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Templeton S, McVeigh CM, Nguyen C, Hunter R, Scieszka D, Herbert GW, Barr EB, Liu R, Gu H, Bleske BE, Campen MJ, Bolt AM. Acute inhalation of tungsten particles results in early signs of cardiac injury. Toxicol Lett 2023; 384:52-62. [PMID: 37442282 PMCID: PMC10528412 DOI: 10.1016/j.toxlet.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Epidemiological studies have established that exposure to tungsten increases the risk of developing cardiovascular diseases. However, no studies have investigated how tungsten affects cardiac function or the development of cardiovascular disease. Inhalation of tungsten particulates is relevant in occupational settings, and inhalation of particulate matter has a known causative role in driving cardiovascular disease. This study examined if acute inhalation to tungsten particulates affects cardiac function and leads to heart tissue alterations. Female BALB/c mice were exposed to Filtered Air or 1.5 ± 0.23 mg/m3 tungsten particles, using a whole-body inhalation chamber, 4 times over the course of two weeks. Inhalation exposure resulted in mild pulmonary inflammation characterized by an increased percentage and number of macrophages and metabolomic changes in the lungs. Cardiac output was significantly decreased in the tungsten-exposed group. Additionally, A', an indicator of the amount of work required by the atria to fill the heart was elevated. Cardiac gene expression analysis revealed, tungsten exposure increased expression of pro-inflammatory cytokines, markers of remodeling and fibrosis, and oxidative stress genes. These data strongly suggest exposure to tungsten results in cardiac injury characterized by early signs of diastolic dysfunction. Functional findings are in parallel, demonstrating cardiac oxidative stress, inflammation, and early fibrotic changes. Tungsten accumulation data would suggest these cardiac changes are driven by systemic consequences of pulmonary damage.
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Affiliation(s)
- Sage Templeton
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Charlotte M McVeigh
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Colin Nguyen
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Russell Hunter
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - David Scieszka
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Guy W Herbert
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Edward B Barr
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Rui Liu
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Haiwei Gu
- Center for Translational Science, Florida International University, Port St. Lucie, FL 34987, USA
| | - Barry E Bleske
- The University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, NM 87131, USA
| | - Matthew J Campen
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Alicia M Bolt
- The University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, USA.
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Chow SL, Bozkurt B, Baker WL, Bleske BE, Breathett K, Fonarow GC, Greenberg B, Khazanie P, Leclerc J, Morris AA, Reza N, Yancy CW. Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e4-e30. [PMID: 36475715 DOI: 10.1161/cir.0000000000001110] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Complementary and alternative medicines (CAM) are commonly used across the world by diverse populations and ethnicities but remain largely unregulated. Although many CAM agents are purported to be efficacious and safe by the public, clinical evidence supporting the use of CAM in heart failure remains limited and controversial. Furthermore, health care professionals rarely inquire or document use of CAM as part of the medical record, and patients infrequently disclose their use without further prompting. The goal of this scientific statement is to summarize published efficacy and safety data for CAM and adjunctive interventional wellness approaches in heart failure. Furthermore, other important considerations such as adverse effects and drug interactions that could influence the safety of patients with heart failure are reviewed and discussed.
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Shi J, Xiao J, Wang X, Jung SM, Bleske BE, Markowitz JS, Patrick KS, Zhu HJ. Plasma Carboxylesterase 1 Predicts Methylphenidate Exposure: A Proof-of-Concept Study Using Plasma Protein Biomarker for Hepatic Drug Metabolism. Clin Pharmacol Ther 2021; 111:878-885. [PMID: 34743324 DOI: 10.1002/cpt.2486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
Hepatic drug-metabolizing enzymes (DMEs) play critical roles in determining the pharmacokinetics and pharmacodynamics of numerous therapeutic agents. As such, noninvasive biomarkers capable of predicting DME expression in the liver have the potential to be used to personalize pharmacotherapy and improve drug treatment outcomes. In the present study, we quantified carboxylesterase 1 (CES1) protein concentrations in plasma samples collected during a methylphenidate pharmacokinetics study. CES1 is a prominent hepatic enzyme responsible for the metabolism of many medications containing small ester moieties, including methylphenidate. The results revealed a significant inverse correlation between plasma CES1 protein concentrations and the area under the concentration-time curves (AUCs) of plasma d-methylphenidate (P = 0.014, r = -0.617). In addition, when plasma CES1 protein levels were normalized to the plasma concentrations of 24 liver-enriched proteins to account for potential interindividual differences in hepatic protein release rate, the correlation was further improved (P = 0.003, r = -0.703), suggesting that plasma CES1 protein could explain ~ 50% of the variability in d-methylphenidate AUCs in the study participants. A physiologically-based pharmacokinetic modeling simulation revealed that the CES1-based individualized dosing strategy might significantly reduce d-methylphenidate exposure variability in pediatric patients relative to conventional trial and error fixed dosing regimens. This proof-of-concept study indicates that the plasma protein of a hepatic DME may serve as a biomarker for predicting its metabolic function and the pharmacokinetics of its substrate drugs.
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Affiliation(s)
- Jian Shi
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jingcheng Xiao
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Xinwen Wang
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Sun Min Jung
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, The University of New Mexico, Albuquerque, New Mexico, USA
| | - John S Markowitz
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA
| | - Kennerly S Patrick
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Bleske BE, Raley RE, Hunter TS, Anderson JR. Curricular-driven screening for atrial fibrillation at community pharmacies. J Am Pharm Assoc (2003) 2021; 62:541-545.e1. [PMID: 34772632 DOI: 10.1016/j.japh.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of stroke. It can be asymptomatic and patients may be unaware they have AF. Therefore, there is a need to develop a sustainable community model to screen for unrecognized AF. OBJECTIVE The objective is to assess a curriculum driven model developed by the University of New Mexico College of Pharmacy (UNM-CoP) to evaluate AF screening at three community pharmacy sites. METHODS Screenings and education for AF were performed by fourth year pharmacy students during their advanced pharmacy practice experience (APPE) community rotation at pre-selected independent pharmacies. Patients were screened using the KardiaMobile device (AliveCor®, Mountain View, California), an FDA-cleared device that interprets a medical-grade ECG in 30 seconds. All screening materials and devices were provided by UNM-CoP. Semi-structured interviews with each targeted pharmacy were conducted to assess the logistics, value, and sustainability of the program (N=5 pharmacists). RESULTS AF assessment was performed over a 7-month period by 8 students at three pharmacies. Students screened a total of 63 patients (62% female, 56 ± 14 years of age) with 92% of the encounters taking less than 10 minutes to complete. Three patients (4.7%) were found to have possible AF. Positive scores were noted when assessing value to the pharmacy (8.8 ± 0.8, scale 1-10 with 10 being high value) and professionally (9.7 ± 0.6). DISCUSSION Student-pharmacists provides a likely pathway for sustainability for this clinical initiative and provides for a novel and measurable APPE patient interaction. CONCLUSION Curricular driven AF assessment in community pharmacies was shown to be a feasible model. Additional studies are needed to assess whether population-based real-time assessment and detection of AF can reduce the risk of stroke in previously undetected AF. If stroke reduction is realized, reimbursement for service is likely and can contribute to further sustainability.
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Garcia M, Salazar R, Wilson T, Lucas S, Herbert G, Young T, Begay J, Denson JL, Zychowski K, Ashley R, Byrum S, Mackintosh S, Bleske BE, Ottens AK, Campen MJ. Early Gestational Exposure to Inhaled Ozone Impairs Maternal Uterine Artery and Cardiac Function. Toxicol Sci 2021; 179:121-134. [PMID: 33146391 DOI: 10.1093/toxsci/kfaa164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Exposure to air pollutants such as ozone (O3) is associated with adverse pregnancy outcomes, including higher incidence of gestational hypertension, preeclampsia, and peripartum cardiomyopathy; however, the underlying mechanisms of this association remain unclear. We hypothesized that O3 exposures during early placental formation would lead to more adverse cardiovascular effects at term for exposed dams, as compared with late-term exposures. Pregnant Sprague Dawley rats were exposed (4 h) to either filtered air (FA) or O3 (0.3 or 1.0 ppm) at either gestational day (GD)10 or GD20, with longitudinal functional assessments and molecular endpoints conducted at term. Exposure at GD10 led to placental transcriptional changes at term that were consistent with markers in human preeclampsia, including reduced mmp10 and increased cd36, fzd1, and col1a1. O3 exposure, at both early and late gestation, induced a significant increase in maternal circulating soluble FMS-like tyrosine kinase-1 (sFlt-1), a known driver of preeclampsia. Otherwise, exposure to 0.3 ppm O3 at GD10 led to several late-stage cardiovascular outcomes in dams that were not evident in GD20-exposed dams, including elevated uterine artery resistance index and reduced cardiac output and stroke volume. GD10 O3 exposure proteomic profile in maternal hearts characterized by a reduction in proteins with essential roles in metabolism and mitochondrial function, whereas phosphoproteomic changes were consistent with pathways involved in cardiomyopathic responses. Thus, the developing placenta is an indirect target of inhaled O3 and systemic maternal cardiovascular abnormalities may be induced by O3 exposure at a specific window of gestation.
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Affiliation(s)
- Marcus Garcia
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Raul Salazar
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Thomas Wilson
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Selita Lucas
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Guy Herbert
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Tamara Young
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Jessica Begay
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Jesse L Denson
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Katherine Zychowski
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Ryan Ashley
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, New Mexico 88003
| | - Stephanie Byrum
- Arkansas Children's Research Institute, Little Rock, Arkansas 72202
| | - Samuel Mackintosh
- Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Barry E Bleske
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
| | - Andrew K Ottens
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia 23298-0709
| | - Matthew J Campen
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131
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Her LH, Wang X, Shi J, Choi HJ, Jung SM, Smith LS, Wu AH, Bleske BE, Zhu HJ. Effect of CES1 genetic variation on enalapril steady-state pharmacokinetics and pharmacodynamics in healthy subjects. Br J Clin Pharmacol 2021; 87:4691-4700. [PMID: 33963573 DOI: 10.1111/bcp.14888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS Enalapril is a prodrug and needs to be activated by carboxylesterase 1 (CES1). A previous in vitro study demonstrated the CES1 genetic variant, G143E (rs71647871), significantly impaired enalapril activation. Two previous clinical studies examined the impact of G143E on single-dose enalapril PK (10 mg); however, the results were inconclusive. A prospective, multi-dose, pharmacokinetics and pharmacodynamics (PK/PD) study was conducted to determine the impact of the CES1 G143E variant on enalapril steady-state PK and PD in healthy volunteers. METHODS Study participants were stratified to G143E non-carriers (n = 15) and G143E carriers (n = 6). All the carriers were G143E heterozygotes. Study subjects received enalapril 10 mg daily for seven consecutive days prior to a 72 hour PK/PD study. Plasma concentrations of enalapril and its active metabolite enalaprilat were quantified by an established liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. RESULTS The CES1 G143E carriers had 30.9% lower enalaprilat Cmax (P = 0.03) compared to the non-carriers (38.01 vs. 55.01 ng/mL). The carrier group had 27.5% lower AUC0-∞ (P = 0.02) of plasma enalaprilat compared to the non-carriers (374.29 vs. 515.91 ng*h/mL). The carriers also had a 32.3% lower enalaprilat-to-enalapril AUC0-∞ ratio (P = 0.003) relative to the non-carriers. The average maximum reduction of systolic blood pressure in the non-carrier group was approximately 12.4% at the end of the study compared to the baseline (P = 0.001). No statistically significant blood pressure reduction was observed in the G143E carriers. CONCLUSIONS The CES1 loss-of-function G143E variant significantly impaired enalapril activation and its systolic blood pressure-lowering effect in healthy volunteers.
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Affiliation(s)
- Lucy H Her
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Xinwen Wang
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Jian Shi
- Alliance Pharma, Inc, Malvern, PA, United States
| | - Hee Jae Choi
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Sun Min Jung
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Logan S Smith
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Audrey H Wu
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, The University of New Mexico, Albuquerque, NM, United States
| | - Hao-Jie Zhu
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
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7
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Wang X, Her L, Xiao J, Shi J, Wu AH, Bleske BE, Zhu HJ. Impact of carboxylesterase 1 genetic polymorphism on trandolapril activation in human liver and the pharmacokinetics and pharmacodynamics in healthy volunteers. Clin Transl Sci 2021; 14:1380-1389. [PMID: 33660934 PMCID: PMC8301577 DOI: 10.1111/cts.12989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 01/20/2023] Open
Abstract
Trandolapril, an angiotensin-converting enzyme inhibitor prodrug, needs to be activated by carboxylesterase 1 (CES1) in the liver to exert its intended therapeutic effect. A previous in vitro study demonstrated that the CES1 genetic variant G143E (rs71647871) abolished CES1-mediated trandolapril activation in cells transfected with the variant. This study aimed to determine the effect of the G143E variant on trandolapril activation in human livers and the pharmacokinetics (PKs) and pharmacodynamics (PDs) in human subjects. We performed an in vitro incubation study to assess trandolapril activation in human livers (5 G143E heterozygotes and 97 noncarriers) and conducted a single-dose (1 mg) PK and PD study of trandolapril in healthy volunteers (8 G143E heterozygotes and 11 noncarriers). The incubation study revealed that the mean trandolapril activation rate in G143E heterozygous livers was 42% of those not carrying the variant (p = 0.0015). The clinical study showed that, relative to noncarriers, G143E carriers exhibited 20% and 15% decreases, respectively, in the peak concentration (Cmax ) and area under the curve from 0 to 72 h (AUC0-72 h ) of the active metabolite trandolaprilat, although the differences were not statistically significant. Additionally, the average maximum reductions of systolic blood pressure and diastolic blood pressure in carriers were ~ 22% and 23% less than in noncarriers, respectively, but the differences did not reach a statistically significant level. In summary, the CES1 G143E variant markedly impaired trandolapril activation in the human liver under the in vitro incubation conditions; however, this variant had only a modest impact on the PK and PD of trandolapril in healthy human subjects.
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Affiliation(s)
- Xinwen Wang
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Lucy Her
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jingcheng Xiao
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jian Shi
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Audrey H Wu
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Wittstrom KM, Godwin DA, Bleske BE. Intervention and remediation: A descriptive study of practices in pharmacy education. Curr Pharm Teach Learn 2021; 13:206-212. [PMID: 33641729 DOI: 10.1016/j.cptl.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION This descriptive survey study was designed to collect specific data about intervention and remediation approaches used by schools and colleges of pharmacy (S/COPs) to meet the requirements of the Accreditation Council for Pharmacy Education Standard 17. METHODS An electronic survey was developed and sent to all members of the American Association of Colleges of Pharmacy Curriculum and Student Services Personnel Special Interest Groups. The survey gathered details about institutional criteria and practices used in identification of students at risk of failure, steps of early intervention, and approaches to academic remediation. Descriptive data are presented. RESULTS About 70% of accredited S/COPs responded with a complete survey. There was no statistically significant difference between public or private institutional practices. All respondents reported remediation approaches, but only 85% had structured intervention practices. There was marked variability in reports of specific details for both intervention and remediation. CONCLUSIONS There is great diversity in approaches to both intervention and remediation. This study provides baseline data on which to build future research that might determine best practices to optimize student outcomes. A theoretical framework is provided.
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Affiliation(s)
- Kristina M Wittstrom
- University of New Mexico, College of Pharmacy, Albuquerque NM 87131-0001, United States.
| | - Donald A Godwin
- University of New Mexico, College of Pharmacy, Albuquerque NM 87131-0001, United States.
| | - Barry E Bleske
- University of New Mexico, College of Pharmacy, Albuquerque NM 87131-0001, United States.
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9
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Zychowski KE, Tyler CRS, Sanchez B, Harmon M, Liu J, Irshad H, McDonald JD, Bleske BE, Campen MJ. Vehicular Particulate Matter (PM) Characteristics Impact Vascular Outcomes Following Inhalation. Cardiovasc Toxicol 2020; 20:211-221. [PMID: 31410643 PMCID: PMC7015791 DOI: 10.1007/s12012-019-09546-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Roadside proximity and exposure to mixed vehicular emissions (MVE) have been linked to adverse pulmonary and vascular outcomes. However, because of the complex nature of the contribution of particulate matter (PM) versus gases, it is difficult to decipher the precise causative factors regarding PM and the copollutant gaseous fraction. To this end, C57BL/6 and apolipoprotein E knockout mice (ApoE-/-) were exposed to either filtered air (FA), fine particulate (FP), FP+gases (FP+G), ultrafine particulate (UFP), or UFP+gases (UFP+G). Two different timeframes were employed: 1-day (acute) or 30-day (subchronic) exposures. Examined biological endpoints included aortic vasoreactivity, aortic lesion quantification, and aortic mRNA expression. Impairments in vasorelaxation were observed following acute exposure to FP+G in C57BL/6 animals and FP, UFP, and UFP+G in ApoE-/- animals. These effects were completely abrogated or markedly reduced following subchronic exposure. Aortic lesion quantification in ApoE-/- animals indicated a significant increase in atheroma size in the UFP-, FP-, and FP+G-exposed groups. Additionally, ApoE-/- mice demonstrated a significant fold increase in TNFα expression following FP+G exposure and ET-1 following UFP exposure. Interestingly, C57BL/6 aortic gene expression varied widely across exposure groups. TNFα decreased significantly following FP exposure and CCL-5 decreased in the UFP-, FP-, and FP+G-exposed groups. Conversely, ET-1, CCL-2, and CXCL-1 were all significantly upregulated in the FP+G group. These findings suggest that gas-particle interactions may play a role in vascular toxicity, but the contribution of surface area is not clear.
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Affiliation(s)
- Katherine E Zychowski
- Department of Pharmaceutical Sciences, The University of New Mexico, College of Pharmacy, Albuquerque, NM, USA.
| | | | - Bethany Sanchez
- Department of Pharmaceutical Sciences, The University of New Mexico, College of Pharmacy, Albuquerque, NM, USA
| | - Molly Harmon
- Department of Pharmaceutical Sciences, The University of New Mexico, College of Pharmacy, Albuquerque, NM, USA
| | - June Liu
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | - Barry E Bleske
- Department of Pharmacy Practice & Administrative Sciences, The University of New Mexico, College of Pharmacy, Albuquerque, NM, USA
| | - Matthew J Campen
- Department of Pharmaceutical Sciences, The University of New Mexico, College of Pharmacy, Albuquerque, NM, USA
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10
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Anderson JR, Hunter T, Dinallo JM, Glaser D, Roybal LK, Segovia A, Raley R, Bleske BE. Population screening for atrial fibrillation by student pharmacists at health fairs. J Am Pharm Assoc (2003) 2020; 60:e52-e57. [PMID: 32014442 DOI: 10.1016/j.japh.2019.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/08/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Individuals with unrecognized atrial fibrillation (AF) may be at an increased risk of stroke. There is a need to develop a sustainable and reproducible population-based screening model to identify unrecognized AF. OBJECTIVE The objective of this study is to evaluate AF screening and education at student pharmacist-driven health fairs. METHODS Screening for AF was performed by student members of the American Pharmacist Association Academy of Student Pharmacists with preceptor oversight. Participants were screened using the KardiaMobile device (AliveCor, Mountain View, CA), a Food and Drug Administration-cleared device that interprets a medical-grade electrocardiogram in 30 seconds. Student pharmacists also calculated a CHA₂DS₂-VASc score. Participant education was provided using an American Heart Association AF patient information sheet. Learning assessment was evaluated with 3 multiple choice questions. RESULTS Students screened a total of 697 participants over a 6-month period at 13 health fairs. Overall, 71% of the participants were women aged 56 ± 15 years (mean ± SD). Sixteen of the participants (2.3%) who were screened received results indicating possible AF. None of the participants with a possible positive finding had symptoms suggestive of AF. Of these 16 participants, 11 (69%) had a CHA₂DS₂-VASc score greater than or equal to 2 (2.7 ± 0.7). Most participants answered each learning assessment question correctly. More than 95% of participants believed that screening for AF at health fairs was important or very important. CONCLUSION Student pharmacist-driven health fairs were shown to be feasible models to screen for AF and were effective in providing AF education to the public. Student pharmacists also cultivated a clinical skill that is transferable to their future practice setting, including the community pharmacy setting. Additional studies are needed to assess whether population-based real-time assessment and detection of AF can reduce the risk of stroke in individuals with previously undetected AF.
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11
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Scoville BA, Segal JH, Salama NN, Heung M, Bleske BE, Eyler RF, Mueller BA. Single dose oral ranolazine pharmacokinetics in patients receiving maintenance hemodialysis. Ren Fail 2019; 41:118-125. [PMID: 30909832 PMCID: PMC6442103 DOI: 10.1080/0886022x.2019.1585371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: Ranolazine is a novel anti-angina treatment approved in the United States for chronic stable angina. Ranolazine pharmacokinetics have not been studied previously in patients who receive maintenance hemodialysis. This study describes the pharmacokinetics of ranolazine and three major metabolites (CVT-2738, CVT-2512, CVT-2514) in patients receiving thrice weekly hemodialysis. Methods: Eight participants receiving maintenance hemodialysis completed this prospective, open-label study (study identifier NCT01435174 at Clinicaltrials.gov). Three participants received a single tablet of ranolazine 500 mg (followed by an interim analysis), and five received 2 tablets of ranolazine 500 mg. Blood samples were collected over 65 h to determine the pharmacokinetic characteristics during and between hemodialysis sessions. Non-compartmental analysis was used to determine the individual pharmacokinetic parameters. Results: Ranolazine off-hemodialysis elimination phase half-lives were 3.6 and 3.9 h for 500 mg and 1000 mg doses, respectively. The time to maximum concentration ranged from 2 to 18 hours and the average maximum concentration was 0.65 ± 0.27 mcg/mL and 1.18 ± 0.48 mcg/mL for ranolazine 500 mg and 1000 mg dose, respectively. The mean hemodialysis percent reduction ratio for the ranolazine 500 mg dose was 52.3 ± 8.1% and for the ranolazine 1000 mg dose was 69.2 ± 37.6%. Conclusions: Data on ranolazine dosing in patients receiving maintenance hemodialysis is almost non-existent. Given the extent of pharmacokinetic variability observed with the 500 mg and 1000 mg oral doses of ranolazine, neither can be recommended as a starting dose in patients receiving maintenance hemodialysis. Guided by the information gained form this study about the extent of hemodialytic drug clearance, further multi-dose clinical trials of ranolazine are needed to optimize therapeutic outcomes in this patient population.
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Affiliation(s)
| | - Jonathan H Segal
- b Department of Internal Medicine , University of Michigan School of Medicine , Ann Arbor , MI , USA
| | - Noha N Salama
- c Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy , Cairo University , Cairo , Egypt.,d Department of Pharmaceutical and Administrative Sciences , St. Louis College of Pharmacy , St. Louis , MO , USA
| | - Michael Heung
- b Department of Internal Medicine , University of Michigan School of Medicine , Ann Arbor , MI , USA
| | - Barry E Bleske
- e Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - Rachel F Eyler
- f Department of Pharmacy Practice , University of Connecticut School of Pharmacy , Storrs , CT , USA
| | - Bruce A Mueller
- g Department of Clinical Pharmacy , University of Michigan College of Pharmacy , Ann Arbor , MI , USA
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12
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Mohammad RA, Ellingrod VL, Bleske BE. Implementing and evaluating virtual patient cases within a team‐based learning pedagogy in a therapeutics course sequence. J Am Coll Clin Pharm 2019. [DOI: 10.1002/jac5.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rima A. Mohammad
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan
| | - Vicki L. Ellingrod
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan
- School of Medicine, Department of Psychiatry University of Michigan Ann Arbor Michigan
| | - Barry E. Bleske
- College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences University of New Mexico Albuquerque New Mexico
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13
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Seekatz AM, Schnizlein MK, Koenigsknecht MJ, Baker JR, Hasler WL, Bleske BE, Young VB, Sun D. Spatial and Temporal Analysis of the Stomach and Small-Intestinal Microbiota in Fasted Healthy Humans. mSphere 2019; 4:e00126-19. [PMID: 30867328 PMCID: PMC6416366 DOI: 10.1128/msphere.00126-19] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 02/07/2023] Open
Abstract
Although the microbiota in the proximal gastrointestinal (GI) tract have been implicated in health and disease, much about these microbes remains understudied compared to those in the distal GI tract. This study characterized the microbiota across multiple proximal GI sites over time in healthy individuals. As part of a study of the pharmacokinetics of oral mesalamine administration, healthy, fasted volunteers (n = 8; 10 observation periods total) were orally intubated with a four-lumen catheter with multiple aspiration ports. Samples were taken from stomach, duodenal, and multiple jejunal sites, sampling hourly (≤7 h) to measure mesalamine (administered at t = 0), pH, and 16S rRNA gene-based composition. We observed a predominance of Firmicutes across proximal GI sites, with significant variation compared to stool. The microbiota was more similar within individuals over time than between subjects, with the fecal microbiota being unique from that of the small intestine. The stomach and duodenal microbiota displayed highest intraindividual variability compared to jejunal sites, which were more stable across time. We observed significant correlations in the duodenal microbial composition with changes in pH; linear mixed models identified positive correlations with multiple Streptococcus operational taxonomic units (OTUs) and negative correlations with multiple Prevotella and Pasteurellaceae OTUs. Few OTUs correlated with mesalamine concentration. The stomach and duodenal microbiota exhibited greater compositional dynamics than the jejunum. Short-term fluctuations in the duodenal microbiota were correlated with pH. Given the unique characteristics and dynamics of the proximal GI tract microbiota, it is important to consider these local environments in health and disease states.IMPORTANCE The gut microbiota are linked to a variety of gastrointestinal diseases, including inflammatory bowel disease. Despite this importance, microbiota dynamics in the upper gastrointestinal tract are understudied. Our article seeks to understand what factors impact microbiota dynamics in the healthy human upper gut. We found that the upper gastrointestinal tract contains consistently prevalent bacterial OTUs that dominate the overall community. Microbiota variability is highest in the stomach and duodenum and correlates with pH.
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Affiliation(s)
- Anna M Seekatz
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew K Schnizlein
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark J Koenigsknecht
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason R Baker
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - William L Hasler
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Vincent B Young
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Duxin Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Increased expression of microRNA 155 (miR-155) results in a decrease in endothelial nitric oxide synthase (eNOS) expression and impaired endothelial function. Factors that have been shown to increase expression of miR-155 may be mitigated by WS 1442, an extract of hawthorn leaves and flowers (Crataegus special extract) that contains a range of pharmacologically active substances including oligomeric proanthocyanidins and flavonoids. The purpose of this study is to determine the effect of WS 1442 on the expression of miR-155 and eNOS in the presence of tumor necrosis factor (TNF-α). Human umbilical vein endothelial cells (HUVECs) were studied after the exposure to TNF-α, with or without simvastatin (positive control) and WS 1442. The expression levels of eNOS, phosphorylated eNOS, and miR-155 in the different HUVEC treatment groups were determined by western blot and quantitative real-time polymerase chain reaction, respectively. To evaluate the effect of WS 1442 on the eNOS activity, the medium and intracellular nitrate/nitrite (NO) concentrations were also analyzed using a colorimetric Griess assay kit. The results demonstrated that TNF-α upregulated miR-155 expression and decreased eNOS expression and NO concentrations. WS 1442 also increased miR-155 expression and decreased eNOS expression but, unlike TNF-α, increased phosphorylated eNOS expression and NO concentrations. Surprisingly, WS 1442 increased miR-155 expression; however, WS 1442 mitigated the overall negative effect of miR-155 on decreasing eNOS expression by increasing expression of phosphorylated eNOS and resulting in an increase in NO concentrations. In the setting where miR-155 may be expressed, WS 1442 may offer vascular protection by increasing the expression of phosphorylated eNOS.
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Affiliation(s)
- Xinwen Wang
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Yan Liang
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
- The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Jian Shi
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Barry E Bleske
- Department of Pharmacy Practice & Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
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15
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Koenigsknecht MJ, Baker JR, Wen B, Frances A, Zhang H, Yu A, Zhao T, Tsume Y, Pai MP, Bleske BE, Zhang X, Lionberger R, Lee A, Amidon GL, Hasler WL, Sun D. In Vivo Dissolution and Systemic Absorption of Immediate Release Ibuprofen in Human Gastrointestinal Tract under Fed and Fasted Conditions. Mol Pharm 2017; 14:4295-4304. [PMID: 28937221 DOI: 10.1021/acs.molpharmaceut.7b00425] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In vivo drug dissolution in the gastrointestinal (GI) tract is largely unmeasured. The purpose of this clinical study was to evaluate the in vivo drug dissolution and systemic absorption of the BCS class IIa drug ibuprofen under fed and fasted conditions by direct sampling of stomach and small intestinal luminal content. Expanding current knowledge of drug dissolution in vivo will help to establish physiologically relevant in vitro models predictive of drug dissolution. A multilumen GI catheter was orally inserted into the GI tract of healthy human subjects. Subjects received a single oral dose of ibuprofen (800 mg tablet) with 250 mL of water under fasting and fed conditions. The GI catheter facilitated collection of GI fluid from the stomach, duodenum, and jejunum. Ibuprofen concentration in GI fluid supernatant and plasma was determined by LC-MS/MS. A total of 23 subjects completed the study, with 11 subjects returning for an additional study visit (a total of 34 completed study visits). The subjects were primarily white (61%) and male (65%) with an average age of 30 years. The subjects had a median [min, max] weight of 79 [52, 123] kg and body mass index of 25.7 [19.4, 37.7] kg/m2. Ibuprofen plasma levels were higher under fasted conditions and remained detectable for 28 h under both conditions. The AUC0-24 and Cmax were lower in fed subjects vs fasted subjects, and Tmax was delayed in fed subjects vs fasted subjects. Ibuprofen was detected immediately after ingestion in the stomach under fasting and fed conditions until 7 h after dosing. Higher levels of ibuprofen were detected in the small intestine soon after dosing in fasted subjects compared to fed. In contrast to plasma drug concentration, overall gastric concentrations remained higher under fed conditions due to increased gastric pH vs fasting condition. The gastric pH increased to near neutrality after feedingbefore decreasing to acidic levels after 7 h. Induction of the fed state reduced systemic levels but increased gastric levels of ibuprofen, which suggest that slow gastric emptying and transit dominate the effect for plasma drug concentration. The finding of high levels of ibuprofen in stomach and small intestine 7 h post dosing was unexpected. Future work is needed to better understand the role of various GI parameters, such as motility and gastric emptying, on systemic ibuprofen levels in order to improve in vitro predictive models.
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Affiliation(s)
- Mark J Koenigsknecht
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Jason R Baker
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Bo Wen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Ann Frances
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Huixia Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Alex Yu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Ting Zhao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Yasuhiro Tsume
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico , Albuquerque, New Mexico 87120, United States
| | - Xinyuan Zhang
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration , Silver Spring, Maryland 20993, United States
| | - Robert Lionberger
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration , Silver Spring, Maryland 20993, United States
| | - Allen Lee
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Gordon L Amidon
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - William L Hasler
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Duxin Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan , Ann Arbor, Michigan 48109, United States
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16
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Wang X, Rida N, Shi J, Wu AH, Bleske BE, Zhu HJ. A Comprehensive Functional Assessment of Carboxylesterase 1 Nonsynonymous Polymorphisms. Drug Metab Dispos 2017; 45:1149-1155. [PMID: 28838926 DOI: 10.1124/dmd.117.077669] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022] Open
Abstract
Carboxylesterase 1 (CES1) is the predominant human hepatic hydrolase responsible for the metabolism of many clinically important medications. CES1 expression and activity vary markedly among individuals; and genetic variation is a major contributing factor to CES1 interindividual variability. In this study, we comprehensively examined the functions of CES1 nonsynonymous single nucleotide polymorphisms (nsSNPs) and haplotypes using transfected cell lines and individual human liver tissues. The 20 candidate variants include CES1 nsSNPs with a minor allele frequency >0.5% in a given population or located in close proximity to the CES1 active site. Five nsSNPs, including L40Ter (rs151291296), G142E (rs121912777), G147C (rs146456965), Y170D (rs148947808), and R171C (rs201065375), were loss-of-function variants for metabolizing the CES1 substrates clopidogrel, enalapril, and sacubitril. In addition, A158V (rs202121317), R199H (rs2307243), E220G (rs200707504), and T290M (rs202001817) decreased CES1 activity to a lesser extent in a substrate-dependent manner. Several nsSNPs, includingL40Ter (rs151291296), G147C (rs146456965), Y170D (rs148947808), and R171C (rs201065375), significantly reduced CES1 protein and/or mRNA expression levels in the transfected cells. Functions of the common nonsynonymous haplotypes D203E-A269S and S75N-D203E-A269S were evaluated using cells stably expressing the haplotypes and a large set of the human liver. Neither CES1 expression nor activity was affected by the two haplotypes. In summary, this study revealed several functional nsSNPs with impaired activity on the metabolism of CES1 substrate drugs. Clinical investigations are warranted to determine whether these nsSNPs can serve as biomarkers for the prediction of therapeutic outcomes of drugs metabolized by CES1.
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Affiliation(s)
- Xinwen Wang
- Department of Clinical Pharmacy (X.W., N.R., J.S., H.-J.Z.) and Cardiovascular Center (A.H.W.), University of Michigan, Ann Arbor, Michigan; and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Nada Rida
- Department of Clinical Pharmacy (X.W., N.R., J.S., H.-J.Z.) and Cardiovascular Center (A.H.W.), University of Michigan, Ann Arbor, Michigan; and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Jian Shi
- Department of Clinical Pharmacy (X.W., N.R., J.S., H.-J.Z.) and Cardiovascular Center (A.H.W.), University of Michigan, Ann Arbor, Michigan; and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Audrey H Wu
- Department of Clinical Pharmacy (X.W., N.R., J.S., H.-J.Z.) and Cardiovascular Center (A.H.W.), University of Michigan, Ann Arbor, Michigan; and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Barry E Bleske
- Department of Clinical Pharmacy (X.W., N.R., J.S., H.-J.Z.) and Cardiovascular Center (A.H.W.), University of Michigan, Ann Arbor, Michigan; and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy (X.W., N.R., J.S., H.-J.Z.) and Cardiovascular Center (A.H.W.), University of Michigan, Ann Arbor, Michigan; and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
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17
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Remington TL, Bleske BE, Bartholomew T, Dorsch MP, Guthrie SK, Klein KC, Tingen JM, Wells TD. Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course. Am J Pharm Educ 2017; 81:55. [PMID: 28496275 PMCID: PMC5423071 DOI: 10.5688/ajpe81355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/19/2016] [Indexed: 05/15/2023]
Abstract
Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.
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Affiliation(s)
| | - Barry E Bleske
- University of New Mexico College of Pharmacy, Albuquerque, New Mexico
| | - Tracy Bartholomew
- Center for Research on Learning and Teaching, University of Michigan, Ann Arbor, Michigan
| | | | - Sally K Guthrie
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Kristin C Klein
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Jeffrey M Tingen
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Trisha D Wells
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
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18
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Affiliation(s)
- Paul J Hauptman
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Zackary D Goff
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Andrija Vidic
- Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - John T Chibnall
- Department of Psychiatry, Saint Louis University School of Medicine, St Louis, Missouri
| | - Barry E Bleske
- College of Pharmacy, University of New Mexico, Albuquerque
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19
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Albabtain M, Brenner MJ, Nicklas JM, Hummel SL, McCormick MP, Pawlowski JL, Remington TL, Gure TR, Dorsch MP, Bleske BE. Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population. Med Sci Monit 2016; 22:4978-4985. [PMID: 27988787 PMCID: PMC5193121 DOI: 10.12659/msm.898538] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The association of hyponatremia with cognitive impairment and mobility in heart failure (HF) patients is unknown. The purpose of this study was to determine if hyponatremia is associated with cognitive and mobility impairment as measured by simple, validated, and time-sensitive tests. Material/Methods This was a prospective study in patients with reduced and preserved ejection fraction (HFrEF, HFpEF) seen in outpatient HF clinics. Hyponatremia was defined as sodium level ≤136 mEq/L. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) tool, and mobility was measured with the Timed Up and Go test (TUG-t). Results A total of 121 patients were evaluated; 30% were hyponatremic (134±1.9 mEq/l, range 128–136 mEq/l). Overall, 92% of hyponatremic patients had cognitive impairment (MoCA <26) compared to 76% of the non-hyponatremic patients [relative risk 1.2 (confidence interval: 1.02–1.4, p=0.02)]. In regard to mobility, 72% of hyponatremic patients and 62% of non-hyponatremic patients (p=0.4) had TUG-t times that were considered to be worse than average. A total of 84% (N=76) of HFrEF and 71% (N=22) of HFpEF patients had cognitive impairment (p=0.86). HFrEF patients had significantly lower overall MoCA scores (21.2±3.7 vs. 23.3±3.6, p=0.006) and similar TUG-t times compared to HFpEF patients. Conclusions Most heart failure patients (HFrEF and HFpEF) seen in an ambulatory setting had impairment of cognitive function and mobility, with a higher prevalence among those with hyponatremia. Screening can be done using tests that can be administered in a clinical setting.
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Affiliation(s)
- Monirah Albabtain
- Department of Pharmacy, Prince Sultan Military Medical City, Riyad, Saudi Arabia
| | | | - John M Nicklas
- Division of Cardiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Scott L Hummel
- Division of Cardiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | | | | | - Tami L Remington
- College of Pharmacy and Health System, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael P Dorsch
- College of Pharmacy and Health System, University of Michigan, Ann Arbor, MI, USA
| | - Barry E Bleske
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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20
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Tyler CR, Zychowski KE, Sanchez BN, Rivero V, Lucas S, Herbert G, Liu J, Irshad H, McDonald JD, Bleske BE, Campen MJ. Surface area-dependence of gas-particle interactions influences pulmonary and neuroinflammatory outcomes. Part Fibre Toxicol 2016; 13:64. [PMID: 27906023 PMCID: PMC5131556 DOI: 10.1186/s12989-016-0177-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/25/2016] [Indexed: 11/29/2022] Open
Abstract
Background Deleterious consequences of exposure to traffic emissions may derive from interactions between carbonaceous particulate matter (PM) and gaseous components in a manner that is dependent on the surface area or complexity of the particles. To determine the validity of this hypothesis, we examined pulmonary and neurological inflammatory outcomes in C57BL/6 and apolipoprotein E knockout (ApoE−/−) male mice after acute and chronic exposure to vehicle engine-derived particulate matter, generated as ultrafine (UFP) and fine (FP) sizes, with additional exposures using UFP or FP combined with gaseous copollutants derived from fresh gasoline and diesel emissions, labeled as UFP + G and FP + G. Results The UFP and UFP + G exposure groups resulted in the most profound pulmonary and neuroinflammatory effects. Phagocytosis of UFP + G particles via resident alveolar macrophages was substantial in both mouse strains, particularly after chronic exposure, with concurrent increased proinflammatory cytokine expression of CXCL1 and TNFα in the bronchial lavage fluid. In the acute exposure paradigm, only UFP and UFP + G induced significant changes in pulmonary inflammation and only in the ApoE−/− animals. Similarly, acute exposure to UFP and UFP + G increased the expression of several cytokines in the hippocampus of ApoE−/− mice including Il-1β, IL-6, Tgf-β and Tnf-α and in the hippocampus of C57BL/6 mice including Ccl5, Cxcl1, Il-1β, and Tnf-α. Interestingly, Il-6 and Tgf-β expression were decreased in the C57BL/6 hippocampus after acute exposure. Chronic exposure to UFP + G increased expression of Ccl5, Cxcl1, Il-6, and Tgf-β in the ApoE−/− hippocampus, but this effect was minimal in the C57BL/6 mice, suggesting compensatory mechanisms to manage neuroinflammation in this strain. Conclusions Inflammatory responses the lung and brain were most substantial in ApoE−/− animals exposed to UFP + G, suggesting that the surface area-dependent interaction of gases and particles is an important determinant of toxic responses. As such, freshly generated UFP, in the presence of combustion-derived gas phase pollutants, may be a greater health hazard than would be predicted from PM concentration, alone, lending support for epidemiological findings of adverse neurological outcomes associated with roadway proximity. Electronic supplementary material The online version of this article (doi:10.1186/s12989-016-0177-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina R Tyler
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Katherine E Zychowski
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Bethany N Sanchez
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Valeria Rivero
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Selita Lucas
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Guy Herbert
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - June Liu
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Hammad Irshad
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | - Barry E Bleske
- Department of Pharmacy Practice & Administrative Sciences, The University of New Mexico, Albuquerque, NM, USA
| | - Matthew J Campen
- Department of Pharmaceutical Sciences, The University of New Mexico College of Pharmacy, Albuquerque, NM, USA.
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21
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Bleske BE, Remington TL, Wells TD, Klein KC, Guthrie SK, Tingen JM, Marshall VD, Dorsch MP. A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes. Am J Pharm Educ 2016; 80:120. [PMID: 27756928 PMCID: PMC5066923 DOI: 10.5688/ajpe807120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 05/22/2023]
Abstract
Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.
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Affiliation(s)
- Barry E. Bleske
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
- University of New Mexico College of Pharmacy, Albuquerque, New Mexico (at time of publication)
| | | | - Trisha D. Wells
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | | | | | - Jeffrey M. Tingen
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
- University of Virginia Health System, Charlottesville, Virginia (at time of publication)
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Bleske BE, Cornish LA, Erickson SR, Nicklas JM. Evaluation of ACE Inhibitor Therapy for Congestive Heart Failure in an Outpatient Setting. J Pharm Technol 2016. [DOI: 10.1177/875512259801400106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Angiotensin-converting enzyme (ACE) inhibitor therapy is considered the standard of care for the treatment of congestive heart failure. Despite this, clinical experience suggests that not all patients may be receiving ACE inhibitor therapy or may be receiving low dosages. This study was performed to better understand the use of ACE inhibitor therapy in clinical practice. Design and Participants: We reviewed the medical therapy of 110 patients with a history of congestive heart failure referred to an outpatient heart failure clinic at a university teaching hospital. Outcome Measures: This observational study evaluated the use of ACE inhibitors, including dosage, as well as other drugs to treat congestive heart failure. Results: Approximately 85% (93/110) of patients were receiving an ACE inhibitor. Twenty percent (22/110) were receiving enalapril 20 mg/d or more, captopril 150 mg/d or more, lisinopril 20 mg/d or more, or quinapril 40 mg/d or more. The remaining patients (n = 71) were receiving these drugs at lower dosages. However, 21 of the remaining patients (19% of all patients) were receiving lower dosages based on patient-specific parameters; 47 of the remaining patients (43% of all patients) were eligible to have their dosage increased. Ten eligible patients were not receiving an ACE inhibitor. The majority of patients were also receiving digoxin (70%) and loop diuretic (80%) therapy. Conclusions: Approximately 85% of patients were receiving ACE inhibitor therapy, with 9% of eligible patients not receiving an ACE inhibitor. In the patients receiving ACE inhibitor therapy, approximately 50% (47/93) were receiving dosages below those suggested in the guidelines. Overall, the use of ACE inhibitor therapy is varied and intervention appears required to ensure that all patients receive appropriate therapy for the treatment of congestive heart failure.
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Shi J, Wang X, Nguyen JH, Bleske BE, Liang Y, Liu L, Zhu HJ. Dabigatran etexilate activation is affected by the CES1 genetic polymorphism G143E (rs71647871) and gender. Biochem Pharmacol 2016; 119:76-84. [PMID: 27614009 DOI: 10.1016/j.bcp.2016.09.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
The oral anticoagulant prodrug dabigatran etexilate (DABE) is sequentially metabolized by intestinal carboxylesterase 2 (CES2) and hepatic carboxylesterase 1 (CES1) to form its active metabolite dabigatran (DAB). A recent genome-wide association study reported that the CES1 single nucleotide polymorphisms (SNPs) rs2244613 and rs8192935 were associated with lower DAB plasma concentrations in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) study participants. In addition, gender differences in exposure to DAB were observed in clinical studies. The aim of this study was to examine the effect of CES1 genetic polymorphisms and gender on DABE activation using several in vitro approaches. The genotypes of the CES1 SNPs rs2244613, rs8192935, and the known loss-of-function CES1 variant rs71647871 (G143E), and the activation of DABE and its intermediate metabolites M1 and M2 were determined in 104 normal human liver samples. DABE, M1, and M2 activations were found to be impaired in human livers carrying the G143E variant. However, neither rs2244613 nor rs8192935 was associated with the activation in human livers. The incubation study of DABE with supernatant fractions (S9) prepared from the G143E-transfected cells showed that the G143E is a loss-of-function variant for DABE metabolism. Moreover, hepatic CES1 activity on M2 activation was significantly higher in female liver samples than male. Our data suggest that CES1 genetic variants and gender are important contributing factors to variability in DABE activation in humans. A personalized DABE treatment approach based on patient-specific CES1 genotypes and sex may have the potential to improve the efficacy and safety of DABE pharmacotherapy.
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Affiliation(s)
- Jian Shi
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Xinwen Wang
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Jenny-Hoa Nguyen
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Barry E Bleske
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Yan Liang
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States; The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Li Liu
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States; The Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, United States.
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Bachyrycz A, Shrestha S, Bleske BE, Tinker D, Bakhireva LN. Opioid overdose prevention through pharmacy-based naloxone prescription program: Innovations in health care delivery. Subst Abus 2016; 38:55-60. [PMID: 27164192 DOI: 10.1080/08897077.2016.1184739] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Given that opioid misuse/abuse and opioid overdose have reached epidemic proportions in the United States, expansion of naloxone access programs are desperately needed. The objective of this study was to describe emerging trends in naloxone rescue kit (NRK) prescription patterns by pharmacists in New Mexico as an example of a unique health care delivery system. METHODS The study presents cross-sectional analysis of the data on NRK prescriptions by pharmacists who received naloxone pharmacist prescriptive authority certification since 2013. Data were obtained from the Prevention of Opioid Overdose by New Mexico Pharmacists (POINt-Rx) Registry, maintained by the University of New Mexico and the New Mexico Pharmacists Association. RESULTS Since 2013, 133 NRKs prescribed by pharmacists have been reported to the POINt-Rx Registry. The mean age of the patients was 41.5 ± 12.0 years (range: 19-67 years), and 60.2% were female participants. Only 11.3% of the prescriptions were from pharmacists practicing in rural/mixed urban-rural areas. The majority of NRKs (89.5%) were first-time prescriptions. The most common reason for a NRK prescription was patient's request (56.4%), followed by a pharmacist's prescription of NRK due to high dose of prescription opioids (28.6%) and history of opioid misuse/abuse (15.0%). In addition to opioids, other frequently reported substances included alcohol (9.2%) and benzodiazepines (10.8%). More than a third of patients (38.5%) reported polysubstance use in the previous 72 hours. CONCLUSIONS These results indicate that patients at risk of opioid overdose might feel comfortable soliciting NRKs from a pharmacist. Participation of pharmacists in rural areas in the naloxone prescriptive authority highlight the opportunity for this novel health care delivery model in underserved areas; however, the program is clearly underutilized in these areas. Such a model can provide expanded patient access in community practices, whereas systematic efforts for uptake of the program by policy makers, communities, and pharmacists continue to be needed nationwide.
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Affiliation(s)
- Amy Bachyrycz
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA.,b Walgreens Pharmacy , Albuquerque , New Mexico , USA
| | - Shikhar Shrestha
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA
| | - Barry E Bleske
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA
| | - Dale Tinker
- c New Mexico Pharmacists Association , New Mexico , USA
| | - Ludmila N Bakhireva
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA.,d Department of Family and Community Medicine , School of Medicine, University of New Mexico , Albuquerque , New Mexico , USA.,e Division of Epidemiology and Biostatistics, Department of Internal Medicine , School of Medicine, University of New Mexico , Albuquerque , New Mexico , USA
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Shi J, Wang X, Nguyen J, Wu AH, Bleske BE, Zhu HJ. Sacubitril Is Selectively Activated by Carboxylesterase 1 (CES1) in the Liver and the Activation Is Affected by CES1 Genetic Variation. ACTA ACUST UNITED AC 2016; 44:554-9. [PMID: 26817948 DOI: 10.1124/dmd.115.068536] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/20/2016] [Indexed: 12/11/2022]
Abstract
Sacubitril was recently approved by the Food and Drug Administration for use in combination with valsartan for the treatment of patients with heart failure with reduced ejection fraction. As a prodrug, sacubitril must be metabolized (hydrolyzed) to its active metabolite sacubitrilat (LBQ657) to exert its intended therapeutic effects. Thus, understanding the determinants of sacubitril activation will lead to the improvement of sacubitril pharmacotherapy. The objective of this study was to identify the enzyme(s) responsible for the activation of sacubitril, and determine the impact of genetic variation on sacubitril activation. First, an incubation study of sacubitril with human plasma and the S9 fractions of human liver, intestine, and kidney was conducted. Sacubitril was found to be activated by human liver S9 fractions only. Moreover, sacubitril activation was significantly inhibited by the carboxylesterase 1 (CES1) inhibitor bis-(p-nitrophenyl) phosphate in human liver S9. Further incubation studies with recombinant human CES1 and carboxylesterase 2 confirmed that sacubitril is a selective CES1 substrate. The in vitro study of cell lines transfected with wild-type CES1 and the CES1 variant G143E (rs71647871) demonstrated that G143E is a loss-of-function variant for sacubitril activation. Importantly, sacubitril activation was significantly impaired in human livers carrying the G143E variant. In conclusion, sacubitril is selectively activated by CES1 in human liver. The CES1 genetic variant G143E can significantly impair sacubitril activation. Therefore, CES1 genetic variants appear to be an important contributing factor to interindividual variability in sacubitril activation, and have the potential to serve as biomarkers to optimize sacubitril pharmacotherapy.
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Affiliation(s)
- Jian Shi
- Department of Clinical Pharmacy (J.S., X.W., H.-J.Z.), and Department of Pharmaceutical Sciences (J.N.), University of Michigan, Ann Arbor, Michigan; Cardiovascular Center, University of Michigan Health Systems, Ann Arbor, Michigan (A.H.W.); and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Xinwen Wang
- Department of Clinical Pharmacy (J.S., X.W., H.-J.Z.), and Department of Pharmaceutical Sciences (J.N.), University of Michigan, Ann Arbor, Michigan; Cardiovascular Center, University of Michigan Health Systems, Ann Arbor, Michigan (A.H.W.); and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Jenny Nguyen
- Department of Clinical Pharmacy (J.S., X.W., H.-J.Z.), and Department of Pharmaceutical Sciences (J.N.), University of Michigan, Ann Arbor, Michigan; Cardiovascular Center, University of Michigan Health Systems, Ann Arbor, Michigan (A.H.W.); and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Audrey H Wu
- Department of Clinical Pharmacy (J.S., X.W., H.-J.Z.), and Department of Pharmaceutical Sciences (J.N.), University of Michigan, Ann Arbor, Michigan; Cardiovascular Center, University of Michigan Health Systems, Ann Arbor, Michigan (A.H.W.); and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Barry E Bleske
- Department of Clinical Pharmacy (J.S., X.W., H.-J.Z.), and Department of Pharmaceutical Sciences (J.N.), University of Michigan, Ann Arbor, Michigan; Cardiovascular Center, University of Michigan Health Systems, Ann Arbor, Michigan (A.H.W.); and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
| | - Hao-Jie Zhu
- Department of Clinical Pharmacy (J.S., X.W., H.-J.Z.), and Department of Pharmaceutical Sciences (J.N.), University of Michigan, Ann Arbor, Michigan; Cardiovascular Center, University of Michigan Health Systems, Ann Arbor, Michigan (A.H.W.); and Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, New Mexico (B.E.B.)
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Dorsch MP, Farris KB, Bleske BE, Koelling TM. A web application for self-monitoring improves symptoms in chronic systolic heart failure. Telemed J E Health 2015; 21:267-70. [PMID: 25654615 DOI: 10.1089/tmj.2014.0095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine if a Web application that promoted mindfulness of the progress of the chronic disease through self-monitoring improved quality of life in heart failure. MATERIALS AND METHODS This was a prospective single-center single-group study. Participants were instructed how to use the Web application and to perform self-monitoring daily for 12 weeks. A comprehensive physical exam, assessment of New York Heart Association (NYHA) class, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and an evaluation of self-management were performed in person at baseline and at 12 weeks. RESULTS Participants consisted of older (mean, 59 years), predominantly female (63%) adults with NYHA class II or III symptoms. NYHA classification (preintervention versus postintervention, 2.5±0.13 versus 2.0±0.13; p=0.0032) and MLHFQ score (55.7±4.6 versus 42.6±5.1, respectively; p=0.0078) improved over 12 weeks of self-monitoring. A trend toward improvement was also demonstrated in weight (preintervention versus postintervention, 209±9.6 pounds versus 207±9.4 pounds; by paired t test, p=0.389), number of times exercised per week (1.29±0.5 versus 2.5±0.6, respectively; p=0.3), and walk distance (572±147 yards versus 845±187 yards, respectively; p=0.119). Jugular venous distention (preintervention versus postintervention, 8.1±0.6 cm versus 6.7±0.3 cm; p=0.083) and peripheral edema (29.2% versus 16.7%, respectively; p=0.375) decreased after 12 weeks of self-monitoring via the Web application. CONCLUSIONS A Web application for self-monitoring heart failure over 12 weeks improved both NYHA classification and MLHFQ score. The trend in improved physical activity and physical exam support these outcomes. The number of patients reporting a sodium-restricted diet increased over the 12 weeks, which may have led to the positive findings.
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Affiliation(s)
- Michael P Dorsch
- 1 Department of Pharmacy Services, College of Pharmacy, University of Michigan Hospitals and Health Centers , Ann Arbor, Michigan
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Bleske BE, Dillman NO, Cornelius D, Ward JK, Burson SC, Diez HL, Pickworth KK, Bennett MS, Nicklas JM, Dorsch MP. Heart failure assessment at the community pharmacy level: A feasibility pilot study. J Am Pharm Assoc (2003) 2014; 54:634-41. [DOI: 10.1331/japha.2014.14039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bleske BE, Remington TL, Wells TD, Dorsch MP, Guthrie SK, Stumpf JL, Alaniz MC, Ellingrod VL, Tingen JM. Team-based learning to improve learning outcomes in a therapeutics course sequence. Am J Pharm Educ 2014; 78:13. [PMID: 24558281 PMCID: PMC3930237 DOI: 10.5688/ajpe78113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/27/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To compare the effectiveness of team-based learning (TBL) to that of traditional lectures on learning outcomes in a therapeutics course sequence. DESIGN A revised TBL curriculum was implemented in a therapeutic course sequence. Multiple choice and essay questions identical to those used to test third-year students (P3) taught using a traditional lecture format were administered to the second-year pharmacy students (P2) taught using the new TBL format. ASSESSMENT One hundred thirty-one multiple-choice questions were evaluated; 79 tested recall of knowledge and 52 tested higher level, application of knowledge. For the recall questions, students taught through traditional lectures scored significantly higher compared to the TBL students (88%±12% vs. 82%±16%, p=0.01). For the questions assessing application of knowledge, no differences were seen between teaching pedagogies (81%±16% vs. 77%±20%, p=0.24). Scores on essay questions and the number of students who achieved 100% were also similar between groups. CONCLUSION Transition to a TBL format from a traditional lecture-based pedagogy allowed P2 students to perform at a similar level as students with an additional year of pharmacy education on application of knowledge type questions. However, P3 students outperformed P2 students regarding recall type questions and overall. Further assessment of long-term learning outcomes is needed to determine if TBL produces more persistent learning and improved application in clinical settings.
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Dorsch MP, Nemerovski CW, Ellingrod VL, Cowger JA, Dyke DB, Koelling TM, Wu AH, Aaronson KD, Simpson RU, Bleske BE. Vitamin D receptor genetics on extracellular matrix biomarkers and hemodynamics in systolic heart failure. J Cardiovasc Pharmacol Ther 2014; 19:439-45. [PMID: 24500905 DOI: 10.1177/1074248413517747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Vitamin D deficiency has been associated with the development of myocardial hypertrophy and inflammation. These findings suggest that vitamin D status and vitamin D receptor (VDR) genomics may play a role in myocardial fibrosis. The aim of this pilot study was to determine the association between vitamin D levels, VDR polymorphisms, and biomarkers of left ventricular remodeling and hemodynamics. METHODS In a cross-sectional pilot study, patients with ejection fraction (EF) <40% (and New York Heart Association ≥ II) undergoing right heart catheterization were included in the study. Blood was collected for determination of 25-hydroxyvitamin D level (antibody competitive immunoassay), VDR genotypes (BsmI, ApaI, TaqI, and FokI), and biomarkers (N-terminal propeptide of collagen type III [PIIINP], matrix metalloproteinase 2, and galectin 3). The vitamin D genotypes were determined through the use of pyrosequencing. RESULTS A total of 30 patients with a mean EF of 17% ± 8% were enrolled. There was a significant association between the BsmI C allele, ApaI G allele, and TaqI A allele, which formed a haplotype block (CGA) for analysis. There were no differences in baseline parameters between patients with the VDR haplotype block (n = 20) and those without (n = 10). Individual genotypes were not associated with any biomarker or hemodynamics. Patients with the CGA haplotype demonstrated significantly higher log PIIINP values (1.74 ± 0.32 mcg/mL vs 1.36 ± 0.31 mcg/mL, P = .0041). When evaluating vitamin D levels below and above the median level (19 ng/mL), there was no significant difference between these 2 groups in regard to biomarker levels for left ventricular remodeling. CONCLUSION This study has shown that a biomarker for collagen type III synthesis, PIIINP, was associated with the CGA haplotype of BsmI, ApaI, and TaqI single nucleotide polymorphisms on the VDR. These findings suggest that VDR genetics may play a role in myocardial fibrosis in patients with systolic heart failure.
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Affiliation(s)
- Michael P Dorsch
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, Michigan, USA
| | | | - Vicki L Ellingrod
- Department of Clinical and Social Administrative Sciences, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
| | | | - D Bradley Dyke
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Todd M Koelling
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Audrey H Wu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Keith D Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Robert U Simpson
- Department of Pharmacology, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Barry E Bleske
- Department of Clinical and Social Administrative Sciences, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
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Abstract
Heart failure (HF) often presents as dyspnea either with exertion and/or recumbency. Patients also experience dependent swelling and fatigue. Measurement of the left ventricular ejection fraction (LVEF) identifies HF patients who may respond to pharmacologic therapy and/or electrophysiologic device implantation. Angiotension converting enzyme inhibitors, beta blockers, and aldosterone inhibitors can significantly lower the mortality and morbidity of HF in patients with an LVEF less than 35%. Cardiac defibrillators and biventricular pacemakers can also improve outcomes in selected patients with a decreased LVEF. The authors provide a guide for therapeutic decisions based on the inclusion criteria of the major clinical trials.
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Affiliation(s)
- John M Nicklas
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1600 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
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Bleske BE, Cornelius D, Ward JK, Burson SC, Pickworth KK, Bennett MS, Diez HL, Dorsch MP, Nicklas JM. Heart Failure Assessment at the Community Pharmacy Level - A Feasibility Pilot Study. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Clarke MM, Dorsch MP, Kim S, Aaronson KD, Koelling TM, Bleske BE. Baseline albumin is associated with worsening renal function in patients with acute decompensated heart failure receiving continuous infusion loop diuretics. Pharmacotherapy 2013; 33:583-8. [PMID: 23553379 DOI: 10.1002/phar.1241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVES To identify baseline predictors of worsening renal function (WRF) in an acute decompensated heart failure (ADHF) patient population receiving continuous infusion loop diuretics. DESIGN Retrospective observational analysis. SETTING Academic tertiary medical center. PATIENTS A total of 177 patients with ADHF receiving continuous infusion loop diuretics from January 2006 through June 2009. MEASUREMENTS AND MAIN RESULTS The mean patient age was 61 years, 63% were male, ~45% were classified as New York Heart Association functional class III, and the median length of loop diuretic infusion was 4 days. Forty-eight patients (27%) developed WRF, and 34 patients (19%) died during hospitalization. Cox regression time-to-event analysis was used to determine the time to WRF based on different demographic and clinical variables. Baseline serum albumin 3 g/dl or less was the only significant predictor of WRF (hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.60-5.16, p=0.0004), which remained significant despite adjustments for other covariates. CONCLUSION Serum albumin 3 g/dl or less is a practical baseline characteristic associated with the development of WRF in patients with ADHF receiving continuous infusion loop diuretics.
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Affiliation(s)
- Megan M Clarke
- Department of Pharmacy Services, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
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Lose JM, Dorsch MP, Bleske BE. Evaluation of Proprotein Convertase Subtilisin/Kexin Type 9: Focus on Potential Clinical and Therapeutic Implications for Low-Density Lipoprotein Cholesterol Lowering. Pharmacotherapy 2013; 33:447-60. [DOI: 10.1002/phar.1222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer M. Lose
- Department of Pharmacy; University of Michigan Hospitals and Health Centers; Ann Arbor; Michigan
| | - Michael P. Dorsch
- Department of Pharmacy; University of Michigan Hospitals and Health Centers; Ann Arbor; Michigan
| | - Barry E. Bleske
- University of Michigan College of Pharmacy; Ann Arbor; Michigan
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Tankanow R, Tamer HR, Streetman DS, Smith SG, Welton JL, Annesley T, Aaronson KD, Bleske BE. Interaction Study between Digoxin and a Preparation of Hawthorn (Crataegus oxyacantha). J Clin Pharmacol 2013. [DOI: 10.1177/0091270003253417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Foster DR, Yee S, Bleske BE, Carver PL, Shea MJ, Menon SS, Ramachandran C, Welage LS, Amidon GL. Lack of Interaction Between the Peptidomimetic Substrates Captopril and Cephradine. J Clin Pharmacol 2013; 49:360-7. [DOI: 10.1177/0091270008329554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bleske BE, Clark MM, Wu AH, Dorsch MP. The Effect of Continuous Infusion Loop Diuretics in Patients With Acute Decompensated Heart Failure With Hypoalbuminemia. J Cardiovasc Pharmacol Ther 2013; 18:334-7. [DOI: 10.1177/1074248412474347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Hypoalbuminemia is believed to decrease diuretic effectiveness and contribute to diuretic resistance that is observed in patients with nephrotic syndrome. Hypoalbuminemia is also seen in patients with acute decompensated heart failure (ADHF). However, the role of hypoalbuminemia on the effectiveness of continuous infusion diuretics in patients with ADHF is not known. Methods: To evaluate hypoalbuminemia (albumin ≤3 g/dL) and diuretic effectiveness, we performed a retrospective study in 162 patients admitted to a tertiary care center for treatment of ADHF over a 3-year period. All patients received continuous infusion diuretic for at least a 2-day time period. Results: A total of 33 patients were determined to have hypoalbuminemia. Average net urine output over a 2-day study period was similar between patients with and without hypoalbuminemia (−1462 ± 1734 vs −1233 ± 1560 mL, P = .46, respectively). In addition, diuretic doses (furosemide equivalent/24 hours) were similar between the 2 groups (788 ± 671 vs 778 ± 713 mg, P = .91, respectively) as was baseline serum creatinine (1.6 ± 0.6 vs 1.6 ± 0.6 mg/dL, P = .5, respectively). Conclusion: Overall, hypoalbuminemia did not decrease the diuretic effectiveness when measured by the net urine output in patients receiving continuous infusion diuretics for the treatment of ADHF.
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Affiliation(s)
- Barry E. Bleske
- Department of Clinical and Social Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacy Services, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Megan M. Clark
- Department of Pharmacy Services, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Audrey H. Wu
- Department of Internal Medicine, Division of Cardiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Michael P. Dorsch
- Department of Pharmacy Services, University of Michigan Health Systems, Ann Arbor, MI, USA
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Abstract
Azilsartan-chlorthalidone fixed combination is a new drug in the management of hypertension. Azilsartan has been shown to have greater blood pressure-lowering effects than other angiotensin-receptor blockers (ARBs), and the debate regarding the superiority of chlorthalidone over hydrochlorothiazide has been ongoing for years. The combination is unique because it is the first to partner an ARB with this, possibly more effective, diuretic. This review will address trials involving both components of this drug, as well as phase III trials involving the fixed-combination product. The article will also discuss the benefit of combination therapy in the treatment of hypertension.
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Affiliation(s)
- Jerrica E Shuster
- University of Michigan Hospitals and Health Centers, Ann Arbor, MI 48109, USA.
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38
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Chow SL, Singh H, DiDomenico RJ, Dunn SP, Johnson SG, Marrs JC, Vardeny O, Bleske BE. Key Articles Related to Complementary and Alternative Medicine in Cardiovascular Disease: Part 2. Pharmacotherapy 2011. [DOI: 10.1592/phco.31.10.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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39
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Bleske BE, Erickson SR, Fahoum S, Devarakonda KR, Welage LS, Koudmani M, Pantham N, Edwin SB, Devarakonda S, Shea MJ, Martha S, Khalidi N. Cardiovascular risk among university students from developed and developing nations. Open Cardiovasc Med J 2011; 5:117-22. [PMID: 21673835 PMCID: PMC3111723 DOI: 10.2174/1874192401105010117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 04/14/2011] [Accepted: 04/15/2011] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A key aspect in halting global increase in cardiovascular events is prevention and especially prevention at an early age. Unfortunately, global data regarding cardiovascular risk factors in the young are limited. Therefore the objectives of this study were to identify the most common cardiovascular risk factors among young adults in a university setting in both developed and developing countries. METHODS Lifestyle and cardiovascular risk factors (smoking status, rates of physical activity, alcohol use, family history, blood pressure, fasting lipid panel, fasting blood glucose) were prospectively evaluated in young adults at three different university settings [University of Michigan (Ann Arbor, USA), University of Kalamoon (Deratiah, Syria), and Kakatiya University (Warangal, India)]. RESULTS A total of 296 subjects (mean age and standard deviation 22 ± 3 years) were evaluated. Rates of current smoking were markedly higher (p < 0.001) in Syria (43%) compared with the USA (6.2%) and India (1.7%). Subjects in India were significantly (p < 0.001) less likely to engage in physical activity (20.2%) compared with the USA (90.7%) and Syria (68.8%). Fasting blood glucose levels and body mass index were significantly higher (p < 0.001) in Syria as compared to other countries. Significant differences were also noted in LDL, HDL, and triglycerides among the three sites. CONCLUSIONS Cardiovascular risk factors among young adults in a university setting vary depending on global setting. Based upon the results of this study, targeted interventional programs based on risk findings from individual countries may be a reasonable future strategy to help reduce long term cardiovascular morbidity and mortality.
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Affiliation(s)
- Barry E Bleske
- Department of Clinical and Social Administrative Sciences, College of Pharmacy, University of Michigan, USA
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40
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Abstract
There is significant controversy around whether chlorthalidone (CTD) is superior to hydrochlorothiazide (HCTZ) in hypertension management. The objective of this analysis was to evaluate the effects of CTD compared with HCTZ on cardiovascular event (CVE) rates. We performed a retrospective observational cohort study from the Multiple Risk Factor Intervention Trial data set from the National Heart, Lung, and Blood Institute. The Multiple Risk Factor Intervention Trial was a cardiovascular primary prevention trial where participants were men 35 to 57 years of age enrolled and followed beginning in 1973. CVEs were measured yearly, and time to event was assessed by Cox regression. Systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, potassium, glucose, and uric acid were measured yearly. The difference between groups was evaluated by repeated-measures mixed modeling, and each model was adjusted for predictors of each variable. CVEs were significantly lower in those on CTD (adjusted hazard ratio: 0.51 [95% CI: 0.43 to 0.61];
P
<0.0001) and on HCTZ (adjusted hazard ratio: 0.65 [95% CI: 0.55 to 0.75];
P
<0.0001) compared with those who took neither drug. When comparing the 2 drugs, CTD had significantly fewer CVEs compared with HCTZ (
P
=0.0016). CTD displayed significantly lower SBP (
P
<0.0001), lower total cholesterol (
P
<0.0001), lower low-density lipoprotein cholesterol (
P
=0.0009), lower potassium (
P
=0.0003), and higher uric acid (
P
<0.0001) over time compared with HCTZ. In conclusion, both HCTZ and CTD reduce CVEs compared with neither drug. When comparing both drugs, CTD reduces CVEs more than HCTZ, suggesting that CTD may be the preferred thiazide-type diuretic for hypertension in patients at high risk of CVEs.
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Affiliation(s)
- Michael P. Dorsch
- From the University of Michigan Health System (M.P.D.), Ann Arbor, MI; School of Public Health (B.W.G.), College of Pharmacy (S.R.E., B.E.B.), and Medical School (A.B.W.), University of Michigan, Ann Arbor, MI
| | - Brenda W. Gillespie
- From the University of Michigan Health System (M.P.D.), Ann Arbor, MI; School of Public Health (B.W.G.), College of Pharmacy (S.R.E., B.E.B.), and Medical School (A.B.W.), University of Michigan, Ann Arbor, MI
| | - Steven R. Erickson
- From the University of Michigan Health System (M.P.D.), Ann Arbor, MI; School of Public Health (B.W.G.), College of Pharmacy (S.R.E., B.E.B.), and Medical School (A.B.W.), University of Michigan, Ann Arbor, MI
| | - Barry E. Bleske
- From the University of Michigan Health System (M.P.D.), Ann Arbor, MI; School of Public Health (B.W.G.), College of Pharmacy (S.R.E., B.E.B.), and Medical School (A.B.W.), University of Michigan, Ann Arbor, MI
| | - Alan B. Weder
- From the University of Michigan Health System (M.P.D.), Ann Arbor, MI; School of Public Health (B.W.G.), College of Pharmacy (S.R.E., B.E.B.), and Medical School (A.B.W.), University of Michigan, Ann Arbor, MI
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Barnes MM, Dorsch MP, Hummel SL, Koelling TM, Bleske BE. Treatment of Heart Failure with Preserved Ejection Fraction. Pharmacotherapy 2011; 31:312-31. [DOI: 10.1592/phco.31.3.312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stout SM, Nielsen J, Bleske BE, Shea M, Brook R, Kerber K, Welage LS. The impact of paroxetine coadministration on stereospecific carvedilol pharmacokinetics. J Cardiovasc Pharmacol Ther 2010; 15:373-9. [PMID: 20705902 DOI: 10.1177/1074248410372926] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE to assess the impact of paroxetine coadministration on the stereoselective pharmacokinetic (PK) properties of carvedilol. DESIGN prospective, randomized, 2-phase crossover. SETTING the University of Michigan General Clinical Research Unit and Michigan Clinical Research Unit. PARTICIPANTS twelve healthy volunteers aged 18 to 45 years, male and female, receiving no treatment with prescription or nonprescription medications. INTERVENTIONS participants received single dose oral carvedilol (12.5 mg) with and without coadministration of immediate-release paroxetine (10 mg orally twice daily), in random order. Blood samples were collected at 0, 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6, 8, 10, 12, and 24 hours post-carvedilol dose for determination of R and S carvedilol plasma enantiomer concentrations by high pressure liquid chromatography. MEASUREMENTS AND MAIN RESULTS pharmacokinetic (PK) parameters were calculated for each enantiomer by noncompartmental methods and compared between study phases by analysis of variance (ANOVA) controlling for study phase order and subject, with Tukey's studentized range test post hoc. Area under the concentration-time curve (AUC) increased significantly with paroxetine coadministration, approximately 2.5-fold and 1.9-fold for the R and S enantiomers, respectively. R/S AUC ratio increased significantly, from approximately 2.3 to 3.0. Individual increases in enantiomeric AUCs with paroxetine coadministration ranged from 0% to 571% and changes in R/S ratio ranged from -8% to 108%. Heart rate, P-R interval, and blood pressure were monitored and no clinically significant changes in carvedilol effects were noted. CONCLUSION this study demonstrated a PK drug-drug interaction between paroxetine and carvedilol, with considerable interparticipant variability in carvedilol PK parameters and magnitude of drug interaction. Stereoselectivity of carvedilol metabolism is preserved with paroxetine coadministration, and R/S AUC ratio generally widens. Although this drug interaction could potentially increase adrenergic antagonism and have significant clinical effects in patients, these effects were not seen in our healthy volunteer participants.
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Affiliation(s)
- Stephen M Stout
- The University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
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43
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Stout SM, Nielsen J, Welage LS, Shea M, Brook R, Kerber K, Bleske BE. Influence of metoprolol dosage release formulation on the pharmacokinetic drug interaction with paroxetine. J Clin Pharmacol 2010; 51:389-96. [PMID: 20400652 DOI: 10.1177/0091270010365559] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies have demonstrated an influence of dosage release formulations on drug interactions and enantiomeric plasma concentrations. Metoprolol is a commonly used beta-adrenergic antagonist metabolized by CYP2D6. The CYP2D6 inhibitor paroxetine has previously been shown to interact with metoprolol tartrate. This open-label, randomized, 4-phase crossover study assessed the potential differential effects of paroxetine on stereoselective pharmacokinetics of immediate-release (IR) tartrate and extended-release (ER) succinate metoprolol formulations. Ten healthy participants received metoprolol IR (50 mg) and ER (100 mg) with and without paroxetine coadministration. Blood samples were collected over 24 hours for determination of metoprolol plasma enantiomer concentrations. Paroxetine coadministration significantly increased S and R metoprolol area under the plasma concentration-time curve from time 0 to the 24-hour blood draw (AUC(0-24h)) by 4- and 5-fold, respectively for IR, and 3- and 4-fold, respectively, for ER. S/R AUC ratios significantly decreased. These results demonstrate a pharmacokinetic interaction between paroxetine and both formulations of metoprolol. The interaction is greater with R metoprolol, and stereoselective metabolism is lost. This could theoretically result in greater beta-blockade and lost cardioselectivity. The magnitude of the interaction was similar between metoprolol formulations, which may be attributable to low doses/drug input rates employed.
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Affiliation(s)
- Stephen M Stout
- University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI 48109-1065, USA
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44
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Chow SL, Dorsch MP, Dunn SP, Jackevicius CA, Page RL, Trujillo T, Vardeny O, Wiggins B, Bleske BE. Key articles related to complementary and alternative medicine in cardiovascular disease: part 1. Pharmacotherapy 2010; 30:109. [PMID: 20030478 DOI: 10.1592/phco.30.1.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Complementary and alternative medicine (CAM) therapy has gained popularity in America over the past several years, reflected in the increased utilization of these agents. Given the abundance of nontraditional products available to the public, clinicians should be made aware of the existing evidence relating to CAM therapy to better provide patient care in a meaningful manner. This bibliography article compiled key articles specific to CAM therapy and cardiovascular disease, which include primary literature, review articles, consensus statements, and abstracts of landmark studies. Based on the numerous published reports available on this topic, this bibliography, as part 1 of 2, focuses on the efficacy of CAM therapy in cardiovascular disease.
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Affiliation(s)
- Sheryl L Chow
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, CA 91766, USA.
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Hwang HS, Boluyt MO, Converso K, Russell MW, Bleske BE. Effects of Hawthorn on the Progression of Heart Failure in a Rat Model of Aortic Constriction. Pharmacotherapy 2009; 29:639-48. [DOI: 10.1592/phco.29.6.639] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Wu Y, Zhang F, Wang Y, Krishnamoorthy M, Roy-Chaudhury P, Bleske BE, Meyerhoff ME. Photoinstability of S-nitrosothiols during sampling of whole blood: a likely source of error and variability in S-nitrosothiol measurements. Clin Chem 2008; 54:916-8. [PMID: 18443178 DOI: 10.1373/clinchem.2007.102103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The determination of reference intervals for the concentration of total S-nitrosothiols (RSNOs) in blood is a highly controversial topic, likely because of the inherent instability of these species. Most currently available techniques to quantify RSNOs in blood require considerable sample handling and multiple pretreatment steps during which light exposure is difficult to completely eliminate. We investigated the effect of brief light exposure on the stability of RSNO species in blood during the initial sampling process. METHODS A novel amperometric RSNO sensor, based on an immobilized organoselenium catalyst at the distal tip of an electrochemical nitric oxide detector, was used to determine RSNO species in diluted whole blood without centrifugation or pretreatment. Porcine blood was collected into aluminum foil-wrapped syringes via a 12-inch butterfly needle tube assembly. Two blood samples were collected from the same animal -- one with the butterfly needle tubing wrapped in aluminum foil and one with the tubing exposed to ambient room light. The RSNO concentrations in these sequential blood samples were determined by a standard addition procedure. RESULTS Eight sets of measurements were made in 6 animals. Samples exposed to light yielded RSNO concentrations only 23.6% (7.2%) [mean (SD)] of the RSNO concentrations determined in samples that were shielded from light and obtained from the same animals. CONCLUSIONS These results suggest significant photoinstablity of RSNOs in whole blood and indicate the critical importance of proper light protection during sampling and processing of blood samples for the accurate determinations of endogenous RSNO concentrations.
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Affiliation(s)
- Yiduo Wu
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109-1055, USA
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48
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Chavey WE, Bleske BE, Van Harrison R, Hogikyan RV, Kesterson SK, Nicklas JM. Pharmacologic management of heart failure caused by systolic dysfunction. Am Fam Physician 2008; 77:957-964. [PMID: 18441861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Heart failure caused by systolic dysfunction affects more than 5 million adults in the United States and is a common source of outpatient visits to primary care physicians. Mortality rates are high, yet a number of pharmacologic interventions may improve outcomes. Other interventions, including patient education, counseling, and regular self-monitoring, are critical, but are beyond the scope of this article. Angiotensin-converting enzyme inhibitors and beta blockers reduce mortality and should be administered to all patients unless contraindicated. Diuretics are indicated for symptomatic patients as needed for volume overload. Aldosterone antagonists and direct-acting vasodilators, such as isosorbide dinitrate and hydralazine, may improve mortality in selected patients. Angiotensin receptor blockers can be used as an alternative therapy for patients intolerant of angiotensin-converting enzyme inhibitors and in some patients who are persistently symptomatic. Digoxin may improve symptoms and is helpful for persons with concomitant atrial fibrillation, but it does not reduce cardiovascular or all-cause mortality. Serum digoxin levels should not exceed 1.0 ng per mL (1.3 nmol per L), especially in women.
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Affiliation(s)
- William E Chavey
- Department of Family Medicine, University ofMichigan, Ann Arbor, Michigan, USA.
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Hwang HS, Bleske BE, Ghannam MMJ, Converso K, Russell MW, Hunter JC, Boluyt MO. Effects of Hawthorn on Cardiac Remodeling and Left Ventricular Dysfunction after 1 Month of Pressure Overload-induced Cardiac Hypertrophy in Rats. Cardiovasc Drugs Ther 2008; 22:19-28. [DOI: 10.1007/s10557-008-6082-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 01/02/2008] [Indexed: 11/28/2022]
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50
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Bleske BE, Zineh I, Hwang HS, Welder GJ, Ghannam MMJ, Boluyt MO. Evaluation of hawthorn extract on immunomodulatory biomarkers in a pressure overload model of heart failure. Med Sci Monit 2007; 13:BR255-BR258. [PMID: 18049426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Hawthorn extract (Crataegeus sp.) a botanical complementary and alternative medicine is often used to treat heart failure. The mechanism(s) by which hawthorn extract may treat heart failure is unknown but may include, theoretically, immunological effects. Therefore, the purpose of this study is to determine the effect of hawthorn extract on the immunomodulatory response in a pressure overload model of heart failure. MATERIAL/METHODS A total of 62 male Sprague-Dawley rats were randomized to either aortic constriction + vehicle (AC; n=15), aortic constriction + hawthorn 1.3 mg/kg (HL, n=17), aortic constriction + hawthorn 13 mg/kg (HM, n=15), or aortic constriction + hawthorn 130 mg/kg (HH, n=15). Six months after surgical procedure animals were sacrificed and plasma samples obtained for the measurement of the following immunomodulatory markers: interleukin (IL) IL-1ss, IL-2, IL-6, IL-10; and leptin. RESULTS The mortality rate following 6 months of aortic constriction was 40% in the AC group compared to 41%, 60%, and 53% for the HL, HM, and HH groups respectively (P>0.05 compared to AC). Aortic constriction produced a similar increase in the left ventricle/body weight ratio for all groups. Hawthorn extract had no effect on the immunomodulatory markers measured in this study, although there appeared to be a trend suggesting suppression of IL-2 plasma concentrations. CONCLUSIONS In this animal model of heart failure, hawthorn extract failed to significantly affect the immunomodulatory response characterized after 6 months of pressure overload at a time when approximately 50% mortality was exhibited. Mechanisms other than immunological may better define hawthorn's effect in treating heart failure.
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Affiliation(s)
- Barry E Bleske
- College of Pharmacy, University of Michigan, Ann Arbor, MI 48109-1065, USA
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