A multicenter study of gender bias in student evaluations of teaching in pharmacy programs.

INTRODUCTION: Student evaluations of teaching (SET) are widely used to assess effectiveness of teaching. Studies conducted to assess the presence of gender bias in SET have produced mixed results. The purpose of this study was to evaluate the presence and degree of gender bias in SET of didactic courses in United States pharmacy programs. METHODS: A three-year, retrospective, multi-institutional analysis of anonymous SET data were analyzed from required didactic courses. Analysis included gender, SET questions, mean scale score, and number of students responding to each question. A hierarchical linear model was used to compare the gender difference with the normalized SET scores as the outcome. RESULTS: A total of 2114 SET scores were included from seven pharmacy schools across eight campuses. Analysis of the results revealed that the combined data were skewed secondary to one institution whose results fell significantly outside the mean. When this school was excluded, the difference between SET scores did not differ by gender, b = 0.021, t(1,702) = 0.69, P = .49, with similar SET scores for female faculty (mean = 4.41, SD = 0.35, range = 2.54-5) and male faculty (mean = 4.44, SD = 0.32, range = 2.67-5). CONCLUSIONS: After secondary analysis, the aggregated data showed no significant difference between ratings of male and female instructors. However, there were differences within individual programs. This illustrates the importance of applying assessment principles to SET to determine the presence of bias so that continuous quality improvement strategies may be applied.

Preclinical pharmacokinetics and metabolism of MNP001, a piperidine analog of 3-carbamyl compounds.

MNP001 is a newly synthesized 3-carbamyl-4-methylpyrrole analog with dual pharmacophores simultaneously to inhibit phosphodiesterase type 4 (PDE4) and to antagonize L-type calcium channels. The physicochemical properties of MNP001, including solubility, pKa, Log P, plasma protein binding and plasma/blood partitioning, were determined to support the pharmacokinetic characterization. The preclinical pharmacokinetic parameters were determined in an in vivo rat model and the metabolic pathways of MNP001 were characterized by incubating the compound in vitro in rat or human microsomes/supersomes cocktails. MNP001 was found to have a low solubility in simulated intestinal fluid but a high solubility in simulated gastric fluid. MNP001 is a highly lipophilic compound with a Log P value greater than 4. MNP001 was highly bound to the plasma protein and had an uneven partition between red blood cells and plasma. MNP001 exhibited a rapid absorption, broad distribution, slow systemic clearance and a low but pharmacologically relevant oral bioavailability in rats. The low oral bioavailability was possibly caused by the low aqueous solubility of MNP001 in the gastrointestinal tract. However, 8 h after oral dosing, the mean plasma level of MNP001 was able to remain about 2-fold greater than the minimum effective concentration. The major metabolite of MNP001 was defined as a tetrahydropyridine product (MNP001-M4) of CYP3A4-mediated phase I oxidation. The possibility that the major metabolite MNP001-M4 may have a comparable antihypertensive efficacy to MNP001 needs to be studied.

Y-site physical compatibility of hydrocortisone continuous infusions with admixtures used in critically ill patients.

PURPOSE: Critically ill patients with septic shock often receive multiple intravenous medications, necessitating either the placement of separate lines for medication administration or administration of medications concurrently through a Y-site connector only where compatibility has been demonstrated. The purpose of this study was to examine the physical compatibility of hydrocortisone infusions and select intravenous medications through a simulated Y site. METHODS: The medications tested for simulated Y-site physical compatibility with hydrocortisone included acetaminophen, albumin, cefepime, ciprofloxacin, cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine. Hydrocortisone in solution with 0.9% sodium chloride injection was combined with an equivalent volume of solutions of each test drug at maximum or commercially available concentrations used clinically in intensive care units, as appropriate. The samples were evaluated using turbidimetric measurements and examined visually against light and dark backgrounds to determine physical compatibility. Observations and analyses were completed over a one-hour period at 15-minute intervals beginning immediately after mixing. Each test was performed in triplicate. RESULTS: All study medications demonstrated visual and/or turbidimetric physical compatibility when combined with hydrocortisone in a simulated Y-site infusion. No medications demonstrated a visual physical incompatibility when combined with hydrocortisone. CONCLUSION: Acetaminophen, albumin, cefepime, ciprofloxacin, cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine exhibited physical compatibility with hydrocortisone via Y-site infusion.

Physical Compatibility of Medications Used in Critically Ill Patients with Balanced Fluid Solutions.

Using balanced fluids for resuscitation in patients with septic shock may lead to improved patient outcomes. However, compatibility data on co-administering balanced fluids via y-site connector with other intravenous medications is lacking. The purpose of this study was to examine the physical compatibility of frequently used intravenous medications for patients with septic shock with balanced fluids, Plasma-Lyte A, and Lactated Ringers, using a simulated y-site. Medications studied were acyclovir, amiodarone, ampicillin, aztreonam, cefepime, ceftriaxone, ciprofloxacin, heparin, hydrocortisone, gentamicin, levofloxacin, meropenem, piperacillin-tazobactam, tobramycin, and vancomycin. All medications were assessed with Plasma-Lyte A; amiodarone, ampicillin, cefepime, hydrocortisone, and levofloxacin were also assessed for compatibility with Lactated Ringers, based on missing or conflicting compatibility data. The medications were diluted to maximum concentrations used for patient administration and mixed with the balanced fluid solution in equal volumes. Physical compatibility was determined by assessing samples visually against light and dark backgrounds and using a laboratory turbidimeter. Assessments occurred at time of mixing and at 15-minute intervals up to one hour. Amiodarone demonstrated turbidimetric incompatibility when combined with Plasma- Lyte A or Lactated Ringers and should not be co-administered with either of these fluids via y-site connector. Each remaining study drug displayed visible and turbidimetric compatibility with the assessed balanced fluid. Acyclovir, ampicillin, aztreonam, cefepime, ceftriaxone, ciprofloxacin, gentamicin, heparin, hydrocortisone, levofloxacin, meropenem, piperacillin-tazobactam, tobramycin, and vancomycin exhibited physical compatibility with Plasma- Lyte A in a simulated y-site for up to one hour. Ampicillin, cefepime, hydrocortisone, and levofloxacin were also physically compatible with Lactated Ringers.

Impact of co-curricular involvement on academic success of pharmacy students.

INTRODUCTION: The purpose of this study was to examine the relationship between participation in co-curricular activities and academic performance of pharmacy students enrolled in a traditional PharmD program. METHODS: Pharmacy students self-reported their activities in an online portfolio, allowing calculation of equivalent hours spent in co-curricular pursuits in a given academic year for each student during the six year period. Inferential statistics were used to elucidate the differences in co-curricular engagement by student rank, progression status, and leadership experience as well as differences in grade point average (GPA) by level of co-curricular participation and leadership experience. RESULTS: Participation in co-curricular activities was less for students earning a deficiency than students with satisfactory academic performance. Students who were very engaged in co-curricular activities earned higher GPAs on average and were more likely to hold a leadership position. Leaders earned higher GPAs, were less likely to incur academic deficiencies, and were more involved in all types of co-curricular activities than students who did not hold a leadership position. CONCLUSIONS: The results of this study offer evidence in support of the importance of co-curricular involvement to the development of the whole pharmacy student, including academic success. The provision of co-curricular opportunities by pharmacy programs provides personal and professional development opportunities to students and supports deep learning associated with improved academic performance and overall success.

Validation of HPLC analysis method of a novel antihypertensive agent MS23 in rat plasma.

MS23 is a vasodilator with unique dual action pharmacological profile to inhibit type 4 PDE and antagonize L-type calcium channels. We validated an analytical protocol for MS23 in rat plasma using high performance liquid chromatography (HPLC). A C18 column and a phosphate/acetonitrite buffer were used for chromatographic separation. UV detection was performed at 307 nm. The calibration curve for MS23 was linear in the range from 50 to 10,000 ng/ml. The limit of quantification (LOQ) was 50 ng/ml. The results demonstrate that the method has linearity (R = 0.9989), specificity, and acceptable precision/accuracy. This method is simple, economic, and sufficient for in vivo pharmacokinetic studies on the compound.

Y-site Physical Compatibility of Beta-blocker Infusions with Intensive Care Unit Admixtures.

Parenteral beta-blocker therapy via continuous infusion has shown promising results for improved outcomes for patients with septic shock. As patients with septic shock may require multiple intravenous medications, compatibility is necessary to co-infuse these medications through a y-site connector. The purpose of this study was to examine the physical compatibility of select intravenous drugs used for patients with septic shock combined with various intravenous beta-blockers including esmolol, labetalol, and metoprolol through a simulated y-site infusion. The tested drugs included albumin, levothyroxine, acetaminophen, esomeprazole, doripenem, epinephrine, ibuprofen, norepinephrine, levofloxacin, cefepime, ciprofloxacin, meropenem, cisatracurium, and hydrocortisone. Equal volumes of normal saline, esmolol, labetalol, and metoprolol were combined with each test drug at maximum or commercially available concentrations as appropriate used clinically in intensive care units.The samples were examined visually against a white and black background andalso using turbidimetric measurements to determine physical compatibility.Beginning immediately after mixing, observations and analyses were taken over a one-hour period at 15-minute intervals. Each test was performed in triplicate. Many of the test drugs demonstrated visual and/or turbidimetric physical compatibility when combined with esmolol, labetalol, or metoprolol during a simulated y-site infusion. Albumin, cefepime, and hydrocortisone demonstrated physical incompatibility when combined with labetalol and should not be co-infused with labetalol. Esomeprazole and ibuprofen demonstrated physical incompatibility when combined with esmolol and labetalol and should not be co-infused with either beta-blocker. Esmolol and ciprofloxacin mixtures exhibited a statistically significant difference from control solutions and should not be co-infused.

Physical compatibility of cisatracurium with selected drugs during simulated Y-site administration.

PURPOSE: The physical compatibility of cisatracurium with selected drugs during simulated Y-site administration was studied. METHODS: Study drugs were selected based on the lack of physical compatibility data with cisatracurium and their use in intensive care units. Test admixtures were prepared by mixing 2.5-mL samples of varying concentrations of calcium gluconate, diltiazem, esomeprazole, regular insulin, nicardipine, pantoprazole, and vasopressin with either 2.5 mL of normal saline 0.9% (control) or 2.5 mL of cisatracurium (experimental) to simulate a 1:1 Y-site ratio. Drug infusions were prepared at the maximum concentrations used clinically. Physical compatibility of the admixtures was determined by visual and turbidimetric assessments performed in triplicate immediately after mixing and at 15, 30, and 60 minutes. Visual incompatibility was defined as a change in color, the formation of haze or precipitate, the presence of particles, or the formation of gas in the experimental groups compared with the controls. Disturbances invisible to the naked eye were determined by assessing changes in turbidity of experimental admixtures compared with the controls. RESULTS: None of the admixtures exhibited visual changes when mixed with cisatracurium. Six of the seven admixtures exhibited turbidimetric compatibility with cisatracurium. Pantoprazole admixtures demonstrated a significant difference in turbidimetric assessment between the control and experimental groups when mixed with cisatracurium (p < 0.001). CONCLUSION: Calcium gluconate, diltiazem hydrochloride, esomeprazole, regular insulin, nicardipine hydrochloride, and vasopressin demonstrated physical compatibility with cisatracurium over 60 minutes during simulated Y-site administration. Cisatracurium and pantoprazole should not be coadministered due to a significant difference in turbidity between control and experimental samples.

Physical compatibility of various drugs with neonatal total parenteral nutrient solution during simulated Y-site administration.

PURPOSE: The physical compatibility of various drugs with neonatal total parenteral nutrient (TPN) solution during simulated Y-site administration was evaluated. METHODS: Study drugs were selected based on the lack of compatibility data with them and neonatal TPN solution and the frequency of use in a local neonatal unit. These drugs included amiodarone, caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, midazolam, pentobarbital, phenobarbital, and rifampin. Equal volumes of neonatal TPN solution or sterile water for injection were combined with study drugs or sterile water for injection at concentrations used clinically in neonates. Each test was performed in triplicate. The samples were examined via turbidimetric analysis and visually against light and dark backgrounds immediately after mixing and at 0.25, 0.5, 1, 2, and 3 hours after mixing. Analysis of variance was used to determine statistically significant differences between the test and control solutions. RESULTS: Many of the drugs studied exhibited no visual or turbidimetric evidence of incompatibility when combined with neonatal TPN solution for up to three hours in a simulated Y-site injection. Pentobarbital, phenobarbital, and rifampin formed visible precipitation immediately after mixing with the neonatal TPN solution. CONCLUSION: Caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, and midazolam exhibited no visual or turbidimetric evidence of incompatibility when combined with a neonatal TPN solution for up to three hours in a simulated Y-site injection. Amiodarone, pentobarbital, phenobarbital, and rifampin were not compatible with the neonatal TPN solution and should not be coadministered via Y-site injection.

Visual compatibility of common nebulizer medications with 7% sodium chloride solution.

PURPOSE: The visual compatibility of hypertonic saline solution with various other drugs used for nebulizer therapy in cystic fibrosis (CF) was assessed. METHODS: Nebulized hypertonic saline solution has proved to be an effective adjunctive therapy for management of CF-related respiratory symptoms. Admixing of hypertonic saline solution and standard medications for nebulizer delivery has been suggested as a way to reduce the time-treatment burden on patients with CF, but that practice has been discouraged due to concerns about potential incompatibilities that could lead to precipitate formation (in the nebulizer or airway) and impeded drug delivery. For the study described here, visual and turbidimetric testing was conducted to assess the compatibility of admixtures of hypertonic saline solution and 11 medications widely used in CF (acetylcysteine, albuterol, atropine, cromolyn sodium, dexamethasone, glycopyrrolate, ipratropium, metaproterenol, sodium bicarbonate, terbutaline, and tobramycin). Three samples each of admixtures of the 11 drugs and 7% sodium chloride (experimental samples) or sterile water for injection (control samples) were prepared. The testing procedure entailed four turbidimetry measurements obtained at 15-minute intervals, as well as visual checks for signs of incompatibility (e.g., haze, particle or gas formation, alteration of color); analysis of variance was used to evaluate differences in test results between the experimental and control samples. RESULTS: Ten of the 11 medications assessed were visually compatible with 7% sodium chloride solution, as determined by serial turbidimetric testing and visual inspection; only cromolyn sodium was found to be visually incompatible with hypertonic saline. CONCLUSION: Eleven medications used in nebulizers for the treatment of CF were visually compatible with 7% sodium chloride solution.

HPLC/MS/MS analysis of 3-carbamyl-4-methylpyrrole analog MNP001, a highly potent antihypertensive agent, in rat plasma.

Chemically synthesized 3-carbamyl-4-methylpyrroles were characterized as a group of antihypertensive agents with dual-targeting mechanism to simultaneously inhibit type 4 phosphodiesterase (PDE4) and L-type calcium channels. A 5-butyl analog of the pyrrole family, MNP001, was found to have high potency in reducing animal blood pressure and heart rate. A method for measuring MNP001 using high performance liquid chromatography combined with tandem mass spectrometry (HPLC/MS/MS) was developed. The calibration curve for MNP001 showed good linearity with the value of correlation coefficient greater than 0.987 over the range of 0.25-500 ng/mL. The results for inter-day and intra-day precision as well as accuracy were acceptable according to the criteria established by FDA. The lower limit of quantification was 0.25 ng/mL. This method was quick, sensitive and sufficient for in vivo pharmacokinetic and pharmacodynamic studies on this novel antihypertensive pyrrole compound.