OBJECTIVE: To describe an intentional topiramate ingestion by an adolescent and warn of the potential for topiramate abuse. CASE SUMMARY: A 17-year-old female intentionally ingested approximately eight 100-mg topiramate tablets for the purpose of “getting high.” Soon after ingestion, she was found at school obtunded and nonresponsive. Upon transfer to the emergency department, she became combative and aggressive with evolving neurologic abnormalities including incoherence, confusion, disorientation, and significant speech impairments including echolalia. Approximately 24 hours after ingestion, the patient had completely recovered without requiring specific treatment or experiencing sequelae. DISCUSSION: The clinical effects following acute topiramate intoxication appear consistent with the drug's known pharmacologic properties. There are few other reports of topiramate ingestions and most cases have had mild outcomes. CONCLUSIONS: Due to the multifactorial effects topiramate may have upon the central nervous system and its anorectic effect, abuse of this drug by adolescents should be considered upon presentation of an adolescent with mental status changes.

Purpose The evolution and expansion of a school of pharmacy–sponsored resident teaching and learning program (RTLP) are described. Summary Since its establishment in 2012, Auburn University Harrison School of Pharmacy’s RTLP has grown to include up to 12 residency programs in Alabama and on the Gulf Coast of Mississippi and Florida. Program requirements include seminar attendance, teaching experiences and observations, and development of an electronic teaching portfolio. Residents are provided support and guidance from an assigned faculty mentor and from chosen teaching mentors in each teaching activity. A program satisfaction survey was developed to assess residents’ reasons for RTLP participation and their views on the manageability of program requirements, the level of residency program support received, the usefulness of seminar content, and other aspects of the program. Resident feedback has been used by RTLP coordinators to modify and refine program requirements. Major changes have included a switch to alternative information delivery mechanisms, clarification of mentor roles and responsibilities, and a transition from longitudinal seminars to intensive workshop days. At the end of the 2016–17 residency year, the RTLP had hosted a total of 66 residents from 12 different residency programs, with a 93.9% retention rate and a more than 3-fold increase in total resident enrollment. Conclusion Evolution of a school of pharmacy–sponsored RTLP was essential to meet the growing needs of affiliated residency programs while optimizing faculty resources.

Highly active antiretroviral therapy (HAART) is a mainstay of treatment for patients with Human Immunodeficiency Virus (HIV). Since second line HAART therapies can be costlier and less effective, it is essential to understand the duration of initial HAART therapies. The overall aim of this study was to estimate the effects of daily pill burden on the time to discontinuation of the initial HAART regimen. Patients were initially identified through the clinic's CAREWARE database. A chart review was conducted for data collection, where only adult, female, HIV-positive patients initiating therapy at the study clinic between 1 January 2001 and 31 December 2011 were included. All study subjects were followed up from the initiation of HAART to treatment discontinuation. A Kaplan–Meier curve was generated to describe time to discontinuation by regimens, and a Cox proportional hazards model was developed to assess the impact of different regimen and patient demographic characteristics on the hazard of discontinuation of the initial regimen. A total of 498 charts were initially reviewed. After assessment of these patients for inclusion criteria, a cohort of 115 adult female patients who initiated HAART at the study clinic was included. Patients treated with 1 pill/day regimen had a significantly longer time to discontinuation than regimens of >1 pills/day (mean duration of initial therapy was 1062.56 days vs. 631.70 days, respectively, p = 0.003). Compared to 1 pill/day regimens, >1 pills/day regimens were associated with a higher hazard of discontinuation (hazard ratio (HR) =3.44 with 95% confidence interval (CI) = 1.25, 9.48). A higher viral load and patients without insurance were also found to be significantly associated with increased hazards of discontinuation. Overall, female HIV patients initiating therapy with the 1 pill/day HAART regimen were less likely to discontinue their treatment compared to patients initiating with >1 pills/day HAART regimen.