Pharmacokinetic and pharmacodynamic considerations of antibiotics and antifungals in liver transplantation recipients.

The liver plays a major role in drug metabolism. Liver transplantation impacts the intrinsic metabolic capability and extrahepatic mechanisms of drug disposition and elimination. Different levels of inflammation and oxidative stress during transplantation, the process of liver regeneration, and the characteristics of the graft alter the amount of functional hepatocytes and activity of liver enzymes. Binding of drugs to plasma proteins is affected by the hyperbilirubinemia status and abnormal synthesis of albumin and alpha-1-acid glycoproteins. Postoperative intensive care complications such as biliary, circulatory, and cardiac also impact drug distribution. Renally eliminated antimicrobials commonly present reduced clearance due to hepatorenal syndrome and the use of nephrotoxic immunosuppressants. In addition, liver transplantation recipients are particularly susceptible to multidrug-resistant infections due to frequent manipulation, multiple hospitalizations, invasive devices, and frequent use of empiric broad-spectrum therapy. The selection of appropriate anti-infective therapy must consider the pathophysiological changes after transplantation that impact the pharmacokinetics and pharmacodynamics of antibiotics and antifungal drugs.

Optimizing preoperative antibiotics in patients with ß-lactam allergies: A role for pharmacy.

PURPOSE: Patients with a reported ß-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting. METHODS: A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018. RESULTS: Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group. CONCLUSION: Implementation of a pharmacy-driven BLA reconciliation significantly increased ß-lactam preoperative use without negative safety outcomes.

Impact of a Pharmacy Student Organization on the Admissions Experience and Student Professional Development.

Objective. To evaluate the impact of a program which integrated student pharmacists into the admissions process on pharmacy school candidates' perceptions of the program and on participants' professional development. Methods. An anonymous survey regarding the pharmacy school admission process was sent to candidates following their visit to campus and interviews from fall 2014 through spring 2017. A second survey of all student pharmacists enrolled in January 2018 was conducted to assess the impact of a student-led organization, Pharmacy Student Ambassadors (PSA), on their professional development. Results. The response rate for the survey completed by candidates was 66% (335/504) and the response rate for the survey completed by enrolled student pharmacists was 50% (166/330). Almost all of the candidates were satisfied with the admissions process (96%, 322/335). They cited the welcoming and friendly environment and opportunity to interact with student pharmacists as the best aspects of the admissions process. In the survey of enrolled students, the majority of PSA volunteers agreed or strongly agreed with statements regarding their organization's influence on professional development (76%), enhancing communication skills (77%), self-reflection (78%), and feeling respected and valued (73%). Furthermore, the majority of student pharmacists agreed or strongly agreed that participation in the PSA positively impacted their own admissions process (87%), made interviewees more at ease and comfortable (88%), increased their knowledge and understanding of the culture in the program (82% and 75% respectively), and influenced their personal decisions to attend the University of Michigan College of Pharmacy (63%). Conclusion. Student pharmacist involvement in the admissions process was correlated with pharmacy school candidate satisfaction and contributed to enrolled students' positive perceptions regarding their professional development.

Impaired replication elongation in Tetrahymena mutants deficient in histone H3 Lys 27 monomethylation.

Replication of nuclear DNA occurs in the context of chromatin and is influenced by histone modifications. In the ciliate Tetrahymena thermophila, we identified TXR1, encoding a histone methyltransferase. TXR1 deletion resulted in severe DNA replication stress, manifested by the accumulation of ssDNA, production of aberrant replication intermediates, and activation of robust DNA damage responses. Paired-end Illumina sequencing of ssDNA revealed intergenic regions, including replication origins, as hot spots for replication stress in ΔTXR1 cells. ΔTXR1 cells showed a deficiency in histone H3 Lys 27 monomethylation (H3K27me1), while ΔEZL2 cells, deleting a Drosophila E(z) homolog, were deficient in H3K27 di- and trimethylation, with no detectable replication stress. A point mutation in histone H3 at Lys 27 (H3 K27Q) mirrored the phenotype of ΔTXR1, corroborating H3K27me1 as a key player in DNA replication. Additionally, we demonstrated interactions between TXR1 and proliferating cell nuclear antigen (PCNA). These findings support a conserved pathway through which H3K27me1 facilitates replication elongation.