Ohio Society of Health-System Pharmacists

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  • 26 May 2020 12:24 PM | OSHP Admin (Administrator)

    Author: Tyler Perry, PharmD, Summa Health System

    At this point, many people are settling down after the American Society of Health System Pharmacists (ASHP) Residency match. Round 1 of the match went by in a blur, round 2 was just as hectic, and the scramble was exactly that. This year, 7,364 applicants, both PGY1 and PGY2, participated in the match, 4,425 received a match during round one, 346 received a match in round two, 43 programs were left in the scramble. Which leaves 2,593 candidates potentially without a match. One question remains I want to make sure does not go by the wayside. What advice should be considered for the candidates that did not match?

    The first thing to think about would be determining if you are considering re-applying through next year’s residency cycle. While it may feel like there is time to relax, the search and application season will be starting in August-September. Dr. Jaclyn Boyle, a PGY1 residency program director at Northeast Ohio Medical University (NEOMED)/AxessPointe and Assistant Dean of Student Success at NEOMED, was kind enough to give some advice on the matter. She stated the importance of “knowing what makes you stand out amongst other applicants, demonstrating enthusiasm, and describing how you are going to benefit a residency program.” The takeaway here being, that you will have a year to mature, self-reflect, and think about how you can improve your odds in the future. This self-reflection can be extremely beneficial when preparing for interviews and creating letters of intent.  You can speak to how you’ve grown in the months leading up to your interviews and what you’ve learned. During this time, it would also be beneficial to seek out a mentor that can help you to prepare and hone your application materials and interview skills. She also stated that “being aware of changes in pharmacy practice at large (particularly in the state you want to practice in)” will be important going further as well. Staying up to date on the current events in pharmacy and practice changes will be invaluable as continue that life-long learning model and prepare for pharmacy interviews. And lastly, she stated that “being very knowledgeable about what the program offers/doesn't offer and making sure it is a good fit for your short- and long-term career goals” is also particularly important.  I asked her specifically what advice she would have for a candidate in the meantime until the next match cycle.  She stated how important it is to start networking, developing yourself professionally, and practicing your interview skills. Some of her recommendations for professional development included seeking out additional training, educational opportunities, and volunteer experiences.

    I think Dr. Boyle hit the nail on the head when it comes to developing yourself and networking. One of the most important things you can do until the next match cycle occurs is to continue to learn and gain more experience.  During these months, you can potentially gain pharmacy practice experience that will be bring new skills and knowledge that will be very beneficial. There are a few resources online from organizations and other pharmacists for candidates that haven’t matched including ASHP and ACCP as well as books, blogs, and forums.  One common theme that you will see with these resources, is that you shouldn’t give up. At the end of the day, you are still graduating with a Doctor in Pharmacy! You are a qualified applicant to work in many areas of the profession and based on the other 2,593 applicants, you are not alone. Reach out to preceptors, current and past, and ask if they are aware of any opportunities available or coming soon that align with your career interests. There may be entry-level pharmacist positions at the very same hospitals or community pharmacies that you sought out in the residency search process. Reach out to your mentors and ask if they are can help you network, review your CV, or help you hone your interview skills. There are many options after match day that keep you in the game if you DON’T GIVE UP. Continue to work, continue to learn, and continue to grow as a person and as a pharmacist.


  • 5 May 2020 12:49 PM | OSHP Admin (Administrator)

    Author: Laura Nice, PharmD, PGY2 Oncology Pharmacy Resident, University of Louisville Hospital 

    Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment over the past 10 years. Traditional chemotherapy targets fast growing cells and halts the production of cells, including the body’s healthy cells. This leads to characteristic chemotherapy adverse events, including myelosuppression, nausea/vomiting, alopecia, and more. Alternatively, ICIs work to enhance the body’s immune system to fight cancer.1 These are monoclonal antibodies given intravenously every two to four weeks. Inhibiting cytotoxic-T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death 1 (PD-1), or programmed cell death ligand 1 (PD-L1) stops the cancer from suppressing T cell activation, thereby allowing the immune system to fight (Table 1). In other terms, cancer places an “invisibility cloak” on itself to hide from the body’s immune system. ICIs remove this “invisibility cloak” and gives the T cells a chance to fight against the foreign cancer cells.

    Table 1. Currently available immune checkpoint inhibitors (ICIs) and their mechanism of action.

     

    Atezolizumab (Tecentriq®)

    Durvalumab (Imfinzi®)

    Avelumab (Bavencio®)

    Ipilimumab (Yervoy®)

    Nivolumab (Opdivo®)

    Pembrolizumab (Keytruda®)

    Cemiplimab (Libtayo®)

    Mechanism of Action

    Anti-PD-L1

    Anti-CTLA-4

    Anti-PD-1

    While ICI’s mechanism leads to an antitumor effect in many cancers, not all cancers respond to immunotherapy. Response to immunotherapy can be predicted by biomarkers, such as the percentage of PD-L1 on cancer cells. This helps to guide whether ICIs can be used alone or in combination with chemotherapy. For certain cancers, ICIs have led to improved survival outcomes and have become first line treatment options. For example, KEYNOTE-024 evaluated pembrolizumab versus chemotherapy in patients with non-small-cell lung cancer and a PD-L1 percentage > 50%.2 Updated survival outcomes showed a median overall survival of 30.0 months for patients receiving pembrolizumab versus 14.2 months for patients receiving chemotherapy.

    As more patients are exposed to ICIs, it is important for pharmacists and healthcare professionals to identify their major side effect: immune-related adverse events (irAEs). The underlying increase in T cell activation may also attack healthy organs, leading to an inflammatory response ranging from mild to life-threatening. Most commonly, irAEs are seen in the skin, gastrointestinal tract, lungs, endocrine, thyroid, musculoskeletal, and cardiovascular systems.3 Any changes in organ systems in patients who are currently receiving or have received ICIs should include an assessment for irAEs. Typical manifestations may include skin rash, itching, shortness of breath, diarrhea, fatigue, and abnormal lab parameters. For example, a patient admitted to the hospital for diabetic ketoacidosis without a history of diabetes and currently on pembrolizumab for melanoma should spark concern for an endocrine irAE. Or, consider a patient currently on atezolizumab for lung cancer who comes to the local pharmacy with complaints of shortness of breath and new onset chest pain. Pneumonitis is on the differential diagnosis and this patient should be further evaluated by the healthcare team.

    Studies have shown variable rates of irAEs, including a meta-analysis of patients receiving PD-L1 and PD-1 inhibitors, which found 66% of patients experienced any irAE and 14% of patients experienced severe irAEs.4 Rates of irAEs can also vary among ICIs; for example, gastrointestinal events were found to be more common with ipilimumab (30-40%) compared to PD-1/PD-L1 inhibitors.5 Fortunately, guidelines have been developed to assist in treatment of irAEs.3 For severe irAEs, first line therapy is high dose corticosteroids (1-2 mg/kg/day prednisone equivalents) to help calm the immune system. The course of corticosteroids for severe irAEs should include a taper over 4-6 weeks. In the event corticosteroids do not improve symptoms, second-line irAE therapy options include infliximab, intravenous immunoglobulin, mycophenolate, and vedolizumab. Once the irAE has resolved, the oncology team will assess the risk and benefit of resuming ICIs.

    While ICIs may have serious adverse events, their mechanism of action and efficacy have provided a novel drug class to treat cancer. As patients are living longer with cancer there will be more patients who are on or have received ICIs. Pharmacists in all patient care settings have the opportunity to identify irAEs and can assist in recommending appropriate irAE management.

    References:

    1.      Darvin, P., Toor, S.M., Sasidharan Nair, V. et al. Immune checkpoint inhibitors: recent progress and potential biomarkers. Exp Mol Med. 2018; 50:1–11. https://doi.org/10.1038/s12276-018-0191-1.

    2.      Reck M, Rodriguez-Abreu D, et al. Updated Analysis of KEYNOTE-024: Pembrolizumab Versus Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer With PD-L1 Tumor Proportion Score of 50% or Greater. J Clin Oncol. 2019; 37:537-546.

    3.      Brahmer JR, Lacchetti C, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guidelines. J Clin Oncol. 2018; 36:1714-1768.

    4.      Wang Y, Zhou S, Yang F, et al. Treatment-Related Adverse Events of PD-1 and PD-L1 Inhibitors in Clinical Trials: A Systematic Review and Meta-analysis. JAMA Oncol. 2019; 5(7):1008-1019.

    5.      Kumar V, Chaudhary N, Garg M, Floudas CS, Soni P, Chandra AB. Current Diagnosis and Management of Immune Related Adverse Events (irAEs) Induced by Immune Checkpoint Inhibitor Therapy. Front Pharmacol. 2017 Feb 8;8:49.


  • 14 Apr 2020 12:52 PM | OSHP Admin (Administrator)

    Author: Brittany Bates, PharmD, BCPS; OSHP President-Elect

    The current situation we are dealing with regarding COVID-19 has certainly created a great deal of uncertainty in our personal and professional lives. There are plenty of disappointments and frustrations that we are all dealing with: cancelled professional meetings, workload and workflow changes, moving pharmacy education to the virtual world, and dealing with public health concerns. Throughout these challenging times, I hope you try to find some silver linings: perhaps the satisfaction of trying new things or challenging yourself/your team to be innovative in the way we conduct our business. The way we react and respond to this event will likely pave the way in which our profession continues to evolve. Teamwork and innovative thinking will help us prevail through COVID-19, and remember when facing difficult circumstances...this too shall pass.

    Other OSHP updates that I wanted to pass along include the new formation of a provider status implementation task force. The goal of this task force is to work alongside other state organizations as pharmacist provider status takes shape in Ohio. Thank you to Alex Hoffman for leading the task force!  Changes within our practice scope are already beginning to change in response to COVID-19, with the recent incorporation of pharmacy personnel to administer testing. Reimbursement for these activities and continued advocacy for the ability to perform and be reimbursed for services we provide to patients remain on ongoing challenge.

     An exciting update for this fall is that OSHP will be moving our Residency Showcase to a new venue at the Columbus Convention Center. Thank you to Jordan Long, Jessie Winters, and Bob Parsons for making this move possible!  And lastly, stay tuned for information regarding a new date for the OSHP Annual Meeting which was postponed from the May 7th and 8th dates. Thank you to the Educational Affairs Division and all those who have submitted CE for your hard work up until this point. We appreciate the patience of our members as we continue to plan and adapt to these unique circumstances.

  • 24 Mar 2020 12:16 PM | OSHP Admin (Administrator)

    Author: Jessica Hinson, PharmD, BCACP, Professional Affairs Division Director, OSHP

    Ohio Northern University Raabe College of Pharmacy

    “Wellbeing” and “Burnout” have been trending topics recently among healthcare professional organizations recently.  OSHP has even focused on the importance of these ideas with the 2019 Annual Meeting having a focus of “Taking Better Care of Ourselves for Our Patients”. 

    Although many of us may be becoming numb to these topics as they have become buzzwords in our profession, it is important to remember that these ideas became headline news because of their importance to ourselves and to our patients.

    Several pharmacy organizations, including ASHP, have published statements supporting efforts to protect pharmacist well being through reduction of burnout and excessive stressors in the workplace.  There are now published recommendations now in the form of both consensus statements as well as from individual organizations with ways in which employers can improve the wellness of their pharmacists while improving care provided to patients.

    That leaves one question remaining...what can we do as practitioners in the meantime? 

    Here are some tips from the National Council for Behavioral Health on how we can take better care of ourselves

    1. Practice Self-Acceptance

    We frequently focus on the parts of ourselves that we wish to change.  We look to obtain the ideal weight, dress in a particular manner, or perfect our appearance.  These goals may have the best intentions, but also focus on the negativity we feel about ourselves.  Practice self-acceptance by celebrating your traits that you love and learning to accept those you have previously thought of as flaws.

    2. Blossom into a Social Butterfly!

    Even if you are an introvert like myself, fostering close relationships with others has been shown to make us happier and healthier.  Take time for friends and family, put yourself in new social situations, and volunteer for causes that you love.  Connecting with people that love the same things you do will bring you happiness and lower your stress.

    3. Work on your fitness

    This doesn’t mean you have to purchase a gym membership or join crossfit (although those things are awesome!)  Even getting just 10 minutes more a day will help reduce stress, increase relaxation, and lower anxiety.

    4. Be more like Sleeping Beauty

    Many of us don’t get enough sleep, especially with pressures of work, family, and life in general.  The National Sleep Foundation recommends 7-9 hours of sleep a night.  Remember your sleep hygiene lessons such as avoiding using televisions and phones in bed before you go to sleep!

    5. Put Yourself First

    As healthcare professionals and educators we frequently put the needs of others before our own.  Remember that you can only give as much of yourself as you care for!  Recognize your limits, remove toxicity from your life, and take time to treat yourself occasionally.  Relax, recharge, and flourish.

    I hope these tips can help us recenter ourselves and live a better healthier life.

    Resource:

    https://www.mentalhealthfirstaid.org/external/2018/01/healthy-ways-improve-mental-well-2018/


  • 11 Feb 2020 11:11 AM | OSHP Admin (Administrator)

    Author: Matthew Merical, PharmD Candidate 2022

    “Policy” is not a word too many of us can find exciting; it reminds us of items we don’t like in our organizations or dogmatic rules to follow.

    “Advocacy”, on the other hand, might just sound more friendly. It evokes strong images of teamwork, making a statement, and standing firm.

    During the month of February, the Cedarville University chapter of SSHP partnered with our chapter of APhA-ASP for the purpose of promoting advocacy to students, engaging them in opportunities to promote the profession of pharmacy. With this partnership, we have streamlined our classmates’ abilities to attend Student Legislative Day and planned informational events that explain the legislative process. With this, we are equipping students to be good advocates, and explaining to them the “why” behind being involved.

    Starting with our kickoff, students heard about upcoming events, saw posters from their peers and faculty on how to get involved, and met with other students to discuss their passions in the profession. Our unique ideas and different mindsets helped us challenge each other to ultimately support the profession

    Our major event in the month, Bills Bills Bills (lovingly named after a campus-favorite donut shop), will use a game structure to show students how the legislative “Bill” process works, while letting them vote on interesting policies that are integrated into the game.

    Finally, while not a result of our partnership with other student organizations, we will have an opportunity for student pharmacists to network with local pharmacists at our annual Networking Dinner. We anticipate professional connections will be fostered, developing conversations about what the future of pharmacy looks like and showing students how they can continue advocating for the profession.

    ASHP’s PAI 2030 goals address many challenges the future of our profession faces. Many of these hurdles will be easy to address, and others require diligent work. It is an exciting time to join the profession due to the unique challenges we face, and we must move forward by educating ourselves, our communities, and other medical professions on the services we can provide. Most importantly for our chapter and others, this work can start now with student involvement. As student pharmacists finish school to join the workforce, we should be prepared and passionate about advocating and encouraging others to get involved.

    As a challenge and encouragement, this work can be done as we work together and share a unified voice. The chapter meetings, conversations with peers, and ability to get involved are all within reach of each of us and are the foundation for change.

    One small spark might not start the fire, but many certainly will.



  • 21 Jan 2020 12:37 PM | OSHP Admin (Administrator)

    Author: Payton Winghart, PharmD.

    With the frequency of seasonal influenza outbreaks, it is easy to forget that the flu can often be associated with severe morbidity and mortality, especially in certain populations, like pediatrics.1 Children, in particular, those that are less than 5 years of age or those with underlying medical conditions such as asthma, sickle cell disease, epilepsy, or metabolic disorders are at high risk for severe influenza complications1In pharmacy, we understand that primary prevention is the most effective way of combating the flu. A primary role of a pharmacist is to promote influenza vaccinations and educate parents and caregivers on the benefits of receiving the vaccine to those who are eligible (i.e. children 6 months old and older).1 However, vaccination rates are not as high as one would like. Thus,secondary treatment measures are often utilized. One of the newest agents used to combat the flu is baloxavir (Xofluza).2

    Baloxavir was FDA approved on October 24, 2018 for the treatment of acute, uncomplicated influenza for patients ages 12 years old and older.3 Baloxavir works by inhibiting the endonuclease within the polymerase acidic protein sub-unit of the viral polymerase. In targeting a particular site on the virus than other antivirals currently on the market, baloxavir has the added advantage of aiming to inhibit a different part of the viral replication process. Therefore, it can be used in oseltamivir-resistant strains of influenza. It should be administered within 48 hours of symptom onset and is given as a single 40 mg dose if the patient is between 40 and 80 kg or 80 mg dose if the patient is greater than 80 kg.4 The cost of the dose of this medication is approximately $150.3 Some of the common adverse effects associated with baloxavir are diarrhea, nose and throat irritation, headache, and upset stomach, similar to oseltamivir and the other neuraminidase inhibitors.The Institute for Safe Medication Practices has issued an alert regarding life-threatening hypersensitivity reactions associated with baloxavir after a single dose. As for administration,it should not be taken concomitantly with calcium or calcium containing products.Baloxavir is the first and only FDA-approved treatment specifically indicated for those at high risk of flu complications.5

    The CAPSTONE-2 Trial was one of the trials that was conducted to evaluate the efficacy of a single, oral dose of baloxavir compared with placebo.The main outcome measure was time to improvement of influenza symptoms from day 1 up to day 14. This was a randomized, parallel, double blind, placebo-controlled trial with a total of 2,184 participants. Results showed that baloxavir was well-tolerated and associated with faster recovery in high risk influenza patients compared to placebo, ultimately leading to FDA approval.Another trial known as the MINISTONE-2 trial evaluated the safety and efficacy of baloxavir in children ages 1-12 compared to the safety and efficacy of oseltamivir in this population. The primary endpoint of the study was the proportion of patients with adverse events at day 29. The study results demonstrated that baloxavir successfully reduced the length of viral shedding by one day when compared to oseltamivir. Baloxavir also had a favorable tolerability profile in terms of adverse effects, and was similar to those of oseltamivir.7

    There are certain advantages and disadvantages to using baloxavir in clinical practice. As far as benefits are concerned, the one-time dose allows for ease of administration and encourages adherence.

    3 It also provides coverage for patients who may be infected with oseltamivir-resistant influenza strains.3 There is also evidence that it may reduce time to symptom alleviation by one day in comparison to oseltamivir.6 In terms of detriments of baloxavir therapy, the cost of the one-time therapy is higher than that of a full course of oseltamivir.6 Baloxavir has also been shown to be less effective against influenza B strains, which is particularly an issue this season, as most of the outbreaks have been caused by influenza B.7 The use of baloxavir has also not been studied in as many populations as oseltamivir, so safety in the very young and very old is still to be determined.7 In conclusion, despite the limitations associated with baloxavir therapy, influenza infection remains a healthcare burden in our society, and the development of new medications such as baloxavir are our next best step secondary to promoting vaccination.


    References:

    1. People at High Risk for Flu Complications. Centers for Disease Control and Prevention. 2018; https://www.cdc.gov/flu/highrisk/index.htm

    2. Hayden FG, Sugaya N, Hirotsu N, et al. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. N Engl J Med. 2018;379(10):913-923.

    3. Mushtaq A. Baloxavir: game-changer or much ado about nothing? Lancet Respir Med. 2018;6(12):903-904.

    4. Ng KE. Xofluza (Baloxavir Marboxil) for the Treatment Of Acute Uncomplicated Influenza. P T. 2019;44(1):9-11.

    5. Takashita E, Morita H, Ogawa R, et al. Susceptibility of Influenza Viruses to the Novel Cap-Dependent Endonuclease Inhibitor Baloxavir Marboxil. Front Microbiol. 2018;9:3026.

    6. Ison M, Portsmouth S, Uehara T, et al. Phase 3 Trial of Baloxavir Marboxil in High-Risk Influenza Patients (CAPSTONE-2 Study. Open Forum Infectious Diseases. 2018;5:S764-S765.

    7. Koshimichi H, Tsuda Y, Ishibashi T, Wajima T. Population Pharmacokinetic and Exposure-Response Analyses of Baloxavir Marboxil in Adults and Adolescents Including Patients With Influenza. J Pharm Sci. 2019;108(5):1896-1904.




  • 27 Dec 2019 12:54 PM | OSHP Admin (Administrator)

     Author: Katie McKinney, PharmD, MS, BCPS, FACHE, FASHP.     

      

    “The first time I ever flew in a plane, I was skydiving.”

    “I coach a high school dance team.”

    “I am an officer in the Ancient Accepted Scottish Rite.”

    “I have gone waterfall rappelling!”

    “Last month I competed in my first chess tournament.”


    OSHP has amazing members.

    Each of the above statements came from an active member in OSHP!

    How do you celebrate what makes others’ unique?

    How might you recognize the gifts and contributions of your colleagues at your practice sites, local affiliated chapters and in our state organization?

    Now’s the time!

    Nominations for OSHP’s eleven awards are open through January 15, 2020.

    Visit https://www.ohioshp.org/Awards to view the award criteria and submit nominations.

    Click into “About” for each award.

    The Nomination Form can be found within the individual award description.

    As we consider the beginning of a new year, and a new decade, be reminded that OSHP has partnered with the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience. “In positive psychology research, gratitude is strongly and consistently associated with greater happiness. Gratitude helps people feel more positive emotions, relish good experiences, improve their health, deal with adversity, and build strong relationships.”1

    Please take a moment to cultivate gratitude for a colleague by nominating her or him for one of OSHP’s Awards. Perhaps this may allow you to accomplish one of your 2020 goals early in the year, in the recognition and appreciation of others or appreciating others as a way to strengthen your individual resilience and improve your well-being.

    You might also consider involving someone new in your professional activities as a way to recognize his or her contributions to patient care and your department. Extend the invitation to a newly hired technician to join you at an upcoming event with your local-affiliated chapter. You will enjoy the opportunity to learn more about your colleague, make introductions to others and contribute to her or his professional development and advancement. Embrace opportunities in 2020 for your growth as well as your role in the growth of others.

    Thank you to the members of OSHP for your voluntary work in 2019 and living into our mission to optimize patient health by advocating for the advancement of pharmacy practice to promote comprehensive, quality care across the health-care continuum.

    Please enjoy a safe, happy and healthy 2020!

    Katie McKinney, PharmD, MS, BCPS, FACHE, FASHP

    President, OSHP, 2019-2020


    1.      https://www.health.harvard.edu/newsletter_article/in-praise-of-gratitude


  • 17 Dec 2019 12:08 PM | OSHP Admin (Administrator)

    Author: Brittany Bates, OSHP President-Elect

    As the holiday season is upon us, I thought I would share a personal story of gratitude.

    In my fourth year as a pharmacist, I received a  call that changed the trajectory of my life and my career. My healthy, forty-nine-year old mother was being rushed to a large medical center with suspected bacterial meningitis. That first day was a mix of blurred chaos and vivid images that will forever be etched in my mind. During the nine days my mother spent in the hospital, I experienced fear and uncertainty. I also experienced joy and amazement at each stage of her improvement. Looking back, I feel an immense amount of gratitude for what this experience taught me.

    First, I am thankful for my education and my clinical experiences during residency. This training allowed me to understand what was happening to my mother and interpret medical terminology for my family. I am also thankful for the medical professionals who took extra time with me, answered my questions, and even accepted recommendations from “the patient’s daughter who is a pharmacist.” Being on the other side of the healthcare team provided me with insights into the scary and frustrating role of being a patient or advocating for a family member. I attempt to keep this in mind each time I interact with patients or their families.

    Next, I am thankful for my pharmacy and physician colleagues. In the true spirit of teamwork, they covered my service and allowed me to take off the time I needed. Further, they were a resource to me when I had complicated questions about my mother’s condition. At this point in my career I was rounding on an internal medicine service, but I found myself drawn to infectious diseases. The firsthand experience with my mother’s diagnosis strengthened my passion for infectious diseases and shaped the direction of my career in the following years. Today I teach CNS infections to students at Ohio Northern University, and my students are likely to hear about my mother’s case!

    Finally, I am most grateful that my mother made a full recovery. An underlying medical problem was identified during her hospitalization that will require lifelong treatment, but her condition is manageable. We are fortunate. My whole experience with my mother’s illness helped me to appreciate that I am part of one of the greatest professions. The work we do, and our collaboration with other health care professionals, benefits so many—including, at times, our own families.

    I hope that in this holiday season all of us can remember special moments of gratitude as we embrace the serious challenges we face each day. I also want to express my own gratitude for your support of OSHP and for the opportunity I have to lead this organization.

    Happy Holidays!

    Brittany Bates, OSHP President-Elect

  • 3 Dec 2019 1:34 PM | OSHP Admin (Administrator)

    Author: Chad Harvey, PharmD, BCPS

    The Greater Cincinnati Society of Health-System Pharmacists (GCSHP) has had a busy year so far and there are no signs of that letting up. This is by design of course! The chapter has focused a lot of energy on drumming up participation from pharmacists while also expanding programming to be more inclusive of technicians, residents, and pharmacy students. While overall participation improvements have been modest, they have still been noticeable.

    The biggest event of the year for the chapter is our annual “GCSHP CE Day” which successfully completed its 3rd year in September. This event provides 4 hours of ACPE-accredited CE (including 1 hour of medication safety) and provides CE for pharmacy technicians. Registration is free for members and students (small charge for non-members) and all attendees are provided a catered meal. CE presentations are provided by clinical pharmacists, pharmacy administration, and pharmacy technicians, among others, which allows participants to learn from a variety of leaders in the field of pharmacy. New to the event is the involvement of pharmacy students through collaboration with the University of Cincinnati James L. Winkle College of Pharmacy’s CoCA programming. This year’s event had about 30 attendees, which unfortunately was a steep decline from previous years. Many factors for this decline have been identified and will be considered in the future as plans to continue growing the event have already begun.

    In each November and December, the chapter will have sponsored drug dinners for members. The November dinner was an extra event to allow participating GCSHP members to learn from a renowned speaker. The December dinner will be our annual “holiday dinner” to aid in increasing membership, as well as collect toy donations for a family in need. The latter has historically been well attended and we expect a great turnout again this year.

    In the spring we will host two more events. The first event is our annual Ohio Law CE. This event has a large turnout each year and provides pharmacists and pharmacy technicians with 1 hour of ACPE-accredited law CE. This event has a catered dinner and presentation, which is provided by an Ohio Board of Pharmacy representative. The second spring event is our annual Best Practices and Research Symposium, which allows pharmacy students, residents, and practicing pharmacists, an opportunity to present their research. This interactive symposium uses electronic posters and small groups to provide a unique presentation setting and creates the chance to view many presentations in a short time frame.

    The year will wrap-up in late spring/early summer with officer elections and transitions, along with our annual GCSHP social event, and finally the yearly planning event. So far, this has been a successful year for GCSHP and we look to continue growing our chapter through this year and into the future.

    Thank you,

    Chad Harvey, PharmD, BCPS.  President - Greater Cincinnati Society of Health-System Pharmacists

  • 12 Nov 2019 1:09 PM | OSHP Admin (Administrator)

    What’s the mechanism of resistance (gene, and effect) seen in Escherichia coli (E. coli) that induces resistance to piperacillin-tazobactam but retains susceptibility to cephalosporins?

    Benjamin Newell, PharmD, PGY1 Resident; Nathan Wirick, PharmD, BCPS, BCIDP; Sandra Axtell, PharmD, BCPS. Cleveland Clinic Hillcrest Hospital

    There are various resistance mechanisms that have been described forE. coli. However, in the case of piperacillin-tazobactam resistance and cephalosporin susceptibility it involves an amino acid substation in the blaTEM-1 and blaSHV-1gene markers.1These gene variations are capable of hydrolyzing penicillins and first generation cephalosporins, without effecting oxyimino cephalosporins. Ceftazidime, cefuroxime,ceftriaxone, and cefepime are all oxyimino cephalosporins.1,2

    Investigators explored E. coli isolates with these gene characteristics and of the 32 isolates, 28 (88%) harbored blaTEM-1 and blaSHV-1 and none contained an extended-spectrum beta lactamase (ESBL)-AmpC beta-lactamase gene which would elicit greater cephalosporin resistance.2 Common risk factors associated with TEM-1 and SHV-1 isolates are recenthospitalization, hematologic malignancy, and gastrointestinal tract infection. The ability to recognize these high-risk patients can potentially aid in de-escalation of carbapenems and utilization of cephalosporins instead to assist in reserving carbapenems for ESBL-AmpC producing enterobacteriaceae.2 Testing for these variations would be ideal but without commercial laboratory tests for these genes, providers will need to utilize susceptibilities to identify possible mutated isolates.

    A case report describing this particular resistance mechanism involved a patient who presented with sepsis and was initiated on piperacillin-tazobactam, however did not exhibit clinical improvement after four days of therapy. Once susceptibility data was available, the patient was transitioned to ceftriaxone, andthere was significant clinical improvement.3Investigators examined a similar scenario that de-escalation of therapy to ceftriaxone is safe and effective once the blood stream isolate is identified as E. coli in the absence of ESBL.4

    In conclusion, the incidence of TEM-1 or SHV-1 genes is low, only 3% ratereportedat one health-system over 2 years.Initiating a third or fourth generation cephalosporin may be beneficial over piperacillin-tazobactam, if these isolates are more frequent unless anaerobic or enteroocccal coverage is necessary. There may also be consideration of converting patients to cefepime or ceftriaxone if the patient is slow to respond to piperacillin-tazobactam, since it will take approximately two days to have susceptibilities back from the culture draw and there is no commercial product to detect these genes on a susceptibility report. This way patients are treated appropriately and de-escalation can occur at a timely rate.

    References

    Shaikh S, Fatima J, Shakil S, Rizvi, S, Kamal MA. Antibiotic resistance and extended spectrum beta-lactamases: Types epidemiology and treatment. Saudi J Biol Sci. 2015 Jan;22(1):90-101.

    Baker TM, Rogers W, Chavada KD, Westblade LF, Jenkins SG, Nicolau DP. Epidemiology of Bloodstream Infections Caused by Escherichia coli and Klebsiella pneumonia that are piperacillin-tazobactam-nonsusceptible but ceftriaxone-susceptible. Open forum Infect Dis. 2018 Nov 19;5(12):300-7.

    Carlisle L, Justo JA, Al-Hasan MN. Bloodstream infection due to piperacillin/tazobactam non-susceptible, cephalosporin-susceptible Escherichia coli: A missed opportunity for de-escalation of therapy. Antibiotics 2018;(7)4:104.

    Bookstaver PB, Nimmich EB, Smith TJ, Justo JA, Krohn J, Hammer KL, Troficanto C. Cumulative effect of an antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of antimicrobial therapy in gram negative bloodstream infections. Antimicrob Agents Chemother.2017 Aug 24;61(9):189-17.


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