St. Louis, MO, United States

St. Louis College of Pharmacy
St. Louis, MO, United States

St. Louis College of Pharmacy is a private and independent nonsectarian professional university in St. Louis, Missouri. It was founded in 1864. Located on a five acre campus in St. Louis' Central West End medical community, the St. Louis College of Pharmacy is the oldest college of pharmacy west of the Mississippi River. The College’s 6,000 living alumni represent 50 states and 11 foreign countries. Approximately 72 percent of practicing pharmacists in the St. Louis region are graduates of St. Louis College of Pharmacy.The College admits students directly from high school and integrates the liberal arts and science with a six-year professional curriculum leading to the PharmD degree. In 2014, the College will be expanding to a seven-year program which will allow students to obtain a Bachelor of Science degree after four academic years.Enrollment is currently at 1,260 students, with incoming freshmen classes of approximately 250 students. These students are taken directly from high school, with a handful of applicants allowed to transfer each year until the third year of the program. St. Louis College of Pharmacy is accredited by both the Accreditation Council for Pharmacy Education as well as the Higher Learning Commission North Central Association of Colleges and Schools, both out of Chicago. St. Louis College of Pharmacy is consistently ranked as one of the best and most respected pharmacy schools in the country. Wikipedia.

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Acquired von Willebrand disease increases bleeding risk in patients implanted with a continuous-flow left ventricular assist device. Lower aspirin doses decrease the risk of bleeding without an increased risk of embolic events. No published studies in the U.S. have compared the incidence of bleeding and thrombotic events between antithrombotic regimens with and without aspirin. A single-center, retrospective analysis was conducted of adult patients implanted with a HM II. Patients received warfarin and aspirin 81 mg daily or warfarin alone. The primary endpoint was a composite of death, bleeding events, and thrombotic events from the date of HM II implantation to first event or 18 months. Secondary endpoints included the individual components of the primary endpoint and the proportion of patients alive with HM II or transplanted. The Wilcoxon rank-sum test and Fisher’s exact test were utilized for statistical analysis. Of the seventy-six patients meeting inclusion criteria, 44 received warfarin and aspirin and 32 received warfarin alone. Baseline characteristics were similar between groups. Warfarin alone was not associated with an increased risk of the primary composite outcome (53% versus 59%, respectively, p=0.64). No significant difference was observed in any bleeding event (34% versus 43%, respectively, p=0.48) nor any thrombotic event (9% versus 11%, respectively, p=1.00) with warfarin alone compared to warfarin and aspirin. Elimination of antiplatelet therapy from the HM II antithrombotic regimen was associated with no significant difference in the composite outcome of bleeding events, thrombotic events, or death, nor the individual components of each endpoint. Copyright © 2017 by the American Society for Artificial Internal Organs

McCall R.P.,St. Louis College of Pharmacy
Physics Teacher | Year: 2013

Systematic errors can cause measurements to deviate from the actual value of the quantity being measured. Faulty equipment (such as a meterstick that is not marked correctly), inaccurate calibration of measuring devices (such as a scale to measure mass that has not been properly zeroed), and improper use of equipment by the experimenter (such as misinterpreting the range of a voltmeter) are all examples of systematic errors. Some systematic errors are constant, whereas others are proportional to some quantity that changes in the experiment (whether that quantity is being measured or not). Systematic errors in a variety of laboratory exercises have been described in articles in The Physics Teacher1-8. © 2013 American Association of Physics Teachers.

Boyer A.F.,University of Washington | Schoenberg N.,University of Washington | Babcock H.,University of Washington | Micek S.T.,St. Louis College of Pharmacy | Kollef M.H.,University of Washington
Chest | Year: 2015

Background: The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available. Methods: This study was a prospective 12-month cohort study (January 2013 to December 2013). Results: We prospectively surveyed 1,209 patients ventilated for ≥ 2 calendar days. Sixty-seven VACs were identified (5.5%), of which 34 (50.7%) were classified as an infection-related VAC (IVAC) with corresponding rates of 7.0 and 3.6 per 1,000 ventilator days, respectively. The mortality rate of patients having a VAC was significantly greater than that of patients without a VAC (65.7% vs 14.4%, P < .001). The most common causes of VACs included IVACs (50.7%), ARDS (16.4%), pulmonary edema (14.9%), and atelectasis (9.0%). Among IVACs, 44.1% were probable VAP and 17.6% were possible VAP. Twenty-five VACs (37.3%) were adjudicated to represent potentially preventable events. Eighty-six episodes of VAP occurred in 84 patients (10.0 of 1,000 ventilator days) during the study period. The sensitivity of the VAC criteria for the detection of VAP was 25.9% (95% CI, 16.7%-34.5%). Conclusions: Although relatively uncommon, VACs are associated with greater mortality and morbidity when they occur. Most VACs represent nonpreventable events, and the VAC criteria capture a minority of VAP episodes. © 2015 American College Of Chest Physicians.

News Article | February 17, 2017

Washington University in St. Louis is collaborating with the biopharmaceutical company Pfizer Inc. on research aimed at speeding the development of new drugs. The university is the first academic institution in the Midwest to join Pfizer’s Centers for Therapeutic Innovation’s (CTI) collaborative network. The new collaboration is aimed at supporting translational research that has the greatest potential to bring innovative therapies to patients. The collaboration will focus on certain rare diseases, as well as on immunology and inflammation, oncology, neuroscience, and cardiovascular and metabolic diseases. In particular, the program will focus on approaches that involve large-molecule therapeutics and antibodies that have the potential to address multiple diseases. “We are excited to be combining the resources and expertise of Pfizer scientists with the talents of our Washington University faculty in this effort to develop the next generation of therapeutics,” said Jennifer K. Lodge, Ph.D., vice chancellor for research at Washington University and a professor of molecular microbiology at the School of Medicine. “With our strength in basic science and translational research and the expertise of Pfizer in drug development, the new collaboration could help St. Louis and our region become even better positioned to make major contributions to benefit patients.” CTI brings together academic and National Institutes of Health (NIH) researchers with Pfizer scientists and patient foundations, to collaborate in drug discovery in broad areas of interest to the global pharmaceutical maker. “We look forward to beginning this new collaboration with Washington University,” said Anthony Coyle, Ph.D., senior vice president and CTI’s chief scientific officer. “Washington University’s world-class scientific expertise is an excellent addition to CTI’s network of academic collaborators, and CTI is proud to complement Pfizer’s long-standing relationship with this institution.” As part of the collaboration, Washington University researchers will be able to apply for funding to support research projects aimed at drug discovery. A joint steering committee made up of Washington University researchers and Pfizer scientists will be responsible for selecting the research projects and tracking their progress. If the steering committee selects a project, the project team would have access to Pfizer’s resources, scientific equipment and opportunities to collaborate with Pfizer scientists, who have extensive expertise in drug development and protein science. “I am pleased that our faculty will be able to participate in this program and have the potential to work on important projects in collaboration with Pfizer,” said David H. Perlmutter, M.D., executive vice chancellor for medical affairs and dean of the School of Medicine. “We are moving into an era in which academic-industry collaborations could capitalize on our considerable research talents and activities and, by collaborating with outstanding pharmaceutical companies like Pfizer, we can facilitate our goal of getting new drugs to patients as soon as possible.” The Washington University faculty serving on the joint steering committee include Karen Seibert, Ph.D., a professor of anesthesiology and of pathology and immunology and of genetics; Michael S. Kinch, Ph.D., associate vice chancellor and director of Washington University’s Center for Research Innovation in Business; Thaddeus S. Stappenbeck, M.D., Ph.D., the Conan Professor of Laboratory and Genomic Medicine; Leena M. Prabhu, Ph.D., associate director of Washington University’s Office of Technology Management; and Patricia J. Gregory, Ph.D., assistant vice chancellor and executive director of corporate and foundation relations. “This kind of collaboration between academic medical centers and private industry holds great potential for identifying the best ideas and moving them through the research pipeline as quickly as possible,” said Seibert, who served as vice president of research and development for Pfizer at the company’s St. Louis site before joining Washington University. “The fact that Pfizer has a long history of operating in St. Louis with well-established laboratories, equipment and a local team of experienced scientists means we have the potential to begin our collaborations and joint projects right away,” added Seibert, who also co-directs the Center for Clinical Pharmacology, which is a collaboration between the St. Louis College of Pharmacy and the School of Medicine.

News Article | October 10, 2016

Many children with sickle cell disease experience frequent and severe pain episodes, requiring emergency room visits or hospitalization. In search of more effective ways to treat such pain, researchers at Washington University School of Medicine in St. Louis have found that adding a low dose of the drug methadone to standard treatment can limit pain experienced by children with the condition. The study is available online in the journal Pediatric Blood & Cancer. “More than half of sickle cell patients have at least one episode of significant pain every year, and about 20 percent experience multiple episodes each year that require hospital stays,” said first author Jennifer Horst, M.D., an instructor of pediatrics at the School of Medicine and an emergency room physician at St. Louis Children’s Hospital. “In this study, the pediatric patients who received a one-time dose of methadone rated their pain levels much lower than those who took standard pain-killing drugs. In many cases, their pain went away, so we believe methadone has the potential to make life better for these pediatric patients.” The researchers followed 24 children and 23 adults who were hospitalized after suffering episodes of severe sickle cell pain. Patients are treated with pain-killing drugs, usually opioids such as morphine, until their pain is under control. In this study, the researchers gave half of the patients a single, low dose of the long-duration opioid methadone. The result was that many of them then needed lower amounts than usual of other opioid drugs to control their pain. Severe pain occurs when the shape of red blood cells becomes sickle-like in shape, making it more difficult for the cells to flow through blood vessels. As a result, the red blood cells don’t supply enough oxygen to tissues in the body that need it. Horst and senior investigator Evan D. Kharasch, M.D., Ph.D., the Russell D. and Mary B. Shelden Professor of Anesthesiology, compared pain relief in patients given morphine with pain relief in those whose treatments were supplemented with methadone. Morphine is the standard painkiller prescribed to sickle cell patients. Methadone also frequently is used to treat pain, particularly in patients having surgery or those with cancer. The latter drug also is used in detoxification and maintenance therapy for individuals who are dependent on opioid drugs, including heroin. Study patients who did not receive methadone were given morphine to treat their pain. All of the patients in the study were able to regulate the amount of pain-killing drugs they received. The children who received methadone rated their pain lower on a standard scale that indicated no pain to severe pain. They also rated their pain relief as better, at 7 to 8 on a scale of 1 to 10, while those who didn’t get methadone rated their pain relief at around 4 or 5 during the first 72 hours of their hospital stays. In adults, however, pain relief linked to methadone was not statistically significant. Kharasch — also a professor of biochemistry and molecular biophysics and director of the Center for Clinical Pharmacology, a research center operated by St. Louis College of Pharmacy and the School of Medicine — said the problem in adults may have been that their doses were too low. “Because adult patients have lived with sickle cell disease their entire lives, it’s possible they develop a tolerance to pain medications, and pain-killing drugs, including methadone, become generally less effective,” he said. “However, we wanted to make sure methadone was safe to use in sickle cell patients, so we actually gave very low doses of the drug. That might be why the adults didn’t register the same improvements in pain scores.” Kharasch and Horst said methadone may help relieve pain from sickle cell disease because the drug has pain-killing properties that are different from morphine and because it remains in the body longer. “Methadone has a faster onset and lasts longer than other, typical pain medicines, so we think it may be useful in getting some patients relief before they have to be hospitalized,” Horst said. “We’d like to treat pain more quickly, especially in children, so that their pain crises can be resolved more quickly and they can go home sooner. Children who come in several times a year can miss a lot of school. That affects their quality of life.” Horst and Kharasch believe they have demonstrated that the drug can be used safely in children but said they will have to study larger numbers of kids and adults before determining whether methadone can be incorporated as a standard treatment for sickle cell-related pain. They also believe larger studies could help establish the most effective doses of the drug in children and adults. In addition, they plan to evaluate whether treating patients with methadone in the emergency department might potentially prevent the need for hospitalization in some patients.

Hardesty J.S.,St. Louis College of Pharmacy | Juang P.,St. Louis College of Pharmacy
Pharmacotherapy | Year: 2011

Clostridium difficile is an emerging pathogen in certain health care systems and community-based populations that is associated with high rates of morbidity and mortality, as well as increased costs for the health care system. As recurrence rates increase, new pharmacologic agents to treat C. difficile infection are needed. Fidaxomicin, a novel macrocyclic antibiotic, was recently approved by the United States Food and Drug Administration for the treatment of C. difficile-associated diarrhea. Originally isolated from fermentation broth of Dactylosporangium aurantiacum subspecies hamdenensis, the drug has a selective spectrum, distinctive pharmacokinetic and pharmacodynamic properties, and a favorable adverse-effect profile. Fidaxomicin has demonstrated similar clinical cure rates (i.e., resolution of diarrhea) compared with vancomycin, with lower recurrence rates and higher global cure rates (i.e., resolution of diarrhea without recurrence) in non-restriction endonuclease analysis type BI, North American Pulsed Field type 1 (NAP1), polymerase chain reaction ribotype 027 (or non-BI/NAP1/027) strains. Overall, fidaxomicin has been generally well tolerated, with the most common adverse effects reported as mild gastrointestinal complaints. Fidaxomicin appears to be a useful agent in the treatment of severe C. difficile infection, demonstrating decreased rates of recurrence.

Pearce E.F.,St. Louis College of Pharmacy | Murphy J.A.,University of Toledo
Annals of Pharmacotherapy | Year: 2014

Objective: To evaluate the clinical literature and potential clinical role of vortioxetine (Brintellix) for the treatment of major depressive disorder (MDD). Data Sources: A MEDLINE search (1966-February 2014) was conducted using the search terms vortioxetine, Lu AA21004, and depression. Bibliographies of all articles retrieved were also reviewed. All references included were published between 1999 and 2014. Study Selection/Data Extraction: All studies that included humans and were published in English, with data describing vortioxetine for the treatment of MDD, were reviewed. Data Synthesis: Vortioxetine is a novel multimodal antidepressant agent, which inhibits the 5-HT transporter protein, acts as a 5-HT3 antagonist, 5-HT1A receptor agonist, 5-HT7 receptor antagonist, and a partial agonist of the 5-HT1B receptor. It has been studied in 10 short-term (6-8 weeks), 1 relapse-prevention, and 3 long-term extension trials. Vortioxetine demonstrated efficacy in reducing Montgomery-Asberg Depression Rating Scale or Hamilton Rating Scale for Depression scores in 6 of the short-term trials. The proportion of individuals who responded to treatment and achieved remission increased over time in all 3 long-term trials. The most common adverse effects, consistently reported by >10% of individuals in the clinical trials include nausea and headache. Conclusions: Vortioxetine is an effective agent for the treatment of MDD, but it does not have any clear advantages over other available treatment options. © The Author(s) 2014.

Bollmeier S.G.,St. Louis College of Pharmacy | Prosser T.R.,St. Louis College of Pharmacy
Annals of Pharmacotherapy | Year: 2014

Objective: To evaluate the efficacy and safety of the combination of fluticasone furoate/vilanterol (FF/VI) and compare it with other inhaled combination corticosteroid/long-acting β2-receptor agonists for maintenance treatment of chronic obstructive pulmonary disease (COPD). Data Sources: A PubMed and EMBASE search in June 2013 using the MeSH terms fluticasone and vilanterol identified trials using this combination for COPD. Additional information was gathered from references cited in the identified publications, the manufacturer, and package insert as well as the registry. Study Selection/Data Extraction: Preference was given to randomized controlled clinical trials. Data from animal trials, clinical trials for asthma, and non-English sources were excluded. Data Synthesis: Given once daily, FF/VI improves trough forced expiratory volume at 1 s by about 230 mL in a 28-day trial versus placebo. However, a more modest increase (100-130 mL) was seen in 2 longer 28-week trials. In the longest trial of 1 year, a slight but significant decrease in the yearly rate of moderate plus severe exacerbations, the time to first moderate or severe exacerbation, and the frequency of exacerbations requiring systemic corticosteroids was seen. There was no difference in the rate of exacerbations requiring hospitalization. The product appears to have the adverse effect profile typical of its class. Conclusions: Of the inhaled corticosteroid/long-acting β2 receptor agonist combinations, VI/FF is the first allowing once-daily dosing. Similar to the other combination products, it may slightly decrease the incidence of COPD exacerbations in the patient subset with Global Initiative for Chronic Obstructive Lung Disease risk category C or D. There are no direct safety or efficacy data comparing this with other available inhaled combination products. The once-daily dosing might improve adherence in select patients. The Ellipta delivery device may assist some who are unable to use other devices correctly. © The Author(s) 2013.

Zhang D.,University of Washington | Micek S.T.,St. Louis College of Pharmacy | Kollef M.H.,University of Washington
Critical Care Medicine | Year: 2015

Objective: To assess the timing of appropriate antibiotic therapy as a determinant of postinfection hospital and ICU lengths of stay in patients with sepsis. Design: Single-center retrospective cohort study (January 2008-December 2012). Setting: One thousand two hundred fifty-bed academic hospital. Patients: One thousand fifty-eight consecutive blood culture positive patients. Interventions: We retrospectively identified adult patients with severe sepsis or septic shock. Timing of appropriate antibiotic therapy was determined from blood culture collection time to the administration of the first dose of antibiotic therapy with documented in vitro susceptibility against the identified pathogen. We constructed generalized linear models to examine the determinants of attributable lengths of stay. Measurements and Main Results: The median (interquartile range) time from blood culture collection to the administration of appropriate antibiotic therapy was 6.7 hours (0.0-23.3 hr). Linear regression analysis adjusting for severity of illness and comorbid conditions identified time to appropriate antibiotic therapy to be an independent determinant of postinfection ICU length of stay (0.095-d increase per hr of time to deliver appropriate antibiotic therapy; 95% CI, 0.057-0.132 d; p < 0.001) and postinfection hospital length of stay (0.134-d increase per hr of time to deliver appropriate antibiotic therapy; 95% CI, 0.074-0.194 d; p < 0.001). Other independent determinants associated with increasing ICU length of stay and hospital length of stay were mechanical ventilation (both ICU and hospital lengths of stay) and incremental peak WBC counts (hospital length of stay only). Incremental changes in severity of illness assessed by Acute Physiology and Chronic Health Evaluation II scores and comorbidity burden assessed by the Charlson comorbidity score were independently associated with decreases in ICU length of stay and hospital length of stay. Conclusions: We identified time to appropriate antibiotic therapy in patients with sepsis to be an independent determinant of postinfection ICU and hospital lengths of stay. Clinicians should implement local strategies aimed at timely delivery of appropriate antibiotic therapy to improve outcomes and reduce length of stay. Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Hetland A.,St. Louis College of Pharmacy | Carr D.B.,Washington University in St. Louis
Annals of Pharmacotherapy | Year: 2014

Objective: To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. Data Sources: The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Study Selection and Data Extraction: Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. Data Synthesis: Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. Conclusions: Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific classes of medications, educate their patients, and/or consider safer alternatives. © The Author(s) 2014.

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