Neurocritical Care Altered Pharmacokinetics in Critical Illness Epilepsy Antiepileptic Drugs Patient Assessment
Dr. Sherif Mahmoud is a clinical associate professor at the Faculty of Pharmacy, University of Alberta. He is also a neurocritical care clinical pharmacist at the University of Alberta Hospital. He received his BSc (Pharm) degree and Master’s in Clinical Pharmacy from Ain-Shams University and his PhD in pharmacokinetics from the University of Alberta. He has been involved in pharmacy practice for more than 20 years where he had many roles as a clinician, researcher and educator. Dr. Mahmoud’s research areas include neurocritical care pharmacotherapy (subarachnoid hemorrhage, status epilepticus), antiepileptic drugs, epilepsy and altered pharmacokinetics in critical illness. This in addition to teaching patient assessment skills in various practice settings. His approach to patient assessment is unique and exceptional as acknowledged by his students and peers. Dr. Mahmoud is a recipient of several awards and has numerous publications throughout his career. In addition, he is the editor of “Patient Assessment in Clinical Pharmacy: A Comprehensive Guide”, an indispensable resource for pharmacists looking to learn or improve crucial patient assessment skills relevant to all pharmacy practice settings. Dr. Mahmoud is the co-chair elect of the Neurocritical Care Society Research Operations Subcommittee and an active member of the Neurocritical Care Society pharmacy research committee.
GCSRT – Clinical Research Training, Harvard Medical School (2019)
Advanced training in methods and conduct of clinical research (clinical trials and epidemiology)
PhD, Pharmacokinetics, University of Alberta (2010)
Master of Science, Clinical Pharmacy, Ain Shams University (2005)
Bachelor of Science, Pharmacy, Ain Shams University (2000)
Neurosciences Intensive Care Unit, University of Alberta Hospital, Edmonton, Alberta
Presidential Citation, Neurocritical Care Society, Boca Raton, FL, USA (2018)
Teaching Excellence Award, Faculty of Pharmacy, University of Alberta (2016)
Preceptor Recognition Award, Faculty of Pharmacy, University of Alberta (2016)
Staff Pharmacist of The Year, University of Alberta Hospital Pharmacy, Alberta Health Services (2010)
Graduate Students Teaching Award, Faculty of Pharmacy, University of Alberta (2009)
Queen Elizabeth II Graduate Scholarship, University of Alberta (2009)
Pharmacy PhD Alumni Graduate students Scholarship, University of Alberta (2008)
Dr L Chatten Best Poster Award, Faculty of Pharmacy, University of Alberta (2007)
Publications – A complete list of publications can be found here.
Books and Book Chapters
1. Patient Assessment in Clinical Pharmacy: A Comprehensive Guide (Springer Nature; 2019) - Editor. Link to Book is here
2. Drugs and Drugs: A Practical Guide to the Safe Use of Common Drugs in Adults - Section Co-editor (Neurologic Agents) - In Press 2019
Areas of Interest: Neurocritical Care (Subarachnoid Hemorrhage, Status Epilepticus); Clinical Pharmacokinetics; Antiepileptic Drugs; Epilepsy; Patient Assessment.
Overall research goal: Translating benchside and bedside observations into clinical practice protocols that will potentially improve outcomes in patients with life-threatening neurological illnesses (e.g. subarachnoid hemorrhage, status epilepticus) and patients with epilepsy.
I. Subarachnoid Hemorrhage
Subarachnoid hemorrhage (SAH) is a neurological emergency characterized by the extravasation of blood into the subarachnoid space. Although SAH accounts for 5% of all strokes, given the relatively younger age at onset, it has a significant burden on productive-life years. The average mortality rate for SAH has been reported to range from 30-50%, with a significant proportion of survivors left with disability. Neurological and medical complications are common after SAH and contribute significantly to the overall prognosis. The aim of this research is pharmacotherapy optimization of existing therapies and translation of new therapeutics in SAH for the sake of preventing those complications and improving patient outcomes.
II. Status Epilepticus
Status epilepticus (SE) is the second most common life-threatening neurological illness in the world. It is defined by the International League Against Epilepsy (ILAE) as “a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms which lead to abnormally prolonged seizures (after time point t1). It is a condition that can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.” Due to the significant amount of morbidity and mortality associated with SE, determination of the most effective therapies, particularly in refractory forms of SE, is essential. The aim of this research is pharmacotherapy optimization of existing therapies and translation of new therapeutics in SE for the sake improving patient outcomes.
III. Therapeutic Drug Monitoring of Antiepileptic Drugs and Optimization of Epilepsy Management
Therapeutic drug monitoring (TDM) of antiepileptic drugs aims for seizure control while minimizing drug adverse effects. Seizure occurrence is unpredictable and some medication side effects can be subtle in their presentation or indistinguishable from other conditions. Therefore, it can be challenging to determine if the current AED dosage is effective and safe in the long term. TDM has been employed with phenytoin, valproic acid, phenobarbital and carbamazepine, among other AEDs, to inform dose adjustments to address lack of seizure control and prevent toxicity within a narrow reference range. Unlike these classic AEDs, newer AEDs such as levetiracetam and lacosamide have demonstrated a wide therapeutic range, a limited side effect profile and predictable pharmacokinetics and TDM has not been incorporated into their routine use. However, there have been reports of altered AEDs exposure in select populations with various comorbidities. The aim of this research is pharmacotherapy optimization of antiepileptic drugs (AEDs) in seizures and epilepsy patients with superimposing comorbidities such as renal impairment, renal replacement therapies and critical illness.
IV. Altered Pharmacokinetics and Pharmacodynamics of Drugs in the Critically Ill
Pathophysiological changes due to critical illness such as systemic inflammation, body fluid volume alterations, hemodynamic instability and organ dysfunction combined with ICU management might affect the pharmacokinetics (PK) and pharmacodynamics (PD) of drugs. Examples of these changes include augmented renal clearance (ARC), reduced oral drug absorption and increased sensitivity to drugs. PK and PD alterations can lead to therapy failure, increase in adverse drug reactions, longer hospital stay and increased overall healthcare cost. The goal of this research is to highlight altered pharmacokinetics and pharmacodynamics of drugs in critically ill and propose therapy optimization strategies to improve patient outcomes.
Patient Assessment Skills for Clinical Pharmacists
Patient assessment is the first step within the pharmacy patient care process, a framework for pharmacists practice. Patient assessment is an integral component of pharmacists’ day-to-day practice regardless of their practice setting (community, hospitals, and specialized clinics). Therefore, acquiring patient assessment skills is indispensable for proper patient care. Dr. Mahmoud is the editor of “Patient Assessment in Clinical Pharmacy: A Comprehensive Guide”, an indispensable resource for pharmacists looking to learn or improve crucial patient assessment skills relevant to all pharmacy practice settings.
Management of Neurological Disorders for Pharmacists
This includes, but not limited to, headache disorders, seizures and epilepsy, antiepileptic drugs, neuropathies, stroke, traumatic brain injury
Basic and advanced principles in pharmacokinetics and their application in clinical practice.
Clinical Decision Making Skills for Pharmacists
Advanced skills to facilitate critical thinking, evidence search and appraisal and decision making in clinical practice
PHARM 203: Introduction to Pharmacology
PHARM 417: Neurology
PHARM 447: Psychiatry
PHARM 489: Seminars in Therapeutics and Professional Practice
PHARM 503: Advanced Pharmacotherapy
PHARM 523: Advanced Pharmacotherapy - Part I
PHARM 532: Patient Assessment
PHARM 533: Advanced Pharmacotherapy - Part II
Nursing 215: Pharmacotherapeutics in Nursing
Students will develop knowledge of various types of neurologic and oncologic conditions and complications and will apply therapeutic and pharmaceutical science knowledge to various patient care scenarios. Students will further develop their critical thinking and self-directed learning skills, along with their breadth and depth of therapeutic knowledge, as they incorporate principles of evidence-based therapeutic decision making within the patient care process framework. (Restricted to Pharmacy students.)Fall Term 2020
Students will expand their knowledge and skills in order to provide care to various patient populations. Students will engage in active learning and focus on using evidence, applying the biopsychosocial model, making decisions, monitoring outcomes, and adjusting drug therapy for complex patients across the age spectrum. Students will further develop their critical thinking and advocacy skills in the provision of care. (Restricted to Pharmacy students.)Winter Term 2021