BACKGROUND:This case report presents the first documented instance of vaginal candidiasis linked to the intake of a hair, skin, and nails supplement. CASE PRESENTATION:A 64-year-old Caucasian female patient, with a history of chronic kidney disease and multiple comorbidities, developed symptoms of vaginal yeast infection after beginning the supplement. The adverse event was evaluated using the Naranjo Adverse Drug Reaction Probability Scale, scoring a 5, indicating a probable association. Despite extensive literature searches, no similar cases were found, suggesting this might be a unique reaction. This report highlights potential safety concerns with dietary supplements, particularly those not regulated by the Food and Drug Administration, underscoring the need for further investigation into their adverse effects. CONCLUSIONS:The case emphasizes the importance of considering dietary supplements as potential contributors to adverse health events, especially in patients with complex medical histories.

BACKGROUND AND PURPOSE:Intercultural and Global Health Issues was developed to address learning outcomes in communication, ways of thinking, intercultural personal skills, and intercultural knowledge. The aim of this study was to assess learning gains of pharmacy students through self-assessment.EDUCATIONAL ACTIVITY AND SETTING:Course design, learning outcomes, objectives, and activities were created to meet the expected educational outcomes. A revised rubric was created from the American Association of Colleges and Universities (AACU) Valid Assessment of Learning in Undergraduate Education rubrics on Intercultural knowledge, Information literacy, and Creative thinking. Students completed self-assessments at the beginning and end of the course. Ward hierarchical clustering, paired sample t-tests, and independent t-tests analyzed multidimensional data in two clusters.FINDINGS:Cluster 1 (C1) students reported pre-course capstone performances for cultural self-awareness, problem solving, and access and use of information ethically and legally. Post-course scores for C1 students statistically increased for all AACU domains reaching capstone performances for intercultural competence, creative thinking, and information literacy. Cluster 2 (C2) students reported capstone performance levels for all AACU domains from the beginning to the end of the course. All students reported achievement of self-efficacy, creative thinking, and cultural competency at the end of the course. There was no statistically significant difference in course learning outcome scores for C1 and C2 students.SUMMARY:Students achieved embedded learning outcomes of ways of thinking, communication, interpersonal skills, and intercultural knowledge as demonstrated from self-assessments. Course activities aided students' demonstration of self-efficacy, creative thinking, and intercultural knowledge.

Background: In the United States, the scheduling system for controlled substances was established by the Controlled Substance Act of 1970. In 2009, Parker et al. published the study “Physicians' knowledge and attitudes toward scheduling.” Since 2009, the opioid epidemic has gathered national attention from social and scientific perspectives as the number of drug overdose deaths in the United States has nearly tripled. Objective: To follow up on a 2009 survey by Parker, et al. to determine prescribers' knowledge and attitudes regarding the controlled substance scheduling system and assess the impact of the controlled substance scheduling system on providing optimal patient care. Methods: The cross-sectional survey was designed to assess prescribers' attitudes and mailed to 400 randomly selected physicians and 400 randomly selected nurse practitioners. Results: Prescribers across all groups provided consistent responses suggesting an overall lack of understanding of controlled substance regulations, a negative attitude towards the controlled substance scheduling system, and a detrimental effect on providing optimal patient care. Responses from nurse practitioners differed significantly from physicians in 75 % (3 of the 4) questions regarding regulations, suggesting nurse practitioners possess a greater understanding of pharmaceutical regulations. Specialists' responses demonstrated an enhanced level of dissatisfaction regarding the controlled substance scheduling system compared to primary care providers in 75 % (3 of the 4) questions. Questions regarding the impact of the scheduling system on prescribing patterns differed significantly across multiple demographic groups, notably between physicians and nurse practitioners, differences in practice setting, and primary state of practice for 75 % (3 of the 4) questions. Conclusions: The results of this survey confirm the findings of Parker, et al., and further display the need for investigation into how to improve the controlled substance scheduling system in the United States.

Hyperkalemia is a common electrolyte disorder in patients with chronic kidney disease (CKD) that increases in prevalence with the decline of glomerular fltration rate (GFR). Another risk of hyperkalemia is the use of renin-angiotensin-aldosterone system inhibitors (RAASi) and/or mineralocorticoid receptor antagonists (MRAs) in managing CKD and proteinuria. The treatment of chronic hyperkalemia is challenging especially for outpatients. Treatment options for hyperkalemia include the potassium exchange resins of which two new potassium binders, Patiromer Sorbitex Calcium, and Sodium Zirconium Cyclosilicate (SZC) have demonstrated their clinical efficacy in reducing serum potassium with a positive safety profile. The old potassium exchange resin sodium polystyrene sulfonate (Kayexalate™) has some negative side effects including colonic necrosis, hypomagnesemia, and hypernatremia. In this review and literature search, we compare the available oral potassium exchange resins, highlight their advantages and disadvantages and comment on efficacy and safety parameters specifically in CKD patients.

PURPOSE:This narrative review explores the currently published studies that have evaluated tenapanor for the treatment of hyperphosphatemia in end-stage kidney disease (ESKD) patients on hemodialysis. This medication's new phosphate lowering mechanism of action reduces intestinal phosphate absorption predominantly through reduction of passive paracellular phosphate flux by inhibition of the sodium/hydrogen exporter isoform 3 (NHE3). Tenapanor additionally prevents active transcellular phosphate absorption compensation by decreasing the expression of sodium phosphorus 2b transport protein (NaPi2b).METHODS:A comprehensive search of the literature was conducted using PubMed and ClinicalTrials.gov search engines. The search term "tenapanor hyperphosphatemia" was used for study retrieval. Results were limited to studies published in the English language and excluded review articles. Human, animal, and in vitro studies were included. No date range was specified.RESULTS:A total of 11 primary studies were identified and included in this review, the largest human study of which enrolled 236 patients. Each study is presented in table format along with measured end points.CONCLUSIONS:Tenapanor is the first drug in its class that lowers hyperphosphatemia in ESKD patients through a novel mechanism of action involving paracellular inactive transport. Although more studies are needed, early results indicate that tenapanor may have a place in managing hyperphosphatemia in ESKD patients both as monotherapy and as an adjunct to existing phosphate binder therapy.

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).

PharmD students make significant clinical interventions during their last year of training in clinical rotations at a variety of practice sites. These interventions ranged from performing dosage adjustments to preventing adverse drug reactions and saved $92,803 dollars in the Federally Qualified Health Center practice sites that were included in this study over a 1-year period of time. The following study examines the types of interventions made and their associated cost savings.

Purpose Diabetic nephropathy (DN) is a major complication of diabetes. Paricalcitol is a vitamin D analog that is typically used for secondary hyperparathyroidism in patients with chronic kidney disease but may have some beneficial effect on DN. This review evaluates the effect of paricalcitol in combination with renin-angiotensin-aldosterone system inhibitor therapy in managing DN. Methods A literature search was conducted of PubMed and ClinicalTrials.gov. Limits were set to include only clinical trials in humans written in English. The search terms used were paricalcitol and diabetic nephropathy. The following outcomes of kidney function and damage as well as adverse drug events were assessed and included: 24-h urine albumin excretion, serum phosphorus and calcium concentrations, urinary albumin excretion rates, estimated glomerular filtration rate, and markers of inflammation and endothelial function. Findings Four studies with a total of 389 patients were identified for review through the process described above. Two of the 6 studies provide evidence of the effect of paricalcitol on DN by way of reduction in urine albumin to creatinine ratio and urinary albumin excretion rate when compared with placebo. One study reported an increase in serum phosphorous, 1 study observed a decrease in estimated glomerular filtration rate, and 1 study reported no effect on inflammatory markers or endothelial function. Implications The number of clinical trials examining the effect of paricalcitol in DN is small. The studies that have been completed enrolled <300 patients. Paricalcitol can reduce protein in the urine, but there is no compelling evidence that it preserves kidney function.

PURPOSE:The purpose of this retrospective cohort study was to measure the difference between cholecalciferol and ergocalciferol in their ability to effect vitamin D, parathyroid hormone (PTH), calcium, and phosphorous serum concentrations in patients with stage 3 or 4 chronic kidney disease.METHODS:This was a retrospective cohort study conducted within a single-center ambulatory nephrology clinic. Patients eligible for the study were identified through medical records displaying each patient's initiation on either ergocalciferol or cholecalciferol from 2013 to 2016. Patients' baseline vitamin D, PTH, calcium, and phosphorous serum concentrations were taken prior to treatment initiation, and patients were reassessed with a second measurement within 12 months of therapy.RESULTS:Out of 149 eligible patients, 110 were excluded. There were 33 patients included on cholecalciferol and 6 patients on ergocalciferol. A significant difference was observed in the percent change of phosphorous serum concentrations from baseline following drug administration (p=0.03). The mean changes from baseline to final serum phosphorous concentrations (mg/dL) were 0.12 and -0.3 for cholecalciferol and ergocalciferol, respectively. There was no significant difference in vitamin D (14.9, 15.1, p=0.97), PTH (5.6, 2.3, p=0.72), or calcium (0.05, -0.17, p=0.08) serum concentrations between cholecalciferol and ergocalciferol, respectively. There was a statistically significant increase in the mean change in serum phosphorous concentrations within the cholecalciferol group compared to the ergocalciferol group.CONCLUSION:In this small pilot study, cholecalciferol treatment appeared to increase serum phosphorous concentrations compared to ergocalciferol. These observations may warrant further large-scale studies that are appropriately powered to validate such findings.

INTRODUCTION:Butler University College of Pharmacy and Health Sciences (BUCOPHS) and Purdue University College of Pharmacy (PUCOP) created Block Scheduling and Institutional Track programs with the goal of better preparing students interested in pursuing postgraduate residency and/or a career in institutional practice. While informal feedback has been positive from both students and preceptors, more formalized feedback was sought. The objective of this study was to determine whether preceptors perceived additional benefits in precepting students selected through Block Scheduling and Institutional Track programs compared to students scheduled on rotations through a traditional preference or optimization process.METHODS:A 12-item electronic survey instrument was sent to BUCOPHS and PUCOP preceptors who had precepted block-scheduled and/or institutional track students in the 2014-15 and 2015-16 academic years.RESULTS:The majority of preceptors (71.4%) felt that the time they spent orienting block and institutional track students was less or significantly less when compared to orienting traditionally scheduled students. Seventy-three percent (73.2%) of preceptors reported that block-scheduled and institutional track students were more or significantly more prepared for residency positions than traditional students. The majority of preceptors (93%) indicated they would recommend block scheduling or an institutional track to other practice sites. Reported benefits to the preceptor included additional time to dedicate to patient care, additional time to complete projects and initiatives for the pharmacy department, and publishable research produced from student projects mentored.CONCLUSION:Preceptors perceived benefits in precepting block-scheduled and institutional track students compared to traditionally scheduled rotation students.

Vitamin D plays an important role in the management of Secondary Hyperparathyroidism (SHPT) for Chronic Kidney Disease Patients with Mineral and Bone Disorder (CKD-MBD). The National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease Improving Global Outcomes (KDIGO) have published clinical practice guidelines and commentaries in 2010 and 2017, respectively, that provide some guidance on how vitamin D and vitamin D receptor activators (VDRAs) should be used in practice [1-3]. There are currently two vitamin D products (cholecalciferol and ergocalciferol) and three VDRAs (calcitriol, paricalcitol, and doxercalciferol) used in clinical practice in the United States for treating SHPT in CKD patients. Another vitamin D product, calcifediol (Rayaldee), has recently appeared on the market again, as it was approved and marketed from 1980 to 2001. The clear reason for the product withdraw is unknown; however, it was deemed that the product was not withdrawn for any safety reasons.

A probable relationship exists between hydralazine and the development of amenorrhea.

Introduction: With over a third of the doctor of pharmacy curriculum relying on experiential education (EE), it is critical that students are assessed and graded in accordance with their actual performance. The objective of this paper is to review advanced pharmacy practice experience (APPE) grading across the Big Ten Academic Alliance to describe how APPE grading occurs at these institutions and highlight differences in approach and outcomes. Methods: Experiential directors/deans were asked to import de-identified data (e.g., APPE curriculum, midpoint and final evaluation score and grade, number of preceptors, number of students, number of years of pharmacy school, total hours of APPEs offered, number and duration of APPEs per year, grading scale information). A chi-square test including pairwise comparisons with a Bonferroni p-value adjustment for multiple comparisons was performed. Results: Seven college/schools submitted data from over 3600 students between 2012-2015. The distribution of letter grades differed significantly across all colleges/schools in 2012-2013, 2013-2014 and 2014-2015 (p < 0.0001). Similarly, the distribution of letter grades by rotation type varied significantly for all colleges/schools (p < 0.0001). Students in acute care, ambulatory care, and other patient care rotation types were less likely to obtain an "A" and more likely to obtain a "B" compared to students in other rotation types. Conclusions: When letter grades are used for APPEs, the trend suggests over 95% of students receive an "A" or "B" grade. Final grades varied by rotation type with more "B" grades observed in patient care rotations than "A" grades over the three-year period.

BACKGROUND AND PURPOSE:To use parts of the APhA Career Pathway Evaluation Program for Pharmacy Professionals in a career development laboratory designed to provide students with relevant information that will help them prepare for successful careers across the profession of pharmacy.EDUCATIONAL ACTIVITY AND SETTING:Students enrolled in the second professional year of pharmacy school participated in an interactive three-hour career development laboratory. Students completed the APhA Career Pathway Evaluation Program for Pharmacy Professionals Online Assessment Tool prior to the laboratory. In class, the students were randomized into eight groups. Two career profiles were assigned to each group for discussion during a thirty-minute brainstorming session. The groups reported their knowledge for each career profile to the entire class, and the instructors supplemented the discussion with details and more specific information about each profile.FINDINGS:Two years of data were collected (n=300 students). One hundred and twenty four (41.3%) students responded to the voluntary post-laboratory survey questions. Overall, students rated the career pathway activities favorably with an average score of 8.13 out of 10. After participation in the discussion, 74 (59.7%) respondents indicated their career interests had been impacted.SUMMARY:This career development laboratory is one example of how the APhA Career Pathway Evaluation Program for Pharmacy Professionals can be effectively incorporated into the PharmD curriculum in order to help students explore the various career options they might not have otherwise discovered on their own.

Special Acknowledgments: According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Professional Affairs Committee is to study issues associated with the professional practice as they relate to pharmaceutical education, and to establish and improve working relationships

Purpose. To determine if there is sufficient evidence to recommend the addition of pentoxifylline to standard ACE inhibitor and ARB therapy in chronic kidney disease patients to reduce proteinuria and preserve kidney function. Methods: A search of the literature was conducted using the PubMed.gov and ClinicalTrials.gov search engines and the search terms “pentoxifylline renoprotection”, “pentoxifylline CKD”, and “pentoxifylline nephropathy”. Results were limited to studies in human subjects and published in the English language. No date range was specified. Studies focused on the effects of pentoxifylline on drug induced nephropathy were excluded. Results: Nine relevant articles were retrieved and evaluated. The two main populations studied were patients with chronic kidney disease (CKD) and patients with CKD and comorbid type 2 diabetes. Six of the nine studies reported a significant reduction in proteinuria in pentoxifylline treated patients. Four studies reported a significant change in estimated glomerular filtration rate (eGFR). Conclusion: Addition of pentoxifylline to ACE inhibitor and ARB therapy may improve proteinuria in CKD patients. There is conflicting evidence as to whether pentoxifylline will improve kidney function as measured by eGFR.Key words: pentoxifylline renoprotection, pentoxifylline CKD , pentoxifylline nephropathy.This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Purpose: The objective of this short review is to evaluate the efficacy of ferric pyrophosphate citrate and to determine its place in therapy based on the current published literature.Methods: A literature search was conducted and pared down to yield 4 placebo controlled Phase II and HI clinically relevant trials.Findings: Ferric pyrophosphate citrate is a new intradialytic iron supplementation product that has been found to reduce the dose of erythropoiesis stimulating agents and intravenous iron supplementation and to increase serum ferritin concentrations. (C) 2016 Elsevier HS Journals, Inc. All rights reserved.