy Resident/Kingsbrook Jewish Medical Center (KJMC), Brooklyn, NY [17]

11:10 AM THE ROLE OF HMG-C0A REDUCTASE INHIBITORS IN ELDERLY PATIENTS FOLLOWING MYCARDIAL INFARCTION Maxine Lee, Pharm.D. / PGY-1 Pharmacy Practice Resident’The Mount Sinai Medical Center, New York, NY [43]

11:30 AM RETROSPECTIVE MEDICATION EVALUATION OF DABIGATRAN ETEXILATE USE AT A PRIVATE COMMUNITY TEACHING HOSPITAL. Caroline Hopke, Pharm.D./PGY1 Pharmacy Resident/ Kingsbrook Jewish Medical Center (KJMC), Brooklyn, NY. [49]

11:50 AM ANTIFACTOR Xa AND FACTOR II MONITORING IN A PATIENT WITH ANTIPHOSPHOLIPID ANTIBODY SYNDROME Celeste M. Vinluan, Pharm.D./ PGY-1 Pharmacy Practice Resident/ St. Luke’s-Roosevelt Hospital, New York, NY [52]

12:10 PM EVALUATION OF RIVAROXABAN USE AT LONG ISLAND JEWISH (LIJ) HOSPITAL Kimberly E. Ng, PharmD. PGY1 Pharmacy Resident/Long Island Jewish Medical Center, New Hyde Park, NY [6]

Session I - Room 2 – HS 118 Moderator: Mary Choy Evaluator: Michele Graci, Lauren McKeon

Infectious Disease

10:30 AM ANTTI-NMDAR ENCEPHALIITIS – A PATIENT CASE Elena Denisko, Pharm.D./PGY-1 Pharmacy Practice Resident/, Beth Israel Medical Center, New York, NY [1]

10:50 AM ESCALATING DOSES OF DAPTOMYCIN FOR THE TREATMENT OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA Franklin Jeng, B.S., Pharm.D./PGY-1 Pharmacy Practice Resident/New York Methodist Hospital, Brooklyn, NY [8]

11:10 AM IMPACT OF CLINICAL PHARMACISTS’ INTERVENTIONS THROUGH AN ANITRETROVIRAL STEWARDSHIP PROGRAM Julie Anne Billedo, Pharm.D./ PGY-2 Ambulatory Care Pharmacy Resident/ The Brooklyn Hospital Center (TBHC), Brooklyn, NY [9]

11:30 AM CONTINUOUS INFUSION OF AMPHOTERICIN B DEOXYCHOLATE IN THE TREATMENT OF CRYPTOCOCCAL MENINGITIS – A CASE REPORT Karina Tselenchuk, Pharm.D., Pharmacy Resident (PGY-1), Beth Israel Medical Center, New York, NY [12]

11:50 AM PILOT STUDY FOR REAL-TIME REVIEW OF EMPIRIC ANTIMICROBIAL THERAPY FOR URINARY CULTURES IN AN INNER-CITY EMERGENCY DEPARTMENT (ED) Michelle Krawczynski, Pharm.D./ PGY-2 Ambulatory Care Resident/ Brookdale University Hospital and Medical Center, Brooklyn, NY [14]

12:10 PM EVALUATION OF VANCOMYCIN EVERY 8 HOURS TREATMENT COURSES IN ADULT PATIENTS Erica Brumer, PharmD/PGY1 Pharmacy Practice Resident / New York University Langone Medical Center, NY, NY [16]

New York City Regional Residency Conference RESIDENTS’ PLATFORM PRESENTATIONS

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Session I – Room 3 – HS 119 Moderator: Evangelia Davanos Evaluator: Valerie Ng, Yuliana Toderika

Medicine

10:30 AM EFFECTS OF CHRONIC ORAL PROTON PUMP INHIBITOR THERAPY ON SERUM MAGNESIUM AND CALCIUM LEVELS Mohammad A. Rattu, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY [3]

10:50 AM EVALUATION OF ARGATROBAN DOSING PRACTICES AND IMPACT ON EFFICACY AND SAFETY MEASURES Charrai A. Byrd, Pharm.D./ PGY-1 Pharmacy/Practice Resident/ Lenox Hill Hospital, New York, NY [5]

11:10 AM ASSESSING THE SAFETY AND TOLERABILITY OF LURASIDONE-USE IN THE ELDERLY: A RETROSPECTIVE CHART REVIEW Megan Flinchum, PharmD/ PGY-1 Pharmacy Resident/Kingsbrook Jewish Medical Center, Brooklyn, NY [11]

11:30 AM A RETROSPECTIVE ANALYSIS OF DABIGATRAN 75MG TWICE DAILY IN THE RENALLY IMPAIRED Jimmy Johnson, PharmD PGY-1 Pharmacy Resident/ North Shore University Hospital, Manhasset NY [34]

11:50 AM EVALUATION OF HYPOGLYCEMIA ORDER SET AND DIABETES ORDER SET ON THE GENERAL MEDICAL FLOOF OF A COMMUNITY HOSPITAL Tammy Wu, Pharm.D./ PGY-1 Resident Practice Resident/ New York Methodist Hospital, NY [13]

12:10 PM COMPLIANCE WITH INSTITUTIONAL GUIDELINES FOR THE TREATMENT OF ACUTE VENOUS THROMBOEMBOLISM (VTE) Rivka Hecht, B.S., Pharm.D./ PGY-1 Pharmacy Practice Resident/ Brookdale University Hospital and Medical Center, Brooklyn, NY [15]

Session I – Room 4 – HS 121 Moderator: Helen Eldabie Evaluator: Nadia Fergusen, Shalonda Williams

Medicine

10:30 AM IMPACT OF PHARMACIST INVOLVEMENT ON MEDICATION RECONCILIATION IN AN EMERGENCY DEPARTMENT Diana Farino, Pharm.D./ PGY-1 Pharmacy Practice Resident Long Island Jewish Medical Center New Hyde Park, NY [7]

10:50 AM USE OF VALPROIC ACID FOR TREATMENT OF DELERIUM IN PALLATIVE CARE PATIENTS-A CASE REPORT Alla Melamed, Pharm.D., PGY1-Pharmacy Resident, Beth Israel Medical Center, NY, NY [22]

11:10 AM TOPIRAMATE FOR APPETITE SUPRESSION-A PATIENT CASE Anna Shmayenik, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Beth Israel Medical Center, New York, NY [23]

11:30 AM SAFETY AND TOLERABILITY OF RAPID DOSE TITRATION OF ACETYLCHOLINESTERASE INHIBITORS Kathleen Jodoin, Pharm.D./ PGY-1 Pharmacy Resident Kingsbrook Jewish Medical Center, Brooklyn, NY [30]

11:50 AM RETROSPECTIVE EVALUATION OF THE EFFECTIVENESS OF AN ORDER TEMPLATE IN OPTIMIZING USE OF COLCHICINE PROPHYLAXIS FOR GOUT IN A U.S. VETERAN POPULATION Jane J. Wong, Pharm.D., PGY-1 Pharmacy Practice Resident at New York Harbor Healthcare System (VA NYHHS), Brooklyn, NY [29]

12:10 PM PILOT AND REVISION OF A BASAL-BOLUS DOSING GUIDELINE FOR THE MANAGEMENT OF HYPERGLYGEMIA IN NON-CRITICALLY ILL ADULT PATIENTS Germin Shenoda Fahim, Pharm.D./ PGY-1 Pharmacy Resident/ The Brooklyn Hospital Center (TBHC), Brooklyn, NY [35]

New York City Regional Residency Conference RESIDENTS’ PLATFORM PRESENTATIONS

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Session I – Room 5– Pratt 120 Moderator: Salvatore Ventrice Evaluator: Timothy Nguyen, Magda Fulman

Infectious Disease

10:30 AM PIPERACILLIN-TAZOBACTAM VERSUS CARBAPENEMS FOR THE TREATMENT OF URINARY TRACT INFECTIONS CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE PRODUCING ENTEROBACTERIACEAE Steven Wang, Pharm.D. / PGY-1 Pharmacy Practice Resident / New York Methodist Hospital, Brooklyn, NY [31]

10:50 AM MEASURING THE IMPACT OF PEPTIDE NUCLEIC ACID FLUORESCENCE IN SITU HYBRIDIZATION (PNA FISH) FOR IDENTIFICATION OF COAGULASE-NEGATIVE STAPHYLOCCOCCI ON VANCOMYCIN USE IN BACTEREMIC PATIENTS Christy Su, Pharm.D PGY-1 Pharmacy Practice Resident/The Brooklyn Hospital Center, Brooklyn, NY [25]

11:10 AM ANTIBIOTIC STEWARDSHIP FOR CATHETER-ASSOCIATED URINARY TRACT INFECTIONS: EARLY IMPACT OF GUIDELINE IMPLEMENTATION Christine Ciaramella, Pharm.D./ PGY-1 Pharmacy Practice Resident/ NYU Langone Medical Center, New York, NY [26]

11:30 AM ADMINISTRATION OF A SURVEY TO EVALUATE THE ATTITUDES OF HOUSESTAFF PHYSCIANS TOWARD ANTIMICROBIAL USES, RESISTANCE AND ANTIMICROBIAL STEWARDSHIP PROGRAM (ASP) Nehal Gamal Hashem, PharmD/PGY-2 Infectious Disease Pharmacy Resident/The Brooklyn Hospital Center, Brooklyn, NY [42)

11:50 AM EVALUATING THE EFFICACY OF QUINOLONES OR AMINOGLYCOSIDES WITH PIPERACILLIN-TAZOBACTAM FOR THE TREATMENT OF HEALTHCARE-ASSOCIATED PNEUMONIA Jasmine George, Pharm.D. PGY-1 Pharmacy Practice, Bronx Lebanon Hospital Center, Bronx, NY [27]

12:10 PM CLINICALLY OBSERVED INCIDENCE OF ALLERGIC REACTIONS IN PENICILLIN ALLERGIC PATIENTS WHO RECEIVE THEAPY WITH A CEPHALOSPORIN OR MEROPENEM Danielle Joset, Pharm.D./PGY-1 Pharmacy Practice Resident NYU Langone Medical Center [37]

Session I- Room 6 – Pratt 121 Moderator: Alina Lyubarskaya Evaluator: Karina Muzykovsky, John Papadopoulos

Critical Care 10:30 AM EFFICACY AND SAFETY OF IV FAMOTIDINE VS. IV PANTOPRAZOLE FOR STRESS ULCER

PROPHYLAXIS IN THE CRITICALLY ILL: A PROSPECTIVE, RANDOMIZED STUDY Benjamin Wee, B.S., Pharm.D./ PGY-2 Critical Care Pharmacy Resident/ Kingsbrook Jewish Medical Center, Brooklyn, NY [20]

10:50 AM THE USE OF TRANEXAMIC ACID IN ORTHOPEDIC SURGERY: A RETROSPECTIVE STUDY Joseph Samide, Pharm.D./PGY-2 Critical Care PGY-2 Pharmacy Resident, New York Methodist Hospital [24]

11:10 AM EFFICACY AND TOLERABILITY OF HYALURONATE VISCOSUPPLEMENTATION AT A VETERANS AFFAIRS HOSPITAL Jeffrey Balsam, BA, PharmD/ PGY-1 Pharmacy Practice Resident/ James J. Peters VA Medical Center, Bronx, NY [28]

11:30 AM MANAGEMENT OF HYPERGLYCEMIA IN SURGICAL PATIENTS AT A TEACHING INSTITUTION Marieli Rivera Cruz, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Brookdale University Hospital and Medical Center, Brooklyn, NY [44]

11:50 AM

REDUCING HEEL LANCE INDUCED PAIN IN THE NEONATAL INTENSIVE CARE UNIT Mark Shen, Pharm. D./Pharmacy Practice Resident (PGY-1)/Winthrop-University Hospital, Mineola, NY [64}

12:10 PM EVALUATION OF POSTOPERATIVE INTRAVENOUS ACETAMINOPHEN ON OPIOID CONSUMPTION IN LABOR AND DELIVERY PATIENTS Eileen Tang, Pharm.D., PGY-2 Critical Care Pharmacy Resident/New York Methodist Hospital, Brooklyn, NY [56}

New York City Regional Residency Conference RESIDENTS’ PLATFORM PRESENTATIONS

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Session II – Room 1- HS 107 Moderator: Peter Caranese Evaluator: Maria Claudio, Elizabeth Chung

Clinical Practice/Administration 1:30 PM IMPACT OF PATIENT MEDICATION EDUCATION BY A PHARMACIST ON PATIENT’S

SATISFACTION THROUGH HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) SCORES Corrine A Larkai, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Bronx Lebanon Hospital Center, Bronx, NY [4]

1:50 PM RX TRANSITION: EVALUATION OF MEDICATION ADMINISTRATION TIMES BEFORE AND AFTER IMPLEMENTATION OF AN AUTOMATED DISPENSING SYSTEM May Jabra, Pharm.D./ PGY-2 Pharmacy Informatics Resident/ New York Methodist Hospital, Brooklyn, NY [19]

2:10 PM EVALUATION OF MEDICATION ORDERS SENT ELECTRONICALLY IN A HOSPITAL-BASED CLINIC Elise Kim, Pharm.D./PGY-1 Pharmacy Resident/ Kingsbrook Jewish Medical Center, Brooklyn, New York [21]

2:30 PM THE IMPACT OF PHARMACIST-DRIVEN PATIENT DISCHARGE COUNSELING ON HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) SCORES: TARGETING A UNIT IN NEED OF IMPROVEMENT Sadaf Raminfar, PharmD/ PGY-1 Pharmacy Practice Resident/ Beth Israel Medical Center Brooklyn Division, Brooklyn, NY [55]

2:50 PM DESIGN AND IMPLEMENTATION OF TOOLS TO TEST KNOWLEDGE OF AND COMPLIANCE WITH USP <797> REGULATIONS Alfred J Custer II, Pharm.D./ PGY-1 Pharmacy Practice Resident St. Luke’s-Roosevelt Hospital Center, New York, NY [57]

3:10 PM TO REDUCE MEDICATION DOSING ERRORS IN CRITICALLY ILL OBESE PATIENTS: A QUALITY IMPROVEMENT INITIATIVE Grace I. Shyh, Pharm.D.PGY-1 Pharmacy Practice Resident/ Montefiore Medical Center, Bronx, NY [51]

Session II – Room 2 – HS 118 Moderator: Salvatore Ventrice Evaluator: Joyce Wu, Dorothy Chiu

Oncology

1:30 PM EFFICACY OF RASBURICASE SINGLE, LOW DOSE COMPARED TO WEIGHT-BASED MULTI-DOSE REGIMENS IN PATIENTS AT RISK FOR TUMOR LYSIS SYNDROME Justin Chiang, Pharm.D./ PGY-1 Pharmacy Practice Resident/ North Shore University Hospital, Manhasset, NY [33]

1:50 PM DEVELOPMENT OF BK VIRUS-ASSOCIATED HEMORRHAGIC CYSTITIS FOLLOWING ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTION Monank Patel, Pharm.D./PGY2-Oncology/Mount Sinai Medical Center [18]

2:10 PM OVERVIEW AND TREATMENT OF WALDENSTROM’S MACROGLOBINEMIA Grace E. Jiang, Pharm.D., PGY-1 Pharmacy Practice Resident The Mount Sinai Medical Center, New York, NY [41]

2:30 PM CLINICAL PEARL: PHARMACIST ROLE IN THE MANAGEMENT OF CHEMOTHERAPY EXTRAVASATION Monique Garcia, Pharm.D./ PGY-1 Pharmacy Practice Resident/ St. Luke’s-Roosevelt Hospital Center, New York, NY [54]

2:50 PM USING A MULTIDISCIPLINARY APPROACH TO OPTIMIZE SMART PUMP TECHNOLOGY TO PROMOTE MEDICATION SAFETY IN ADULT ONCOLOGY PATIENTS William Yu Pharm. D., Practice Resident PGY-1/Pharmacy Practice Resident (PGY-1)/Winthrop-University Hospital [63]

3:10 PM HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) Tamara Fawal-Vefali, Pharm.D./PGY-1 Pharmacy Practice Resident/ The Mount Sinai Medical Center, New York, NY [45]

New York City Regional Residency Conference RESIDENTS’ PLATFORM PRESENTATIONS

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Session II – Room 3 –HS 119

Moderator: Mary Choy Evaluator: John Papadopoulos, Sharon Blum

Infectious Disease 1:30 PM RISK OF DEVELOPING CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA AT A COMMUNITY

HOSPITAL IN PATIENTS RECEIVING A PROTON PUMP INHIBITOR OR H2 RECEPTOR ANTAGONIST Lisa Modelevsky, Pharm.D./ PGY-1 Pharmacy Resident North Shore LIJ – Plainview Hospital, Plainview, NY [65]

1:50 PM ANALYSIS OF SEIZURE ACTIVITY WITH CEFEPIME USE IN A LARGE METROPOLITAN TEACHING HOSPITAL Rachel Staudt, Pharm.D, PGY1 Pharmacy Resident/The Mount Sinai Medical Center, New York, NY [47]

2:10 PM PREVALENCE OF COLONIZATION AND ANTIMICROBIAL RESISTANCE IN SPINAL CORD INJURED OUTPATIENTS WITH URINARY CATHETERIZATION UNDERGOING URODYNAMIC EVALUATION Kirsten Woelfel, PharmD/ PGY-1 Pharmacy Practice Resident/James J. Peters VA Medical Center, Bronx NY [61

2:30 PM

POLYMYXIN B USE FOR MULTI-DRUG RESISTANT URINARY TRACT INFECTIONS Samantha Smalley, Pharm.D. / PGY-1 Pharmacy Resident/ Kingsbrook Jewish Medical Center [53]

2:50 PM COMPARISON OF THE CLINICAL AND MICROBIOLOGICAL OUTCOMES IN DIABETIC AND NON-DIABETIC PATIENTS WITH ACUTE PYELONEPHRITIS Kathleen Lynch, PharmD / PGY-1 Pharmacy Practice Resident / The Brooklyn Hospital Center, Brooklyn, NY [58]

3:10 PM COMPARISON OF TWO ORAL VANCOMYCIN DOSING REGIMENS FOR TREATMENT OF CLOSTRIDIUM DIFFICLE INFECTION. M. Ramirez, PharmD, PGY1 Pharmacy Resident/Montefiore Medical Center, Bronx, New York [50]

Session II – Room 4 – HS 121

Moderator: Timothy Nguyen Evaluator: Rochelle Rubin, Vitalina Rozenfeld

Medicine 1:30 PM ORAL PHOSPHATE BINDERS: SELECTING THE BEST AGENT Jesni Mathew, PharmD PGY-1

Pharmacy Practice Resident/Montefiore Medical Center, Bronx, NY [36]

1:50 PM IMPACT OF INPATIENT WARFARIN COUNSELING Timothy Ho, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Long Island Jewish Medical Center, New Hyde Park, NY [38]

2:10 PM EVALUATING WARFARIN ADVERSE DRUG REACTIONS LEADING TO EMERGENCY DEPARTMENT ADMISSIONS Doris Wong, Pharm.D./ PGY-1 Pharmacy Practice Resident Beth Israel Medical Center – Brooklyn Division, Brooklyn, NY [48]

2:30 PM TRANEXAMIC ACID (CYKLOKAPRON®) ADMINISTRATION IN THE EMERGENCY DEPARTMENT Milena Grace Wong, Pharm.D./PGY-1 Pharmacy Resident St. Luke’s-Roosevelt Hospital Center, New York, NY [59]

2:50 PM INTRAVENOUS N-ACETYLCYSTEINE ADMINISTRATION IN ACUTE LIVER INJURY Quy Huynh, PharmD, PGY1 Pharmacy Resident/Montefiore Medical Center, Bronx, NY [46]

3:10 PM BK VIREMIA IN RENAL TRANSPLANT RECEPIENTS: A DESCRIPTIVE STUDY Jason J. Chheda, PharmD/ PGY-2 Transplant Pharmacy Resident Mount Sinai Medical Center, New York, NY [39]

New York City Regional Residency Conference RESIDENTS’ PLATFORM PRESENTATIONS

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Session II – Room 5 –Pratt 120

Moderator: Helen Eldabie Evaluator: Arash Dabestani, Vito Limoncelli

Clinical Practice/Administration

1:30 PM COMMUNITY PHARMACISTS READINESS TO ASSESS, ADVISE AND REFER PATIENTS TO QUIT

LINE SERVICES Christina Tarantola, PharmD, PGY1 Resident, Kings Pharmacy/Brooklyn, NY [32]

1:50 PM PHARMACIST INTERVENTIONS THROUGH COLLABORATIVE DRUG THERAPY MANAGEMENT IN AN INTERDISCIPLINARY HIV CLINIC Rebecca Arcebido, PharmD/PGY-2 Pharmacy Resident in Ambulatory Care The Brooklyn Hospital Center, Brooklyn, NY [10]

2:10 PM EVALUATION OF NUTRITION SUPPORT PHARMACIST INTERVENTIONS AND SUBSEQUENT DEVELOPMENT OF A STANDARDIZED PROGRESS NOTE Amanda Giancarelli, Pharm.D., CNSC/ PGY-1 Pharmacy Practice Resident/ The Brooklyn Hospital Center, Brooklyn, NY [40]

2:30 PM ASSESSING THE IMPACT OF A PHARMACIST-LED PATIENT EDUCATION PROGRAM ON HEMODIALYSIS PATIENTS USING PHOSPHATE BINDERS Binil T. Varghese, Pharm.D./ PGY-1 Pharmacy Practice Resident James J. Peters VA Medical Center, Bronx NY [62]

2:50 PM AN EVALUATION OF A PHARMACY-LED INTRAVENOUS-TO-ORAL ANTIMICROBIAL CONVERSION PROTOCOL Tayla Inderlin, BS, PharmD, PGY-1 Pharmacy Practice Resident James J. Peters VA Medical Center, Bronx, NY [60]

3:10 PM

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INSTRUCTIONS FOR MODERATORS AND EVALUATORS OF PLATFORM PRESENTATIONS

General Information

• Program consists of two major sessions • Sessions are divided into 4 rooms, each having 11 presentations (5 AM and 6 PM) • Moderators and evaluators will be assigned to a specific room for an entire session

Moderators Prior to the first presentation of the session • Familiarize yourself with abstracts for presentations in your session • Arrive early and sit at front of room • Discuss session “plan” with evaluator • Obtain computer CD or USB stick from first presenter • Check to see that equipment is working properly Prior to each presentation • Introduce yourself and evaluator • Provide name and place of employment • Tell attendees to complete evaluation forms and return them to the evaluator • Introduce presenter (ask presenter for correct pronunciation of his/her name) • Provide name, place of employment, and title of presentation Other responsibilities • KEEP SESSIONS ON TIME! DO NOT START EARLY OR LATE. • Presentation and questions should take no more than 15 minutes • Give one-minute “warning” to presenter at the 11-minute mark. At this point the presenter should wrap up and allow for questions • Cut the presenter off if time is running short • Ensure that presenter is asked at least one question • Be prepared for equipment problems. If you are unable to resolve a problem, inform someone at the registration desk

Evaluators Prior to the first presentation of the session • Familiarize yourself with abstracts for presentations in your session • Review format of evaluation form • Arrive early and sit at back of room near door if possible • Discuss session “plan” with moderator Prior to each presentation • Distribute evaluation forms to all present Other responsibilities • Assist moderator in KEEPING SESSION ON TIME! • Ask questions regarding resident’s involvement in project if not clear from presentation • Allow time for attendees to complete evaluation forms • Collect evaluation forms • Scan forms to identify specific comments • Provide constructive comments to presenter based on your (and others’) observations • Provide presenter with completed evaluation forms • Provide evaluation as quickly as possible to keep session on time

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[1] ANTTI-NMDAR ENCEPHALIITIS – A PATIENT CASE Elena Denisko, Pharm.D./PGY-1 Pharmacy Practice Resident/, Beth Israel Medical Center, New York, NY OBJECTIVE: Anti-NMDAR encephalitis is a recently discovered diagnosis with an increasing number of reported cases. Early presentation includes headache, fever, nausea, vomiting, diarrhea, or upper respiratory illness. The symptoms progress to include rapid change in behavior or psychosis, seizures, decreased responsiveness, abnormal movements, and autonomic instability. Females constitute 80% of anti-NMDAR encephalitis cases. Diagnosis is confirmed by detection of antibodies to NR1 subunit of the NMDAR in serum or CSF. Half of female patients, over the age of 18, present with an ovarian teratoma. First-line treatment consists of resection of the tumor, glucocorticoids, intravenous immune globulin, and plasma exchange. Rituximab and/or cyclophosphamide may be used for patients that do not improve on first-line therapy. Lack of treatment can lead to neurologic deterioration and death. A case of anti-NMDAR encephalitis will be presented and reviewed. SUMMARY: A 2-year-old male with a past medical history of complex partial seizures was transferred to Beth Israel for further epilepsy monitoring and management. Patient was admitted following a seizure, weakness of left arm, fever of 101 °F, irritability, episodes of crying and screaming for over 30 minutes with hitting and biting, lethargy, and inappropriate laughing. Upon initial admission, patient was restarted on his home medication of levetiracetam. Subsequently, levetiracetam was discontinued and patient was started on topiramate, divalproex, and clobazam. After many diagnostic tests to rule out other possible diseases, patient was diagnosed with anti-NMDAR encephalitis. Patient received intravenous immune globulin, prednisone, and plasmapheresis. Seizure-like events continued with increasing doses of antiepileptics and first-line treatment for anti-NMDAR encephalitis. Patient was initiated on rituximab. As of 22nd day of hospital stay, the patient continued to receive rituximab and was stabilized for upcoming surgical procedure. CONCLUSION: A patient diagnosed with anti-NMDAR encephalitis underwent first-line treatment and continues to receive second-line therapy of rituximab. Anti-NMDAR encephalitis is a recently discovered condition that is gaining prevalence. Its etiology, progression and treatment are still being studied through case reports. LEARNING ASSESSMENT QUESTION: Which of the following is used in management of anti-NMDAR encephalitis? A. Rituximab B. IVIG C. Plasma exchange D. Prednisone E. All of the above

[3] EFFECTS OF CHRONIC ORAL PROTON PUMP INHIBITOR THERAPY ON SERUM MAGNESIUM AND CALCIUM LEVELS Mohammad A. Rattu, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY OBJECTIVE: The OTC availability and chronic utilization of oral PPIs has led to increased rates of electrolyte imbalances. PPI package inserts state that low serum Mg++ and Ca++ levels have been reported rarely if using PPIs for > 3 months, but the prevalence may vary in veterans. The primary objective was to trend serum Ca++ and Mg++ levels at baseline and 1, 3, 6, 12, 24, and 36 months after drug initiation. Secondary objectives were serum K+ levels at the aforementioned intervals, cases of low Mg++ (<1.8 mEq/L) at 1, 3, 12, and 36 months after drug initiation, and cases of low Mg++ in patients < 55 and > 55 years of age. METHOD/SUMMARY: Data collection and analysis were for patients who filled an outpatient prescription for an oral PPI between October 31, 2007 and October 31, 2012. Inclusion criteria were male and female patients between the ages of 18 and 65. Excluded patients were those with concomitant H2RAs (e.g., famotidine, ranitidine), structural gastrointestinal malabsorption (e.g., IBD), dialysis, and alcohol abuse. RESULTS/DISCUSSION: Of 406 patients screened, there were 10 on pantoprazole 20mg, 66 on pantoprazole 40mg, and 69 on omeprazole 20mg. There was a dose-related trend toward lower levels of Ca++ / Mg++ / K+ in patients on pantoprazole 40mg vs. 20mg. With pantoprazole 40mg daily, there was an age-related trend toward increased rates of hypomagnesemia if > 55 vs. < 55 years of age. In comparison to pantoprazole 40mg daily, there was a trend toward lower rates of hypomagnesemia with pantoprazole 20mg and omeprazole 20mg. CONCLUSION: In patients with greater risks (e.g., higher doses, older age) for hypomagnesemia / hypocalcemia / hypokalemia, it may be prudent to check Mg++ / Ca++/ K+ levels immediately prior to, and within 3 months of, initiation of pantoprazole. LEARNING ASSESSMENT QUESTION: In patients on PPIs, which would be the LEAST LIKELY reason for low Mg++ levels? A. Prolonged PPI use B. Alcohol ingestion C. Concomitant H2RAs D. Young age E. Higher doses of PPIs

[2] USE OF ASPIRIN AND STATINS FOR THE PRIMARY PREVENTION OF MYOCARDIAL INFARCTION AND STROKE IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS Tae Eun Park, Pharm.D./PGY2 Infectious Diseases Pharmacy Resident/SUNY Downstate Medical Center, Brooklyn, NY OBJECTIVE: Patients with HIV are at increased risk of myocardial infarction (MI) and stroke due to lipodystrophy leading to dyslipidemia, insulin resistance, and vascular endothelium dysfunction caused by the effects of HIV infection itself, antiretrovirals, and aging. The purpose of this study was to evaluate if HIV-positive patients were receiving aspirin and/or statins for the primary prevention for the increased risk of MI or stroke. METHODS: This was a single center, retrospective study including HIV-positive males between ages 45 and 79 years old and females between ages 55 and 79 years old and patients who did not miss more than 2 consecutive appointments at the outpatient HIV clinic in our institution between January 1, 2012 and December 31, 2012. For the outcome measures, patients qualified for aspirin therapy for the primary prevention of MI were defined as having Framingham Risk Score (FRS) 10-year CHD risk ≥ 10% and/or the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) 5-year CHD risk ≥ 5%. Patients qualified for aspirin and statin therapy for the prevention of stroke were defined as having FRS 10-year stroke risk ≥ 10%. RESULTS: A total number of 262 patients were included for the evaluation of CHD risk, and 50.7% (n=133/262) of those patients had high risk of developing MI within 10 years. Overall, 44.4% (n=59/133) of patients were prescribed with aspirin for the primary prevention of MI. There was a total number of 268 patients included for the evaluation of stroke risk, and 16.4% (n=44/268) of them had high risk of having a stroke within 10 years. Out of 44 patients, there were 7 patients only on aspirin (15.9%), 1 only on statin (2.3%), 18 on both aspirin and statin (40.9%), and 18 on no therapy (40.9%). Hypertension (OR 3.3, 95% CI 1.5-7.9, p=0.023) and diabetes (OR 4.9, 95% CI 2.4-10.4, p<0.001) were more likely associated with the use of aspirin whereas current smoking (OR 0.32, 95% CI 0.15-0.65, p=0.012) was less likely. CONCLUSION: Based on the evaluation of HIV-positive patients at increased risk of MI or stroke, patients with hypertension and diabetes were more likely to be on aspirin although there was a general underutilization of aspirin and statins for the primary prevention of MI or stroke. LEARNING ASSESSMENT QUESTION: What is the CHD risk associated with HIV-positive patients? A. ARVs B. HIV infection C. Smoking D. Dyslipidemia E. All of the above

[4] IMPACT OF PATIENT MEDICATION EDUCATION BY A PHARMACIST ON PATIENT’S SATISFACTION THROUGH HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) SCORES Corrine A Larkai, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Bronx Lebanon Hospital Center, Bronx, NY OBJECTIVE: To measure the impact of clinical pharmacist’s involvement via the patient medication education program on HCAHPS scores. The scores of two questions regarding communication about medicine and two questions regarding pain control were compared. METHOD/SUMMARY: A retrospective, single center study that compared the HCAHPS scores at the Bronx Lebanon Hospital Center beginning the month of August 2011 through October 2011, to the HCAHPS scores beginning the month of August 2012 through October 2012 to assess the impact of the patient medication education performed by the pharmacist as part of the interdisciplinary team during their hospital stay. Patient’s active medication list was generated each morning by the pharmacy department and given to the medical residents to be reviewed with each patient during medical rounds. A pharmacist provided follow up counseling to each patient; all medication related concerns including issues relating to uncontrolled pain were addressed and communicated by a pharmacist to the appropriate medical staff. The Fisher Exact test was used to analyze the statistical significance of the study. RESULTS/DISCUSSION: Patient medication education by a pharmacist significantly improved patient satisfaction regarding communication about new medicines, receiving information about possible side effects of their medications, pain control during their hospital stay, as well as hospital staff doing everything possible to manage pain. CONCLUSION: Patient medication education by a pharmacist statistically improved HCAHPS scores at the Bronx-Lebanon Hospital Center. LEARNING ASSESSMENT QUESTION: Patients satisfaction and HCAHPS score can only be improved by patient medication education by a pharmacist.

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EVALUATION OF ARGATROBAN DOSING PRACTICES AND IMPACT ON EFFICACY AND SAFETY MEASURES Charrai A. Byrd, Pharm.D./ PGY-1 Pharmacy/Practice Resident/ Lenox Hill Hospital, New York, NY OBJECTIVE: Argatroban is a synthetic direct thrombin inhibitor that is considered first line therapy for the treatment of Heparin Induced Thrombocytopenia. Since this is a high alert medication where safety and efficacy is important, the goal of this study is to evaluate the appropriate use of guidelines on Argatroban and appropriate heparin allergy documentation at Lenox Hill Hospital. METHOD/SUMMARY: This retrospective analysis was conducted on patients who received Argatroban from January1, 2012 to December 31, 2012 through electronic and paper chart review. All patients included in the study were over 18 years of age. Descriptive statistics parameters such as patient demographics, efficacy, safety, time to PTT after initial infusion, and mean starting dose were used to characterize data. RESULTS/DISCUSSION: A total of 32 patients were included for evaluation. The mean initial dose was 0.65 mcg/kg/min. Out of the total patient study,only 8 patients received proper initial dosing per Lenox Hill Hospital guidelines. On average, the time to obtain initial PTT took over 4 hours, 2.5 hours more than the recommended time to monitor initial PTT per hospital guidelines. No minor or major bleeding was reported. Heparin allergy was not consistently documented in the medical record, n = 27 (84%). CONCLUSION: Recommendations would include revising Lenox Hill Hospital guidelines that include heparin allergy documentation as well as creating order set to facilitate more appropriate dosing and monitoring of Argatroban. More education would be provided to pharmacists, doctors, and nurses on dosing and monitoring patients. An annual medication use evaluation should be performed on Argatroban to ensure its proper use. LEARNING ASSESSMENT QUESTION: The issue(s) with prescribing Argatroban at Lenox Hill Hospital included which of the following? A. Initial dose is inconsistent with guidelines B. Time to first PTT is delayed C. Documentation of suspected heparin allergy is lacking D. None of the above E. All of the above

[7] IMPACT OF PHARMACIST INVOLVEMENT ON MEDICATION RECONCILIATION IN AN EMERGENCY DEPARTMENT Diana Farino, Pharm.D./ PGY-1 Pharmacy Practice Resident Long Island Jewish Medical Center New Hyde Park, NY OBJECTIVE: Medication reconciliation upon hospital admission by pharmacists has been proven to be extremely effective in reducing discrepancies in medication regimens. However the true impact of pharmacist’s interventions in preventing prescribing errors and adverse drug events due to medication reconciliation discrepancies is less well known. This study will evaluate the accuracy of medication histories obtained by the admitting team to that of pharmacists, and will identify the severity level of medication discrepancies and there potential impact. METHOD/SUMMARY: Pharmacists conducted medication reconciliation on patients admitted to Long Island Jewish Hospital (LIJH) through the emergency department from February 2013 to March 2013. The medication history obtained by the admitting team was compared to the history obtained by the pharmacist, and any discrepancies were documented. The severity of the discrepancies was evaluated using a modified version National Coordinating Council for Medication Error Reporting and Prevention’s 9-point rating scale. RESULTS/DISCUSSION: A total of 37 patients were included in the analysis. Out of the 37 patients included, 65% of the patients had at least one error in their home medication list. A total of 55 discrepancies were documented with the most common type being an error of omission (60%), followed by incorrect strength (20%), incorrect frequency (15%), and an incorrect medication (5%). The most common error category was category C; however, a large percentage of the errors were categorized in the serious risk category and one error was categorized as a life threatening error. CONCLUSION: Pharmacist driven medication reconciliation obtained more complete medication histories, had a higher potential for correcting errors, and can improve medication safety during hospitalization LEARNING ASSESSMENT QUESTION: Approximately what percentage of patients will have an error in their prescription medication history at admission? A. 7% B. 47% C. 67% D. 87%

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EVALUATION OF RIVAROXABAN USE AT LONG ISLAND JEWISH (LIJ) HOSPITAL Kimberly E. Ng, PharmD. PGY1 Pharmacy Resident/Long Island Jewish Medical Center, New Hyde Park, NY OBJECTIVE: Rivaroxaban is a new option for the treatment and prevention of thromboembolic events such as deep vein thrombosis (DVT), pulmonary embolism (PE) and in the setting of nonvalvular atrial fibrillation. Long Island Jewish Medical Center approved rivaroxaban to the formulary in July 2012. A checklist with approval criteria for order verification was implemented in February 2013 to ensure that the medication is being prescribed safely and appropriately at the institution. Assessment of rivaroxaban use will identify trends in utilization and evaluate the impact of a pharmacy order verification checklist on appropriate prescribing habits. METHOD/SUMMARY: Medical records of patients who were prescribed rivaroxaban from July 2012 through May 2013 were reviewed. Using a data collection sheet, rivaroxaban use was assessed for contraindications and appropriate dosing based upon the indication. Patients prescribed rivaroxaban before and after implementation of the checklist for verification were compared to reveal if any differences in the amount of inappropriately prescribed or verified orders occurred. RESULTS/DISCUSSION: A total of 74 orders for rivaroxaban were evaluated for appropriateness. Of the verified orders, 49 orders were appropriately verified while 25 orders were inappropriately verified. In comparing the pre- and post-checklist orders, there was a 15% increase in the number of correctly verified orders post checklist implementation. CONCLUSION: This medication use evaluation demonstrated the use of rivaroxaban within the institution as well as the success of a pharmacist checklist during order verification. LEARNING ASSESSMENT QUESTION: According to the Long Island Jewish Hospital checklist for pharmacy order verification, it is appropriate to verify rivaroxaban 10 mg po daily for a 70 year old patient with non-valvular atrial fibrillation and CrCl = 27 mL/min? A. True B. False

[8] ESCALATING DOSES OF DAPTOMYCIN FOR THE TREATMENT OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA Franklin Jeng, B.S., Pharm.D./PGY-1 Pharmacy Practice Resident/New York Methodist Hospital, Brooklyn, NY OBJECTIVE: The objective of this study is to determine if escalating doses of daptomycin are associated with improved clinical and microbiological outcomes. METHODS: Data was collected retrospectively. Patients with positive blood cultures for methicillin-resistant Staphylococcus aureus (MRSA) from January 2008 to December 2012 were evaluated. Patients were included if they were ≥18 years of age and received ≥48 hours of daptomycin therapy. Patients were excluded if there were concomitant use of other anti-MRSA antibiotics for >48 hours, use of daptomycin for non-susceptible MRSA, or no follow-up cultures after the initiation of daptomycin therapy. Group 1 patients received daptomycin at ≤6 mg/kg/dose, and were compared with group 2 patients, who received >6 mg/kg/dose. Primary outcome measures were rates of clinical response and microbiological failure. RESULTS: Of the 166 patients screened, 35 patients met the selection criteria. Mean daptomycin doses were 5.47 mg/kg for group 1 and 7.01 mg/kg for group 2. Evaluable successful clinical response was documented for 6 of 12 (50%) patients in group 1, as compared with 8 of 12 (67%) patients in group 2. Microbiological failures were seen in 3 of 17 (17.6%) group 1 patients and in 0 of 14 (0%) group 2 patients. Hospital length of stay from initiation of daptomycin was 16 vs. 15 days and in-hospital mortality was 36% vs. 31% for group 1 and group 2, respectively. Significant increases in creatine phosphokinase were not observed in either of the treatment groups. CONCLUSION: Escalated dosing of daptomycin, when compared with non-escalated doses, may improve efficacy outcomes for MRSA bacteremia without increasing the risk of adverse effects. LEARNING ASSESSMENT QUESTION: What is the highest dose of daptomycin that has been studied in healthy volunteers? A. 4 mg/kg B. 6 mg/kg C. 8 mg/kg D. 10 mg/kg E. 12 mg/kg

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IMPACT OF CLINICAL PHARMACISTS’ INTERVENTIONS THROUGH AN ANITRETROVIRAL STEWARDSHIP PROGRAM (ARVSP) Julie Anne Billedo, Pharm.D./ PGY-2 Ambulatory Care Pharmacy Resident/ The Brooklyn Hospital Center (TBHC), Brooklyn, NY [9] OBJECTIVE: A previous TBHC study conducted on November 2010 to January 2012 data revealed that although an ARVSP pharmacist was successful in identifying and intervening in 80% of antiretroviral (ARV) related clinically significant drug-drug interactions (CSDDIs) upon patient admission, 57% of CSDDIs occurring during hospitalization were missed. These results prompted the ARVSP to assign a pharmacist to regularly screen medication lists of patients on ARVs for CSDDIs during hospitalization. The objective of this study was to evaluate the impact of clinical pharmacists intervening on CSDDIs that occur during hospitalizations. METHODS: This was a retrospective chart review of adult patients with HIV or AIDS treated with ARV admitted from September 2012 to February 2013 to be compared with the November 2010 to January 2012 data. A CSDDI was defined as either an interaction which resulted in the use of an alternative agent or a dose and/or frequency change. Regimens were screened for CSDDIs and cross-referenced using the Liverpool HIV drug reference, the Micromedex database, and the U.S. Department of Health and Human Services HIV guidelines. RESULTS: A total of 437 admissions met inclusion criteria, 252 in the pre-intervention and 185 in the post-intervention study. A total of 84 CSDDIs were identified in the pre-intervention study, 23 (27%) of which occurred during hospitalization. A total of 76 CSDDIs were identified in the post-intervention study, 19 (25%) of which occurred during hospitalization. The percent of CSDDIs intervened upon during hospitalization in the pre- and post-intervention groups were 43% and 95%, respectively (p=0.0007). CONCLUSION: Pharmacists have a significant impact in the number of CSDDIs identified during patient hospitalization. ARVSPs, including ARV restriction and continuous monitoring by clinical pharmacists, are critical in the prevention of CSDDIs and medication errors upon admission and throughout hospitalization. LEARNING ASSESSMENT QUESTION: Which class of ARVs is associated with the most CSDDIs? A. Non-nucleoside reverse transcriptase inhibitors B. Nucleoside reverse transcriptase inhibitors C. Protease inhibitors D. Integrase inhibitors

[11] ASSESSING THE SAFETY AND TOLERABILITY OF LURASIDONE-USE IN THE ELDERLY: A RETROSPECTIVE CHART REVIEW Megan Flinchum, PharmD/ PGY-1 Pharmacy Resident/Kingsbrook Jewish Medical Center, Brooklyn, NY OBJECTIVE: The use of antipsychotic medications in dementia-related psychosis is labeled with a black boxed warning due to an increased risk of death. However, antipsychotics are still routinely used in the elderly for other appropriate psychiatric indications. There is a need to examine health data from this patient population to determine if any differences in safety exist between commonly used atypical antipsychotics. The objective of this study was to evaluate the safety of lurasidone in the elderly population when compared to risperidone at Kingsbrook Jewish Medical Center. METHOD/SUMMARY: This was a retrospective, single-centered, chart review. An electronically-generated report indicated patients that have had any order(s) placed for lurasidone from November 2011 to November 2012. Upon attainment of this report, each patient profile was evaluated for inclusion (65-85 years old, standing diagnosis of schizophrenia, any active order for lurasidone or risperidone during a KJMC admission) to this study, with a targeted sample size of 40 patients. RESULTS/DISCUSSION: A total of 22 patients were included in the analysis, 11 patients in the lurasidone group and 11 patients in the risperidone group. There was no statistically significant difference found in number of ADEs that occurred between the lurasidone and risperidone groups (7 events vs. 9 events, respectively; p=0.699). In terms of the percentage of patients that experienced of at least one ADE, there was no significant difference between patients in the lurasidone group and patients in the risperidone group (6 vs 4, respectively; p=0.669). No specific ADE occurred significantly more in one group over the other. Of note, there were no hypotensive episodes noted in the lurasidone group whereas there were 4 episodes in risperidone group (p=0.331). On average, patients taking lurasidone utilized more antihypertensives compared to patients taking risperidone (2.1/patient vs. 1.3/patient, respectively; p=0.049). CONCLUSION: There was no significant difference in occurrence of ADEs between the lurasidone and risperidone groups among elderly patients with schizophrenia or schizoaffective disorder. However, larger studies are needed to detect any true safety TRUNCATED….

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PHARMACIST INTERVENTIONS THROUGH COLLABORATIVE DRUG THERAPY MANAGEMENT IN AN INTERDISCIPLINARY HIV CLINIC Rebecca Arcebido, PharmD/PGY-2 Pharmacy Resident in Ambulatory Care The Brooklyn Hospital Center, Brooklyn, NY OBJECTIVE: Studies demonstrate pharmacist interventions through collaborative drug therapy management (CDTM) in primary care clinics and HIV clinics have positive patient outcomes in diabetes, hypertension and virologic control. However, studies evaluating the role of an HIV pharmacist in managing antiretroviral therapy (ART) concurrently with chronic disease states are lacking. This study evaluated the frequency and types of CDTM interventions made by a pharmacist as part of an interdisciplinary healthcare team in an outpatient HIV primary clinic. METHOD/SUMMARY: This was a retrospective data analysis that included adult patients > 18 years of age, diagnosed with HIV, whose healthcare is provided by The Brooklyn Hospital Center’s Program for AIDS Treatment and Health Center were included in this study. In compliance with the New York State Council of Health-System Pharmacists (NYSCHP) outcome metrics for CDTM programs, both HIV-related and chronic disease state interventions regarding appropriate medication indication, effectiveness, safety, adherence and cost avoidance were assessed. Two year outcomes were quantified through review of medication management notes documented in a secure, online database entered from 2011 to 2012. Data were analyzed using descriptive statistics. RESULTS/DISCUSSION: A total of 864 patient visits were managed by CDTM. Fifty-nine percent of patients seen were male and the average age was 50 years. An average of 704 NY CDTM interventions was made per year, with the majority in the categories of need for additional treatment and non-adherence. CONCLUSION: This study demonstrates a role for CDTM-managed patient care by an ambulatory care clinical pharmacist in HIV primary care clinics. An HIV pharmacotherapy specialist has the ability to address and manage several disease states simultaneously, with most interventions made in the categories of ART adherence and laboratory monitoring. Future studies are needed to compare clinical outcomes in patients seen by a pharmacist versus patients not seen by pharmacist as part of an interdisciplinary team. LEARNING ASSESSMENT QUESTION: Most interventions identified for untreated indications were in the category of: A. Smoking cessation B. Hyperlipidemia C. HIV D. A and C only E. All of the above

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CONTINUOUS INFUSION OF AMPHOTERICIN B DEOXYCHOLATE IN THE TREATMENT OF CRYPTOCOCCAL MENINGITIS – A CASE REPORT Karina Tselenchuk, Pharm.D., Pharmacy Resident (PGY-1), Beth Israel Medical Center, New York, NY CASE OBJECTIVE: Amphotericin B deoxycholate (AmB-d) has remained the cornerstone of therapy for treatment of life threatening fungal infections in immunocompromised patients. However, it is associated with infusion related reactions and nephrotoxicity. Recently, continuous infusions of AmB-d have been shown to decrease the incidence of nephrotoxicity and infusion-related side effects, compared with traditional administration of the same amount of drug over 2-6 hours. CASE SUMMARY: A 24 year-old male with a past medical history of HIV (diagnosed 05/2012), asthma, and neurosyphillis status post treatment on 03/2013 presented with weakness, headache, 3 week history of chest and back pain. The patient was recently treated for Cryptococcus meningitis with amphotericin B and flucytosine on 02/2013 with minimal adverse reactions. On presentation, the patient was septic with fevers, leukopenia, and tachycardia. The patient was started on AmB-d 0.7 mg/kg/day and flucytosine 100 mg/kg/day. On day 2 of induction therapy, the patient experienced high fevers and rigors likely attributable to the AmB-d conventional infusion. Anti-fungal therapy was modified to liposomal amphotericin 6 mg/kg/day and pre-medication therapy with diphenhydramine 25 mg IV and meperidine 25 mg IV was initiated. Despite these modifications the patient continued to experience high fevers and rigors. Additionally, the patient developed acute renal failure in spite of hydration therapy. Infectious Disease was consulted and it was recommended to start the patient on a continuous infusion of AmB-d in an attempt to reduce adverse reactions. CASE DISCUSSION: This case report suggests that the continuous infusion of AmB-d may be a suitable alternative method of administration for anti-fungal therapy in patients who experienced infusion related reactions with conventional administration of amphotericin. CASE CONCLUSION: The patient completed a 14 day course of induction therapy. After the changes in therapy, there was little to no reports of fevers, chills, and rigors. Therefore, continuous infusions of AmB-d may be an effective and well tolerated alternative to traditional rapid infusions, especially in patients who have experienced adverse reactions with treatment in the past. TRUNCATED….

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EVALUATION OF HYPOGLYCEMIA ORDER SET AND DIABETES ORDER SET ON THE GENERAL MEDICAL FLOOF OF A COMMUNITY HOSPITAL Tammy Wu, Pharm.D./ PGY-1 Resident Practice Resident/ New York Methodist Hospital, NY OBJECTIVE: Significant changes have been made in diabetes management with guidelines targeting euglycemia. Efforts to create standardized order sets for insulin dosing and hypoglycemia management have increased. Evaluation of the diabetes and hypoglycemic order set (DOS and HOS) is important for clinical efficacy. METHODS: A 2012 retrospective analysis of adult diabetics on the general medicine floors with a blood glucose <70 mg/dL on glucometer and/or used a DOS component were randomly selected. Primary endpoints were time to hypoglycemic event (HE) reversal, hypoglycemic recurrence within 24 hours, DOS use, and time to euglycemia using scheduled basal-bolus insulin. Safety endpoints were repeat HE’s during hospital stay and adverse events. RESULTS: 200 electronic databases were reviewed (DOS=50, HOS=150). Primary endpoints revealed no difference in interventions made post-HE, time to intervention or repeat fingerstick, repeat HE, or DOS use (p=0.738, p=0.46, p=0.734, p=0.768, p=0.194), respectively. Patient’s morning blood glucose 24 hours post-basal-bolus therapy showed ~36% decrease. There was no significance in recurrent HE within 24 hours, HE within 24 hours of initiating basal-bolus regimen with total daily dose (TDD) of insulin or HOS initiation (p=0.768, p=0.54, p=0.6), respectively. DOS patient’s weight and TDD of insulin showed a 1:1 relationship. Patients on insulin were more likely to have the HOS (p=0.0683). Patients with a HE had significant changes to management within 24 hours and HOS implementation (p=0.044, p<0.001), respectively. CONCLUSION: The DOS and HOS did not alter patient outcomes. However, it has been shown in other studies that order set use improved glycemic control and reduced hypoglycemia. Patient weight and TDD of insulin was 1 unit/kg/day which may be due to patient obesity. LEARNING ASSESSMENT QUESTION: How many doses of glucagon can be given to treat hypoglycemia? A.1 B.2 C.3 D.4

[15] COMPLIANCE WITH INSTITUTIONAL GUIDELINES FOR THE TREATMENT OF ACUTE VENOUS THROMBOEMBOLISM (VTE) Rivka Hecht, B.S., Pharm.D./ PGY-1 Pharmacy Practice Resident/ Brookdale University Hospital and Medical Center, Brooklyn, NY OBJECTIVE: Approximately one million cases of VTE are documented in the US each year. In 2009, Brookdale University Hospital and Medical Center (BUHMC) developed anticoagulant clinical practice guidelines outlining VTE treatment. Compliance has not been evaluated since updating the guidelines in 2012. The project aimed to describe current practices of acute VTE treatment at BUHMC and assess adherence to treatment guidelines. METHODS: A retrospective chart review of patients admitted from December 2012 through February 2013 with a diagnosis for deep vein thrombosis, pulmonary embolism or venous thrombosis at any time during hospitalization was performed. Patients older than eighteen years of age who met diagnostic criteria for VTE were included. Patients who refused therapy related to VTE management, who were pregnant and in whom treatment was initiated at an alternative institution were excluded. Compliance of VTE management with institutional guidelines was evaluated using anticoagulant dosing, duration of parenteral anticoagulant and warfarin bridging, frequency of monitoring, and safety associated with anticoagulants as outcome measures. RESULTS: Twenty-eight patients were included in the study; twenty-two received anticoagulants. Appropriate initial dosing was utilized in 86% patients receiving enoxaparin and 29% of patients receiving unfractionated heparin (UFH). Mean duration of bridging in those who received parenteral anticoagulants was 4 days. Daily international normalized ratio (INR) monitoring was conducted in 78% of patients receiving warfarin and activated partial thromboplastin time (aPTT) was monitored every 6 hours until therapeutic in 43% of patients receiving UFH. Two patients experienced bleeding events after receiving anticoagulants. Overall compliance to guidelines was approximately 46%. Average length of stay was 7 days in patients treated in concordance with guidelines and 12 days in those who were not. CONCLUSION: This project demonstrated the need for increased hospital-wide education, increased pharmacist involvement in VTE management and improvement in anticoagulant dosing and monitoring. ASSESSMENT QUESTION: Compliance with VTE treatment guidelines at BUHMC is associated with: A) Decreased patient safety B) Reduced compensation by public insurance agencies C) Increased risk of VTE recurrence D) Decreased length of stay

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PILOT STUDY FOR REAL-TIME REVIEW OF EMPIRIC ANTIMICROBIAL THERAPY FOR URINARY CULTURES IN AN INNER-CITY EMERGENCY DEPARTMENT (ED) Michelle Krawczynski, Pharm.D./ PGY-2 Ambulatory Care Resident/ Brookdale University Hospital and Medical Center, Brooklyn, NY OBJECTIVE: Empiric antibiotics are often prescribed during ED visits based on subjective urinary tract infection (UTI) symptoms. Follow-up with patients once culture results are available is a challenge. A previous quality assurance study at this institution provided evidence that empiric UTI therapy prescribed in the ED could be improved via follow-up once culture data is available. This study evaluated the effect of a pharmacist in reviewing urine cultures in a real-time manner to optimize safe and effective medication use. METHOD: ED urine culture reports were generated 3 times a week from Feb to May 2013. Cultures were cross referenced with antimicrobials prescribed at ED discharge. Appropriateness was determined by a pharmacist based on sensitivity, dosing accuracy, and length of therapy. Patients were contacted by phone for applicable interventions. Primary outcome was the number of unmatched empiric therapy to actual culture growth. Secondary endpoints included pharmacist interventions and number of antibiotic days spared. RESULTS: A total of 34 cultures were included in analysis; 23 (68%) had mismatched empiric therapy. The most common mismatch was negative culture with an antimicrobial prescribed (20/23, 87%). A total of 45 days of excess antibiotic use was prevented due to negative cultures. Three cultures grew organisms resistant to the empiric regimen. Therapeutic treatments, frequency, duration, and dose changes were recommended in 10 (29%) patients. CONCLUSION: Majority of empiric UTI regimens required interventions. Dedicating a pharmacist to provide patient follow-up by reviewing urinary cultures and empiric antibiotic therapies in the ED, resulted in decreased antibiotic usage. LEARNING ASSESSMENT QUESTION: What is the most common intervention made from culture review in this study? A. Abx dose changes B. Abx discontinuation C. Abx drug change D. Abx frequency change

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EVALUATION OF VANCOMYCIN EVERY 8 HOURS TREATMENT COURSES IN ADULT PATIENTS Erica Brumer, PharmD/PGY1 Pharmacy Practice Resident / New York University Langone Medical Center, NY, NY OBJECTIVE: Vancomycin (V) remains first line therapy for methicillin-resistant Staphylococcus aureus (MRSA) infections in hospitalized patients. As per consensus review, a dose of 15-20 mg/kg based on actual body weight (ABW) given every 8-12 hours is recommended for adult patients with normal renal function, to achieve a trough of 15-20 mg/L for serious MRSA infections. Limited data is available on V every 8 hours (Q8H) dosing. Our hospital nomogram recommends V 15 mg/kg Q8H for patients <50 years old with a creatinine clearance (CrCl) >80 mL/min to achieve therapeutic troughs. The objective of this study was to evaluate patients who received Q8H treatment courses (TC). METHOD/SUMMARY: Adult patients who received Q8H TC for ≥120 hours from March 1, 2009-October 1, 2012 and had trough(s) collected at steady state were included in our retrospective chart review. Percent of therapeutic (10-15 mg/L for uncomplicated cellulitis, urinary tract infection, non MRSA bacteremia; 15-20 mg/L for all other indications), supratherapeutic (>20 mg/L) and subtherapeutic levels obtained during Q8H TC, and rate of nephrotoxicity were evaluated. RESULTS/DISCUSSION: We included 100 patients who received 107 Q8H TC. Median age was 38 years, median CrCl was 133 mL/min and median ABW was 67 kg. Fifty-two TC had positive cultures. S. aureus was present in 63% of TC (20/33 MRSA). The most common indications were febrile neutropenia, pneumonia, and bacteremia. Only 31% of TC were initially dosed Q8H. Therapeutic trough was attained in 73% of Q8H TC where a median dose of 18 mg/kg was used. Supratherapeutic troughs were documented in 28% of TC at a median time of 8 days. Eighteen percent of TC had subtherapeutic troughs where a mean dose of 16 mg/kg was used. Rate of nephrotoxicity was 4%. CONCLUSION: Therapeutic trough was attained in 73% of V Q8H TC. LEARNING ASSESSMENT QUESTION: What vancomycin dosing interval is recommended for adult patients with normal renal function and serious MRSA infections? A. Q1-2H B. Q3-6H C. Q8-12H D. Q24H

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IMPACT OF PHARMACIST-PROVIDED EDUCATION ON HEART FAILURE READMISSION: A PILOT STUDY Helene Maltz, B.S., Pharm.D., PGY-2 Internal Medicine Pharmacy Resident/Kingsbrook Jewish Medical Center (KJMC), Brooklyn, NY OBJECTIVES: Heart failure (HF) is associated with a 30-day KJMC readmission rate of 28.3%. Readmission may result in increased morbidity for patients and reduced Medicare reimbursement. Discharge instructions and reinforcement of HF-related education can improve patients’ understanding of their disease and health-related outcomes. This study assessed whether the addition of pharmacist-based discharge counseling may reduce HF and overall readmission rates. METHODS: In a prospective, single-centered, cohort study of HF patients in the acute setting, included subjects were educated by designated pharmacists regarding medication management, dietary sodium, the importance of physical activity, and when to contact their HF provider based on symptomatology. Patients were excluded if they had cognitive impairment, were non-English speaking, were not discharged to home, were readmitted for elective procedures, or refused to participate in the study. Subjects were contacted within 7 days of discharge to identify any complications and 30-day readmission was assessed. The 30-day HF and overall readmission rates were compared to the baseline rates prior to initiation of the study using the Fisher’s exact test. IRB approval was received RESULTS/DISCUSSION: Over 2.5 months, 45 patients were included, 62.2% with systolic HF. By day 30 post-discharge, 11.1% (n = 5) wer readmitted for HF and 35.6% (n = 16) were readmitted overall. Compared to baseline readmission rates of 7.2% and 28.3%, respectively, the differences were not statistically significant (p = 0.5267 and 0.3493). The majority of readmissions were for non-HF conditions. High readmission rates may be related to the severity of illness and socioeconomic status of KJMC’s patient population. The study is limited by its small sample size and the narrow focus and delivery of the provided counseling. CONCLUSIONS: Reduction in 30-day HF readmission rates may require more comprehensive counseling and reconciliation than provided in this study. Further study with larger sample size is warranted. LEARNING ASSESSMENT QUESTION: Which of the following statements about heart failure readmission is true? A. readmission is costly B. readmission may represent inadequate treatment during index admission C. readmission may not be fully reimbursed by CMS D. all of the above

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RX TRANSITION: EVALUATION OF MEDICATION ADMINISTRATION TIMES BEFORE AND AFTER IMPLEMENTATION OF AN AUTOMATED DISPENSING SYSTEM May Jabra, Pharm.D./ PGY-2 Pharmacy Informatics Resident/ New York Methodist Hospital, Brooklyn, NY OBJECTIVE: The prevailing question in the healthcare world remains as to how we can improve patient care. Technology offers solutions that can improve timely administration of medications, decrease number of missing medications and errors. A potential solution is automated dispensing systems (ADS) with a goal of optimizing healthcare professional’s workflow consequently optimizing patient care. METHOD/SUMMARY: An ADS was implemented in the first computerized provider order entry nursing unit in our institution in October 2011. Three reports were analyzed for a two year time period to assess the impact of ADS before and after implementation of the new device. To evaluate the efficacy and benefits of the new device the medication administration record was reviewed. Occurrence reports were reviewed for medication errors, delay in delivery and narcotic discrepancy. In addition missing medication reports were also analyzed to further reflect the ADS impact. Nurse questionnaires were also conducted to assess user satisfaction. RESULTS/DISCUSSION: The average time to administration prior to ADS compared to post implementation decreased from 45 minutes to 37 minutes. Missing medication requests by nurses dropped from an average of 161 to 56 per month after implementation of the device. Missing medication went down to as low as 10 per month as compared to 119 in the pre- implementation phase. Medication is securely stored in locked cabinets that lead the user to the correct bin reducing medication picking errors. These medication errors were eliminated with the institution of the new device. CONCLUSION: ADS have allowed for an improvement in healthcare workflow. Nurses have easy access to medications leading to enhanced timely medication administration and a drop in medication requests. This allows more time in both nurse and pharmacist workflow avoiding duplication of work. Because automated dispensing system leads the user to the correct compartment a decrease in medication errors was prominent. In conclusion, ADS have facilitated the day to day workflow and decreased medication errors all in an effort to improve patient care. TRUNCATED….

[18]

DEVELOPMENT OF BK VIRUS-ASSOCIATED HEMORRHAGIC CYSTITIS

FOLLOWING ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTION Monank Patel, Pharm.D./PGY2-Oncology/Mount Sinai Medical Center OBJECTIVE: Management of BK virus-associated hemorrhagic cystitis (BKV-HC) is institution-specific and often guided by limited data available for anti-viral therapy and supportive care measures. METHODS: Single-center retrospective chart review of all allogeneic hematopoietic stem cell transplant (allo-HSCT) patients over 2.5 years with detectable BK viruria or viremia and with signs and symptoms of HC. RESULTS: 15 of 158 patients (9%) had confirmed BK viruria and/or viremia. Of these, 12 (80%) developed HC with grade III-IV HC occurring in 50% of cases. Many patients did not receive anti-BK therapy and when treatment was initiated various doses of intravenous cidofovir were prescribed. CONCLUSIONS: As management of BKV-HC at our institution varies between BMT attending physicians, a standardized protocol for our institution would promote a step-wise approach to include both supportive care measures as well as anti-viral treatment for BK virus infection. Learning Assessment Question: Which of the following are management strategies of BKV-HC? A. Supportive care B. Cidofovir C. Ciprofloxacin D. Decrease immunosuppression

[20] EFFICACY AND SAFETY OF IV FAMOTIDINE VS. IV PANTOPRAZOLE FOR STRESS ULCER PROPHYLAXIS IN THE CRITICALLY ILL: A PROSPECTIVE, RANDOMIZED STUDY Benjamin Wee, B.S., Pharm.D./ PGY-2 Critical Care Pharmacy Resident/ Kingsbrook Jewish Medical Center, Brooklyn, NY OBJECTIVE: There is limited published literature regarding the efficacy and safety of intravenous (IV) proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in the critically ill. Published head-to-head trials that evaluated the efficacy and safety between PPIs and histamine-2 receptor antagonists (H2RAs) for SUP among the critically ill are limited and had inconsistent study methodologies. The objective of this study is to evaluate the efficacy and safety of IV pantoprazole vs. IV famotidine for SUP in critically ill patients. METHOD/SUMMARY: This is an ongoing prospective, open-label, randomized study of patients admitted to the ICU/CCU between January 2013 to April 2013. Each admitted patient was randomized to famotidine 20 mg IVPB Q12H or pantoprazole 40 mg IVPB QAM. Risk factors for stress-related mucosal bleeding (SRMB) were assessed within 24 hours of ICU/CCU admission. Primary endpoint was the incidence of overt and clinically significant upper gastrointestinal bleeding (UGB). Secondary outcomes included safety parameters (e.g., C. difficile infection, nausea/vomiting, hypomagnesemia). RESULTS/DISCUSSION: There were 85 patients randomized to IV pantoprazole (n = 45) and IV famotidine (n = 40). Both groups had similar baseline characteristics including APACHE II scores and risk factors for SRMB. No statistically significant differences were found between IV pantoprazole and IV famotidine for overt bleeding (6.7% vs. 0%, respectively) and clinically significant bleeding (2.2% vs. 0%, respectively). No statistical significant difference was found for all safety parameters between both groups. CONCLUSION: No significant difference was found for the incidence of overt and clinically significant UGB between IV famotidine and IV pantoprazole among critically ill patients. Study is still ongoing. LEARNING ASSESSMENT QUESTION: Which is NOT a risk factor for SRMB? A. Renal failure B. INR=1 C. Sepsis D. Mech. Vent. ≥ 48 hours

[21]

EVALUATION OF MEDICATION ORDERS SENT ELECTRONICALLY IN A HOSPITAL-BASED CLINIC Elise Kim, Pharm.D./PGY-1 Pharmacy Resident/

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Kingsbrook Jewish Medical Center, Brooklyn, New York OBJECTIVE: Electronic prescribing (e-prescribing) has the potential to reduce medication errors and improve efficiency compared to traditional handwritten prescribing, but may introduce new opportunities for errors. Available literature shows that prescription errors can originate by both the prescriber and the computer systems. Most studies assess e-prescribing errors identified when orders are received by pharmacies. The objective of this study was to identify and quantify errors of e-prescribing sent from an electronic medical record system (EMR) by prescribers. METHOD/SUMMARY: A retrospective chart review of e-prescriptions using an outpatient EMR was performed. Starting from November 20, 2012, a report was generated of e-prescriptions sent by each of four specified outpatient primary care providers (PCPs). All e-prescriptions were sequentially reviewed to identify any new or revised prescription sent electronically to a pharmacy. The target sample size was 50 e-prescriptions per PCP. If there were less than 50 e-prescriptions sent on November 20, 2012 from one prescriber, e-prescriptions from the day before were reviewed, and so on, until the target of 50 unique e-prescriptions was reached for each PCP. This process was repeated for the other 3 PCPs. The data collected for each e-prescription was the name of medication, dosage form, dose, directions, quantity, and day supply. Each component of the e-prescription was examined for internal consistency. RESULTS/DISCUSSION: The target sample size of 200 unique prescriptions was met. Eight (4%) e-prescriptions were found to have a prescription error. Of the 8 prescription errors, 7 (87.8%) were due to inconsistencies between quantities and days supply, and 1 (12.5%) error was due to unclear direction. CONCLUSION: There were only a small number of errors found in electronic prescriptions reviewed. The most common e-prescription errors were discrepancies between quantities and day supply. LEARNING ASSESSMENT QUESTION: Which of the following problems with prescription(s) has/have been eliminated with e-prescribing? A. Omitting components in prescriptions B. Illegible handwriting C. Inappropriate abbreviations D. B & C

[23] TOPIRAMATE FOR APPETITE SUPRESSION-A PATIENT CASE Anna Shmayenik, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Beth Israel Medical Center, New York, NY OBJECTVE: A case of excessive appetite in a patient who was treated with Topiramate will be presented and reviewed. Topiramate is a broad-spectrum neurotherapeutics agent approved for use in epilepsy, prophylaxis of migraine, and weight management in combination with phentermine. Topiramate has shown weight loss properties in at least 6 placebo-controlled obesity trials. Topiramate has also been shown to be efficacious for treatment of binge eating, suggesting its effect on appetite suppression. SUMMARY: A 50-year-old female with a past medical history of, nasopharyngeal cancer and PEG tube placement 1 year ago was admitted to the Palliative Care unit. During the hospitalization, the patient went into respiratory distress requiring an emergency tracheostomy and had a seizure likely due to hypoxia. As per a neurology consult the patient was started on levetiracetam. A new CT scan revealed metastasis to the brain resulting in initiation of dexamethasone. The patient began complaining of polyphagia. The decision was made to start topiramate to control her appetite. Stimulant appetite suppressants were not an option for this patient due to the history of seizures. The initial dose was 25mg every 12 hours, with a dose titration planned every 7 days. On day 6 of therapy, the patient reported mild improvement. CASE DISCUSSION: Topiramate’s effectiveness for weight loss is reported in multiple studies; however the mechanism of action of this effect is not well understood. Some studies suggest that topiramate may suppress appetite and is therefore helpful in binge eating in combination with cognitive behavioral therapy. The appetite suppressant effect and weight loss effect is likely to be dose dependant, with the recommended daily doses between 100-300mg. Literature also suggests that it may take about 1-3 months before this effect is seen, however one study suggested that some patients experience an improvement in symptoms much sooner. LEARNING ASSESSMENT: Which of the following is not an approved indication for topiramate?

[22]

USE OF VALPROIC ACID FOR TREATMENT OF DELERIUM IN PALLATIVE CARE PATIENTS-A CASE REPORT Alla Melamed, Pharm.D., PGY1-Pharmacy Resident, Beth Israel Medical Center, NY, NY OBJECTIVE: The drug of choice for treatment of delirium in palliative care patients is haloperidol, however, it is associated with side effects such as extrapyramidal symptoms and QTc prolongation. Valproic acid is a carboxylic acid that is FDA approved for absence and complex partial seizures and as an adjunct to treatment of other types of seizures among other indications. Currently, no randomized, controlled trials exist evaluating the use of valproic acid in delirium. This case report demonstrates a successful treatment of delirium in a palliative care patient. SUMMARY: 67-year old female with past medical history of HTN, aneurysm, CHF, CVA, dementia and uncontrolled diabetes presented to emergency department with a chief complaint of altered mental status that has been worsening during the last two months. Prior to admission, patient was started on haloperidol due to dementia and ‘screaming”. Upon ED admission, patient was not able to use her upper body, did not speak and had a downward focusing gaze. QTc interval prolongation was found on ECG, which was attributed to haloperidol. After neurological evaluation, the differential diagnosis was NMS versus dystonia versus Parkinsonism associated with haloperidol. Haloperidol was held, with some improvement seen. Since then, extremity rigidity has decreased, but patient did not follow commands, appeared confused and agitated. Valproic acid IV 1000 mg twice daily was initiated for patient’s delirium with olanzapine 7.5 mg at bedtime and 2.5 mg every 6 hours as needed. The following day, patient was more responsive. Days later, the patient was much calmer and was able to tolerate oral intake, however still was not able to move both extremities. Two days later, decreased rigidity was observed in upper extremities. Valproic acid dose was decreased to 250 mg twice daily and olanzapine 7.5 mg at bedtime was continued. Olanzapine was held due to increased sedation and valproic acid was continued at 250 mg twice daily. Olanzapine 2.5 mg at bedtime, along with valproic acid, was restarted and patient was finally discharged in stable condition. CONCLUSION: This case report suggests that the use of valproic acid in combination with a low dose of atypical antipsychotic is may be a safe and effective in treatment of delirium in the palliative care patient population who do not tolerate haloperidol. ASSESSEMENT QUESTION: What is the drug of choice for treatment of delirium in palliative care patients? A. Aripiprazole B. Haldol C. Valproic acid D.Zyprexa

[24] THE USE OF TRANEXAMIC ACID IN ORTHOPEDIC SURGERY: A RETROSPECTIVE STUDY Joseph Samide, Pharm.D./PGY-2 Critical Care PGY-2 Pharmacy Resident, New York Methodist Hospital OBJECTIVE: Hyperfibrinolysis is a common surgical problem and is associated with perioperative bleeding. Tranexamic acid, a potent antifibrinolytic, has been found to reduce total blood loss and transfusion requirements in patients undergoing certain types of orthopedic surgery. The objective of our study was to examine the effect of tranexamic acid on postsurgical bleeding at our institution. METHODS: A total of 169 patients were included in this retrospective analysis. All patients in the study underwent either total hip or knee replacement. The active arm (n=84) received tranexamic acid during the perioperative period and was compared to a historical cohort (n=85) that did not receive antifibrinolytic therapy. The primary outcomes were the decline in post-operative hemoglobin, transfusion requirements, and incidence of venous thromboembolism (VTE). RESULTS: Our results showed there was less of a decline in postoperative day one hemoglobin from baseline in patients receiving tranexamic acid (-2.3 g/dL) compared with the control (-2.9 g/dL) (p<0.001). There was also less of a decline in postoperative hemoglobin on day two (-2.6 g/dL vs.-3.3 g/dL; p<0.001) and day three (-3 g/dL vs. -3.7 g/dL; p<0.001) in the active arm. The number of patients transfused was four (4.8%) in the active arm, compared to ten (12%) in the control arm, for an overall reduction in transfusion by 60%. The incidence of VTE was similar between the two groups, and no increase in side effects was noted in the active arm. CONCLUSION: Our results indicate that the administration of tranexamic acid reduces perioperative blood loss and decreases the need for transfusion. The reduction in perioperative bleeding does not appear to come at an increase in thromboembolic events and the effectiveness of tranexamic acid is apparent in patients receiving the appropriate VTE prophylaxis. LEARNING ASSESSMENT QUESTION: What are the benefits of using tranexamic in orthopedic patients? A. Reduces the need for transfusion B. Reduces postoperative blood loss C. Reduces hospital length of stay D. A and B only E. All of the above

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MEASURING THE IMPACT OF PEPTIDE NUCLEIC ACID FLUORESCENCE IN SITU HYBRIDIZATION (PNA FISH) FOR IDENTIFICATION OF COAGULASE-NEGATIVE STAPHYLOCCOCCI ON VANCOMYCIN USE IN BACTEREMIC PATIENTS Christy Su, Pharm.D PGY-1 Pharmacy Practice Resident/The Brooklyn Hospital Center, Brooklyn, NY [ OBJECTIVE: In June 2012, PNA FISH (AdvanDx, Woburn, MA) was instituted at The Brooklyn Hospital Center for rapid identification of coagulase-negative staphylococci (CoNS), which is commonly considered a contaminant from Staphylocccus aureus. The goal of this ASP driven initiative was to ensure timely differentiation of staphylococci in blood cultures which are positive for gram positive cocci in clusters (GPCC) by gram stain, thereby reducing empiric use of vancomycin. This study will compare vancomycin usage by days of therapy pre- and post-implementation of PNA FISH. METHOD: This retrospective chart review compared vancomycin usage in patients with positive blood cultures for CoNS from February to September 2012. Patients were excluded if they had bacteremia due to clinically significant CoNS, received vancomycin for a concurrent infection, or expired prior to notification of gram stain result. The primary outcome was to compare days of vancomycin therapy as a response to gram stain notification for GPCC in the pre- and post-PNA FISH groups. The secondary outcome was to compare hospital length of stay. RESULTS/DISCUSSION: A total of 68 patients with 74 positive blood cultures were included in the analysis. Thirty-six and 38 positive blood cultures were identified in the pre-and post-PNA FISH periods respectively. There was a significant difference in mean days of vancomycin therapy (1.5 + 1.4 vs 0.3 + 0.8 days, p<0.001) between the pre- and post-PNA FISH groups. When comparing median days of hospital length of stay, no significant difference was seen (9, 5-21 vs 9, 6-13 days) between the study groups. CONCLUSION: The implementation of PNA FISH technology significantly reduced the days of vancomycin therapy. This reduction can be attributed to a decreased time to identification of CoNS in conjunction with an effective communication system for the notification of positive PNA FISH results. LEARNING ASSESSMENT QUESTION: Can the use of PNA FISH technology reduce vancomycin usage? A. Yes, of course B. No, there is no difference C. Yes, but studies suggest an efficient communication system is needed to see an effect

[27] EVALUATING THE EFFICACY OF QUINOLONES OR AMINOGLYCOSIDES WITH PIPERACILLIN-TAZOBACTAM FOR THE TREATMENT OF HEALTHCARE-ASSOCIATED PNEUMONIA Jasmine George, Pharm.D. PGY-1 Pharmacy Practice, Bronx Lebanon Hospital Center, Bronx, NY OBJECTIVE: Appropriate empiric treatment for healthcare-associated pneumonia (HCAP) is associated with better patient outcomes. However, appropriate empiric selection of antimicrobials is difficult due to increasing resistance. Current pneumonia guidelines suggest either a quinolone or an aminoglycoside with a ß-lactam antibiotic. At Bronx-Lebanon Hospital, the common empiric regimen for HCAP is ciprofloxacin with piperacillin-tazobactam ± vancomycin. However, the rate of resistance to ciprofloxacin alone on the BLHC 2010 antibiogram for Pseudomaonas, Klebsiella and E. coli (37%, 54%, 33% respectively) suggest that it may not provide adequate coverage for HCAP patients. Thus, aminoglycosides have been added to the order set in July 2012. This study will see if either quinolone or aminoglycoside based regimen resulted in earlier resolution of fever and leukocytosis in patients with HCAP. METHOD/SUMMARY: This study compared HCAP patients on the quinolone based regimen from January-June 2012 to patients on the aminoglycoside based from July 2012- December 2012. The primary endpoints were resolution of leukocytosis within 5 days of antibiotic regimen and resolution of fever after 48-72 hours. RESULTS/DISCUSSION: A total of 88 patients were included in the analysis, 31 patients in the quinolone based regimen and 57 patients in the aminoglycoside based regimen. There was no statistically significant difference in resolution of leukocytosis (67% vs 72%, p= 0.8074) and resolution of fever (54% vs 65%, p=0.3697) between the quinolone and the aminoglycoside based regimens respectively. Further data collection will increase sample size and will help the study meet power. Overall, trends by percent for aminoglycosides based regimens concerning resolution of leukocytosis and fever suggest the regimen is non-inferior compared to the quinolone based group. CONCLUSION: To prevent possible treatment failures, initial antimicrobial therapy regimen needs to account for local bacteriologic patterns. Thus, hospitals have their own antibiogram. Currently, in this study, it seems that the addition of an aminoglycoside based regimen to the order set does not have a statistically significant effect on resolution of fever and leukocytosis when compared to the quinolone based regimen. TRUNACATED….

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ANTIBIOTIC STEWARDSHIP FOR CATHETER-ASSOCIATED URINARY TRACT INFECTIONS: EARLY IMPACT OF GUIDELINE IMPLEMENTATION Christine Ciaramella, Pharm.D./ PGY-1 Pharmacy Practice Resident/ NYU Langone Medical Center, New York, NY OBJECTIVE: Institution specific urinary tract infection (UTI) guidelines were implemented in July 2011. Our guidelines recommend cefepime for empiric treatment of symptomatic catheter-associated urinary tract infections (CA-UTI) based on local susceptibility patterns. The purpose of this study was to evaluate antibiotic therapy for CA-UTI after guideline implementation. METHOD/SUMMARY: A retrospective chart review of patients with CA-UTI, between September 2010 to June 2011 (before guideline implementation; BGI) and September 2011 to June 2012 (after guideline implementation; AGI) was conducted. Initial antibiotic therapy; clinical outcomes; and percentage of those who received appropriate empiric therapy based on in-vitro activity were evaluated. RESULTS/DISCUSSION: Overall, 84 patients with CA-UTI were reviewed (54 BGI and 30 AGI). Duration of urinary catheter prior to positive culture was 6 days in both groups. Escherichia coli (36%), Enterococcus species (25%), and Pseudomonas aeruginosa (19%) were the most common pathogens. Overall, antibiotic susceptibility of cefepime was higher than ciprofloxacin (91% vs. 62%) for Gram-negative organisms. Only 23 patients BGI and 13 patients AGI had a CA-UTI only. Ciprofloxacin was the most commonly used initial treatment in patients with only CA-UTI; however, the use decreased from 44% BGI to 23% AGI (p=NS). Most patients in both groups received appropriate initial therapy with in-vitro activity against the isolated organism (91% BGI vs. 87% AGI, p=NS), and achieved clinical success for the CA-UTI (85% BGI vs. 87% AGI, p=NS). Microbiological clearance at the end of therapy was 40% BGI and 100% AGI (p=0.035) in patients with a CA-UTI only. CONCLUSION: Cefepime should still be considered an appropriate choice for the initial empiric treatment of CA-UTI based on in-vitro susceptibilities. Due to the high resistance of ciprofloxacin, fluoroquinolone use should be limited to patients with a severe penicillin allergy. More education and order-sets need to be implemented to improve adherence to guidelines. LEARNING ASSESSMENT QUESTION: What is the antibiotic recommended for the initial empiric treatment for symptomatic CA-UTI in patients who do not have a severe penicillin allergy? A. Ceftriaxone B. Cefepime C. Trimethoprim-sulfamethoxazole D. Ciprofloxacin E. Vancomycin

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EFFICACY AND TOLERABILITY OF HYALURONATE VISCOSUPPLEMENTATION AT A VETERANS AFFAIRS HOSPITAL Jeffrey Balsam, BA, PharmD/ PGY-1 Pharmacy Practice Resident/ James J. Peters VA Medical Center, Bronx, NY OBJECTIVE: Osteoarthritis (OA) is a progressive condition characterized by increasing joint pain and disability. Available treatments include physical therapy, bracing/orthotics, oral/topical analgesics, and corticosteroid injections. Hyaluronate (HA) injections (viscosupplementation) may be used in patients having an inadequate response or contraindications to the above. The objectives of this study were to assess the duration of efficacy of viscosupplementation as well as to evaluate the effects of repeat injections, concurrent resource utilization, patient demographics, and safety/tolerability. METHOD/SUMMARY: Data was collected on patients who had HA ordered between January 2008 and December 2011. Patients were included if they received at least one knee injection, returned for a follow-up visit, and had an assessment of efficacy. Duration of efficacy was calculated as time between the injection series and pain returning to baseline or patient request for additional medical/surgical interventions. RESULTS/DISCUSSION: 131 patients met inclusion criteria. Mean duration of benefit for all knees injected was 2.8 ± 2.9 months. Patients who received no subsequent injections averaged 2.5 months of relief, while those who received subsequent injections averaged 4.1 months after initial series and 4.9 months after all injection series. Past response to therapy was rarely predictive of future success. Patients who utilized more non-drug therapies, had less severe underlying disease, and had better weight control tended to have better response to subsequent injections. Adverse events were not a major finding in this population. CONCLUSION: Viscosupplementation appears to be a viable- albeit temporary- option for refractory OA. Although safety was not a major concern, it remains unclear if the long-term benefits outweigh the costs. LEARNING ASSESSMENT QUESTION: Which conclusions are supported by this study? A. Viscosupplementation is a temporary solution for arthritis pain B. HA injections appear mostly safe C. HA permanently eliminates the need for surgery D. A and B E. B and C

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RETROSPECTIVE EVALUATION OF THE EFFECTIVENESS OF AN ORDER TEMPLATE IN OPTIMIZING USE OF COLCHICINE PROPHYLAXIS FOR GOUT IN A U.S. VETERAN POPULATION Jane J. Wong, Pharm.D., PGY-1 Pharmacy Practice Resident at New York Harbor Healthcare System (VA NYHHS), Brooklyn, NY OBJECTIVE: Gout is a disorder due to an excess body burden of uric acid, which deposits particularly in the joints. Urate-lowering therapy (ULT) (i.e. allopurinol, febuxostat, probenecid) is the mainstay in chronic gout management. An anti-inflammatory agent (i.e. colchicine, NSAIDs, corticosteroids) is recommended at the initiation of ULT to prevent acute gout attacks. A colchicine order template was implemented on 8/23/2011 at NYHHS. This study evaluated the use of colchicine prophylaxis with ULT after implementation of the colchicine order template. METHOD/SUMMARY: This study compared patients that received colchicine prophylaxis before and after the implementation of the order template. Patients were assessed for appropriate use of colchicine at the initiation of ULT. Secondary endpoints were to examine duration and dose of colchicine, achievement of target uric acid (UA) level (<6 mg/dL), and adjustment of ULT doses for UA levels not at goal. RESULTS/DISCUSSION: A total of 117 patients were included in the analysis, 75 in the pre-template group and 42 in the post-template group. There was a significant difference in appropriate ULT initiation with colchicine (41.3% vs 78.6%, p<0.0001) and appropriate colchicine duration (10.7% vs 31%, p<0.0002) between the pre- and post-template groups, respectively. A subanalysis was performed to determine whether goal UA was reached and ULT dose was adjusted within 1 year, both of which were found to not be statistically significant. CONCLUSION: The implementation of the colchicine order template at VA NYHHS showed a statistically significant improvement in the chronic management of gout, particularly in the appropriate use of colchicine prophylaxis with ULT initiation. LEARNING ASSESSMENT QUESTION: Which of the following is/are considered appropriate in colchicine prophylaxis therapy? A. Use with ULT initiation; B. Continue for at least 12 months; C. Adjust dose to 0.6 mg daily in CrCl <30 mL/min; D. A and C; E. All of the above

[31] PIPERACILLIN-TAZOBACTAM VERSUS CARBAPENEMS FOR THE TREATMENT OF URINARY TRACT INFECTIONS CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE PRODUCING ENTEROBACTERIACEAE Steven Wang, Pharm.D. / PGY-1 Pharmacy Practice Resident / New York Methodist Hospital, Brooklyn, NY OBJECTIVE: Carbapenem antibiotics are considered the drugs of choice for the treatment of infections caused by extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae. However increased utilization of carbapenems is associated with the development of carbapenem-resistant organisms. ESBL-producing enterobacteriaceae generally shows in-vitro sensitivity to piperacillin-tazobactam however clinical efficacy data are limited. The objective of this study was to evaluate the clinical efficacy of piperacillin-tazobactam (PTZ) compared with carbapenems for the treatment of urinary tract infections (UTIs) caused by ESBL-producing enterobacteriaceae. METHOD/SUMMARY: All patients with urine cultures positive for ESBL-producing enterobacteriaceae isolates from January 2008 to October 2012 were retrospectively evaluated. The primary endpoints evaluated were clinical response and microbiological clearance rates. Secondary endpoints included the patients’ length of hospital stay, duration of antibiotic treatment, and in-hospital mortality. RESULTS/DISCUSSION: Of the 541 patients screened, 14 patients were included in the PTZ group and 45 patients were included in the carbapenem group. In the evaluable population, clinical response of UTI was observed in 4 of 4 (100%) patients compared to 27 of 31 (87.1%) patients in the PTZ and carbapenem groups, respectively (P=1.00). Microbiological clearance was observed in 12 of 12 patients (100%) in the PTZ group compared with 27 of 31 patients (87.1%) in the carbapenem group (P=0.56). CONCLUSION: Piperacillin-tazobactam may be effective for the treatment of UTIs caused by ESBL-producing enterobacteriaceae. LEARNING ASSESSMENT QUESTION: Beta-lactamase production is the most frequently encountered mechanism of resistance to beta-lactam antibiotics. A. True B. False

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SAFETY AND TOLERABILITY OF RAPID DOSE TITRATION OF ACETYLCHOLINESTERASE INHIBITORS Kathleen Jodoin, Pharm.D./ PGY-1 Pharmacy Resident Kingsbrook Jewish Medical Center, Brooklyn, NY OBJECTIVE: Current recommendations suggest dose increases of acetylcholinesterase inhibitors (AChEI) every 2-6 weeks to avoid GI and CV ADEs. However, ADEs were observed in trials which used forced titration intervals and may not be representative of a “real-world setting”. Primary objective of this study is to assess the safety and/or tolerability of patients undergoing rapid dose titration (< 2 weeks) in an inpatient setting. METHODS: Retrospective review over past 3 years of patients initiated on an AChEI and received rapid dose titration (< 2 weeks). Primary outcome was total number of adverse GI and CV ADEs. Secondary outcome was incidence of each specific CV and GI ADE. Subgroup analysis compared the number CV ADEs in Phase I (time of AChEI initiation to first dose increase) vs. Phase II (time from first dose increase to patient discharge). Patients previously excluded due to pre-existing CV ADEs were also assessed. RESULTS: Five patients were enrolled in this study. No patients experienced GI AEs. Four patients experienced a total of 25 CV AEs (52% attributed to ≥ 20% decrease in baseline DBP). CV episodes occurred more frequently in Phase I (n = 19) vs. Phase II (n = 6). Decrease in DBP was larger in Phase I (33.5%) vs. Phase II (25%). Patients previously excluded due to pre-existing CV ADEs (n = 6) had greater frequency of CV ADEs (n = 109) but similar decrease in DBP (Phase I 24%; Phase II 16%) compared to study group. SBP also decreased (Phase I 12.5%; Phase II 6.5% ). CONCLUSION: Incidence and severity of CV ADEs was not greater with higher dose administration. Patients with pre-existing CV ADEs had a greater frequency of CV ADEs during AChEI usage but the severity of episodes may not be greater that those without pre-existing CV ADEs. AChEI rapid titration in an inpatient setting may have less of a correlation with CV and GI adverse effects than previously thought, although further study is needed. LEARNING ASSESSMENT QUESTION: Which of the following are adverse drug events that are thought to limit the rapid titration of acetylcholinesterase inhibitors? A. Nausea and vomiting, B. Vertigo and hypertension, C. Hypotension and bradycardia D. QTc and PR interval prolongation, E. A, C, and D

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COMMUNITY PHARMACISTS READINESS TO ASSESS, ADVISE AND REFER PATIENTS TO QUIT LINE SERVICES Christina Tarantola, PharmD, PGY1 Resident, Kings Pharmacy/Brooklyn, NY OBJECTIVES: Due to their easy accessibility, pharmacists can play a big role in smoking cessation. A recent survey showed that only 14% of chain and independent pharmacies offer tobacco cessation services. One way pharmacists can participate in smoking cessation counseling is through the referral of Quit Line services. However, no study has examined the extent to which pharmacists know about Quit Lines, the extent to which they refer their patients to Quit Line services and their perspectives of referring patients to Quit Lines. This study explored pharmacists’ readiness to assess, advise and refer patients to the Quit Line. METHODS/SUMMARY: A cross sectional design was utilized to enroll and interview pharmacists from 15 specialty, chain and community pharmacies in the Brooklyn, NY area from February-May 2013. A qualitative analysis was conducted on the 15 interviews and themes were developed. RESULTS/DISCUSSION: Five out of 15 pharmacists were male and ten out of 15 pharmacists were between the ages of 24-35 and had a PharmD degree. Three universal themes identified from interview data were: 1. Importance of counseling patients about smoking cessation, 2. Techniques for counseling, and 3. Perspectives on Quit Lines. The themes indicate that pharmacists view counseling as important for smoking cessation but do not know techniques widely cited in the literature. Also, they see a value in referring patients to the Quit Line and are interested in partnering with the Department of Health to aid smoking cessation. CONCLUSION: Pharmacists are willing to partner with the Department of Health to provide a referral to the New York State Quit Line. Future studies should investigate owner/ corporate chain decision-maker interest in partnering with the Department of Health to refer patients to the Quit Line. Continuing Education programs need to train pharmacists on the 5A’s model and other techniques for smoking cessation. LEARNING ASSESSMENT QUESTION: What does the AAR pneumonic stand for? 1. Assess, Advise, Refer 2. Ask, Assist, Refer 3. Advise, Assist, Refer 4. Advise, Analyze, Refer

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EFFICACY OF RASBURICASE SINGLE, LOW DOSE COMPARED TO WEIGHT-BASED MULTI-DOSE REGIMENS IN PATIENTS AT RISK FOR TUMOR LYSIS SYNDROME Justin Chiang, Pharm.D./ PGY-1 Pharmacy Practice Resident/ North Shore University Hospital, Manhasset, NY OBJECTIVE: The primary objective of this study was to determine if a single, low dose of rasburicase differed from weight-based dosing regimens to prevent or treat hyperuricemia in patients at risk for tumor lysis syndrome. METHOD/SUMMARY: This was a retrospective, single-center, cohort study which compared patients who received at least one dose of rasburicase at North Shore University Hospital from October 2011 to September 2012. This study compared patients who received a dose of ≤ 7.5 mg of intravenous rasburicase to patients who received a dose of > 7.5 mg of intravenous rasburicase. The primary outcome measure for effectiveness was defined by serum uric acid levels. Secondary endpoints included the need for a second dose of rasburicase, classification of laboratory tumor lysis syndrome, classification of acute kidney injury, and mortality. An exploratory cost analysis, based solely on the cost of medication use of the two different dosing regimens, was also conducted. RESULTS/DISCUSSION: A total of 62 patients were included in the analysis, 25 patients in the ≤ 7.5 mg group and 37 patients in the > 7.5 mg group. Normalization of uric acid levels between treatment arms were similar (100% in the ≤ 7.5 mg group and 95% in the > 7.5 mg group). CONCLUSION: Patients who were treated with ≤ 7.5 mg of intravenous rasburicase (single, fixed dose treatment arm) appeared to achieve similar efficacy outcomes when compared to those patients who received > 7.5 mg doses of intravenous rasburicase (weight-based dose treatment arm). LEARNING ASSESSMENT QUESTION: Which of these correctly defines hyperuricemia? A. ≥ 4 mg/dL B. ≥ 6 mg/dL C. ≥ 8 mg/dL D. ≥ 10 mg/dL

[35] PILOT AND REVISION OF A BASAL-BOLUS DOSING GUIDELINE FOR THE MANAGEMENT OF HYPERGLYGEMIA IN NON-CRITICALLY ILL ADULT PATIENTS Germin Shenoda Fahim, Pharm.D./ PGY-1 Pharmacy Resident/ The Brooklyn Hospital Center (TBHC), Brooklyn, NY OBJECTIVE: Clinical best practices recommend the use of basal bolus insulin regimens for the treatment of inpatient hyperglycemia as they have been shown to reduce hyperglycemia rates in a safe and efficient manner. At The Brooklyn Hospital Center (TBHC) a basal-bolus insulin guideline was recently developed and piloted in an effort to assess its safety and efficacy. The purpose of this study is to evaluate the use of a newly piloted basal-bolus dosing guideline and utilize those results to adjust it prior to its implementation hospital-wide. METHOD/SUMMARY: This was an IRB approved, prospective, multi-phase study. A multi-disciplinary team was developed and created a basal-bolus insulin dosing guideline that was approved by the Pharmacy & Therapeutics Committee. This was followed by a three month, single-unit pilot of the guideline in non-critically ill adult patients. The blood glucose values were compared before and after the intervention. Last, the resulting data from the pilot was used to revise the dosing guideline. RESULTS/DISCUSSION: A total of 43 patients were included in the pilot. Results from the pilot showed a significant decrease in median blood glucose level, an increased number of blood glucose levels within the range of 70-180mg/dL, and comparable hypoglycemia with use of the basal-bolus dosing guideline. Based on results of the pilot, the units per kilogram used for the total daily dose of insulin was increased in certain populations. CONCLUSION: Use of a basal bolus insulin dosing guideline is safe and effective in decreasing blood glucose values in non-critically ill patients at TBHC. It is essential to pilot a new protocol and revise it prior to applying it to a large patient population. LEARNING ASSESSMENT QUESTION: What are the benefits of implementing a basal-bolus insulin dosing guideline? A. Improved glycemic control B. No hypoglycemia C. Less glycemic variability D. A and C

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A RETROSPECTIVE ANALYSIS OF DABIGATRAN 75MG TWICE DAILY IN TH RENALLY IMPAIRED Jimmy Johnson, PharmD PGY-1 Pharmacy Resident/ North Shore University Hospital, Manhasset NY BACKGROUND/OBJECTIVE Dabigatran etexilate is an oral direct thrombin inhibitor that is FDA approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. The FDA approved dabigatran 75 mg twice daily for renally impaired patients (creatinine clearance <30 mL/min) based on the pharmacokinetic properties of the drug. Unlike with warfarin, we have no way to accurately and quantitatively measure the efficacy of dabigatran. During the RE-LY trial it was found that an average activated partial thromboplastin time (aPTT) of 52 seconds and a range of 40 to 76 seconds was produced by dabigatran 150 mg twice daily in patients without renal impairment. This trial set out to determine if the 75 mg twice daily dose of dabigatran etexilate causes anticoagulation in terms of the range and mean aPTT values in the renally impaired as the 150 mg twice daily dose of the same drug in a patient with normal kidney function. This study also trended the incidence of stroke and major bleed events. A major bleed in this study is defined as a reduction in hemoglobin by 2g/dL. METHODS: An IRB approved, retrospective chart review that examined charts of patients receiving dabigatran 75 mg twice daily between Oct 15th 2011 and Nov 1st 2012 was performed . Patients that were, 18 years of age or older and previously took dabigatran in the community were included in the study if they had aPTT’s drawn upon admission. RESULTS:The 15 patients with a creatinine clearance (CrCl) between 15 and 30 mL/min had an average aPTT of 53.82 seconds and a range of aPTTs from 22.1 to 91.1 seconds. None of the patients in this group experienced a stroke. 2 patients experienced bleed events. CONCLUSION:The average aPTT found in patients receiving dabigatran 75 mg BID with a CrCl between 15-30 ml/min was similar (53.82 seconds) compared to that of non-renally impaired patients in the RE-LY trial (52 seconds). LEARNING ASSESSMENT QUESTION:The FDA approved dabigatran 75 mg twice daily for renally impaired patients. What creatinine clearance (mL/min) is it approved for?a) > 60, b) 30-50, c) 15-30, d) <15

[36] ORAL PHOSPHATE BINDERS: SELECTING THE BEST AGENT Jesni Mathew, PharmD PGY-1 Pharmacy Practice Resident/Montefiore Medical Center, Bronx, NY BACKGROUND: In advanced chronic kidney disease (CKD), physiologic compensatory mechanisms do not maintain serum phosphate levels adequately in most patients despite dietary restrictions or hemodialysis. Phosphate retention contributes to patient morbidity and mortality with an increased risk of cardiovascular disease and hyperparathyroidism. A variety of oral phosphate binders are available but the ideal agent remains unclear despite clinical trials. Calcium-based binders, lanthanum carbonate, and sevelamer all control serum phosphate levels to a similar degree. However, many factors influence the choice and effectiveness of treatment including metabolic abnormalities, the presence or history of vascular calcification, and gastrointestinal pH levels. The benefits and risks of each phosphate binder should be considered in the management of hyperphosphatemia. Patient case scenarios and interventions will emphasize the importance of clinical pharmacists, as experts in the pharmacotherapy of these medications, in improving outcomes in patients with renal failure. LEARNING OBJECTIVES: Describe the pathophysiology of hyperphosphatemia in CKD, Assess the pharmacology, efficacy, and safety of currently available oral phosphate binders, Evaluate and recommend appropriate treatment options for hyperphosphatemia in advanced CKD, Formulate a care plan to effectively manage patients with this disease state CONCLUSIONS: To be discussed

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CLINICALLY OBSERVED INCIDENCE OF ALLERGIC REACTIONS IN PENICILLIN ALLERGIC PATIENTS WHO RECEIVE THEAPY WITH A CEPHALOSPORIN OR MEROPENEM Danielle Joset, Pharm.D./PGY-1 Pharmacy Practice Resident NYU Langone Medical Center OBJECTIVE: Cefepime and meropenem are used frequently in the hospital setting when broad-spectrum empiric coverage is desired, yet practitioners often struggle with whether or not to prescribe these antibiotics in patients with a reported penicillin allergy. The purpose of this study is to assess the incidence and type of allergic reactions that occur in patients with a documented penicillin (PCN) allergy who receive one of our formulary cephalosporins (cefepime, ceftriaxone, cefoxitin, cephalexin) or meropenem. METHODS: This is a retrospective chart review of adult patients admitted to NYULMC in 2011 with a documented allergy to PCN or a PCN derivative who received at least one dose of a formulary cephalosporin or meropenem during their admission. Patients were excluded if they had a self-reported or documented allergy to any of the study drugs, received one of these drugs prior to 2011 and tolerated it, reported a PCN intolerance rather than a true allergy, or were discharged home < 96 hours after their first dose. Primary outcomes included the incidence of allergic reactions, type of allergic reaction, time to allergic reaction, and characteristics of those who experience an allergic reaction. RESULTS/DISCUSSION: A total of 175 patients were included in this study; 10 out of 175 individuals (6%) experienced an allergic reaction. The incidence was as follows: cefepime 6% (6/96), meropenem 5% (3/56), cefoxitin 8% (1/13), ceftriaxone 0% (0/69), cephalexin 0% (0/8). The majority of patients experienced a rash with or without pruritis and fever. The median time to reaction was 20 hours, ranging from 1 to 336 hours. Patients who had 3 or more other documented allergies were 6 times more likely to have an allergic reaction (p=0.025). CONCLUSION: The overall incidence of allergic reactions to meropenem, cefepime and ceftriaxone is low; the most common manifestation was a rash with pruritis. Cefepime, ceftriaxone and meropenem may be safely considered for use in patients with a documented penicillin allergy. LEARNING ASSESSMENT QUESTION: What is the most commonly observed manifestation among the low percentage of patients with a documented penicillin allergy who have an allergic reaction to cefepime or meropenem? A. Anaphylaxis B. Rash C. Urticaria D. Bronchospasm E. None of the above

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BK VIREMAI IN RENAL TRANSPLANT RECEPIENTS: A Descriptive Study Jason J. Chheda, PharmD/ PGY-2 Transplant Pharmacy Resident Mount Sinai Medical Center, New York, NY OBJECTIVE: BK virus (BKV) has become an increasingly common cause of allograft dysfunction in the kidney transplant population. Despite understanding that treatment of BKV centers on reducing immunosuppression, many questions still exist. Our purpose was to determine the incidence of BK viremia at our institution, assess how it was managed, and observe outcomes at one year post diagnosis. METHODS/SUMMARY: This was a retrospective, single-center, descriptive study. All kidney transplant recipients diagnosed with BK viremia from January 1st, 2010 to December 31st, 2011 were included, and followed for one year after diagnosis. In line with our protocol, patients with a BK PCR value greater than 10,000 copies/mL were managed more aggressively than patients with a value less than 10,000 copies/mL. Thus, for our overall assessment, all included patients were stratified into either of two groups, based on this PCR cutoff. RESULTS/DISCUSSION: During the given time-points, the incidence of BK viremia was 11%, with a total study population of 30 patients. Resolution at 1 year post-diagnosis was 46.6% in the study population. Patients with peak PCR’s greater than 10,000 copies/mL were observed to have lower resolution rates than those with a value less than 10,000 copies/mL. Overall, graft survival was 100% by the end of the study. Patients with a peak BK PCR value greater than 10,000 copies/mL experienced a more aggressive reduction in daily mycophenolate mofetil doses, with mean tacrolimus trough levels appearing similar between the two groups. CONCLUSION: Many issues regarding BK viremia still exist, including identifying patients that may be at higher risk for development of BKVAN, determining optimal calcineurin inhibitor trough level ranges, and acquiring more experience with direct anti-viral agents, such as leflunomide, in the treatment of BK viremia. Future studies should focus on these issues. LEARNING ASSESSMENT QUESTION: What is the first line treatment option for management of BK viremia? A.) Reduction in immunosuppression B.) Leflunomide C.) Cidofovir D.) None of the above

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IMPACT OF INPATIENT WARFARIN COUNSELING Timothy Ho, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Long Island Jewish Medical Center, New Hyde Park, NY OBJECTIVE: The Joint Commission identified patient education as an essential element to improve outcomes in patients receiving long-term anticoagulation; however, there is a lack of standardization regarding the most effective way to provide education and assess patient knowledge. At Long Island Jewish Hospital, patients newly initiated on warfarin are counseled by a clinical pharmacist (PE) and may also watch an educational video (EV). This study will evaluate the impact of inpatient warfarin counseling on patient knowledge and clinical outcomes. METHOD/SUMMARY: Hospitalized patients receiving warfarin were identified daily through Sunrise Acute Care™ from October 2012 to April 2013. Patients newly prescribed warfarin received one of three educational modalities (EV alone, PE alone, or both PE and EV) and were contacted 3-4 days and 30 days after discharge to assess patient knowledge and clinical outcomes, respectively. The knowledge of patients newly prescribed warfarin and patients on warfarin prior to admission was assessed by the Oral Anticoagulation Knowledge (OAK) test. Clinical outcomes, such as patient-reported occurrence of bleeding, clotting, and rehospitalization, were compared between the three groups who received education. RESULTS/DISCUSSION: A total of 69 patients were included in the analysis. Patients in the EV group, PE group, and PE and EV group had average OAK test scores of 71.7%, 79.3%, and 79.3%, respectively. Patients on warfarin prior to admission had an average OAK test score of 75%. Patients newly initiated on warfarin who received education experienced four bleeding events and four rehospitalizations. CONCLUSION: Patients newly initiated on warfarin who received one of the three educational modalities had similar OAK test scores and had comparable knowledge to patients on warfarin prior to admission. LEARNING ASSESSMENT QUESTION: What are important counseling points for patients on long-term anticoagulation therapy? A. Importance of frequent INR monitoring B. Drug-food interactions C. Adherence D. B and C E. All of the above

[40] EVALUATION OF NUTRITION SUPPORT PHARMACIST INTERVENTIONS AND SUBSEQUENT DEVELOPMENT OF A STANDARDIZED PROGRESS NOTE Amanda Giancarelli, Pharm.D., CNSC/ PGY-1 Pharmacy Practice Resident/ The Brooklyn Hospital Center, Brooklyn, NY [40] OBJECTIVE: Anecdotal experience has led us to believe that during Nutrition Support Service (NSS) consultations, pharmacists are also intervening on non-nutrition related therapies. We sought out to determine the number and types of non-nutrition related interventions made by our NSS and in turn to create a standardized progress note based on those findings in an effort to provide a more efficient documentation method. METHODS: This was an IRB approved, retrospective study of all adult pharmacy NSS consultations from January 1, 2011 - December 31, 2011. Interventions related to the type of nutrition, nutrition access and nutritional supplements were excluded. The intervention categories that were assessed were: fluid and electrolytes, glucose management, alternate therapy, diagnostics, lab monitoring, discontinue medication, add medication, dose adjustment, and other. The primary endpoint of the study was to determine the total number of interventions made by a pharmacist and their acceptance rates. The secondary endpoint was to determine which areas had the most accepted and most denied interventions. From this data, a progress note would be developed based on the most common interventions. RESULTS: 132 adult consults were evaluated with a total of 297 interventions made with an acceptance rate of 89%. The top 3 accepted intervention categories were laboratory monitoring (96%), fluid and electrolytes (96%), and other (100%), which consisted of recommendations to hold or adjust enteral feeds for medication administration, change intravenous access and consult other specialists. The top 3 denied intervention categories were dose adjustment (60%), diagnostics (50%), and add medication (22%). A standardized progress note was subsequently developed based on the most frequently intervened upon areas found in this study. CONCLUSION: The interventions made by pharmacists have identified areas for education and have demonstrated the importance of a pharmacist on nutrition support teams. In addition, the development of a standardized progress note based on the most common interventions will aid in documentation as well as data collection for nutrition support outcomes. TRUNCATED…

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OVERVIEW AND TREATMENT OF WALDENSTROM’S MACROGLOBINEMIA Grace E. Jiang, Pharm.D., PGY-1 Pharmacy Practice Resident/The Mount Sinai Medical Center, New York, NY [41] SUMMARY: Waldenstrom’s Macroglobulinemia is a rare, but indolent cancer of the B-cells with overproduction of IgM antibodies. Asymptomatic patients may be carefully monitored and do not warrant immediate treatment. However, signs and symptoms caused by antibody formation such as neuropathy, organomegaly, cryoglobulinemia, and hyperviscosity necessitate the initiation of treatment. First-line treatment options generally consist of regimens that include either rituximab and/or bortezomib alone or in combination. The patient’s candidacy for bone marrow transplant but also be taken into consideration when choosing the treatment regimen as to avoid stem cell toxic regimens in those patients may receiving a stem cell transplant. CASE PRESENTATION: An 87 year old male with recently diagnosed Waldenstrom’s Macroglobulinemia, who was previously treated with chlorambucil, presented to the emergency department with acute mental status changes, electrolyte abnormalities, and acute kidney injury. The patient was worked up for potential hyperviscosity syndrome secondary to Waldenstrom’s Macroglobulinemia. Serum viscosity level came back normal and the patient was discharged supplementation once electrolytes normalized. LEARNING ASSESSMENT QUESTION: Which of the following regimens should not be used for the treatment of Waldenstrom’s Macroglobulinemia in patients who could potentially receive a stem cell transplant? A. Chlorambucil B. BDR C. Cladribine + rituximab D. A and C

[43] . THE ROLE OF HMG-C0A REDUCTASE INHIBITORS IN ELDERLY PATIENTS FOLLOWING MYCARDIAL INFARCTION Maxine Lee, Pharm.D. / PGY-1 Pharmacy Practice Resident’The Mount Sinai Medical Center, New York, NY [43] SUMMARY: This case presentation evaluated an elderly patient who presented with non-ST segment elevated myocardial infarction and the use of an HMG-CoA redcutase inhibitor in this patient population. CS is a 92 year old male with coronary artery disease, hypertension, hyperlipidemia, paroxysmal atrial fibrillation, and multiple cardioversions. He also had a triple bypass surgery in 1994 and placement of an automatic implantable cardioverter defibrillator (AICD). His medications prior to admission included aspirin, isosorbide mononitrate, simvastatin, warfarin, furosemide, carvedilol, lisinopril, and levothyroxine. CS complained of prolonged chest pain and shortness of breath overnight, which brought him to the emergency department the following morning. In the emergency room, he received nitroglycerin sublingual tablets, aspirin, and supplemental oxygen. The question of whether atorvastatin 80 mg would be beneficial for CS given his age, comorbidities, and current condition came up while verifying his orders. CONCLUSION: Several major trials studied atorvastatin 80 mg in adult patients with myocardial infarction. Evidence suggested high-dose atorvastatin 80 mg once daily was beneficial and safe for patients with myocardial infarctions due to the pleiotropic effects of HMG-CoA reductase inhibitors. Other studies were evaluated for elderly patients, patients already taking a statin, and patients with low lipid levels prior to admission. Because CS was 92 years old, already on simvastatin 10 mg, and had low lipid levels prior to admission, atorvastatin 80 mg once daily while in the hospital would provide some benefit, but not much harm either. LEARNING ASSESSMENT QUESTION: Which trial proved the benefits of atorvastatin 80 mg over pravastatin 40 mg in primary end points of death from any cause, myocardial infarction, and stroke? A. PROVE IT-TIMI 22 B. IDEAL C. MIRACL

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ADMINISTRATION OF A SURVEY TO EVALUATE THE ATTITUDES OF HOUSESTAFF PHYSCIANS TOWARD ANTIMICROBIAL USES, RESISTANCE AND ANTIMICROBIAL STEWARDSHIP PROGRAM (ASP) Nehal Gamal Hashem, PharmD/PGY-2 Infectious Disease Pharmacy Resident/The Brooklyn Hospital Center, Brooklyn, NY [42) OBJECTIVE: The ASP at our institution was established in 2005 in order to improve patient outcomes, reduce adverse effects relating to antimicrobials, educate housestaff, limit the spread of antibiotic resistance and ensure the cost-effective use of resources. The objectives of this study are to: 1) assess the perceptions, attitudes and knowledge of physicians about antimicrobial use, bacterial resistance and the ASP, 2) measure the beliefs and attitudes of physicians to the current system of prior-authorization of antimicrobials, and 3) propose future strategies to educate and inform residents about stewardship practice. METHOD/SUMMARY: We utilized a voluntary, anonymous, traditional paper and pencil survey. All 200 faculty and 260 resident physicians in-training currently employed by our institution were allowed to participate. We utilized two previously validated surveys in this study. The first was originally developed by Abbo et al and second survey was created by Bruno et al evaluated the attitudes of housestaff towards a prior authorization based ASP. RESULTS/DISCUSSION: An interim analysis was performed on 146 completed surveys. The response rate amongst residents was 48% (n=124). Survey respondents were 30% (n=44), 22% (n=32), 18% (n=26) first, second, third and fourth. The most common factors influencing antibiotic selection were risk of missing an infection (73%, n=106) and prescribing for critically ill or immunocompromised patients (84%, n=133). Ninety-one percent (n=133) of survey respondents felt that antibiotics were overused nationally; only 68% (n=100) perceived antibiotic overuse to be a problem at our institution. Seventy-three percent (n=83) agreed that having an antimicrobial stewardship program (ASP) improved individual patient care. When asked if ASP limits clinicians autonomy, 66% (n=75) survey respondents agreed or strongly agreed. CONCLUSION: This information will be vital in the development of guidelines and educational programs to promote appropriate antimicrobial use. LEARNING ASSESSMENT QUESTION: Which of the following is not a goal of ASP? A. Reduce cost, B. Reduce bacterial resistance C. Reduce antibiotic cost D. None of above

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MANAGEMENT OF HYPERGLYCEMIA IN SURGICAL PATIENTS AT A TEACHING INSTITUTION Marieli Rivera Cruz, Pharm.D./ PGY-1 Pharmacy Practice Resident/ Brooklyn University Hospital and Medical Center, Brooklyn, NY [44] OBJECTIVE: Clinical data demonstrates that hyperglycemia in hospitalized patients can lead to increased morbidity and mortality. Glycemic control has been linked to improvement in clinical outcomes and decreased hospital length of stay. The objective of this study was to describe current practices for managing hyperglycemia and achievement of glucose control in surgical patients at Brookdale University Hospital and Medical Center (BUHMC). METHODS: A retrospective chart review was conducted on the surgical unit of BUHMC. Non-critically ill patients, 18 years or older, admitted to the surgical unit of our hospital were included. Patient characteristics and pertinent information to describe patient’s management of hyperglycemia were recorded. Patient’s fasting and random glucose levels were reviewed and evaluated, along with hospital length of stay and physician’s compliance to our institution’s protocol. RESULTS: Forty-three patients were included, 25 (58%) patients had a history of diabetes prior to admission. A total of 1,018 AM and random blood glucose readings were collected and 39% were not controlled. Nineteen patients were managed with correction dose insulin and 7 (37%) patients were treated according to hospital protocol. All patients treated according to the protocol achieved an average AM glucose at goal (< 140 mg/dl). Hospital length of stay was found to be higher in patients with uncontrolled blood glucose (16 vs. 14 days) and also in those who were non-compliant with our protocol (22 vs. 14 days). CONCLUSION: Patients managed according to BUHMC protocol achieved better glycemic control and had a lower hospital length of stay than those who did not achieve glycemic control or were non-compliant to our protocol. LEARNING ASSESSMENT QUESTION: Glycemic control is important in hospitalized patients to prevent which one of the following? A. Infections and Increase in hospital length of stay B. Hospital mortality and Sepsis C. Renal impairment D. All of the above

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HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) Tamara Fawal-Vefali, Pharm.D./PGY-1 Pharmacy Practice Resident/ The Mount Sinai Medical Center, New York, NY OBJECTIVE: To present a patient with hemophagocytic lymphohistiocytosis and discuss the treatment protocols, HLH-94 and HLH-2004, recommended by The Histiocyte Society, as well as the difference between the protocols. METHOD: A 25 year old male presented with 2 months of flu like symptoms. He had an unclear past medical history and no medications prior to admission. He presented with febrile neutropenia, elevated ferritin and triglyceride levels, and low fibrinogen levels. Infectious workup was negative with the exception of a positive herpes simplex titer. DISCUSSION: The patient was diagnosed with HLH and treated according to the recommendations made by The Histiocyte Society 1994 HLH protocol (HLH-94). The protocol includes etoposide and high-dose dexamethasone, however the patient did not receive etoposide due to the multiorgan dysfunction. Conclusion: Although there is a more recent protocol for hemophagocytic lymphohistiocytosis, HLH-2004, it is recommended to follow the HLH-94 protocol until the results of HLH-2004 are published. LEARNING ASSESSMENT QUESTION: The HLH-2004 protocol differs from the HLH-94 protocol in that, HLH-2004 includes A. Intrathecal steroids B. Intrathecal methotrexate C. cyclosporine therapy during initiation phase D. cyclosporine therapy during maintenance phase E. A & C

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ANALYSIS OF SEIZURE ACTIVITY WITH CEFEPIME USE IN A LARGE METROPOLITAN TEACHING HOSPITAL Rachel Staudt, Pharm.D, PGY1 Pharmacy Resident/The Mount Sinai Medical Center, New York, NY PURPOSE: Assess the incidence of nonconvulsive status epilepticus in patients receiving cefepime and to evaluate proper dosing of cefepime at a large, tertiary care teaching hospital in New York City. METHODS: Single center, retrospective, char review to assess cefepime use in 100 adults who received cefepime for a minimum of five days from March 1, 2012 through April 30, 2012. RESULTS: The median duration of cefepime therapy was 7 days. An EEG was ordered on 3 patients with one case each of cerebral hematoma, right sided structural lesion, and no epileptiform discharges. A new AED was ordered for one patient who had recently suffered a subarachnoid hemorrhage. Inappropriate dosing was identified in 13 patients. Of these, 11 patients were receiving subtherapeutic doses and 2 were receiving supratherapeutic doses. Ten patients had a change in SCr ≥ 50% from baseline and required a dosage adjustment, which was accomplished for all but one patient. CONCLUSION:In our retrospective analysis, cefepime was not associated with nonconvulsive status epilepticus. Cefepime dosing was appropriate in the majority of patients based on renal function and indication. For patients with changing renal function, the cefepime dose was appropriately adjusted. Cefepime, which is commonly used as part of an empiric antibiotic regimen for hospital-acquired infections at our hospital, was not found to be associated with seizure risk when dosed appropriately.

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INTRAVENOUS N-ACETYLCYSTEINE ADMINISTRATION IN ACUTE LIVER INJURY Quy Huynh, PharmD, PGY1 Pharmacy Resident/Montefiore Medical Center, Bronx, NY PURPOSE: Acute liver failure (ALF) secondary to acute liver injury (ALI) is associated with high mortality rate and frequent need for transplantation. N-acetylcysteine (NAC) can prevent liver damage caused by acetaminophen (APAP) when given within 24 hours. In non-APAP ALI, NAC may improve hemodynamics, tissue oxygen delivery, and modify disease progression. We sought to evaluate a clinical protocol of NAC administration and its therapeutic benefits in ALI METHODS: Medical records of adult patients who received continuous NAC infusion between August 1, 2010 and July 31, 2012 for ALI were retrospectively reviewed for baseline demographic characteristics. Clinical outcomes and lab values after 7 days of therapy were collected. Cost utilization analysis of treatment with NAC was determined based on patients’ length of hospital stay and drug acquisition cost. Due to the retrospective nature and design of the study, institutional review board and informed consent was not necessary to obtain. SUMMARY OF RESULTS: 46 patients in the APAP and 100 in the non-APAP groups received continuous IV NAC infusion. Patients with ALI secondary to non-APAP etiologies were older, had more renal impairment, higher MELD scores, and longer LOS. Survival was 97.8% and 82.0% at discharge, 96.2% and 70.0% at 7 days, and 92.9% and 65.4% at 30 days in the APAP and non-APAP groups, respectively with transplant-free survival valuing at 97.8% and 77.0% in the APAP and non-APAP groups, respectively. CONCLUSIONS: IV NAC is indicated for APAP-induced ALI with some data supporting its use in non-APAP etiologies. Although similar trends were seen with the use of IV NAC in both groups of our study, the lack of rigorous clinical methodology prevents us from drawing substantial conclusions. Further research must be done to describe the role of IV NAC in non-APAP ALI. LEARNING ASSESSMENT QUESTION: How does NAC help in APAP toxicity? A. Antagonizing receptors B. Treating symptoms of toxicity C. Increases metabolism of parent drug D. Increasing metabolism of toxic metabolite E. All of the above

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EVALUATING WARFARIN ADVERSE DRUG REACTIONS LEADING TO EMERGENCY DEPARTMENT ADMISSIONS Doris Wong, Pharm.D./ PGY-1 Pharmacy Practice Resident Beth Israel Medical Center – Brooklyn Division, Brooklyn, NY OBJECTIVE: Adverse drug events are unwanted harmful incidents from exposure to medication use. Warfarin, an oral anticoagulant used to treat and prevent thromboembolic disorders, is a medication that has been associated with high rates of adverse events. The purpose of this study was to evaluate outpatient use of warfarin therapy leading to emergency department admissions for adverse drug events in adults. METHOD/SUMMARY: The Continuum Health System’s electronic medical record system, PYXIS reports, and Continuum Health partner’s daily warfarin reports was used to identify patients on warfarin therapy. Patients less than 18 years old, oncology patients, and pregnant women were excluded. Data including patient demographics, diagnoses, medications prior to admission, and dates of admission were collected for the study. A retrospective review was used to identify where patients were coming from and to determine the contributing factors leading to the hospital admissions due to warfarin toxicity. RESULTS/DISCUSSION: A total of 97 patients met the inclusion criteria for this project. The majority of patients were female (57% vs. 47%) with an average age of 78.7. Most patients arriving to the ED with warfarin outpatient use associated adverse drug events came from their own home and took more than 5 medications to treat multiple disease states. CONCLUSION: This project identified characteristics that best predict the prevalent causes of warfarin adverse drug events leading to hospital admissions in the community and encouraged adverse events awareness. The information gathered can be used to guide other healthcare providers in improving the quality of care for patients on warfarin therapy. LEARNING ASSESSMENT QUESTION: Factors contributing to the increased risk of warfarin adverse drug events include: A) Age, B) Concomitant medication use for multiple disease state, C) Taking warfarin daily doses ≥ 5mg, D) All of the above, Answer: D

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RETROSPECTIVE MEDICATION EVALUATION OF DABIGATRAN ETEXILATE USE AT A PRIVATE COMMUNITY TEACHING HOSPITAL. Caroline Hopke, Pharm.D./PGY1 Pharmacy Resident/ Kingsbrook Jewish Medical Center (KJMC), Brooklyn, NY. OBJECTIVE: Dabigatran was added to the KJMC formulary on September 26, 2011 with prescribing restrictions. The primary objective of this study is to determine if dabigatran prescribing in the subsequent year adhered to hospital-specific formulary restrictions. Secondary objectives include appropriateness of dose and medication safety experience. METHOD/SUMMARY: This was a retrospective chart review study including all patients admitted to KJMC between 9/6/11 and 9/30/12 that received a dose of dabigatran and/or experienced an adverse drug event. Nursing home residents and patients whom did not receive a dose were excluded. A report of all electronic orders for dabigatran was generated and screened for eligibility. Indication for therapy was confirmed using the medical chart, EKG findings or radiology reports. Prescribing service was identified by prescriber name, consults or progress notes. Admission medication reconciliations were used to determine if the patient was taking dabigatran prior to admission. ADEs were identified from ADE reports, the medical record, and/or documentation in the electronic pharmacy system Appropriateness of dose was determined by renal function and coadministration of interacting medications. RESULTS/DISCUSSION: There were 78 dabigatran orders between 9/26/11 and 9/30/12. Sixty orders for 30 individual patients met eligibility criteria. Dabigatran initiation was essentially 100% adherent to KJMC formulary criteria. Thirty seven percent of orders were initiated during hospitalization, of which 100% were written by cardiologists. Ten of 11 patients received dabigatran for atrial fibrillation. Twenty five percent of orders were under-dosed. Of 12 orders for 75 mg BID, 11 should have received 150 mg BID. All 5 orders written for once daily administration were inappropriate, suggesting a need for prescriber education. Use of dabigatran was limited after adding it to formulary. Reasons for this may include FDA approval of rivaroxaban in November 2011, conversion from warfarin therapy being a long-term decision made in the outpatient setting and concern for use in geriatric patients. CONCLUSION: Prescribers at KJMC are adherent to the current formulary restrictions and these restrictions do not require adjustment. Experience with dabigatran is limited at our institution and prescribers must be educated regarding proper dosing of dabigatran. TRUNCATED….

[51] TO REDUCE MEDICATION DOSING ERRORS IN CRITICALLY ILL OBESE PATIENTS: A QUALITY IMPROVEMENT INITIATIVE Grace I. Shyh, Pharm.D.PGY-1 Pharmacy Practice Resident/ Montefiore Medical Center, Bronx, NY OBJECTIVE: Critically ill obese patients are at high risk for adverse drug events due to many of the physiologic changes that occur in obesity, which consequently affect absorption, volume distribution, binding as well as elimination of the medications. The prevalence of obesity in the critically ill in our medical center is approaching 50%. Understanding the impact of different types of weight (i.e. actual vs. ideal vs. adjusted) on therapeutic dosing is imperative to avoid medication dosing errors and improve therapeutic outcomes. A quality improvement initiative was designed to optimize medication dosing in obese patients by creating a critical care pocket medication dosing guide, ensuring easy access to effective and efficient medication dosing for all clinicians. METHOD/SUMMARY: This study is an amalgamation from the PubMed database via MEDLINE search (1946 – present) of commonly employed weight-based medications in the critical care setting, with a subsequent classification of them based on dosing parameters of actual weight, ideal body weight, and adjusted weight. RESULTS/DISCUSSION: Commonly used critical care medications with dosing based on the ideal body weight include acyclovir, alprazolam, carbamazepine, cyclosporine, erythromycin, opioids, benzodiazepine, propofol, fluoroquinolones, aminoglycosides, digoxin, procainamide, beta-blocks, lidocaine, verapamil, H2-blockers, corticosteroids, and neuromuscular blockers. Medications dosing based on the actual body weight include amphotericin B, daptomycin, fluconazole, warfarin, and low-molecular weight heparin. Lastly drugs using adjusted body weight dosing include phenytoin, propofol, unfractionated heparin, aminoglycosides, corticosteroids, and lidocaine, verapamil, with several overlapping with the ideal body weight-based medications due to their intrinsic volume of distribution properties. Medications such as beta-lactams, amiodarone, vasopressors, require further studies. An ICU Pocket Drug Dosing Card was designed based on the results. CONCLUSION: Given the high prevalence of critically ill obese patients in the intensive care unit, especially endemic to the greater Bronx area, a Pocket Drug TRUNCATED. …

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COMPARISON OF TWO ORAL VANCOMYCIN DOSING REGIMENS FOR TREATMENT OF CLOSTRIDIUM DIFFICLE INFECTION. M. Ramirez, PharmD, PGY1 Pharmacy Resident/Montefiore Medical Center, Bronx, New York OBJECTIVE: Clostridium difficile infection (CDI) is an important cause of nosocomial diarrhea in adult patients that can be associated with significant morbidity and mortality. Management of patients with CDI includes the use of antibiotics directed against C. difficile. For patients with mild to moderate CDI, use of metronidazole for 10 to 14 days is recommended. For more severe but uncomplicated cases, oral vancomycin alone is preferred. While oral vancomycin is the preferred agent for severe CDI, evidence supporting the use of one dosing regimen over another (e.g., 500mg q6h vs. 250mg q6h vs. 125mg q6h) is lacking. Although the lower oral vancomycin dosing regimen appears to be as effective in the treatment of CDI from our empiric observations, no systematic review has been performed to demonstrate its efficacy compared to the higher dosing regimens. The purpose of the current study is to compare the efficacies between oral vancomycin regimens of 125mg q6h to 250mg q6h or higher. METHODS: This was a retrospective chart review comparing clinical outcomes of patients who received oral vancomycin 125mg q6h to those who received doses of 250mg q6h or higher at the Montefiore Medical Center from 2007 to 2010. Medical records of these patients were reviewed for data collection. Data collection included demographics; clinical parameters within 24 hours of CDI diagnosis, at 72 hours after initiation of CDI therapy, and at the end of CDI therapy or time of discharge; concomitant antibiotic therapy; total length of stay (LOS); in-hospital mortality; and 30-day readmission. The primary endpoint was clinical improvement at 72 hours after initiation of oral vancomycin therapy for all included patients. Secondary endpoints included clinical improvement 72 hours after initiation of oral vancomycin therapy stratified by disease severity at baseline; clinical improvement at the end of treatment or date of discharge; total LOS; in-hospital mortality rate and 30-day readmission rate due to all causes and CDI. RESULTS: Patient demographics, clinical parameters and treatment outcomes will be documented. The results will be presented. CONCLUSION: It is predicted that this study will show no differences in clinical outcomes between low dose (125mg q6h) and high dose (≥250mg q6h) oral vancomycin regimens.

[52] ANTIFACTOR Xa AND FACTOR II MONITORING IN A PATIENT WITH ANTIPHOSPHOLIPID ANTIBODY SYNDROME Celeste M. Vinluan, Pharm.D./ PGY-1 Pharmacy Practice Resident/ St. Luke’s-Roosevelt Hospital, New York, NY OBJECTIVE: Antiphospholipid antibody syndrome (APS) is an autoimmune disorder characterized by elevated levels of antiphospholipid antibodies that predispose patients to thrombosis. These antibodies, particularly with lupus anticoagulant activity, may prolong or falsely elevate phospholipid-dependent coagulation tests such as the activated partial thromboplastin time (aPTT) and the international normalized ratio (INR). This case reviews the anticoagulation management of heparin and warfarin in a patient with APS. CASE SUMMARY: A 69 y/o male with a history of APS, hypertension, diabetes, deep venous thrombosis, colon cancer and prostate cancer was admitted for generalized weakness. Patient was noted to have acute kidney injury and hyperkalemia complicated with 3rd degree atrioventricular block. On the 5th day of admission, patient developed right lower extremity pain and an ultrasound showed acute DVT. A thrombectomy was performed and patient was maintained on a heparin drip, monitoring antifactor Xa levels (goal of 0.3-0.7) and bridged to warfarin, monitoring factor II levels (goal of 15-25%). CASE DISCUSSION: The aPTT test has been mainly used to monitor and adjust unfractionated heparin (UFH) whereas the INR measures warfarin’s anticoagulation effect. Antiphospholipid antibodies have demonstrated to prolong the aPTT and increase INR, making these tests unreliable for monitoring anticoagulation. Monitoring heparin antifactor Xa levels and measuring clotting factor II offer a different approach to managing anticoagulation in patients with APS. CASE CONCLUSION: Antifactor Xa and factor II activity levels provided alternative methods for monitoring anticoagulant effects of UFH and warfarin in the presence of antiphospholipid antibodies. LEARNING ASSESSMENT QUESTION: Which of the clotting factors reflected in the INR has the longest half-life and therefore would be an alternative to monitor warfarin therapy? A) II B) VII C) IX D) X

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POLYMYXIN B USE FOR MULTI-DRUG RESISTANT URINARY TRACT INFECTIONS Samantha Smalley, Pharm.D. / PGY-1 Pharmacy Resident/ Kingsbrook Jewish Medical Center OBJECTIVE: Although there are several studies regarding the use of polymyxin B (PMB) for multi-drug resistant (MDR) infections, there are only a few studies that have looked at the efficacy of PMB in treating MDR urinary tract infections (MDRI-UTIs). The purpose of our study was to assess the efficacy of intravenous PMB for treatment of MDR-UTIs at our institution. Additionally, since PMB has a reported nephrotoxicity rate ranging from 25% to 90%, we sought to determine safety of PMB by assessing each patient using the RIFLE criteria (risk, injury, failure, loss, and end-stage renal disease). METHODS: A retrospective chart review of patients receiving PMB for treatment of UTIs from November 1, 2009 through October 31, 2012 was performed. Data were collected from electronic medical records, pharmacy computerized systems, and a microbiology record system. Patients meeting the following inclusion criteria were assessed for both efficacy and nephrotoxicity of PMB: urine cultures available both before and after treatment, presence of MDR organism(s) in urine culture, and treatment with PMB for at least 72 hours. Efficacy was defined by microbiological cure and safety was defined by RIFLE criteria. Patients were excluded from study analysis if they received polymyxin B before first urine culture was taken, urine culture showed less than 100,000 colony forming units (CFUs) or urine culture showed an organism resistant to PMB. RESULTS/DISCUSSION: There was approximately a 60% microbiological cure rate after treatment with PMB in 23 patients with MDR-UTI. Of note, patients with microbiological cure had a median daily dose of 0.91 mg/kg compared to an median of 1.48 mg/kg for patients with microbiological failure. A majority of subjects with microbiological success (85.7%) received daily doses > 1 mg/kg whereas a majority with microbiological failure (55.9%) received daily doses < 1mg/kg. Length of PMB treatment or concurrent beta-lactam use did not appear to affect microbiological outcome. Nearly 30% of patients with baseline renal function data available experienced nephrotoxicity. TRUNCATED….

[55] THE IMPACT OF PHARMACIST-DRIVEN PATIENT DISCHARGE COUNSELING ON HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) SCORES: TARGETING A UNIT IN NEED OF IMPROVEMENT Sadaf Raminfar, PharmD/ PGY-1 Pharmacy Practice Resident/ Beth Israel Medical Center Brooklyn Division, Brooklyn, NY OBJECTIVE: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) provides a standardized survey instrument and data collection mechanism for evaluating patients' perspectives on hospital care. It allows for meaningful comparisons between hospitals on domains that are important to patients, it creates incentives for hospitals to improve quality of care, and it increases accountability by being publicly available. The purpose of this study was to determine how pharmacist discharge counseling will impact the ‘Overall’ HCAHPS score of a specific hospital unit in need of improvement. METHODS: A hospital unit in need of improvement of HCAHPS scores was selected. A daily list of patients with intent to discharge was reviewed. Patients being discharged home were included, while those being discharged to rehabilitation centers, nursing homes, hospices and other such facilities were excluded. Those less than 18 years of age, in addition to those with altered mental status and extensive language barriers were excluded as well. A retrospective review of previous HCAHP scores for the unit selected was analyzed and used as the control. Prospectively, patients were enrolled, provided with discharge counseling by a pharmacist, and included in the randomization of patients who may be mailed an HCAHPS survey. RESULTS: 56 patients were counseled during the 4 month intervention period. The ‘Overall’ HCAHPS score increased from an average of 51.5% to 55.8%. The ‘Discharge Information’ dimension score increased from an average of 72.7% to 79.6%. There was a more significant rise in the Discharge Information’ dimension of the score (from 72.7% to 85.2%) when omitting the two weeks where counseling session were not able to be provided. Finally, the number of weeks above NRC Average increased from 3/19 weeks (15.8%) prior to the intervention, to 7/16 weeks (43.8%) after the intervention. CONCLUSION: Pharmacist involvement in patient discharge counseling improves patient satisfaction and can increase HCAHPS scores. LEARNING ASSESSMENT QUESTION: Why are HCAHPS survey scores important? A. They allow for comparisons between hospitals on domains that are important to patients B. They create incentives for hospitals to improve quality of care C. They increase accountability by being publicly available D. All of the above

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CLINICAL PEARL: PHARMACIST ROLE IN THE MANAGEMENT OF CHEMOTHERAPY EXTRAVASATION Monique Garcia, Pharm.D./ PGY-1 Pharmacy Practice Resident/ St. Luke’s-Roosevelt Hospital Center, New York, NY BACKGROUND: Extravasation is the process by which a medication leaks into areas outside of the venous system. The extravasation of chemotherapy agents can result in discomfort to the patient including local irritation, soft tissue ulcers, and tissue necrosis. In severe cases this may result in nonhealing ulcers requiring skin grafting. OBJECTIVES: 1) Describe the differences between vesicants, irritants, and nonvesicants, 2) Evaluate the treatment options for the management of chemotherapy extravasation, 3) Apply the current practice guidelines in the management of chemotherapy extravasation and 4) Assess the current literature available on the use of antidotes. OUTLINE: This clinical pearl session will review the definitions and pathology of chemotherapy extravasation, summarize the clinical practice guidelines on chemotherapy extravasation, present primary literature identifying the role of antidotes in the management of chemotherapy extravasation, demonstrate the appropriate supplies to include in an extravasation kit, and lastly we will discuss the role of the pharmacist in the management of chemotherapy extravasation. LEARNING ASSESSMENT QUESTION: What is the first step to be taken in the case of peripheral line extravasation with a vinka alkaloid? A. Remove the cannula B. Notify the Physician C. Administer hyaluronidase subcutaneous injections D. Stop the infusion

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EVALUATION OF POSTOPERATIVE INTRAVENOUS ACETAMINOPHEN ON OPIOID CONSUMPTION IN LABOR AND DELIVERY PATIENTS Eileen Tang, Pharm.D., PGY-2 Critical Care Pharmacy Resident/New York Methodist Hospital, Brooklyn, NY OBJECTIVE: Intravenous (IV) acetaminophen has FDA approved indications including fever reduction, management of mild to moderate pain, and management of moderate to severe pain with adjunctive opioid analgesics. Manufacturer claims that IV acetaminophen improves pain relief with reduced opioid consumption ultimately avoiding side effects. However, there are limited data on its use in labor and delivery patients. The purpose of this study is to assess if there is a reduction in opioid consumption when IV acetaminophen is used as an adjunctive analgesia to opioid therapy in patients after delivery. METHODS/SUMMARY: A cohort of labor and delivery patients who were administered both IV acetaminophen and opioids were compared to a control arm that was administered only opioids from January through December 2012. The primary outcome was the total amount of opioid consumption in IV morphine equivalents. Secondary endpoints included change from baseline in pain intensity, number of patients who used patient controlled analgesia therapy, and hospital length of stay. RESULTS/DISCUSSION: One hundred patients were included in the analysis with fifty patients in each group. Patients in the IV acetaminophen and opioids group required 462 mg of morphine and the opioids only group required 457 mg of morphine, showing a similar amount of opioid consumption in both arms. CONCLUSION: The results of this evaluation suggest that the addition of a postoperative dose of IV acetaminophen did not decrease the overall amount of morphine consumption compared to patients who only received opioids for analgesia. LEARNING ASSESSMENT QUESTION: What are the theoretical benefits of adding IV acetaminophen to patients already receiving opioids as claimed by the manufacturer? A. Reduced opioid consumption B. Increased opioid side effects C. Improved pain relief D. A and B E. A and C

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DESIGN AND IMPLEMENTATION OF TOOLS TO TEST KNOWLEDGE OF AND COMPLIANCE WITH USP <797> REGULATIONS Alfred J Custer II, Pharm.D./ PGY-1 Pharmacy Practice Resident St. Luke’s-Roosevelt Hospital Center, New York, NY OBJECTIVE: USP <797> is a regulation issued by the United States Pharmacopoeia (USP) and endorsed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) designed to reduce risks for staff members and patients that are associated with compounded sterile products. The objective of this project is to assess staff pharmacists’ and technicians’ knowledge of the USP <797> regulations after a series of educational sessions and training videos. METHOD/SUMMARY: This project incorporates a written exam and a series of inspections to assess the impact of staff training on knowledge and performance. The exam consists of a pool from which questions could be selected in order to provide variety and specificity for each staff member’s test. Exams are administered after training sessions and on a scheduled basis to test long-term competency. Inspections include visual observation of procedures and a regular verification that policies are followed. The inspections are performed during each shift, and results are reported to the staff and managers. RESULTS/DISCUSSION: This project is ongoing and will continue to track the competency of staff members in the knowledge and skills associated with compounding sterile products according to USP <797> guidelines. An impact has already been seen in the knowledge and skills demonstrated by staff technicians and pharmacists. As hospital pharmacies continue to look for ways to improve patient and employee safety in the area of compounded sterile products, the methods implemented in this project may be applicable at other sites. CONCLUSION: Staff competency in compounding sterile products is vital to patient and employee safety. The exam and inspection strategy outlined in this project have shown an impact at St. Luke’s Hospital. LEARNING ASSESSMENT QUESTION: Choose the principal source of contamination of compounded sterile products. A. Human touch B. Airborne pathogens C. Contaminated ingredients D. Surface particulate matter

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TRANEXAMIC ACID (CYKLOKAPRON®) ADMINISTRATION IN THE EMERGENCY DEPARTMENT Milena Grace Wong, Pharm.D./PGY-1 Pharmacy Resident St. Luke’s-Roosevelt Hospital Center, New York, NY [59] OBJECTIVE: Tranexamic acid is an antifibrinolytic agent that inhibits the activation of plasminogen to plasmin. Tranexamic acid is indicated for short-term use in patients with hemophilia, to reduce the need for replacement therapy with tooth extraction and is used off-label for patients with possible bleeding associated with trauma or surgery. According to the CRASH-2 Trial, the efficacy of tranexamic acid for emergency hemorrhage was observed if used within 3 hours from injury; otherwise, mortality from bleeding would increase after 3 hours. Therefore, it is necessary to design a strategy for the use of tranexamic acid to be administered promptly and appropriately. We implemented a process at our emergency department to efficiently and safely use tranexamic acid. METHOD/SUMMARY: For the timely delivery of tranexamic acid in the emergency department, the medication was provided through automated dispensing cabinets (Pyxis) with an override status. Each tranexamic acid kit includes a filter needle and instructions for appropriate dosing, preparation and administration. For trauma-associated hemorrhage, an initial loading dose of 1,000 mg IV is administered over 10 minutes followed by 1,000 mg as a continuous infusion over 8 hours. To prepare the infusion, a 10 mL ampule (100 mg/mL) is diluted in a Normal Saline 100 mL bag with a final concentration of 1,000 mg/100 mL. Further information on tranexamic acid was delivered to the emergency department nurses during in-service educational sessions. CONCLUSION: Tranexamic acid reduces the risk of bleeding in patients associated with trauma or surgery, but it should be administered as early as possible to provide effectiveness. LEARNING ASSESSMENT QUESTION: Based on the CRASH-2 trial, when should tranexamic acid be administered to trauma patients with significant bleeding? A. <1 hour after injury, B. <3 hours after injury, C. 8 hours after injury, D. A & B, E. All the above

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COMPARISON OF THE CLINICAL AND MICROBIOLOGICAL OUTCOMES IN DIABETIC AND NON-DIABETIC PATIENTS WITH ACUTE PYELONEPHRITIS Kathleen Lynch, PharmD / PGY-1 Pharmacy Practice Resident / The Brooklyn Hospital Center, Brooklyn, NY OBJECTIVE: There is some evidence to suggest that the clinical outcomes and pathogens of acute pyelonephritis (AP) differ between patients with diabetes mellitus (DM) and those without DM. However, current guidelines do not make treatment distinctions based on DM status. The objectives of this study were to identify the microbiological and clinical characteristics of hospitalized patients with AP and investigate differences between patients with and without DM. METHODS/SUMMARY: A retrospective cohort study of adult patients admitted with AP at The Brooklyn Hospital Center. Patient information was accessed through the hospital’s electronic medical record system and patients were identified from primary discharge diagnosis ICD-9 codes for AP within the past 3 years. Patients were then screened for DM; all DM patients were randomly matched in a 2:1 manner to patients without DM admitted with AP during the same time period. RESULTS/DISCUSSION: A total of 48 patients were included in this analysis, 16 with DM and 32 without DM. There was a significantly greater median length of stay among diabetics (6 vs. 3 days, p= 0.047), all other clinical outcomes were similar including rates of complications, and days to clinical stability. There was a greater rate of antimicrobial resistance among DM patients, with a significantly greater rate of infection by multi-drug resistant organisms (MDRO) (25% vs. 3%, p = 0.03). E. coli was the overall most common uropathogen, in 50% of the DM patients and 53% of the non-DM patients. Ceftriaxone monotherapy was the most commonly used empiric regimen in both groups (63% vs. 59%), and there were similar rates of ceftriaxone sensitivity (80% vs. 100%). CONCLUSION: In the setting of AP, patients with DM are at greater risk of infection from MDRO and may require longer lengths of stay. LEARNING ASSESSMENT QUESTION: Current AP treatment guidelines make specific recommendations for patients with DM. True/ False

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AN EVALUATION OF A PHARMACY-LED INTRAVENOUS-TO-ORAL ANTIMICROBIAL CONVERSION PROTOCOL Tayla Inderlin, BS, PharmD, PGY-1 Pharmacy Practice Resident James J. Peters VA Medical Center, Bronx, NY OBJECTIVE: Antimicrobial stewardship programs are designed to promote rational use of antibiotics. Conversion of antibiotics from intravenous (IV) to oral (PO) is an important part of this program and can reduce the length of hospitalization and lower hospital costs. The objective of this evaluation is to assess the effectiveness of a pharmacy led IV-to-PO conversion protocol at the James J. Peters VAMC. METHOD/SUMMARY: This evaluation will be based on data pre-implementation from 10/2011 to 02/2012 and post-implementation from 10/2012 to 02/2013. Patients were included if they were started on an IV antibiotic(s), were on IV antibiotic(s) for at least 48 hours, are able to tolerate oral medications, are hemodynamically stable, and show clinical improvement. The primary endpoint is the difference in average duration of IV antimicrobial therapy between pre- and post-implementation groups. Secondary endpoints include difference in hospital length of stay (LOS), acceptance of recommendations, and drug cost savings. RESULTS/DISCUSSION: A total of 60 patients were included in this study, 31 in the pre-implementation group and 29 in the post-implementation group. Average duration of IV antibiotics in the pre-implementation group was 5.87 days vs. 5.59 days in the post-implementation group (p=0.56). Differences in LOS and drug costs did not differ between the two groups. It was found that conversion notes were written for only 20% of patients in the post-implementation group, and that only 33% of the notes were written on the day the patient met criteria. Only half of the requests were switched to the oral medication, only 1 of which was switched within 24 hours. CONCLUSION: Process improvements are necessary in order to increase effectiveness of this protocol: this includes the expansion of pharmacy involvement and increasing awareness, review, and follow-up. LEARNING ASSESSMENT QUESTION: A barrier to a pharmacy-led conversion protocol is the following: a) charts not reviewed daily b)inadequate follow up c) lacking awareness d) all of the above

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[61]

PREVALENCE OF COLONIZATION AND ANTIMICROBIAL RESISTANCE IN SPINAL CORD INJURED OUTPATIENTS WITH URINARY CATHETERIZATION UNDERGOING URODYNAMIC EVALUATION Kirsten Woelfel, PharmD/ PGY-1 Pharmacy Practice Resident/James J. Peters VA Medical Center, Bronx NY OBJECTIVE: An estimated 270,000 people are living with a spinal cord injury (SCI) in the US. Approximately 65% of SCI patients have urinary catheterization. Chronic catheterization is associated with a 23% to 100% rate of colonization. Urodynamics monitors for changes in bladder emptying to assess the need for catheterization and can be traumatic to the urinary tract, resulting in bacteriuria or UTIs. Limited data exist regarding colonization, antimicrobial resistance, and UTIs pre- and post-procedure in this population. METHOD/SUMMARY: This was a retrospective chart review from July 2008 to December 2012 of SCI outpatients undergoing urodynamic evaluation. Patients were included if they had a documented SCI and urine culture results prior to urodynamics. Patients were excluded if they had signs/symptoms of a UTI at the time of urine culture or were not from the community. RESULTS/DISCUSSION: Ninety-two patients were evaluated: 74 were catheterized and 18 were not. Patients with catheterization were significantly more likely to be colonized than those without (OR=6.706, 95% CI=2.188-20.552, p=0.001). Thirty-four percent of the organisms cultured were considered MDRO. The most common organism cultured was E. coli. Levofloxacin was most commonly prescribed (48.1%), however 60% of organisms were resistant. Forty-seven percent of patients were treated with an inappropriate pre-procedure antibiotic. Of those with sterile urine, 84.6% received antibiotics pre-procedure when none were warranted. One UTI occurred post-procedure (1.1%). Urine bacteria ≥3+, LE ≥1+, WBC≥10, and nitrite+ results on urinalysis were significantly associated with colonization (p<0.0001, all). CONCLUSION: colonization was significantly more likely in catheterized SCI outpatients compared to those without catheterization. Over one-third of the organisms cultured were MDRO. Despite high resistance to fluoroquinolones, this was the most commonly prescribed class. Inappropriate antibiotic use prior to urodynamics may have contributed to resistance. We used this culture information to develop an antibiogram for our institution’s SCI unit. UTIs post-procedure occurred infrequently despite significantly inappropriate prophylaxis. Positive urinalysis results were significantly associated with colonization.

[63]

USING A MULTIDISCIPLINARY APPROACH TO OPTIMIZE SMART PUMP TECHNOLOGY TO PROMOTE MEDICATION SAFETY IN ADULT ONCOLOGY PATIENTS William Yu Pharm. D., Practice Resident PGY-1/Pharmacy Practice Resident (PGY-1)/Winthrop-University Hospital OBJECTIVE: Approximately 38% of medication errors occur during medication administration. Oncology patients are commonly administered high alert medications placing them at increased risk. Smart infusion technology may be used to mitigate these errors. However, due to inconvenience, nurses may circumvent this safety tool. The purpose of this project is to increase the usage of this technology by nurses. METHOD/SUMMARY: A multidisciplinary committee consisting of nurses and pharmacists were formed. Meetings were held by this committee to discuss the adult oncology drug profile in the smart infusion technology and to propose changes. Reports were generated from the smart pump data reporting software to identify areas that need improvement. These reports included usage information, magnitude of overrides of drugs, and the number of identified intercepted medication errors. Approved changes were sent to the informatics pharmacist who updates all of the institution’s pumps. Pharmacists completed walking rounds to provide education on the changes in the drug library and on the use of the smart infusion pumps to the nurses in the unit. The effects of the changes are measured by generating new reports. RESULT/DISCUSSION: The average usage of the smart pump by nurses is 41% prior to the formation of the multidisciplinary committee. From the time the project started (Sept. 2012) until Mar. 2013, the average usage increased to 49%. 42 additions, deletions, and changes to the profile were made. All changes showed significant decrease in unnecessary alerts and increase in smart pump usage. CONCLUSION: Smart infusion pumps have the potential to prevent medication errors but it is the acceptance and trust of this technology by nurses that ultimately determines the actual usage. LEARNING ASSESSMENT QUESTION: The type of response(s) to alerts that shows nursing acceptance to the pump’s settings is: A. Reprogram B. Cancel C. Override D.

B and C

[62]

ASSESSING THE IMPACT OF A PHARMACIST-LED PATIENT EDUCATION PROGRAM ON HEMODIALYSIS PATIENTS USING PHOSPHATE BINDERS Binil T. Varghese, Pharm.D./ PGY-1 Pharmacy Practice Resident James J. Peters VA Medical Center, Bronx NY OBJECTIVE: In patients with chronic kidney disease (CKD), control of phosphorus accumulation is vital in preventing the development of secondary hyperparathyroidism and metastatic calcifications. When hyperphosphatemia can no longer be managed with dietary phosphate restriction, the addition of phosphate binders becomes the next step in therapy. One of the main barriers in the treatment of hyperphosphatemia is poor compliance with phosphate binder therapy. The objective of this study is to determine the impact of a pharmacist-led patient education program on compliance with phosphate binder therapy in hemodialysis patients at the James J. Peters Department of Veteran Affairs Medical Center. METHOD/SUMMARY: The pharmacist-led patient education program included initial medication counseling, assessment of factors contributing to non-compliance, and distribution of written patient education materials. A retrospective chart review was performed on hemodialysis patients with phosphate binder therapy to assess compliance with refills and degree of hyperphosphatemia from 6/1/2012 – 11/1/2012 prior to the patient education program. After the initial counseling session in January 2013, patients were followed for 3 months to assess improvement in compliance and impact on degree of hyperphosphatemia. The following data was collected: patient demographics, type of phosphate binders, refill history, lab values (serum calcium, phosphate (PO4), albumin, PTH), and calculation of calcium-phosphorus product (Ca x P). RESULTS/DISCUSSION: A total of 50 patients were included in the program. There was a significant decrease in serum PO4 levels from baseline to end of follow-up (5.782 to 5.168, p < 0.01). A downward trend was seen in Ca x P but it was not statistically significant (50.43 to 48.83, p=0.5). In patients that were out of their target range for serum PO4 and Ca x P at baseline, there was also a significant decrease in both parameters from baseline to follow-up (PO4: 6.93 to 5.37, p<0.0001; Ca x P: 64.74 to 49.83, p=0.0002). CONCLUSION: The implementation of a pharmacist-led patient education program can aid in improving phosphate binder compliance and controlling hyperphosphatemia.

[64] REDUCING HEEL LANCE INDUCED PAIN IN THE NEONATAL INTENSIVE CARE UNIT Mark Shen, Pharm. D./Pharmacy Practice Resident (PGY-1)/Winthrop-University Hospital, Mineola, NY OBJECTIVE: In the past, pain from skin-breaking procedures was doubtful to occur in neonates, perhaps due to an immature nervous system. Subsequently, pain was demonstrated to occur in these patients and to be associated with adverse consequences. A preliminary observation of heel lances in our hospital's neonatal intensive care unit (NICU) showed that pain management practices may be suboptimal. Our NICU uses the Neonatal Pain, Agitation & Sedation Scale (N-PASS) to assess pain. The objective of the study is to improve pain management from heel lances in neonates. METHOD/SUMMARY: This quality improvement project consisted of three phases: Phase 1- Retrospective chart review of 25 subjects to document pain scores during heel lancing and treatments used to manage pain, prior to educational sessions. Phase 2- Presentations to physicians and nurses on current guidelines and recommendations in the management of heel lance-induced pain in neonates. Phase 3- Retrospective chart review of 25 different subjects (to assess the impact of Phase 2). Sample size analysis: 25 patients per group to show significant differences. RESULTS/DISCUSSION: 50 neonates who had heel lances were enrolled. Pre-intervention, the average pain score was 3.68 out of 10 while nurses used some non-pharmacological methods to manage heel lance-induced pain. Post-intervention, average pain score was 2.56 out of 10, with an 84% increase in the use of sucrose. Overall, average pain scores decreased by 11.2% (p =0.05). CONCLUSION: Education of health care providers raised awareness of pain in their patients and increased the use of sucrose for heel lancing, which was effective in reducing pain. LEARNING ASSESSMENT QUESTION: Which of the following are options for the management of heel lance induced pain in neonates? A. No treatment is needed since this is a painless procedure B. Oral sucrose C. Morphine D. EMLA E. All of the above

[65]

27

RISK OF DEVELOPING CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA AT A COMMUNITY HOSPITAL IN PATIENTS RECEIVING A PROTON PUMP INHIBITOR OR H2 RECEPTOR ANTAGONIST Lisa Modelevsky, Pharm.D./ PGY-1 Pharmacy Resident North Shore LIJ – Plainview Hospital, Plainview, NY [65] OBJECTIVE: Clostridium difficile-associated diarrhea (CDAD) accounts for nearly 14,000 deaths in the United States and $1 billion in healthcare costs annually. Many risk factors for CDAD are well established including broad spectrum antibiotic usage and older age. Conflicting evidence exists regarding the potential increased risk of developing CDAD in hospitalized patients receiving a proton pump inhibitor (PPI) or H2 receptor antagonist (H2RA). The primary objective of this study was to determine if within a community hospital setting, the risk of developing CDAD during a hospital admission is increased among patients receiving a PPI versus an H2RA. METHOD/SUMMARY: This case-control study was conducted using retrospective chart review and a sample size of 200 subjects – 100 patients who developed hospital-acquired CDAD and 100 patients that did not develop CDAD during their admission at Plainview Hospital from January 2010 to March 2013. Patients were stratified by type of acid suppressive therapy (PPI, H2RA, or none) received and duration of therapy. Additional pharmacological stratification included antibiotic usage prior to and during the hospital admission. Non-pharmacological stratification included history of C. difficile infection, age, gender, severity of illness, history of or current traumatic abdominal injury or abdominal surgery, hepatic cirrhosis, and length of stay in hospital prior to developing CDAD. Data analysis was performed using a logistic regression model comparing the odds of developing CDAD among patients receiving a PPI versus an H2RA or neither. RESULTS/DISCUSSION: A total of 192 patients were included in the analysis; 93 patients in the CDAD positive group and 99 patients in the CDAD negative group. Subjects receiving PPI had increased odds of developing CDAD (OR = 8.77, 95% CI: 2.22, 34.48) as compared to subjects receiving H2RA or neither. Acid suppressive therapy was significantly associated with developing CDAD (p <0.0013). CONCLUSION: Patients receiving PPI versus an H2RA or no acid suppressive therapy are at increased risk for developing CDAD. LEARNING ASSESSMENT QUESTION: What are the benefits of reducing unnecessary PPI usage in the hospital setting? A. Reduced risk of developing CDAD B. Cost savings C. Optimized acid suppressive therapy D. B and C E. All of the above

28

NEW YORK CITY REGIONAL PHARMACY RESIDENCY CONFERENCE The Arnold & Marie Schwartz College of Pharmacy

and Health Sciences, Long Island University, Brooklyn, New York

Friday, June 21, 2013

ADVISORY COMMITTEE

Mary Choy, PharmD, CGP Assistant Professor, Touro College of Pharmacy  Clinical Pharmacist, Metropolitan Hospital President, New York City Society of Health‐System Pharmacists  

Henry Cohen*, MS, PharmD, FCCM, BCPP, CGP  Professor of Pharmacy Practice  Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Chief Pharmacotherapy Officer Director of Pharmacy Residency Programs (PGY‐1 & PGY‐2) Kingsbrook Jewish Medical Center  

Robert DiGregorio*, PharmD, BCACP Professor of Pharmacy Practice Arnold & Marie Schwartz College of Pharmacy and Health Sciences  Sr. Director, Pharmacotherapy Services  The Brooklyn Hospital Center  

Christopher Ho, PharmD, BCACP Assistant Professor of Pharmacy Practice Arnold & Marie Schwartz College of Pharmacy and Health Sciences  President‐elect, Royal Counties Society of Health‐System Pharmacists  

Troy Kish, PharmD Assistant Professor of Pharmacy Practice Arnold & Marie Schwartz College of Pharmacy and Health Sciences  Past‐President, Royal Counties Society of Hospital Pharmacists  

Elizabeth Palillo, PharmD Clinical Pharmacy Manager Beth Israel Medical Center 

 Mark Sinnett*, PharmD, FASHP Director, Clinical and Educational Services Director, PGY1 Pharmacy Residency Montefiore Medical Center  * Denotes event founders

Alla Melamed PGY‐1 Pharmacy Resident Beth Israel Medical Center

Anna Shmayenik PGY‐1 Pharmacy Resident Beth Israel Medical Center

Karina Tselenchuk PGY‐1 Pharmacy Resident Beth Israel Medical Center

Doris Wong PGY‐1 Pharmacy Resident Beth Israel Medical Center ‐ Brooklyn Division

Elena Denisko PGY‐1 Pharmacy Resident Beth Israel Medical Center ‐ Petrie

Sadaf Raminfar PGY‐1 Pharmacy Resident Beth Israel Medical Center Brooklyn Division

Jasmine George PGY‐1 Pharmacy Resident Bronx Lebanon Hospital

Corrine Larkai PGY‐1 Pharmacy Resident Bronx Lebanon Hospital

Rivka Hecht PGY‐1 Pharmacy Resident Brookdale University Hospital and Medical Center

Marieli Rivera PGY‐1 Pharmacy Resident Brookdale University Hospital and Medical Center

Michelle Krawczynski PGY‐2 Ambulatory Care Pharmacy Resident Brookdale University Hospital and Medical Center

Jeffrey Balsam PGY‐1 Pharmacy Resident James J. Peters VA Medical Center

Tayla Inderlin PGY‐1 Pharmacy Resident James J. Peters VA Medical Center

Binil Varghese PGY‐1 Pharmacy Resident James J. Peters VA Medical Center

Kirsten Woelfel PGY‐1 Pharmacy Resident James J. Peters VA Medical Center

Christina Tarantola PGY‐1 Community Pharmacy Resident Kings Pharmacy

Megan Flinchum PGY‐1 Pharmacy Resident Kingsbrook Jewish Medical Center

Caroline Hopke PGY‐1 Pharmacy Resident Kingsbrook Jewish Medical Center

Kathleen Jodoin PGY‐1 Pharmacy Resident Kingsbrook Jewish Medical Center

Elise Kim PGY‐1 Pharmacy Resident Kingsbrook Jewish Medical Center

Samantha Smalley PGY‐1 Pharmacy Resident Kingsbrook Jewish Medical Center

Benjamin Wee PGY‐2 Critical Care Pharmacy Resident Kingsbrook Jewish Medical Center

Helene Maltz PGY‐2 Internal Medicine Pharmacy Resident Kingsbrook Jewish Medical Center

Charrai Byrd PGY‐1 Pharmacy Resident Lenox Hill Hospital

Diana Farino PGY‐1 Pharmacy Resident Long Island Jewish Medical Center

Timothy Ho PGY‐1 Pharmacy Resident Long Island Jewish Medical Center

Kimberly Ng PGY‐1 Pharmacy Resident Long Island Jewish Medical Center

Quy Huynh PGY‐1 Pharmacy Resident Montefiore Medical Center

Jesni Mathew PGY‐1 Pharmacy Resident Montefiore Medical Center

Monica Ramirez PGY‐1 Pharmacy Resident Montefiore Medical Center

Grace Shyh PGY‐2 Pharmacy Resident Montefiore Medical Center

Greta Vugman PGY‐1 Pharmacy Resident Mount Sinai Hospital

Monank Patel PGY 2 Oncology Pharmacy Resident Mount Sinai Medical Center

Tamara Fawal PGY‐1 Pharmacy Resident Mount Sinai Medical Center

Rachel Staudt PGY‐1 Pharmacy Resident Mount Sinai Medical Center

Jason Chheda PGY‐2 Solid Organ Transplant Pharmacy Resident Mount Sinai Medical Center

Erica Brumer PGY‐1 Pharmacy Resident New York Langone Medical Center

Franklin Jeng PGY‐1 Pharmacy Resident New York Methodist Hospital

Joseph Samide PGY‐1 Pharmacy Resident New York Methodist Hospital

Steven Wang PGY‐1 Pharmacy Resident New York Methodist Hospital

Tammy Wu PGY‐1 Pharmacy Resident New York Methodist Hospital

Eileen Tang PGY‐2 Critical Care Pharmacy Resident New York Methodist Hospital

May Jabra PGY‐2 Pharmacy Informatics Resident New York Methodist Hospital

Justin Chiang PGY‐1 Pharmacy Resident North Shore University Hospital

Jimmy Johnson PGY‐1 Pharmacy Resident North Shore University Hospital

Danielle Joset PGY‐1 Pharmacy Practice Resdient NYU Langone Medical Center

Christine Ciaramella PGY‐1 Pharmacy Resident NYU Langone Medical Center

Lisa Modelevsky PGY‐1 Pharmacy Resident Plainview Hospital

Johanna Staray PGY‐1 Pharmacy Resident St. Francis Hospital & Health Centers

Alfred Custer PGY‐1 Pharmacy Resident St. Luke's‐Roosevelt Hospital Center

Monique Garcia PGY‐1 Pharmacy Resident St. Luke's‐Roosevelt Hospital Center

Celeste Vinluan PGY‐1 Pharmacy Resident St. Luke's‐Roosevelt Hospital Center

Milena Wong PGY‐1 Pharmacy Resident St. Luke's‐Roosevelt Hospital Center

Tae Eun Park PGY‐2 Infectious Diseases Pharmacy Resident SUNY Downstate Medical Center

Amanda Giancarelli PGY‐1 Pharmacy Resident The Brooklyn Hospital Center

Kathleen Lynch PGY‐1 Pharmacy Resident The Brooklyn Hospital Center

Germin Shenoda Fahim PGY‐1 Pharmacy Resident The Brooklyn Hospital Center

Christy Su PGY‐1 Pharmacy Resident The Brooklyn Hospital Center

Rebecca Arcebido PGY‐2 Ambulatory Care Pharmacy Resident The Brooklyn Hospital Center

Julie Anne Billedo PGY‐2 Ambulatory Care Pharmacy Resident The Brooklyn Hospital Center

Nehal Hashem PGY‐2 Infectious Diseases Pharmacy Resident The Brooklyn Hospital Center

Grace Jiang PGY‐1 Pharmacy Resident The Mount Sinai Medical Center

Maxine Lee PGY‐1 Pharmacy Resident The Mount Sinai Medical Center

Mohammad Rattu PGY‐1 Pharmacy Resident VA New York Harbor Healthcare System

Jane Wong PGY‐1 Pharmacy Resident VA NY Harbor Healthcare System

Alexandra Alleva PGY‐1 Pharmacy Resident Winthrop University Hospital

Timothy Lam PGY‐1 Pharmacy Resident Winthrop University Hospital

Ronik Saha PGY‐1 Pharmacy Resident Winthrop University Hospital

Mark Shen PGY‐1 Pharmacy Resident Winthrop University Hospital

William Yu PGY‐1 Pharmacy Resident Winthrop University Hospital

29

2013 New York City Regional Pharamcy Residency Conference

Participants

RESIDENTS

PHARMACISTS STUDENTSVitalina Rozenfeld Astra Zeneca Inc. Rachel Abrams LIU Pharmacy

Lucy Cannizzaro Beth Israel Medical Center Kwesi Agyare LIU Pharmacy

Alina Lyubarskaya Beth Israel Medical Center Zaki Ahmadi LIU Pharmacy

Lena Ngai Beth Israel Medical Center Dean Patrick Aquino LIU Pharmacy

Elizabeth Palilo Beth Israel Medical Center Sharone Aragon LIU Pharmacy

Heather Brener Beth Israel Medical Center‐ Brooklyn Division Philip Aziz LIU Pharmacy

Doris Wong Beth Israel Medical Center‐ Brooklyn Division Therina Aziz LIU Pharmacy

Sharon Blum Brookdale University Hospital Medical Center Nabiha Baksh LIU Pharmacy

Maria M. Claudio Brookdale University Hospital Medical Center Krystal Calliste LIU Pharmacy

Julia Tsybulsky Continuum Health Partners, Inc. Pansy Elsamadisi LIU Pharmacy

Deborah Wible Continuum Health Partners, Inc. Danielle Garcia LIU Pharmacy

Peter Caranese Interfaith Medical Center Mariana Gebraeel LIU Pharmacy

Antonia Alafris Kingsbrook Jewish Medical Center Julia Giuga LIU Pharmacy

Catherine Millares Kingsbrook Jewish Medical Center Pavel Goriacko LIU Pharmacy

Mark Tartakovsky Kingsbrook Jewish Medical Center Marina Guindy LIU Pharmacy

Paul Nowierski Lenox Hill Hospital Carol Hanna LIU Pharmacy

Chris Ho LIU Pharmacy Mohammed Hossain LIU Pharmacy

Troy Kish LIU Pharmacy Rebecca Hunter LIU Pharmacy

Joseph Nathan LIU Pharmacy Youjin Hwang LIU Pharmacy

Timothy Nguyen LIU Pharmacy Diana Inoyatova LIU Pharmacy

Richard Perry LIU Pharmacy Diana Isakova LIU Pharmacy

Theologia Ternas LIU Pharmacy Anzhelika Khaitova LIU Pharmacy

Yuliana Toderika LIU Pharmacy Thuy Le LIU Pharmacy

Susan Villegas LIU Pharmacy Jina Lee LIU Pharmacy

Amy Wang LIU Pharmacy Rachel Levihaiem LIU Pharmacy

Shalonda Williams LIU Pharmacy Jun Wen Lin LIU Pharmacy

Henry Cohen LIU Pharmacy/Kingsbrook Jewish Medical Center Nohum Mandil LIU Pharmacy

Robert DiGregorio LIU Pharmacy/The Brooklyn Hospital Center Karina Marakhovsky LIU Pharmacy

Lauren Healy Long Island Jewish Medical Center Margarita Matat LIU Pharmacy

Lauren McKeon Long Island Jewish Medical Center Miri Mineh LIU Pharmacy

Vito Limoncelli Maimonides Medical Center Galina Moiseyeva LIU Pharmacy

Valerie Ng Maimonides Medical Center Amal Mousa LIU Pharmacy

Salvatore Ventrice Maimonides Medical Center Stella Mullayev LIU Pharmacy

Dorothy Chiu Memorial Sloan‐Kettering Cancer Center Mai Ngo LIU Pharmacy

Joyce Wu Memorial Sloan‐Kettering Cancer Center Olga Parshikova LIU Pharmacy

Mark Sinnett Montefiore Medical Center Ami Patel LIU Pharmacy

Frank Sosnowski Montefiore Medical Center Bhavik Patel LIU Pharmacy

Nadia Ferguson Montefiore Medical Center ‐ Einstein Division Samira Sangi LIU Pharmacy

Elizabeth Chung New York Harbor Healthcare System VA Rikita Shah LIU Pharmacy

Helen Eldabie New York Methodist Hospital Leyla Shamailova LIU Pharmacy

Nasser Saad New York Methodist Hospital Alexandra Spivak LIU Pharmacy

Gary Wu New York Methodist Hospital Bibin Thomas LIU Pharmacy

Magda Fulman North Shore University Hospital Nathan Trustman LIU Pharmacy

Michele Graci North Shore University Hospital Mabel. Wai LIU Pharmacy

Chung‐Shien Lee North Shore University Hospital Pauly Wang LIU Pharmacy

Leslie Varikattu North Shore University Hospital Muhammad Waqas LIU Pharmacy

Suhail Khan NSLIJ Forest Hills Hospital Johnny Wong LIU Pharmacy

Kin F Huie NY Weill Cornell Medical Center Stanley Wong LIU Pharmacy

Arash Dabestani NYU Langone Medical Center April Yalong LIU Pharmacy

John Papadopoulos NYU Langone Medical Center Jessica Zaher LIU Pharmacy

Boris Nogid Octapharm Inc. Philip Lee Other

Elissa DiPasquale Plainview Hospital Daan Chen St John's University

Jonathan Falsetta Plainview Hospital Andy Zhang St John's University

Dennis Karagannis Plainview Hospital Tolulope Ashaye Touro College of Pharmacy

William Goldman Retiree Jennifer Le Touro College of Pharmacy

Ebtesam Ahmed St. John's University Ama Marfo Touro College of Pharmacy

Janna Roitman St. Luke's/Roosevelt Hospital Yuriy Mullokandov Touro College of Pharmacy

Christine Garibotto Syosset Hospital Lien Nguyen Touro College of Pharmacy

Evangelia Davanos The Brooklyn Hospital Center Ezinne Onukogu Touro College of Pharmacy

Olivia D'Cunha The Brooklyn Hospital Center Sabrina Truc Touro College of Pharmacy

Rebecca Deoras The Brooklyn Hospital Center

Kathleen Minlionica The Brooklyn Hospital Center

Vanita Mistry The Brooklyn Hospital Center

Karina Muzykovsky The Brooklyn Hospital Center

Rochelle Rubin The Brooklyn Hospital Center

Benjamin Lukens The Mount Sinai Medical Center

Amber Ng The Mount Sinai Medical Center

Mary Choy Touro College of Pharmacy

Marylyn Lipman Touro College of Pharmacy

Keith Veltri Touro College of Pharmacy

Deborah Wittman Touro College of Pharmacy

Shan Wang Winthrop University Hospital

30

31

NEW YORK CITY REGIONAL PHARMACY RESIDENCY CONFERENCE

The Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University,

Brooklyn, New York

Friday, June 21, 2013

Please rate the following components of the presentation:

CONFERENCE PROGRAM EVALUATION

Using the following scale, indicate the number which best expresses your opinion on the following items:

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1 2 3 4 5

_______ Program Content _______ Meeting Rooms _______ Program Administration/Organization _______ Conference Location _______ Program Schedule _______ Food/Refreshments _______ Social Program _______ Staff Responsiveness

_______ Meeting Time of Year _______ Overall Program

Check the appropriate box Preceptor Resident Incoming Resident Student Comments and Recommendations for Improvement: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Suggestions for Future Continuing Education Topics: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Thank you for completing this evaluation. The information helps the Committee to improve the quality of subsequent conferences. Optional: Name: ____________________________________________________________________ Address: ____________________________________________________________________ City/State/Zip: ____________________________________________________________________ Phone: ____________________________________________________________________