Acetaminophen (APAP) is widely used as an over-the-counter fever reducer and pain reliever. However, the current therapeutic use of APAP is not optimal. The inter-patient variability in both efficacy and toxicity limits the use of this drug. This is particularly an issue in pediatric populations, where tools for predicting drug efficacy and developmental toxicity are not well established. Variability in toxicity between age groups may be accounted for by differences in metabolism, transport, and the genetics behind those differences. While pharmacogenomics has been revolutionizing the paradigm of pharmacotherapy for many drugs, its application in pediatric populations faces significant challenges given the dynamic ontogenic changes in cellular and systems physiology. In this review we focused on the ontogenesis of the regulatory pathways involved in the disposition of APAP and on the variability between pediatric, adolescent, and adult patients. We also summarize important polymorphisms of the pharmacogenes associated with APAP metabolism. Pharmacogenetic studies in pediatric APAP treatment are also reviewed. We conclude that while a consensus in pharmacogenetic management of APAP in pediatric populations has not been achieved, a systems biology based strategy for comprehensively understanding the ontogenic regulatory pathway as well as the interaction between age and genetic variations are particularly necessary in order to address this question.
Introduction
A postgraduate year 1 (PGY1) pharmacy residency is designed to build upon the Doctor of Pharmacy education. The American Society of Health‐System Pharmacists (ASHP) accreditation standards, along with the competency areas, goals, and objectives (CAGOs), list four required competency areas for the design of pharmacy residency programs. The fourth required competency area goals and objectives (CAGO R4) focuses on the development of residents' skills related to teaching, education, and dissemination of knowledge. A characterization of current programs' approaches to satisfying this CAGO might stimulate improvements and spread innovation.
Objectives
To better characterize how PGY1 pharmacy residency programs incorporate teaching experiences in the training of residents.
Methods
The authors developed a survey to address the goals and objectives under CAGO R4. The survey was distributed to residency program directors (RPDs) of ASHP‐accredited PGY1 pharmacy residency programs and responses were voluntary. All data were analyzed descriptively to determine frequency (n) and percent (%).
Results
21.9% of RPDs surveyed completed the survey, with a wide variation in program demographics. The most common presentations were to pharmacy staff/students (65.6%) and consisted of poster presentations (81.8%) or platform presentations (74.9%). The most common writing experiences included chart notes (94.6%) and drug monographs (88.7%). In regard to precepting, the majority (82.8%) of programs require their residents to co‐precept one to two pharmacy students per residency year. Finally, approximately half of the respondents required their residents to complete a teaching certificate program, with an additional 62.6% of these programs offering pedagogical readings.
Conclusion
Despite offering a number of experiences aimed at achieving the goals and objectives of CAGO R4, considerable variation exists in the design of the experiences offered and how programs assess the residents' learning experiences.
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