Student Research Projects
Until 2015, SCCP at UCSF student members were offered various research project opportunities. Due to the 2018 curriculum changes, recruitment for these research opportunities has been placed on hold for future academic years. All current students will have various opportunities to participate in research projects through the curriculum (via Discovery Projects, IPPE's, APPE's, P3/P4 projects- CP150, HSPR, PharmSci). SCCP at UCSF mainly supports and provides resources for those looking to excel in curriculum and individual projects (e.g. trainings, finding PI's, fostering positive mentor/mentee relationships, poster tips, analyzing data, journal clubs). Any research opportunities available will be relayed to our members (priority to paid members). Thank you for your understanding and continued support through these transformative years.
Recently Completed Projects
Effectiveness of Pharmacist-Led Intervention to Help Reach LDL Levels in SFGH Outpatients Recommended by 2013 AHA Cholesterol Guidelines
SCCP at UCSF Students: Adonia Eskandari ('18), Hindu Rao ('18), Angela Zakinova ('18) Preceptor: Dr. Jaekyu Shin Status: Data analysis in progress Comparison of AUC 0-24 for Published Vancomycin Dosing Protocols Designed for Obese Patients
SCCP at UCSF Students: Kathy Cheung ('17), Brittany McGalliard ('15), Tuba Nemati ('18), Kendra Radtke ('18), Nancy Wong ('16) Preceptor: Dr. Tina Denetclaw Status: Project ongoing; Abstract accepted for 2015 ACCP Global Conference Abstract: Purpose: To evaluate whether AUC 0–24 predicted for published vancomycin dosing protocols as applied to obese patients meet AUC24 and safety targets recommended by current authoritative guidelines. Methods: Data was collected regarding gender, height, weight, age and serum creatinine to calculate the expected AUC 0–24 for obese patients according to the vancomycin dosing methods set forth by the Denetclaw, Reynolds, Wesner and traditional protocols. Obesity was defined as a total body weight greater than 130% of ideal body weight. Mean AUC 0–24 and proportion of patients achieving an AUC 0–24 ≥ 400 mg*h/L were assessed. Results: Ninety-eight consecutive obese patients were evaluated. The mean predicted AUC 0–24 for the Denetclaw obese protocol (763 +/- 230 mg h/L) was higher than the Traditional protocol with or without load, the Reynolds protocol without load, and the Wesner protocol with target trough 10–15 mg/L (p < 0.001 to 0.0239); and not different than the Reynolds protocol with loading dose and the Wesner protocol with target trough 15–20 mg/L (p = 0.1548 and 0.2268). The proportion of patients achieving predicted AUC 0–24 ≥ 400 mg h/L was higher for the Denetclaw protocol than the traditional protocol without a loading dose and Reynolds protocol without a loading dose (p < 0.0001 and 0.0313); and not different than the Traditional protocol with load, the Reynolds protocol with load, the Wesner protocol with target trough 10–15 mg/L, and the Wesner protocol with target trough 15–20 mg/L (p = 0.1512 to 0.9642). Conclusion: Obese patients receiving vancomycin 750 mg or 1000 mg every 6 hours according to the Denetclaw obese protocol, compared to higher, less frequent doses in other protocols, exhibited predicted AUC 0–24 values larger or not different than other protocols applied to obese patients. The Denetclaw protocol may be preferred in obese patients due to a potential decreased nephrotoxicity risk without a loss of efficacy. Case Report on Weight-Based Heparin Dosing in Obese Patients
SCCP at UCSF Students: Jeffrey Kim ('16), Shannan Takhar ('18), Vicki Su ('17) Preceptor: Dr. Tina Denetclaw Status: Data analysis in progress Hemodialysis Dosing for Vancomycin Patients
SCCP at UCSF Students: Ami Patel ('17), Esther Zhang ('18), Tom Zhao ('15) Preceptor: Dr. Tina Denetclaw Status: Data analysis in progress AUC Vancomycin in Obese Patients, Sub-Analysis
SCCP at UCSF Students: Victoria Su ('17), Jade Vitug ('17) Preceptor: Dr. Tina Denetclaw Status: Data analysis in progress Simulation Analysis of Different Creatinine Clearance Estimation Methods for Dosing Target-Specific Oral Anticoagulants in Overweight and Obese Patients: When Does the Method Matter?
SCCP and UCSF Students: Yuliya Byakina ('17), Alice Chyan ('16), Riti Gupta ('15), Duyen-Anh Pham ('17)) Preceptor: Dr. Tina Denetclaw Status: Data analysis in progress; Abstract accepted for 2016 ACCP Virtual Poster Symposium Objective: To evaluate the effect of using total body weight (TBW) compared to ideal body weight (IBW) for estimating creatinine clearance (CrCl) on dosing magnitude in overweight and obese patients for four target-specific oral anticoagulants Results: Using TBW to calculate eCrCl may overestimate the dosing needs for older patients with worse renal function receiving dabigatran, and for older patients with modestly increased SCr and higher degrees of excess weight receiving rivaroxaban. Patients with higher degrees of obesity had different dose determinations for edoxaban depending on the eCrCl method. Dose determination for apixaban was not affected by the eCrCl method. IPPE Quantitative Survey
SCCP at UCSF Students: Zack Pallack ('17), Leanne Thai ('17), Jade Vitug ('17) Preceptor: Dr. Tina Denetclaw Status: Collecting data Objective: To identify barriers and potential solutions for community hospitals providing Introductory Pharmacy Practice Experiences (IPPEs) Comparison of Traditional Versus Divided-Load Vancomycin Dosing Protocols Performance for Non-Obese, Non-Critically Ill Patients
SCCP at UCSF Students: Tony Tran ('17), Tu-Anh Vo ('15), Ken Yang ('17) Preceptor: Dr. Tina Denetclaw Status: Data analysis complete, Manuscript in preparation Dofetilide (Tikosyn) Dosing in Obese Patients
SCCP at UCSF Students: Cynthia Bach ('15), Chiara Bui ('16), Eric Dressler ('17), Chris Meyer ('17) Preceptor: Dr. Tina Denetclaw Status: Project ongoing; Abstract submitted for 2015 ACCP Global Conference Vancomycin Dosing
SCCP at UCSF Students: Calvin Diep ('16), Randall Mello ('14), Gurpreet Singh ('15), Collin Yu ('16) Preceptor: Dr. Tina Denetclaw Status: Drafting manuscript |
Abstracts and Completed Projects
Managing Nonoperable Intracranial Bleeding Associated with Apixaban: A Series of 2 Cases
SCCP at UCSF Students: Sophia Lai ('18), Catherine Lo ('18), Dang Tran ('17) Preceptor: Dr. Tina Denetclaw Status: Manuscript accepted by Journal of Pharmacy Practice (Mar 2017) Abstract: Objective: To report 2 cases of nonoperable intracranial bleeding associated with apixaban managed by 3-factor prothrombin complex concentrate (PCC3). Case Summaries: Case 1 presented with a 1.3-cm left parieto-occipital hemorrhage and a thin subdural hematoma (SDH) on the left tentorium of the brain about 6 hours after his last dose of apixaban. Case 2 presented with a 4-mm left parafalcine SDH with time of most recent apixaban dose unknown. The patients received 24.9 to 25.5 U/kg of PCC3 with none to 1 U fresh frozen plasma (FFP) and demonstrated minimal or no progression in lesions measured by repeat computed tomography (CT) after treatment. One patient was discharged to a skilled nursing facility after 8 days; the other patient was discharged to home after 18 days. Discussion: Apixaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and little clinical experience for managing apixaban-associated intracranial bleeding has been reported to date. These cases describe the clinical use of PCC3 to manage parieto-occipital and subdural hemorrhage associated with apixaban in events not requiring surgical intervention. Conclusion: In these 2 cases, 25 U/kg PCC3, with none to one unit FFP, ceased apixaban-associated intracranial bleeding without apparent thrombogenic complications. Managing Subdural Bleeding Associated with Rivaroxaban: A Series of 3 Cases
SCCP at UCSF Student: Jennifer Koehl ('15) Preceptor: Dr. Tina Denetclaw Status: Manuscript accepted by Journal of Pharmacy Practice (Jan 2016) Abstract: Objective: To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3). Case Summaries: Case 1 presented with a 1-cm thick subdural hemoatoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute right SDH with 2 to 3 mm of midline shift 24 hours after his last dose of rivaroxaban. Case 3 presented with a 1.8-cm thick right cerebral convexity hematoma 12 hours after her last dose of rivaroxaban. All patients received 23 to 55 units/kg PCC3 with 1 to 3 fresh units of fresh frozen plasm (FFP) and demonstrated no progression in lesions measured by repeat computed tomography (CT). Two patients were discharged to rehabilitation facilities and 1 patient ultimately died due to the location of the lesion. Discussion: Rivaroxaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and no clinical experience has been reported to date. These cases begin to illuminate differences among choices for managing bleeding associated with Xa inhibitors. Conclusion: In this case series, 25 to 35 units/kilogram PCC3 and FFP 1 to 3 units ceased rivaroxaban-associated bleeding without thrombogenic complications. Case Report: Apixaban-Associated Gluteal Artery Extravasation Reversed with PCC3 Without FFP
SCCP at UCSF Students: Victor Arias ('18), Rachel Kim ('17), Jackie Tam ('17) Preceptor: Dr. Tina Denetclaw Status: Manuscript accepted by Journal of Pharmacy Practice (Oct 2015) Abstract: Apixaban, an oral factor Xa inhibitor, has no commercially available assay to measure its activity and no specific antidote. To date, recommendations for managing bleeding associated with apixaban are based on studies with animal models and healthy volunteers (who do not have identified thrombogenic risk factors) and expert opinion. No clinical experience has been published in the literature. Ideally, apixaban would be reversed sufficiently to stop a perilous bleed without producing more thrombogenic risk than the patients' underlying risk factors. Three-factor prothrombin complex concentrate (PCC3) is the least thrombogenic among the suggested reversal agents. Fresh frozen plasma (FFP) is sometimes recommended to add to PCC3, but it adds considerable volume. We describe successful management of an active left gluteal arterial extravasation due to trauma and associated apixaban, in a patient with aortic stenosis and atrial fibrillation, by administration of PCC3 alone, without the added volume of FFP. Pulmonary Embolism After Early Change From Rivaroxaban to Aspirin Following Total Knee Replacement in an Obese Patient
SCCP at UCSF Students: Katherine Tran (17), Phyllis Wang ('16) and Gabriel Wong ('17) Preceptor: Dr. Tina Denetclaw Status: Letter accepted by Annals of Pharmacotherapy (Jun 2015) Prevalence and Effects of Potentially Inappropriate Medication Ordering for Drugs with Sedative Effects in Acute Geriatric Inpatient Care using Electronic Health Records
SCCP at UCSF Student: Collin Yu ('16) Preceptor: Dr. Tina Denetclaw Status: Abstract accepted for 2014 APhA Meeting (Oct 2014) Manganese-Enhanced Magnetic Resonance Imaging Reveals Increased DOI-Induced Brain Activity in a Mouse Model of Schizophrenia
SCCP at UCSF Student: Collin Yu ('16) Preceptor: Dr. Tina Denetclaw Status: Manuscript accepted by PNAS (Sep 2014) Abstract: Maternal infection during pregnancy increases the risk for schizophrenia in offspring. In rodent models, maternal immune activation (MIA) yields offspring with schizophrenia-like behaviors. None of these behaviors are, however, specific to schizophrenia. The presence of hallucinations is a key diagnostic symptom of schizophrenia. In mice, this symptom can be defined as brain activation in the absence of external stimuli, which can be mimicked by administration of hallucinogens. We find that, compared with controls, adult MIA offspring display an increased stereotypical behavioral response to the hallucinogen 2,5-dimethoxy-4-iodoamphetamine (DOI), an agonist for serotonin receptor 2A (5-HT2AR). This may be explained by increased levels of 5-HT2AR and downstream signaling molecules in unstimulated MIA prefrontal cortex (PFC). Using manganese-enhanced magnetic resonance imaging to identify neuronal activation elicited by DOI administration, we find that, compared with controls, MIA offspring exhibit a greater manganese (Mn(2+)) accumulation in several brain areas, including the PFC, thalamus, and striatum. The parafascicular thalamic nucleus, which plays the role in the pathogenesis of hallucinations, is activated by DOI in MIA offspring only. Additionally, compared with controls, MIA offspring demonstrate higher DOI-induced expression of early growth response protein 1, cyclooxygenase-2, and brain-derived neurotrophic factor in the PFC. Chronic treatment with the 5-HT2AR antagonist ketanserin reduces DOI-induced head twitching in MIA offspring. Thus, the MIA mouse model can be successfully used to investigate activity induced by DOI in awake, behaving mice. Moreover, manganese-enhanced magnetic resonance imaging is a useful, noninvasive method for accurately measuring this type of activity. Successful Treatment of Ventriculostomy-Associated Meningitis Caused by Multidrug Resistant Coagulase-Negative Staphylococcus epidermidis Using Low-Volume Intrathecal Daptomycin and Loading Strategy
SCCP at UCSF Students: Ion Suehiro ('16) and Phyllis Wang ('16) Preceptor: Dr. Tina Denetclaw Status: Manuscript accepted by Annals of Pharmacotherapy (Jul 2014) Abstract: Objective: To report successful use of low-volume intrathecal (IT) daptomycin and loading strategy for the treatment of ventriculostomy-associated meningitis. Case Summary: A 23-year-old man with a history of multiple ventriculoperitoneal shunt revisions resulting from multidrug-resistant Staphylococcus epidermidis shunt infection presented with meningitis despite suppressive antibiotic therapy. After source control surgery, the patient improved with intravenous daptomycin plus IT vancomycin. Then, 4 days later, significant ventriculostomy output occurred, and the S epidermidis was confirmed to be intermediately sensitive to vancomycin (MIC = 8 µg/mL) and susceptible to daptomycin (MIC = 2 µg/mL). IT vancomycin was changed to IT daptomycin 5 mg in 3 mL normal saline (NS) every 24 hours for 3 days, then every 72 hours for 18 days. The cerebrospinal fluid (CSF) was sterile after 1 day of IT daptomycin and remained so. Creatine kinase remained normal throughout the course of treatment. The patient was discharged on hospital day 50 without antibiotics. Discussion: IT daptomycin has been reported for adult doses ranging from 5 to 10 mg once every 24 to 72 hours in volumes ranging from 5 to 10 mL; drug accumulation has been seen after the third dose of once every 24 hours dosing, and delayed improvement has been seen with once every 72 hours dosing. We planned for rapid load and CSF sterilization and extended the dosing interval once drug accumulation was expected to have occurred. Conclusions: IT daptomycin 5 mg diluted to 3 mL in NS and dosed in a loading strategy was effective and without adverse sequelae. Evaluation of VTE Prophylaxis Protocol
SCCP at UCSF Students: Allison Komirenko ('15), Lexy Reynolds ('15), Christine Tran ('16) Preceptor: Dr. Krishna Shah Status: TBD |