Pharmacy

Permanent URI for this collectionhttps://uwspace.uwaterloo.ca/handle/10012/9947

This is the collection for the University of Waterloo's School of Pharmacy, which includes papers submitted at the conclusion of pharmacy residencies administrated by the School of Pharmacy.

Research outputs are organized by type (eg. Master Thesis, Article, Conference Paper).

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Browsing Pharmacy by Author "Yrigoyen-Dacruz, Lidia"

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    A Quality Assurance Evaluation of Hydromorphone Adverse Events Post-Implementation of a Safety Initiative
    (University of Waterloo, 2019-08) Purivatra, Elsa; Haluk-McMahon, Charlene; El-Masri, Maher; Yrigoyen-Dacruz, Lidia; Duronio, Antoinette
    Purpose: Hydromorphone is a potent opioid that may lead to respiratory and central nervous system depression prompting naloxone use. The primary objective of this study was to evaluate whether a safety initiative implemented at Windsor Regional Hospital involving interchanging hydromorphone intravenous or subcutaneous doses of 1 mg or greater to low dose (0.5 mg) in opioid naïve, medical and surgical patients was associated with naloxone events. The secondary objective was to assess whether there was a compromise in patient pain control with the low dose. Methods: We conducted a retrospective, multicenter, observational study of medical and surgical opioid-naïve patients admitted to Windsor Regional Hospital who received intravenous or subcutaneous hydromorphone within an eighteen-month timeframe. To determine if there is an association between naloxone events and implementation of the safety initiative, we compared patients who experienced a naloxone event (cases) with patients who did not experience a naloxone event (controls) in approximately 1:4 ratio. Efficacy outcomes assessed changes in patient pain control before and after interchange policy implementation (i.e. need for increase in dose, frequency or additional analgesics). Results: Of the 4343 patients who received hydromorphone, 143 opioid naïve patients were included in the final analysis. Of the 27 patients who experienced a naloxone event, 0% of patients were interchanged. In contrast, of the 116 patients who did not experience a naloxone event, 52% were interchanged (OR = 0, 95% 0 to 0.13, p<0.01). There were no significant differences in terms of patient pain control before and after interchange policy implementation. Conclusions: The pharmacist-led safety initiative of interchanging all opioid naïve patients to low dose hydromorphone was not associated with naloxone events and did not compromise patient pain control.
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    Risk and Benefit of Warfarin for Primary Prevention in Atrial Fibrillation Patients on Hemodialysis: A Retrospective Pilot Study
    (University of Waterloo, 2020-07-17) Panic, Gea; McNorton, Kelly; Yrigoyen-Dacruz, Lidia; Duronio, Antoinette
    Background Despite increased awareness and advocacy regarding the opioid epidemic, data from Health Quality Ontario (HQO) shows steady prescribing of opioids with concerning trends toward prescribing more potent opioids. The creation of a quality standard for Opioid Prescribing in Acute Pain provides opportunity for organizations to assess whether they are meeting best practice recommendations. Objective To examine opioid prescribing patterns for patients presenting to the emergency department (ED) and to assess opioid prescribing at discharge in comparison to HQO quality standards. Methods This retrospective, observational study examined adults presenting to two ED sites within in a multi-site community teaching hospital. Patients prescribed intravenous (IV)/intramuscular (IM)/subcutaneous (SC) morphine, hydromorphone, and fentanyl were included. Patients were excluded if intubated, palliative or end-of-life, being treated for overdose, multi-fracture trauma, or admitted for inpatient treatment. Results Opioids were administered to 200 patients, with 12 patients receiving two different opioids (n=212). The most common opioid was morphine (79.7%), route was intravenous (92.9%), and frequency was as a one-time dose (46.2%). Common indications included abdominal pain (32%), trauma (11%), and renal/biliary colic (10.5%). A median parenteral morphine equivalent (MEQ) of 5 mg (IQR, 4-6.67 mg) was given, with 33.5% of patients receiving concurrent non-opioid pain management. Patients who received hydromorphone (OR 6.37), were prescribed as needed (OR 2.32), scheduled (OR 30.81) or repeated doses (OR 3.95), and had an indication of migraine or headache (OR 8.92) were more likely to receive higher doses. At discharge, one in four patients received an opioid prescription, most commonly for acetaminophen/oxycodone 325/5 mg (46%) or acetaminophen/caffeine/codeine 300/15/30 mg (36%) with a median duration of 3.1 days. Conclusion In summary, our organization showed reassuring prescribing patterns, meeting HQO quality standards for dose and duration of discharge prescription.