• Carr, Roxane

    Titles

    Investigator, BC Children's Hospital
    Assistant Professor, Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of British Columbia

    Degrees / Designations
    BSc, BScPharm, PharmD 
    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    Phone
    604-875-2710
    Fax
    Lab Phone
    Assistant
    Lynne Taylor
    Assistant Phone
    604-875-2059
    Mailing Address

    BC Children's Hospital
    Room: Pharmacy - 0B7
    4480 Oak Street
    Vancouver, BC V6H 3N1

    Affiliate Websites
    Research Areas
    • Pediatric pharmacotherapy
    • Pharmacodynamics and pharmacokinetics
    • Medication safety 
    • Clinical pharmacy practice
    Summary

    Dr Roxane Carr’s research focus is to study the safety and effectiveness of drugs used to treat a variety of illnesses in children. She is also interested in studying the impact of various treatment modalities (extracorporeal life support (heart-lung machine), dialysis, and therapeutic plasma exchange (plasmapharesis) on drug dosing in children as well as optimal methods to monitor the drug therapy of children and for pharmacists to communicate about drug therapy issues with children and their care givers. 

    Current Projects

    The Feasibility of Patient and Caregiver Self-Referral to Clinical Pharmacists in the Inpatient Pediatric Setting:  Pharmacists play a significant role in patient care, part of which involves direct interaction with patients and caregivers. During hospitalization, many patients and caregivers may be unaware that a pharmacist is part of their team. In a previous study at our site, we found that only 10% of caregivers recalled speaking with a pharmacist; however 86% of caregivers indicated that they would like to speak with a pharmacist.1 Patients and caregivers may be unaware of how to contact their pharmacist during hospitalization, since they do not have the same direct access to their pharmacist as they would in other settings. Objective: To assess the feasibility of a patient/caregiver self-referral service to pharmacists

    Correlation of limited sampling strategy for mycophenolate in pediatric solid organ transplant patients. Mycophenolate is commonly used as an immunosuppressant in children who have received solid organ transplants to prevent rejection of the graft.  Currently therapeutic drug monitoring is recommended as dosage and serum concentration do not correlate well however it is unclear from the literature what the upper limit of the therapeutic range should be and if limited sampling strategies to estimate area under the curve correlates to effectiveness and adverse drug reactions.  Objective: To describe the correlation between limited sampling strategy for mycophenolate and clinical effectiveness (adverse drug reactions and signs or organ graft rejection)

    Review of Pharmacokinetics of Medications in Children Undergoing Therapeutic Plasma Exchange. Therapeutic Plasma Exchange (TPE), also known as plasmapharesis or “plex”,  is a process that separates plasma for the cellular components of blood, discarding the plasma and exchanging it with replacement physiologic fluids such as albumin or fresh frozen plasma.  TPE is used in the management of many types of conditions, including (but not limited to) systemic lupus erythema, thrombotic thrombocytopenic purpura (TTP), myasthenia gravis, severe septic shock, antiphospholipid antibody syndrome (APS), and Guillain Barre syndrome.  By virtue of its nature, TPE extracts medications from plasma and potentially affects drug disposition and clearance.  However, the degree and impact on the impact of TPE on pharmacokinetics is not well described and currently available literature is limited to case reports with highly variable parameters reported.  This makes optimal dosing of key medications (especially antibiotics, sedative and anti-seizure medications) during and around TPE difficult to predict.  Objectives:  To describe the impact of TPE on serum drug concentrations of phenytoin, phenobarbital, vancomycin, gentamicin, and valproic acid.  To describe optimal dosing around TPE to maintain target drug serum concentrations.
    Selected Publications

    Kendrick JG, Carr RR, Ensom MHH.  Pediatric obesity: Pharmacokinetics and implications for drug dosing. Clin Ther 2015:37:1897-923.

    West N, Ansermino M, Carr RR, Leung K, Zhou G, Lauder GR.  A naloxone admixture to prevent opioid-induced pruritus in children: a randomized controlled trial.  Can J Anaesth 2015;62:891-900.

    Rainkie D, Ensom MHH, Carr RR.  Pediatric assessment of vancomycin empiric dosing (PAVED): a retrospective review.  Paediatr Drugs 2015;17:245-53.

    Bajwa R, Kendrick JG, Carr RR.  The invisible white coat: Awareness of pharmacists in a neonatal intensive care unit.  Can J Hosp Pharm 2014; 67:292-7.

    Carr RR, Ensom MHH, Decarie D.  Stability of epinephrine in standard concentrations. Can J Hosp Pharm 2014; 67:197-202.

    Kendrick JG, Ensom MHH, Steer A, White C, Carr RR.  Standard-Dose versus High-Dose Acyclovir in Children Treated Empirically for Encephalitis: A Retrospective Cohort Study of Its Use and Safety. Pediatr Drugs. 2014; published online February 2014.

    Carney L, Kendrick J, Carr RR.  Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD–PICU). Can J Hosp Pharm 2013;66:21-27.

    Escudero C, Carr R, Sanatani S. Overview of antiarrhythmic drug therapy for supraventricular tachycardia in children.  Prog Pediatr Cardiol 2013;35:55-63.

    Jeffries S, Pattar R, Pitfield A, Carr RR. Use of methadone for prevention of opioid withdrawal in critically ill children.  Can J Hosp Pharm; 2012;65:12-18.

    Daniels JP, Hunc K, Cochrane D, Carr R, Shaw NT, Taylor A, Heathcote S, Brant R, Lim J, Ansermino JM.  Identification by families of pediatric adverse events and near misses overlooked by health care providers.  Can Med Assoc J 2012;184:29-34.
    Grants
    Honours & Awards

    2015/2016  Pharmacotherapy Best Practices Award, Canadian Society of Hospital Pharmacists.  Collins K, Ensom MHH, Rainkie D, Carr RR.  Pediatric assessment of vancomycin empiric dosing 2 (PAVED2).

    2012/2013  Pharmacotherapy Best Practices Award, Canadian Society of Hospital Pharmacists.  Carney L, Kendrick J, Carr RR.  Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD–PICU)

    2011  Fellow, Canadian Society of Hospital Pharmacists

    2010/2011  Pharmacotherapy Best Practices Award, Canadian Society of Hospital  Pharmacists.  Pawluk S, Esau R, Carr RR.  Single versus Double Gram Negative Coverage Empiric Antibiotic Therapy of Febrile Neutropenia in Pediatric Patients. 

    2010  Mentorship Award, Canadian Society of Hospital Pharmacists BC Branch

    2008/2009 Specialties in Pharmacy Practice Award, Canadian Society of Hospital Pharmacists.  Tam J, Ensom MHH, Carr RR.  Pharmacokinetics of Vancomycin and Gentamicin in Pediatric Patients Receiving Extracorporeal Life Support.

    Research Group Members