Studies on adolescent drug abuse, anti­de­pres­sants in the ER, and complications from heart pumps take top honors at annual seminar

Research into adolescent drug abuse, antidepressant medications in the emergency room, and complications from implanted heart pumps took top honors at the Department of Clinical Pharmacy’s 21st annual Spring Research Seminar.

UCSF School of Pharmacy PharmD students, residents, and faculty members presented 36 projects to the pharmacy community on April 30, 2019, at the Parnassus Heights campus.

Top researchers received Rifkind Spring Research Seminar Awards for their efforts, an annual prize made possible by Gary Rifkind, PharmD ’60, to recognize and celebrate clinical pharmacy research. Rifkind attended the research seminar accompanied by his wife, Joyce.

Limiting sales of dextromethorphan to minors

Annie Yan, Class of 2019, won in the student category for her poster titled, “The impact of California Senate Bill 514 on dextromethorphan abuse rates among adolescents: An interrupted time series analysis.”

Dextromethorphan, or DXM, is a drug that’s commonly used as a cough suppressant in over-the-counter cold medications. It’s also abused, and thanks to its availability without a prescription, adolescents, in particular, are at risk of using it recreationally.

Yan’s study looked at the impact of California Senate Bill (SB) 514, which banned the sale of over-the-counter DXM products to minors starting in January 2012. Based on records of 2,028 DXM abuse cases collected by the California Poison Control System between January 2005 and December 2016, Yan calculated an initial 41 percent drop in adolescent DXM abuse rates in California once SB514 took effect.

However, by December 2016 adolescent DXM abuse rates had climbed back up to their previous levels, suggesting that the effect of SB514 was temporary.

Interactions between beta-blockers and antidepressants in the ER

Patrick Finley, PharmD, a faculty member in the Department of Clinical Pharmacy, won in the faculty category for his poster, “Impact of Antidepressants Upon Hospitalizations and Emergency Department Visits Among Patients Stabilized on Beta-Blockers.”

Beta-blockers and antidepressants are each commonly used to treat various medical and psychiatric disorders, but can have severe health consequences, like dangerously low heart rates, when prescribed together. Wimer investigated the insurance claims of 21,292 patients who were prescribed both types of drugs between 2004 and 2011 and tracked whether any of them ended up in the emergency room once they started taking both types of drug.

The study revealed that 4.3 percent of patients in this population ended up in the hospital or emergency room within 30 days of taking both beta-blockers and antidepressants. Patients who were on antidepressants that are known to affect a particular liver enzyme were more likely to experience an adverse outcome from taking both drugs.

Complications in patients with implanted, artificial heart pumps

Dexter Wimer, PharmD, a PGY2 resident in Critical Care, won in the resident category for his poster, “Effect of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy on the incidence of gastrointestinal bleeding in patients with left ventricular assist devices.”

Patients who receive implanted heart pumps, or left ventricular assist devices (LVADs), experience a high risk of gastrointestinal bleeding. In up to half of these patients the source of this bleeding can be traced to abnormal tangles of blood vessels known as arteriovenous malformations.

Some data suggests that two classes of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), may prevent these complications from LVADs. Wimer and his colleagues took a retrospective look at 109 patients who received LVADs between 2012 and 2018 at UCSF Medical Center; about two-thirds of these patients received either ACEi or ARB therapy, while one third did not.

The study showed that ACE inhibitor/ARB therapy did not reduce the risk of gastrointestinal bleeding in these patients in the year following heart pump implantation.