Pharmacology
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/29939
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Browsing Pharmacology by Author "Bhachawat, Neal"
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Item High disease and medication exposure burden associated with patients on chronic dialysis(2020) Rasu, Rafia; Bhachawat, NealIRBexempt#2018-197.Background:Patients with end stage renal disease(ESRD), in addition to chronic dialysis, also receive multiple drug therapies for co-morbidities;Patients manage on average, 10-12 daily medications in regimens, increasing the risk of drug-related adverse effects and medication nonadherence. We want to determine the most common P2Y12-I taken by patients and other medications frequently used by this group. Methods:A retrospective cohort of ESRD patients started on a P2Y12-I between July 20,2011 and December 31,2014 was identified through United States Renal Data System(USRDS) registry data. Within USRDS, we used Medicare Part A, Part B, and mostly Part D pharmacy claims to accurately capture entire prescription filling number to this patient population. Results:The study cohort was restricted to ESRD patients with a known first service date for dialysis prior to study end date, December 31, 2014. 36,590 patients were followed on average 367days(IQR:147, 1627). Median age for patients receiving P2Y12-I was 64(IQR: 55, 73), 54%male, 41%Caucasians. Patients were on dialysis for 3.8years, taking 7 medications(median:7, IQR:5,10) and had 7 different co-morbidities. Top10 medications routinely used (% of patients): Clopidogrel(95%), Sevelamer(39%), Amlodipine(32%), Carvedilol(30%), Calcium Acetate(28%), Metoprolol(27%), Lisinopril(26%), Atorvastatin(26%) and Cinacalcet HCL(26%). Majority medications were antihypertensive drugs and ion-removing agents. Conclusion:Due to the complex medication regimen and high rate of comorbidities in this population, de-prescribing methods may be the next step moving forwards. The goal of this method is to reduce medication burdens and drug adverse events while improving quality of life through targeted deprescribing methods.Item Pain Treatment in Elderly Population with Cancer Diagnosis(2020) Rasu, Rafia; Bhachawat, NealIRBexempt#2020-013.Purpose:Cancer incidence increases with age. One prevalent symptom of cancer is chronic pain,which is frequently treated with opioids and other pain medications. As patients age, physiologic changes occur which alter drug pharmacokinetics, making elderly patients susceptible to drug adverse effects. Falls are a leading cause of death in the elderly and seniors taking opioids are 5-times more likely to suffer one. Our goal is to identify pain treatment in elderly cancer patients, note patient-specific factors and any adverse events.Methods:A cross-sectional study analyzing pain prescriptions to manage acute or chronic pain associated with cancer in patients, age 65+. The population data will be compiled from the National Ambulatory Medical Care Survey (NAMCS)database provided by CDC. Diagnosis was based on ICD-9/10codes and medication codes identified by NAMCS for patient visits.Results:Reported in the NAMCSdatabase between2006and2017 was 276,166,738(weighted frequencies) cancer patient visits with pain medication treatment. Data consisted of 71%white, 53%female. There was almost a 2-fold increase in patient visits from the 2006-2008data period(18%), to the 2009-2011data period(31%). Peak trend was in 2009-2011(p value < 0.001). Cancer diagnoses varied but included:6%prostate,2%colon,5%breast, 4%lung cancers. Out of the 276,166,738 visits,3%were taking opioids,8%mixed opioids,2%nsaids,3%apap and 84%other pain medications. Population regionally:37%South,23%Midwest,22%West,18%Northeast(p value< 0.05). Interestingly, 83% experienced a fall as an adverse event. Conclusion:A notable amount of fall events recorded in this population, greater than the CDC estimated national average;we recommend further assessing this risk. Identifed regional variation: South having majority of pain prescriptions and Northeast havingthe fewest.