Downloaded - Journal of American Pharmacists Association

More documents

Recommendations

Info

Annual Meeting Abstracts 2004 FEATURE Conclusions: In a busy 1,000-bed teaching hospital, various physician orders for lymphoscintigraphy doses required organization. A nuclear pharmacy preparation guideline chart provides a useful guide to accurately dispense Tc-99m sulfur colloid for lymphoscintigraphy procedures. 116—PREPARATION OF [C-11]-CFT FOR PET MEASUREMENT OF CEREBRAL DOPAMINE TRANSPORT ACTIVITY. Moerlein S, Perlmutter J, Patel P, Welch M, Washington University in St. Louis. E-mail: moerleins@mir.wustl.edu Objective: Positron emission tomography (PET) is used to assess changes in degenerative disorders such as Parkinson’s disease or Huntington’s disease. With the goal of developing a more sensitive tracer for measurement of these changes, we have optimized the preparation of carbon-11 labeled β-CFT [(-)-2-β-carbomethoxy-3-β-(4 fluoropheny)tropane] suitable for clinical application in human subjects. Methods: [C-11]Carbon dioxide was produced using the 16-MeV proton beam of a JSW 16/8 medical cyclotron. The target was emptied into a PETtrace MeI MicroLab. This microprocessor-controlled device catalytically converts [C-11]carbon dioxide to [C-11]methane, which is subsequently iodinated to yield [C-11]methyl iodide. Approximately 12 minutes after target emptying, the [C-11]methyl iodide is bubbled into a solution of 0.5 mg of (nor-methyl)β-CFT in 200 µL of dimethylformamide cooled in an ice bath. The reaction mixture is heated at 70º C for 3 minutes. The crude product mixture is diluted with 4 mL of HPLC solvent and purified using semipreparative HPLC (Partisil 10 ODS-3; acetonitrile/10 mM monobasic potassium phosphate (40/60); 5 mL/min). The product fraction is diluted with 150 mL of 4 µM sodium hydroxide, and passed through a SepPak C18 extraction cartridge, which is then rinsed with 10 mL Sterile Water for Injection, USP. The radiopharmaceutical is eluted from the SepPak with 1.1 mL of Ethyl Alcohol, USP, through a 0.2 µ Acrodisc filter into a 10 mL sterile empty vial. The solution is diluted with 10 mL of Saline for Injection, USP to give the reformulated [C-11]β- CFT in a 10% ethanolic solution. Results: Batch yields of [C-11]β-CFT prepared in this manner are 28.3 ± 10.1 mCi (N = 41), with specific activity >1000 Ci/mmol and radiochemical purity >97%, and are sterile and apyrogenic. The overall preparation time is 60 minutes EOB. Conclusions: This methodology is a reliable method for the clinical production of [C-11]β-CFT for PET studies of human subjects. 117—QUALITY CONTROL OF [F- 18]FACBC: A NON-NATURAL AMINO ACID TUMOR IMAGING AGENT. Crowe R, Yu W, Goodman M, Emory University. E-mail: ronald_crowe@emoryhealthcare.org Objective: FACBC, anti-1-amino-3-[F-18]fluorocyclobutyl-1-carboxylic acid, is a non-natural amino acid that has shown promise for PET tumor imaging. An improved method of synthesis has been reported that demonstrates high stereoselectivity and possible suitability for larger scale preparation. Determine and develop potential quality control (QC) methods to ensure safe intravenous administration and begin data collection in anticipation of IND submission. Methods: Design: FACBC was synthesized using an automated chemical process control unit (CPCU) with a computer interface (CTI, Inc.). Upon completion of synthesis, the FACBC is purified by passage through an Ion Retard column assembly and 0.22-µm sterilizing filter before collection. The QC of FACBC included analysis for sterility, pyrogenicity, pH, clarity, and purity. Purity is evaluated using TLC with radiometric detection, GC analysis, and timed radioactive decay. Sterility is evaluated per USP guidelines, and PET is performed using the LAL gelclot method. Setting: All procedures performed in a licensed radiopharmacy laboratory. Patients: Limited to patients presenting probable metastatic brain carcinoma and referred by neurosurgery services of the Emory Healthcare System. Results: For all lots of FACBC, radiochemical and radionuclidic purity have been greater than 99%. Sterility and endotoxin testing have been negative. pH range has been 5.5–6.0. GC analysis has shown only trace amounts of organic solvents. FACBC has been used in 12 people at Emory with no local, neurologic, or systemic toxicities observed. Additional QC testing procedures have been identified as potential requisites for release. Conclusions: QC results have exceeded established in-house limits of acceptability. However, more investigation into the characterization of major nonradioactive species present and evaluation of the potential toxicity of FACBC must be completed to obtain regulatory approval for extensive human use. The Emory FACBC study is a pilot study to determine subsequent broad study feasibility and generate pilot data and is under the oversight of the Emory Radioactive Drug Research Committee. 118—RADIOPHARMACISTS’ SATISFAC- TION WITH THEIR EDUCATION/TRAIN- ING, JOB SATISFACTION, AND PROFES- SIONAL PRACTICE PATTERNS: RESULTS OF A NATIONAL SURVEY. Wittstrom K, Norenberg J, Borrego M, University of New Mexico. E-mail: aaaaa@unm.edu Objective: This study assessed radiopharmacists’ satisfaction with their radiopharmacy training and education (T&E) and job satisfaction. The study also identified factors that have influenced radiopharmacists’ decision to enter, continue, or exit this specialty practice. Methods: A 20-item, self-administered survey was developed and pilot-tested using a convenient sample of practicing radiopharmacists. The study sample included all U.S. radiopharmacists identified through databases of licensed pharmacists, radiopharmacy continuing education program subscribers, and alumni records (N = 789). Follow-up surveys were mailed to nonrespondents. Results: Overall usable response rate was 41% (N = 327). Of those respondents practicing radiopharmacy, 64% were Board Certified Nuclear Pharmacists (BCNPs), 81% were men, 64% listed BS Pharmacy as their highest degree, and 54% received their T&E through a certificate program. Respondents trained in an academic setting felt more prepared to perform radiopharmacy practice functions, compared with those completing a certificate program. Board certification did not influence preparedness to perform radiopharmacy practice functions. Overall, most radiopharmacists were satisfied with their current position. Of the respondents practicing pharmacy, the most frequently cited reasons for leaving radiopharmacy practice, included family reasons, difficult hours, and management issues. Conclusions: The results of the survey provide information regarding radiopharmacists´ satisfaction with their T&E, and job satisfaction with their current radiopharmacy position. Results of this study can be used to improve existing radiopharmacy educational program curricula and to develop new continuing radiopharmacy education programs to address perceived T&E deficiencies. 119—STABILITY OF FILTERED TC-99M SULFUR COLLOID. Ponto J, University of Iowa. E-mail: james-ponto@uiowa.edu Objective: Filtered Tc-99m sulfur colloid has recently gained popularity for use in lymphoscintigraphic mapping of lymphatic flow and identification of sentinel lymph nodes. This study was undertaken to evaluate the stability of filtered Tc-99m sulfur colloid stored in glass vials over a period of 8 hours. Methods: About 100 mCi of routinely prepared Tc-99m sulfur colloid was passed through a 0.1- micron filter (Millex-VV, Millipore Corp, Bedford, Mass.). The filtrate was collected in a sterile glass vial (Hollister-Stier, Spokane, Wash.) and diluted to a concentration of about 4 mCi/mL. Samples were withdrawn from this stock vial at 2-hour intervals and subjected to the following testing: (1) thin-layer chromatography to assess radiochemical purity; (2) measurement of specific activity (mCi/gram) as assayed in a dose calibrator and weighed on an analytical balance, to indirectly assess sedimentation/adsorption to container walls; and (3) measurement of specific activity (mCi/gram) following re-filtration through another 0.1-micron filter to indirectly assess changes in particle size (e.g., aggregation or clumping). This procedure was repeated on a total of ten separate preparations of filtered Tc-99m sulfur colloid. Results: Results are expressed as mean (range) values. (1) Radiochemical purity of the filtered Tc- 99m sulfur colloid in the stock vial decreased slightly from 99.3% (98.7–99.7%) at the time of preparation to 98.6% (98.3–99.5%) at 8 hours. (2) The specific activity of filtered Tc-99m sulfur colloid in the stock vial decreased slightly to 97% (94–101%) of its original value at 8 hours. (3) The specific activity of refiltered samples decreased slightly to 94% 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 255 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 (89%–100%) of the corresponding specific activity of filtered Tc-99m sulfur colloid in the stock vial at 8 hours. Conclusions: Filtered Tc-99m sulfur colloid stored in glass vials appears to maintain acceptable stability, in terms of radiochemical purity, sedimentation and adsorption to container walls, and particulate size, throughout a period of 8 hours. APhA–APPM Specialized Pharmaceutical Services 120—ASSESSMENT OF A COMMUNITY PHARMACY-BASED DISEASE-STATE MAN- AGEMENT PROGRAM. Cuellar D, Dodd M, University of New Mexico. E-mail: mdodd@salud.unm.edu Objective: To describe a community pharmacybased disease-state management (DSM) program in the areas of diabetes and cardiovascular risk reduction in an ethnically diverse population and describe the effectiveness of this program in achieving national treatment guideline goals. Methods: This study reports outcomes from a recently developed community pharmacy-based DSM program in an ethnically diverse community. A retrospective review of patient data collected through January 2004 is presented. All patients seen in the community pharmacy-based DSM program for diabetes or cardiovascular risk reduction are included in this analysis. Physicians or pharmacists refer their patients to this community pharmacybased DSM clinic, or patients self-refer. All patients receive oral and written DSM education during every visit with the pharmacist. A complete medical history is collected at the initial visit. Additionally, blood pressure, glycosylated hemoglobin, fasting glucose, and a fasting lipid panel are obtained at baseline and every 6 weeks after enrollment. A plan is developed with the patient and assessed at each visit. Therapy recommendations are made to the patients’ primary provider after every visit. The analysis includes a description of patient demographics, including number of cardiovascular risks and number of patients at treatment goals by ethnicity, gender, age, type of physician, and type of insurance. Student’s t test is used to analyze differences in blood pressure, glycosylated hemoglobin, fasting glucose, and lipid panel values between visits. Acceptance of treatment recommendations by patients’ primary providers is also described. Results: NA. Conclusions: NA. 121—DEVELOPMENT AND IMPLEMEN- TATION OF A WEB-BASED TOOL TO ALERT, DOCUMENT, AND COMPENSATE CONSULTANT PHARMACISTS UNDER A POLYPHARMACY DRUG USE REVIEW PROGRAM. Trygstad T, University of North Carolina at Chapel Hill, Thorpe J, AccessCare Inc. E-mail: troy@unc.edu Objective: To describe and demonstrate a Webbased product that alerts consultant pharmacists to potential drug-related problems among nursing home patients and documents responses to problem alerts. Methods: A polypharmacy intervention project targeting North Carolina Medicaid recipients in nursing homes was launched in November 2002. The initiative developed rapidly and now serves more than 300 nursing facilities and 18,000 Medicaid patients. The intervention was developed by pharmacists under the auspices of a nonprofit network of physicians serving Medicaid recipients (AccessCare). Consultant pharmacists are paid separately by the network for their response to potential drug therapy problem alerts generated from Medicaid claims data. Early experiences with a paper-based profile alert and documentation system stimulated the development of ConsultRx, a Webbased application. The software was developed in 6 months and involved two programmers and two pharmacists. The program allows consultant pharmacists to access and download patient drug profile data from claims databases for purposes of identifying possible drug-related problems. The database is updated monthly with the most recent claims available that include drug name, amount paid, prescriber, and a host of other associated claims information. Additionally, the program allows for “flagging” of possible drug-related problems and suboptimal therapy. The flagging criteria can be updated whenever desired. The application also allows the pharmacist to document interventions and submit them for payment. Results: The success of ConsultRx is being evaluated after 6 months’ usage. Criteria for success include: (1) number of consultants who elect to use the system to identify and resolve potential drug therapy problems, (2) cost savings associated with editing and submitting claims for payment for drug therapy problem and resolution activities, (3) User satisfaction as measured by user response to a questionnaire administered after 6 months, and (4) efficiency of documentation, as measured by average intervention time from initiation to final submission, number of interventions per user per month, and response to flagging criteria as measured by rates of interventions regarding any of the given criteria. Conclusions: NA 122—EDUCATING PHARMACY STU- DENTS ABOUT END-OF-LIFE CARE THROUGH A CLERKSHIP ROTATION. Amerson A, University of Kentucky, Kelley D, Hospice of the Bluegrass. E-mail: aamer1@uky.edu Objective: Describe the benefit to one hospice in providing rotation experiences for pharmacy students and discuss services that pharmacy students can provide as part of their learning experience. Methods: A 1-month rotation in end-of-life care was begun for pharmacy students at hospice in 1995. Because there was no pharmacist at the hospice site, a college of pharmacy faculty member and the student coordinator for hospice (a nurse) jointly precepted the rotation. The student coordinator coordinated the activities for the student at hospice, and the pharmacy faculty member met with the student weekly for discussions on topics and review of patients and assignments. The hospice now employs a full-time pharmacist who helps precept students with the faculty member. An experience is provided for 8 –10 students per year. Results: Benefits for hospice are that the student provides in-service education for nursing staff, answers drug information questions as needed, works on medication use evaluation projects, counsels patients/caregivers on medication use, develops written information for patients/caregivers, newsletters, and the pharmacy and therapeutics committee, and extends existing pharmacy personnel for team meetings/rounds. Students benefit in that they learn the philosophy of hospice care, see roles of different team members (e.g., chaplain, social worker), address difficult symptom management issues (pain, dyspnea, nausea, vomiting), counsel patients and caregivers, prepare and present written drug information, and see patients in both home and inpatient settings. Specific student projects and activities are described. Comments from student evaluations have been very positive about the experience and indicate that students perceive a benefit from participating in end-of-life patient care. Conclusions: Students learn about opportunities to provide pharmacy services in end-of-life care. Original Citation: This poster was presented at the National Hospice and Palliative Care Organization’s 18th Management and Leadership Conference, September 7, 2003, Phoenix, Ariz. 123—EFFECTS OF A ONE-YEAR PHAR- MACIST MANAGED CORONARY HEART DISEASE RISK REDUCTION PROGRAM AT AN AIR FORCE BASE CLINIC. Nicholson S, Benefis Healthcare, Great Falls, Montana. E-mail: stevecharm1@juno.com Objective: To reduce the risk for coronary heart disease (CHD) in identified patients. Therapeutic targets included attainment of National Cholesterol Education Program (NCEP) LDL cholesterol goals, modification of CHD risk factors, and reduction of 10-year CHD risk estimates. Methods: Patients with diabetes or elevated cholesterol were identified from clinic records and invited to participate. Additional patients were enrolled through physician referrals. A total of 32 patients participated for varying periods up to 14 months. Charts, laboratory reports, and lifestyle questionnaires were used to collect risk data. Appointments were conducted individually with a clinical pharmacist, and these consisted of atherosclerosis education, CHD risk assessment, setting of therapeutic goals, and treatment planning. Intervention targets included nutrition, exercise, smoking, weight, blood pressure, stress level, and medication use. If appropriate, patients were referred to established diabetes, cholesterol, and tobacco cessation programs on base. Medication recommendations were made to the patient’s primary care provider (the pharmacist did not have prescriptive authority). Visits were documented in the patient’s medical record using a standardized charting form cosigned by a physician. Follow-up visits 256 Journal of the American Pharmacists Association www.japha.org March/April 2004 Vol. 44, No. 2 Downloaded From: http://japha.org/ on 01/25/2014
Page 1 and 2: FEATURE APhA2004 Abstracts of Contr
Page 3 and 4: FEATURE Annual Meeting Abstracts 20
Page 29: FEATURE Annual Meeting Abstracts 20
Page 77: FEATURE Annual Meeting Abstracts 20

Downloaded - Journal of American Pharmacists Association

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?