Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association: Endorsed by the Pediatric & Congenital Electrophysiology Society (PACES).

Disorders of the cardiac rhythm may occur in both the fetus and neonate. Because of the immature myocardium, the hemodynamic consequences of either bradyarrhythmias or tachyarrhythmias may be far more significant than in mature physiological states. Treatment options are limited in the fetus and neonate because of limited vascular access, patient size, and the significant risk/benefit ratio of any intervention. In addition, exposure of the fetus or neonate to either persistent arrhythmias or antiarrhythmic medications may have yet-to-be-determined long-term developmental consequences. This scientific statement discusses the mechanism of arrhythmias, pharmacological treatment options, and distinct aspects of pharmacokinetics for the fetus and neonate. From the available current data, subjects of apparent consistency/consensus are presented, as well as future directions for research in terms of aspects of care for which evidence has not been established.

Using a virtual simulation platform for dispensing pediatric prescriptions in a community-based pharmaceutical skills course.

BACKGROUND AND PURPOSE: Safe and accurate dispensing of medications is an essential skill. Pharmacy schools must provide students with the knowledge and practice to enhance special population dispensing skills. The objective of this study is to describe a community pharmacy pediatric simulation completed by first-year pharmacy students and to review student perceptions on confidence and knowledge learned after a MyDispense (Monash University) simulation. EDUCATIONAL ACTIVITY AND SETTING: First-year Pharmaceutical Skills students participated in a MyDispense simulation to identify errors and omissions of prescription orders with a focus on pediatrics. Although students had limited therapeutic knowledge, the activity emphasized federal and Florida law requirements. Retrieval and direct application of these principles along with new experiences in identifying medication errors afforded students to learn in a low-stake, controlled environment. FINDINGS: Of the 64 students enrolled in the Pharmaceutical Skills I course, 57 completed the pre-simulation survey and 56 students completed the post-simulation survey (87.5% response rate). Increased confidence and knowledge were found for most questions. The pre-simulation survey had students most frequently answer neutral followed by disagree or strongly disagree for ability to complete the listed task. The post-simulation survey responses shifted with many students responding with agree or strongly agree for the listed task and found MyDispense to be a helpful simulation tool. SUMMARY: Exposing pharmacy students to pediatric virtual simulations early in the curriculum may increase confidence and knowledge. Future pediatric simulation coursework would benefit longitudinally to further build confidence and enhance retention of knowledge.

An 11-Year Review of Lactobacillus Bacteremia at a Pediatric Tertiary Care Center.

OBJECTIVES: To inform clinical decisions on the use of probiotics in a pediatric inpatient setting, we sought to determine the number of cases of Lactobacillus bacteremia as well as associated patient characteristics in a tertiary-care pediatric hospital over an 11-year period. METHODS: Cases of Lactobacillus bacteremia among admitted patients were identified through positive blood culture reports. The clinical chart for each case was reviewed for presenting symptoms and risk factors such as probiotic use, presence of a central venous catheter, immunocompromised state, impaired intestinal function, and age below 3 months. Concurrent total inpatient probiotic administration was assessed. RESULTS: Over an 11-year period, 8 cases of Lactobacillus bacteremia were identified among 127 845 hospital admissions. All cases were associated with systemic signs of infection. Lactobacillus bacteremia patients most frequently had underlying impaired intestinal function and a central venous catheter. Three cases had a history of probiotic use. The peak number of annual cases did not coincide with the peak number of inpatients who received probiotics. CONCLUSIONS: Lactobacillus bacteremia is uncommon and did not correlate with doses of probiotics-administered in the hospital. However, certain populations may be at higher risk and require extra consideration in clinical decision-making regarding use of probiotics.

Implementing cognitive apprenticeship theory for an ethics module within a first-year pharmacy skills course.

BACKGROUND AND PURPOSE: Critical thinking and problem solving are two skills required to be a successful pharmacist. These skills are often difficult to teach and assess within the classroom. Cognitive apprenticeship theory has been discussed in literature to foster the cognitive and meta-cognitive processes of thinking. Coordinators of a first year Pharmaceutical Skills I course explore how they incorporated this theory into an ethics module to enhance student awareness of thinking and application. EDUCATIONAL ACTIVITY AND SETTING: An ethics module was incorporated into a first year doctor of pharmacy skills course in fall 2021. This module was developed following the four dimensions of cognitive apprenticeship. Lecture materials and ethical debate topics were created by course coordinators and mirrored real time ethical issues surrounding the field of pharmacy. Students were required to use primary literature, the American Pharmacists' Association Code of Ethics, and other ethical terms to support their arguments. Cognitive apprenticeship theory was used throughout the module and post-debate discussions. FINDINGS: The ethics module presented in this course incorporated all dimensions of cognitive apprenticeship. Course coordinators perceived students were able to apply knowledge of ethical principles to scenarios and debates in an effective manner. Purposeful introduction, reiteration, and application offers students the chance to showcase critical thinking and ethical reasoning. SUMMARY: Utilizing the cognitive apprenticeship theory to prepare students for critical thinking is effective when incorporated into a course module. This theory could be successfully implemented into other topics throughout the course and throughout the pharmacy curriculum.

Can Pharmacokinetic Studies Assess the Pulmonary Fate of Dry Powder Inhaler Formulations of Fluticasone Propionate?

In the context of streamlining generic approval, this study assessed whether pharmacokinetics (PK) could elucidate the pulmonary fate of orally inhaled drug products (OIDPs). Three fluticasone propionate (FP) dry powder inhaler (DPI) formulations (A-4.5, B-3.8, and C-3.7), differing only in type and composition of lactose fines, exhibited median mass aerodynamic diameter (MMAD) of 4.5 µm (A-4.5), 3.8 µm (B-3.8), and 3.7 µm (C-3.7) and varied in dissolution rates (A-4.5 slower than B-3.8 and C-3.7). In vitro total lung dose (TLDin vitro) was determined as the average dose passing through three anatomical mouth-throat (MT) models and yielded dose normalization factors (DNF) for each DPI formulation X (DNFx = TLDin vitro,x/TLDin vitro,A-4.5). The DNF was 1.00 for A-4.5, 1.32 for B-3.8, and 1.21 for C-3.7. Systemic PK after inhalation of 500 µg FP was assessed in a randomized, double-blind, four-way crossover study in 24 healthy volunteers. Peak concentrations (Cmax) of A-4.5 relative to those of B-3.8 or C-3.7 lacked bioequivalence without or with dose normalization. The area under the curve (AUC0-Inf) was bio-IN-equivalent before dose normalization and bioequivalent after dose normalization. Thus, PK could detect differences in pulmonary available dose (AUC0-Inf) and residence time (dose-normalized Cmax). The differences in dose-normalized Cmax could not be explained by differences in in vitro dissolution. This might suggest that Cmax differences may indicate differences in regional lung deposition. Overall this study supports the use of PK studies to provide relevant information on the pulmonary performance characteristics (i.e., available dose, residence time, and regional lung deposition).