Since the start of my career in hospital pharmacy, I have been interested in Cystic Fibrosis (CF). My residency project was looking at the effects of a drug, domperidone, on prolactin levels in the CF population. Since then, I have had the opportunity to work closely with the CF team, and have been involved in various CF medication related projects (association with renal toxicity, cost effectiveness of treatment).
In my last two years, I have been proposing research questions and have had the opportunity to pursue four of these projects, all related to medication use in the CF population (medication and associated toxicities, medication adherence). I want to continue to be active in proposing research questions, that can be used to apply back to the CF population to ensure that the medications used in them continue to be appropriate, efficacious, and safe.
Prevalence of hypomagnesemia associated with proton pump inhibitor (PPI) therapy in children with cystic fibrosis.
Health Canada and the FDA have described several case reports of low magnesium thought to be associated with PPI therapy, resulting in arrythmias and hospitalization. CF patients have disease related factors that may increase their risk for hypomagnesemia andthey may be on other medications that may also cause arrythmias. In addition, many CF patients also have gastroesophageal reflux disease, and are on PPI therapy for control of reflux symptoms. This case control study was conducted to describe the incidence of hypomagnesemia, and describe the severity of hypomagnesemia related side effects, and any interventions that were initiated. This is the first study to my knowledge conducted in children, and will be used to help guide our practice in monitoring the safety of PPI therapy in our CF population.
Long-term safety of aminoglycoside administration in children with cystic fibrosis.
Aminoglycoside antibiotics are commonly used to treat CF pulmonary exacerbations. At our centre, we have been using high dose aminoglycoside therapy to treat CF pulmonary infections since 1995. Aminoglycoside antibiotics are associated with side effects like nephrotoxicity and ototoxicity. This retrospective chart review was conducted between 1995 - 2011, to describe the incidence of nephrotoxicity and otoxicity, describe any cumulative dose and pharmacokinetic exposure correlations with toxicities, and describe any risk factors associated with toxicities. To our knowledge, this is the first study that will attempt to look at cumulative dosing and pharmacokinetic exposure to correlate with nephrotoxicity and ototoxicity.
Staphylococcus aureus prophylaxis in cystic fibrosis infants.
In BC, newborn screening for CF became available in fall of 2009. CF babies are diagnosed as early as the first week of life. Guidelines on management of infants with CF differ in their use of antibiotic prophylaxis in the US and the UK. S aureus is a common germ that can infect the airways of young children with CF, causing inflammation and lung damage. After reviewing the information available, at our centre, all CF infants are recommended to initiate on anti-staphyloccus antibiotics. Since this process has started, we have not evaluated our experience with the antibiotic that was chosen at our clinic for efficacy and safety (adverse events). A retrospective chart review was conducted to evaluate our experience with anti-staphylococcus antibiotics. The primary objective was to describe the number of positive respiratory cultures for S aureus. The secondary objectives were to describe the types of bacteria grown, resistance patterns, number of hospitalizations, and side effects that were associated with prophylactic therapy.Honours & Awards
New Hospital Pharmacy Practitioner Award (2009), Canadian Society of Hospital Pharmacists
Pharmacy Practice Residency Award (2006), Canadian Society of Hospital Pharmacists