Download Abstracts - CSHP-BC Branch

CSHP-BC Branch Annual General Meeting Abstracts
November 2012
#1
EVALUATING THE APPROPRIATENESS OF CARBAPENEM PRESCRIBING: A ONE-YEAR
RETROSPECTIVE STUDY OF CARBAPENEM USAGE AT BURNABY HOSPITAL
Sarah Li, BSc(Pharm), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver,
British Columbia
Ivy Chow, BSc(Pharm), ACPR, Pharm.D, Lower Mainland Pharmacy Services, Burnaby General Hospital,
Burnaby, British Columbia
Rationale: Carbapenems, the broadest spectrum beta-lactam antibiotic available on
the market, are very effective in treating severe infections including infections involving
multi-drug resistant organisms. However, misuse or overuse of carbapenems may lead
to undesirable consequences such as Clostridium difficile infections and the
development of resistance. To prevent such consequences, there is a need for
appropriate and responsible carbapenem prescribing practice in hospitals.
Objective: This study aims to evaluate the appropriateness of carbapenem prescribing
in Burnaby Hospital as well as to determine reasons for inappropriate usage in order to
help identify intervention measures to improve responsible prescribing.
Methods: A retrospective chart review was conducted on a random sample of 26
patients admitted on a medical ward at Burnaby Hospital who received ertapenem,
imipenem or meropenem between August 30, 2010 to August 30, 2011. Carbapenem
usage information was gathered, such as indication, duration of treatment, culture and
sensitivity reports, recent antibiotic exposure, and antibiotic agents tried prior to
switching to a carbapenem.
Results: Results showed that 38% cases of carbapenem usage were inappropriate. Three
major reasons for misuse were identified: prescribing carbapenems empirically when
alternative agents were indicated, switching to a carbapenem without allowing previous
antibiotic sufficient time to work, and switching to a carbapenem while better
alternatives existed.
Conclusion: Empiric prescribing of carbapenems presented as a major area for
antimicrobial stewardship. Further studies with a larger scope and longer duration are
needed to explore the appropriateness of carbapenem usage, to determine effective
intervention methods, and to capture safety and resistance pattern of carbapenem use.

#2
THE USE OF SELF-ADMINISTERED MEDICINAL CANNABIS FOR CYSTIC FIBROSIS
SYMPTOM MANAGEMENT: PATIENT-REPORTED EXPERIENCES.
Shalansky, Stephen 1 ; Lee, Kathleen MN 2 ; MacDiarmid, Pat 2 ; Wilcox, Pearce 2
INSTITUTIONS: 1. Pharmacy, Providence Health Care, Vancouver, BC, Canada. 2. Adult Cystic Fibrosis
Clinic, St. Paul, Vancouver, BC, Canada.
Rationale: A number of adult Cystic fibrosis (CF) patients attending our clinic have
disclosed their use of cannabis for symptom control. To our knowledge there have been
no studies examining efficacy of cannabis in the CF population.
Objective: To determine the frequency of cannabis use for symptom control amongst a
cohort of adult CF patients, reasons for use, and perceived efficacy.
Methods: A letter was mailed to all 215 patients registered with the Adult CF Clinic at St.
Paul's Hospital inviting them to participate in an anonymous web-based survey. Those
indicating use of cannabis were asked questions regarding demographics, symptoms
managed, method of delivery, and perceived efficacy.
Results: Of the 85 respondents (40%), 22 (26%) indicated cannabis use for medicinal
reasons. Nineteen (85%) were male and twelve (55%) were over the age of 30. Of the
19 cannabis users who completed the full survey, 11 (58%) indicated daily use. The
most common methods of delivery were mixing with food (79%), smoking (68%) and
vaporizing (63%). Most patients indicated that cannabis improved symptoms including
appetite (84%), sleep (79%), anxiety (79%), pain (74%) and respiratory symptoms (53%).
Subsequent to the survey, clinic staff reported an increase in questions regarding
cannabis use, which has facilitated more open discussion regarding potential risks and
benefits.
Conclusions: Cannabis is commonly used by adult CF patients, and the majority of users
perceive improvement in target symptoms. Potential lung damage through the
inhalation of cannabis via smoking and vaporizing is of concern and should be discussed
with CF patients who disclose cannabis use.

#3
EXPOSURE TO MATERNAL MEDICATIONS - A CASE OF NEONATAL “LOCK-JAW”
Brandi Newby, BScPharm, ACPR, Surrey Memorial Hospital, Surrey, BC
Rebecca Sherlock, MD, FRCPC, Surrey Memorial Hospital, Surrey, BC
Rationale: Many infants are exposed to psychoactive medications during pregnancy.
Extrapyramidal symptoms have occurred in infants born to mothers taking antipsychotic
medications. The specific symptom of “lock-jaw” has not been previously reported in
infants exposed to psychoactive medications.
Identification and description of case and problem: This infant was exposed to
methadone, quetiapine, escitalopram, nortriptyline, gabapentin, zopiclone, rabeprazole,
and benztropine in utero. After birth, a bottle could not be inserted into the infant’s
mouth due to a clenched jaw. This “lock-jaw” persisted for four days; then resolved
without specific treatment. The infant also experienced discontinuation symptoms due
to maternal methadone and psychoactive medication exposure, requiring treatment
with morphine and phenobarbital.
Analysis of problem: The infant’s “lock-jaw” was probably related to in utero exposure
to maternal medications. Assuming similar incidence for extrapyramidal symptoms in
adults and infants, the “lock-jaw” would most likely be due to quetiapine. The risk of
extrapyramidal symptoms is generally less with atypical compared to typical agents;
however this may not be true for infants exposed during pregnancy. In adults, when
antipsychotics are used concurrently with selective serotonin reuptake inhibitors, the
risk of an adverse event is increased. Whether this case was due to quetiapine or the
combination used is not known as escitalopram and nortriptyline may have also
contributed.
Importance of case to pharmacists: Women with successfully treated mental illness
prior to pregnancy will usually continue the same medications throughout their
pregnancy. Health care professionals need to be aware that extrapyramidal symptoms
can occur in the exposed neonate.

#4
ASSESSMENT OF INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES AT BURNABY
HOSPITAL
Cheng, Joyce (BSc. Pharm 2013 Candidate), Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, BC.
Chow, Ivy (BSc. Pharm, ACPR, Pharm.D), Lower Mainland Pharmacy Services, Burnaby General Hospital,
Burnaby, BC.
Mabasa, Vincent (BSc. Pharm, ACPR, Pharm.D), Lower Mainland Pharmacy Services, Burnaby General
Hospital, Burnaby, BC.
Rationale: Influenza and pneumococcal vaccinations are effective in preventing serious
life-threatening complications in elderly patients and patients with chronic diseases.
Therefore, it’s imperative for vaccination rates to be determined and if needed,
improved in hospital inpatients.
Objectives: To determine the baseline vaccination rates for influenza and
pneumococcus at Burnaby Hospital (BH) and to determine the reasons for not
vaccinating in order to develop strategies to improve vaccination rates.
Methods: An evaluation of the influenza and pneumococcus vaccination rates was
conducted on the acute care for elderly ward at BH in a random selection of 100
patients admitted on this unit between June 18, 2011 and September 30, 2011. The
patient’s vaccination status was determined through the nursing admission record, the
family doctor’s medical record, or in consultations with the patient or family. The
primary outcome was the number of patients who were vaccinated with influenza
and/or pneumococcoal vaccine and the secondary outcome was the most common
reason for not receiving the vaccinations.
Results: Forty-seven (44%) of the 108 patients included in the study received both the
pneumococcal and influenza vaccination. Sixty-seven (62%) were vaccinated with the
influenza vaccine and 59 (55%) were vaccinated with the pneumococcal vaccine.
Patients identified time constraints and forgetfulness as the common reasons for not
receiving the influenza vaccination and not being informed as the most common reason
for not receiving the pneumococcal vaccination.
Conclusions: Current influenza and pneumococcal vaccinations rates at BH indicate an
opportunity for intervention. A standardized vaccination program should be considered
at BH to improve rates.

#5
Therapeutic Drug Monitoring in Interstitial Fluid: a Feasibility Study Using a
Comprehensive Panel of Drugs
Tony KL Kiang, BSc(Pharm),PhD,ACPR 1,2 ,Veronika Schmitt, BSc(Pharm) 1 , Urs O Hafeli, PhD 1 , Bev
Chua,DVM 3 ,and Mary HH Ensom, PharmD 1,2,4
1 Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia,
Canada
2 Child and Family Research Institute, Vancouver, British Columbia, Canada
3 Animal Care Centre, The University of British Columbia, Vancouver, British Columbia, Canada
4 Department of Pharmacy, Children’s & Women’s Health Centre of British Columbia, Vancouver, British
Columbia, Canada
Rationale/Objective: This study compared drug concentration-time profiles in
interstitial fluid (ISF) and blood, using an established animal model and a comprehensive
panel of drugs, in order to examine the feasibility of therapeutic drug monitoring (TDM)
in ISF and to design alternative drug sampling methods for the clinic.
Methods: An intravenous, non-toxic bolus of vancomycin, gentamicin, tacrolimus,
mycophenolate, cyclosporine, phenytoin, phenobarbital, valproic acid, carboplatin,
cisplatin, methotrexate, digoxin, or theophylline was administered into the ear vein (n =
4 – 6) of rabbits. Serial (0 – 72 h post-dose) blood and ISF concentrations were
determined by validated analytical assays. Pharmacokinetic parameters were generated
by non-compartmental analysis.
Results: Vancomycin (mean±SD, 75.3±3.9 vs. 89.8±7.8 μgxh/mL), gentamicin
(176.1±22.1 vs. 188.8±18.3 μgxh/mL), and carboplatin (5667.3±716.7 vs. 5004.1±836.9
μgxh/L) showed no significant difference in AUCs in ISF and blood, respectively. Other
AUCs were lower (phenobarbital, valproic acid, cisplatin, methotrexate, digoxin, and
theophylline) or not measureable (tacrolimus, mycophenolate, cyclosporine, and
phenytoin) in ISF. When a drug was detectable, a reduced Cmax and increased Tmax
were evident in ISF, but their concentration-time profiles were similar between the two
matrices (except for gentamicin).
Conclusion/Implication: Using a comprehensive panel of drugs in a single experimental
setting, we have identified agents that can be quantified in ISF. The similarity between
concentration-time curves for many drugs in the two matrices suggests feasibility of
TDM in ISF. Human studies examining suitability of ISF monitoring are being planned in
the clinic. The ultimate goal is to eliminate blood sampling for patients for whom it is
difficult.

#6
Multiple Regression Analysis of Factors Predicting Mycophenolic Acid Free Fraction in
91 Adult Organ Transplant Recipients
Tony KL Kiang, BSc(Pharm),PhD,ACPR 1,2 ,Karen Ng, BSc(Pharm) 1 , and Mary HH Ensom, PharmD 1,2,3
1 Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia,
Canada
2 Child and Family Research Institute, Vancouver, British Columbia, Canada
3 Department of Pharmacy, Children’s & Women’s Health Centre of British Columbia, Vancouver, British
Columbia, Canada
Rationale: Little is known of what contributes to the wide inter-individual variability in
the observed free fraction (f%) of mycophenolic acid (MPA), an immunosuppressant
that is extensively bound to albumin (~97%). The objective of this study was to
determine, using multiple regression analysis, patient factors that predict f% in a large
sample (n = 91) of organ transplant recipients.
Design & Methods: Age, weight, height, daily MPA dose, albumin, serum creatinine
(SrCr), and f% were obtained from islet (n = 16), kidney (n = 28), and heart/lung (n = 47)
transplant recipients. Multiple linear regression analysis and Spearman Rank correlation
were conducted. Significance was set a priori at p < 0.05
Results: The pooled data can be described as (mean ± std): age (52 ± 13 years), weight
(72 ± 15 kg), height (169 ± 9 cm), daily MPA dose (1632 ± 667 mg), albumin (4.2 ± 0.7
g/dL), SrCr (1.3 ± 0.4 mg/dL), and f% (2.9 ± 3.5%).
Multiple regression generated the equation: f% = 1.865 + (0.0357 x age (yr)) + (0.0125 x
weight (Kg)) - (0.0202 x height (cm)) - (0.000323 x total daily dose (mg)) + (0.0122 x
albumin (g/L)) + (0.0160 x SrCr (µmol/L)), but none of the variables were significant
predictors of MPA f%. Spearman Rank correlation of each individual variable confirmed
lack of significant correlation with f%.
Conclusion: Our novel finding of lack of significant predictions in a large sample size of
organ transplant recipients warrant further investigations using additional patient
factors.

#7
DESCRIBING AND ASSESSING THE IMPACT OF EXPANDED PHARMACIST SCOPE OF
PRACTICE AT BURNABY HOSPITAL
Soomi Hwang, 4 th year BSc(Pharm) student 1 , Tamar Koleba, PharmD 2 , Vincent Mabasa, PharmD 2
1 University of British Columbia, Vancouver, BC
2 Burnaby Hospital, Burnaby, BC
Pharmacy Practice and Administration
Rationale: The College of Pharmacists of BC introduced Adapting a Prescription in 2009
to expand a pharmacist’s scope of practice and to optimize health outcomes for patients.
As information on expanded scope of practice (ESP) in a hospital setting is limited, we
describe pharmacist’s experiences, assess impact on patients and the health care
system, and discuss what has been learned about ESP in a hospital setting in British
Columbia.
Description: Clinical pharmacists at Burnaby Hospital (BH) began including ESP activities
in their practice on April 1, 2012. ESP activities that a pharmacist may perform without
prior authorization from a prescriber include re-ordering chronic medications, initiating
OTC medications, changing drug formulations, changing drugs within same therapeutic
classes, and titrating medication doses.
Steps taken: All ESP activities by pharmacists required documentation in the patient
health care record via a Clinical Pharmacy Note (CPN). The CPN were collected from
April 1 st to September 30 th , 2012 and were reviewed. Participating pharmacists were
surveyed to gather feedback on their experiences.
End result: A total of 227 CPN produced by 11 clinical pharmacists were reviewed. Most
pharmacists felt the ESP activities enhanced professional satisfaction and improved
quality of patient care, but identified lack of time and experience as barriers to practice.
Importance: Hospital pharmacists integrated ESP activities into their clinical practice
with relative ease. These activities resulted in improved patient-related clinical and
humanistic outcomes, as well as decreased health-care costs. Preparatory training for
pharmacists and ongoing professional support may help pharmacists overcome barriers
to performing ESP activities.
Figures on next

Figure 1. Breakdown of expanded scope of practice activities
Expanded Scope of Practice Activities
Total
Titrating medication doses (69.6%)
Re-ordering Chronic medications (20.1%)
Initiating OTC medications (4.1%)
Changing drug formulations (4.1%)
Changing medications within therapeutic class …
0 50 100 150 200 250 300
Number of activities (194) Excluded (73)
Figure 2. Outcomes
Outcomes
Clinical (81.5%)
Economic (10.4%)
Humanistic (8.1%)
Outcomes
0 50 100 150 200