Sherif Mahmoud, BSc(Pharm), MSc, PhD, FNCS

Area of Study / Keywords

Neurocritical Care Altered Pharmacokinetics in Critical Illness Epilepsy Antiepileptic Drugs Patient Assessment

About

Dr. Sherif Mahmoud is a clinical professor at the Faculty of Pharmacy and Pharmaceutical Sciences, 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 epilepsy, antiseizure medications, neurocritical care pharmacotherapy and altered action and disposition of drugs in critical illness. Dr. Mahmoud studies how neurological injury and other patient factors alter the pharmacokinetics and pharmacodynamics of drugs, an important avenue for personalized pharmacotherapy. 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 numerous awards and has numerous publications throughout his career. In addition, he is the sole 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 actively involved with the Neurocritical Care Society committees including the research and pharmacy leadership committees. Dr. Mahmoud received multiple accolades for his role in neurocritical care and he is inducted as Fellow of the Neurocritical Care Society (FNCS) for his exceptional service, academic excellence, and leadership in the field of Neurocritical care. 

Dr. Mahmoud's Lab Website - Neurotherapeutics and Clinical Pharmacokinetics Laboratory (Neuro-CPK)

Education

GCSRT – Clinical Research Training, Harvard Medical School

Advanced training in methods and conduct of clinical research (clinical trials and epidemiology) 

PhD, Pharmacokinetics, University of Alberta

Master of Science, Clinical Pharmacy, Ain Shams University

Bachelor of Science, Pharmacy, Ain Shams University

Clinical Practice

Neurosciences Intensive Care Unit, University of Alberta Hospital, Edmonton, Alberta

Select Awards

Fellow of the Neurocritical Care Society - FNCS (2020)

2020 Presidential Citation, Neurocritical Care Society Virtual Annual Meeting (2020)

Neurocritical Care Society Travel Award, The Integra Foundation, USA (2020).

2018 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)

Research

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 study the influence of neurological injury on the action and disposition of drugs, an important step towards precision pharmacotherapy.

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.   

Teaching

Teaching Areas:

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  

Clinical Pharmacokinetics

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 

Courses Taught: 

PHARM 444: Neurology and Oncology

PHARM 448: Advanced Pharmacotherapy

EXPH 2553: CCPP Pharmacotherapy I

PHARM 312: BASE III (Behavioral, Administrative, Social and Evidence based Pharmacy)

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

PHARM 448 - Pharmacotherapy 10

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.)

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2023 November;