The Arkansas Pharmacist Winter 2009

The

Arkansas

Pharmacist

2009 Fall Quarterly Edition

APA Board of Directors

2008 - 2009 Officers

Area Representatives

President................................................Paul Holifield, Pharm.D., Batesville President Elect ............................................Jan Hastings, Pharm.D., Benton Vice President ..................................................Mike Smets, P.D., Fort Smith Past President..................................Stephanie Goodart O’Neal, P.D., Wynne

Area 1 (Northwest)....................................Gary “Buzz” Garner, P.D., Mena Area 2 (Northeast) ..............................Dennis Moore, Pharm.D., Batesville Area 3 (Central).......................................Gary Bass, Pharm.D., Little Rock Area 4 (Southwest/Southeast) ......................Mike Stover, Pharm.D., Rison

Ex-Officio Members APA Executive Vice President ................................................................................................................................................ Mark Riley, Pharm.D., Little Rock Board of Health Member ...................................................................................................................................................................John Page, P.D., Fayetteville Board of Pharmacy Representative ..............................................................................................................................Charles Campbell, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean)........................................................................................Stephanie Gardner, Pharm.D., Ed.D., Little Rock Harding College of Pharmacy Representative (Dean) ....................................................................................................Julie Hixson-Wallace, Pharm.D., Searcy UAMS College of Pharmacy Student Representative ..........................................................................................................................Cristina Easterling, Bryant Harding College of Pharmacy Student Representative ..........................................................................................................................Celia Proctor, Little Rock

District Presidents

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District 1 Kenny Harrison, Pharm.D. Cornerstone Pharmacy 4220 N. Rodney Parham Little Rock, AR 72212

District 3 Danny Ponder, P.D. Ponder Economy Drug, Inc. 400 S College St, Mountain Home, AR 72653

District 5 Lynn Crouse, Pharm.D. Eudora Drug Store 140 S. Main St. Eudora, AR 71640

District 7 John Vinson, Pharm.D. Area Health Education Center 612 South 12th Street Fort Smith, Arkansas 72901

District 2 Brandon Cooper, Pharm.D. Soo’s Drug & Compounding Center 2905 E. Nettleton Ave. Jonesboro, AR 72401

District 4 Cliff Robertson, P.D. Robertson’s N. Heights Pharmacy 1201 E. 35th St. Texarkana, AR 71854

District 6 Michael Butler, Pharm.D. Village Health Mart Drug #1 4440 N. Highway 7 Hot Springs, AR 71909

District 8 Christy Campbell, P.D. Lowery Drug Mart #2 123 Central Ave. Searcy, AR 72143

APA’s Academy of Consultant Pharmacists

APA’s Academy of Compounding Pharmacists

President ................................................Muncy Zuber, P.D., Heber Springs President Elect ................................................Jim Griggs, P.D., Fayetteville

President ..........................................Gary Butler, P.D., Hot Springs Village President Elect ..................................................................To Be Announced

Arkansas State Board of Pharmacy

Arkansas Association of Health System Pharmacists

President ......................................................Bob Dufour, R.Ph., Bentonville Vice President ........................................Lenora Newsome, P.D., Smackover Secretary ............................................................Benji Post, P.D., Pine Bluff Member................................................................Marilyn Sitzes, P.D., Hope Member..........................................................Ronnie Norris, P.D., McGehee Member ..........................................................Steve Bryant, P.D., Batesville Sr. Citizen Public Member ..................................Ross Holiman, Little Rock Public Member ................................................Sharon Capps, R.N., England

President ..............................................Maggie Miller, Pharm.D., Batesville President Elect............................................Jason Derden, Pharm.D., Benton Past President ............................................Justin Boyd, Pharm.D., Ft. Smith Executive Director................................Dennis Moore, Pharm.D., Batesville Treasurer ..............................................Sharon Vire, Pharm.D., Jacksonville Secretary ..................................................Paula Price, Pharm.D., Sherwood Member at Large......................................Brandy Owen, Pharm.D., Conway Member at Large ............................Jody Smotherman, Pharm.D., Batesville Member at Large ................................Jennifer Priest, Pharm.D., Little Rock

The Arkansas Pharmacist

Contents Arkansas Pharmacists Association 417 South Victory Little Rock, AR 72201 501-372-5250 501-372-0546 Fax

Arkansas

Pharmacist The

Features

The Arkansas Pharmacist (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201.

Editorial Staff: Editor: Mark Riley, Pharm.D. Executive Vice President

State Board Elections ................................................................................6 Call for Nominations ..................................................................................6 Awards Solicitation ....................................................................................7 Golden Certificate CE ................................................................................9 Medicating the Elderly ............................................................................10 Wholesale Partners ..................................................................................18 Message from APA Board ........................................................................20 Pharmacy in Arkansas Print......................................................................29 APF Pharmacy Walkway of Honor ..........................................................31 Pharmacy Time Capsules ........................................................................32 APF Golf Tournament ..............................................................................32

Departments

Art & Design Editor: Helen Hooks Communications Specialist Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee.

POSTMASTER: Send address changes to The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201.

Cover photo courtesy of Arkansas Secretary Of State Charlie Daniels.

From the President......................................................................................4 The Executive’s Perspective ......................................................................5 AAHP Report ..........................................................................................13 Safety Nets................................................................................................14 In Memoriam ............................................................................................15 Compounding Report ..............................................................................17 UAMS Report ..........................................................................................22 Calendar of Events ..................................................................................25 Rx and the Law ........................................................................................26 Medicaid Alert ..........................................................................................27 Harding Report ........................................................................................28 Member Classified Advertising................................................................30 Board of Directors Minutes ......................................................................33

Index to Advertisers Pace Alliance ............................................................................................8 Arkansas Pharmacy Support Group ........................................................15 Pharmacy Partners of America ................................................................16 Pharmacists Mutual ................................................................................23 APF Legacy ............................................................................................24 Pharmacy Quality Commitment ..............................................................25

APA Staff Office E-mail Address apasupport@arpharmacists.org Mark S. Riley, Pharm.D. Executive Vice President mriley@arpharmacists.org

Scott Pace, Pharm.D. Associate Executive Vice President scott@arpharmacists.org

Helen Hooks Communications Specialist hhooks@arpharmacists.org

Barbara McMillan Director of Administrative Services & Meetings bmcmillan@arpharmacists.org

Debra Wolfe Director of Public Affairs dwolfe@arpharmacists.org

Celeste Reid Administrative Assistant creid@arpharmacists.org

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From the President Band of Brothers

I met with a few of my pharmacy buddies the other evening. We have a small group that gets together once a month or so to discuss whatever concerns we have at the time. They are, for the most part, independent store owners like me. But others are employee pharmacists and sometimes a chain or hospital pharmacist will join us. We find that the issues are similar for us all.

As we talked about the many issues that affect our practices, several things became obvious. Our professional and personal relationships had evolved greatly. Where we once thought of each other as competitors, we are now colleagues. And where there were once petty differences, we now have become close friends. We have come to the further realization that our individual practices and pharmacy in general face many challenges, but they are not with each other.

Paul Holifield, Pharm.D. Econo Mart Pharmacy Batesville, AR

Our more serious threats come from the PBMs with their ridiculously low reimbursement rates that not only threaten our existence, but cost the consumer plenty. Also from mail order pharmacy that promises savings that never materialize. The complexity of pharmacy practice is another issue that is often a topic for discussion. It is not just prior authorizations and extensions of benefits anymore. It’s accreditation issues required to bill Medicare, fraud waste and abuse training required for all employees each year, and now point-of-sale upgrades to facilitate federal savings accounts.

These are the just some of the many challenges facing pharmacy today. They create a need for pharmacists to establish relationships with each other that will help us cope with the demands that we contend with each day. We must encourage our cohorts to upgrade their pharmacies and embrace the technology that will help them remain viable in this competitive environment.

Therefore our small band of brothers will continue to come together in our monthly meetings and address these and other pressing issues that we all must face. We will share our ideas and alert each other about what we have found that works as well as what does not.

And more importantly, we may simply lend moral support and a sense that if we stay true to values and our mission, we as pharmacists will prevail.

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The Executive’s Perspective Start of a New Year, New State Legislature, New Congress, and New President The American system of democracy is an interesting animal. “The people” (“…of the people, for by the people, and by for the people”) have the privilege of deciding the direction of this great country every two years, to a certain extent, and more completely every four years.

It has always been amazing to me that we can shift directions so dramatically in four years, but just maybe that is the beauty of the system and is ultimately what makes it work. If our leaders go off into “left field” (or “right field”, in terms of political direction) too far, then “the people” tend to make marked changes in the other direction.

The point I am making is that we will see a distinctly different Congress and administration at the national level and healthcare has been listed as one of the top three issues to tackle (along with the economy and Iraq). We have reason to believe the Arkansas delegation in Congress will be in a better position to fix some of the problems that have been thrust on pharmacy. We have broad support across our delegation, and both Senators and our four House members have signed on to most, if not all, of the national pharmacy legislation that has been introduced over the last several years. Congressman Marion Berry has plans to run a bill which will exempt pharmacists and pharmacies from the burdensome DME accreditation provisions. Please support him in every way you can in this endeavor. I feel confident that the other members of our delegation will join him. Of course, none of us can be sure that this legislative initiative will pass, therefore you should still do what you need to do to protect your business and patients as far as DMEPOS credentialing is concerned. But by getting behind Congressman Berry’s leadership, we have a chance for this issue to be fixed for the future.

Mark Riley, Pharm.D.

At the state level, about thirty percent of the legislators will be newcomers. Because of your help and support, I believe that we have a lot of friends in the state legislature. We will be calling on you to contact your Representatives and Senators when appropriate. The most powerful lobbying voice that we have as an association is our membership and I encourage all of you to make sure you communicate with your Representatives and Senators.

In the end, all legislative battles are hard fought and there are no guarantees, but I believe there are many in the process who understand that pharmacy has been “beat up” in the last few years, and, after significant victories last year in Congress, I think we have reason to be optimistic.

I hope that you and yours are doing well as this New Year begins.

Certainly the pharmacy community has much to be thankful for and patients consistently show that pharmacists are highly respected and much needed. And, as always, please contact us if you have a need.

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ARKANSAS STATE BOARD OF PHARMACY ELECTIONS APA BY-LAWS: ARTICLE IV-NOMINEES AND DELEGATES Section 1. BOARD OF PHARMACY NOMINEES. Only Arkansas registered pharmacists primarily engaged in an active practice of profession in Arkansas for the past five (5) years and who for the past five (5) years shall have been an active member in good standing in the Arkansas Pharmacists Association shall be eligible as a candidate for Association nomination to the Arkansas State Board of Pharmacy for a six (6) year term. Candidates for the State Board election shall be nominated from the statewide APA membership and elections for each position shall be on a statewide basis.

APA will submit the names of the three nominees receiving the most votes to the Governor for his consideration. Governor Beebe will evaluate the nominees recommended by APA and make the appointment to the Arkansas State Board of Pharmacy.

NOMINATIONS WILL CLOSE AT NOON, MARCH 15, 2009.

CALL FOR NOMINATIONS Nominations are invited for each of the following positions on the Arkansas Pharmacists Association Board of Directors.

Vice President APA Statewide (Term-One year VP – Four years Board Member)

District 4 President Southwest District (Two year term) Southwest Counties: Crawford, Franklin, Logan, Polk, Scott, and Sebastian

Area III Representative APA Board Member Central - District - 1 (Four year term) Area III Counties: Faulkner, Lonoke, Prairie, Pulaski, Saline and Monroe

District 5 President Southeast District (Two year term) Southeast Counties: Arkansas, Ashley, Bradley, Chicot, Cleveland, Desha, Drew, Grant, Jefferson, and Lincoln

District I President Central District (Two year term) Central Counties: Faulkner, Lonoke, Prairie, Saline, Pulaski, and Monroe

APA OFFICERS AND BOARD OF DIRECTORS The requirements for nominees of the APA Officers are as follows: Arkansas licensed pharmacist who has been a member of this Association in good standing for the past three (3) consecutive years.

No elected member of the APA Board of Directors shall serve for more than eight (8) consecutive years or more than two (2) consecutive terms in the same capacity.

District 2 President Eastern District (Two year term) Eastern Counties: Clay, Craighead, Crittenden, Cross, Green, Lawrence, Lee, Mississippi, Phillips, Poinsett, Randolph, and St. Francis

NOMINATIONS WILL CLOSE AT NOON, MARCH 31, 2009.

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APA AWARDS SOLICITATION Award Nominations Each year APA asks the membership to submit the names of individuals who are deserving of special recognition for their professional activities during the past year. Any active APA member is eligible to nominate a person for the awards. Award recipients are chosen by an APA committee following a review of all nominees. Nominations are now being accepted for the following annual awards to be presented by the Association: Please mark your nomination with an X. If you have more than one nomination, please feel free to photocopy this form.

Pharmacist of the Year The Pharmacist of the Year Award is given to recognize the pharmacist for his/her outstanding contributions to the profession of pharmacy and activities in the advancement of pharmacy during the year.

Young Pharmacist of the Year Nominee must have an entry degree in Pharmacy, received nine or less years ago, and be a member of the APA. Nominee must be in the active practice of pharmacy in the year selected, and actively involved in the profession of pharmacy, displaying an interest in the future of the profession.

APA Community Service Award and Bowl of Hygeia Award This award was established by the A.H. Robbins Company to honor pharmacists who have contributed to the progress of their community. Criteria include: 1) Pharmacist licensed in the State of Arkansas; 2) Recipient must be living and must not be previous recipient of award; 3) Recipient must not be currently serving, nor has he/she served within the immediate past two years, as an officer of the APA in other than an ex-officio capacity or on its awards committee; 4) Recipient must have compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession.

Innovative Pharmacy Practice Award This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy, Association Executives and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy.

Name of Nominee__________________________________________________________________________ Address__________________________________________________________________________________ City/State/Zip ____________________________________________________________________________ Phone __________________________________________________________________________________ Reasons for selecting nominee ______________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Nominator’s Name ________________________________________________________________________ Phone_____________________________ Date ________________________________________________

Attach resume if available Return to: Awards Committee, Arkansas Pharmacists Association, 417 So. Victory, Little Rock, AR 72201

NOMINATIONS WILL CLOSE AT NOON, APRIL 15, 2009.

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Golden Certificate CE

The 5th Annual Golden Certificate CE Program was held on Thursday, October 9th at the UAMS College of Pharmacy.

Over 30 pharmacists who have been licensed by the Arkansas State Board of Pharmacy for over 50 years gathered to earn six hours of continuing education credit. Attendees participated in CE on diabetes, medication therapy management, over-the-counter medications, and breast cancer. APA would like to thank the speakers and the attendees for making the 2008 Golden CE Program a success.

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Medicating the Elderly

MEDICATION-INDUCED NUTRITIONAL PROBLEMS

By Christina Minden, Pharm.D. Central Arkansas Veterans Health System Little Rock, AR Advancing age is associated with a greater incidence of acute illness, chronic diseases, and a corresponding increase in the number of medications taken by an individual. Use of prescription and over-the-counter medications can cause GI symptoms, loss of appetite, and malabsorption of nutrients. Additionally, a large number of community-dwelling elderly individuals take herbal remedies or supplements and these are often not documented on their medication profiles. While complex regimens may be indicated for coexisting medical conditions, all of this increases the risk for drug-drug interactions, drug-nutrient interactions, and adverse reactions.

ent metabolism and function. The first of these is decreased absorption. When the medication acts as a mechanical barrier, access of nutrients to the gastric and intestinal mucosal surfaces is prevented. A prime example of this would be mineral oil, which decreases absorption of the fat-soluble vitamins (A, D, E, and K), calcium, and phosphorus.

A second mechanism for decreased absorption is exhibited when medications and nutrients undergo a complexation or chelation reaction. This is illustrated by the classic reaction of divalent cations, such as Ca, Mg, Zn, and Fe, with fluoroquinolones or tetracyclines.

Drug-induced nutritional problems often develop slowly and occur most freYet another mechanism is to increase the rate of Advancing age is quently with the long-term administratransit and decrease the amount of time available associated with a greater tion of medications for chronic diseases. for absorption of nutrients. For example, chronic incidence of acute Altered taste sensation (dysguesia), apuse of stimulant laxatives and laxative abuse lead illness, chronic diseases, petite suppression, altered sense of to general malabsorption, steatorrhea, and dehydraand a corresponding smell (dysosmia), gastric irritation, altion which results in reduced absorption of glucose, increase in the number tered GI motility, and altered nutrient protein, calcium, sodium, potassium, and fat-soluof medications taken by metabolism and function are all nutrible vitamins. an individual. tion-related adverse effects of medications. Decreased calorie intake and ensuing weight loss can also Decreased absorption of nutrients is also seen with changes in be a result of medications that cause adverse gastrointestinal efpH. For example, risk of vitamin B12 deficiency is greater with fects, sedation and confusion, or a decrease in functional abilities. medications that increase gastric pH, such as histamine-2 (H2) Any of these can have a dramatic impact on nutritional intake on blockers and proton pump inhibitors. An acidic gastric environa population that is already compromised. ment is necessary for the release of cyanocobalamin from dietary protein. Because there are usually ample stores of cyanocobalNutrient Malabsorption amin in the body, the combination of acid suppression and age-reThere are a variety of ways in which medications can alter nutrilated atrophic gastritis may take years of chronic administration

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of medications, like ranitidine or omeprazole, to result in the debisphosphonates, and a variety of other medications. Oral iron velopment of B12 deficiency. Synthetic B12 supplements are not and calcium supplements will also frequently induce nausea or affected by pH of the stomach and oral replacement is often efgastric upset. Non-steroidal anti-inflammatory agents affect the fective. Intramuscular injections are needed only when there is a mucosal lining by both local irritation and through systemic efdeficiency of intrinsic factor which is essential for absorption of fects on prostaglandin synthesis. (Table 2) vitamin B12 in the ileum.

Medication-Induced Dysguesia and Dysosmia A final mechanism of action for reducing absorption of micronuEffects on olfaction and taste can also decrease appetite. Smell trients is seen with antibiotic-associated destruction of normal GI and taste disturbances are often induced by cardiovascular medflora. Intestinal flora is responsible for the synthesis of vitamin K ications, like angiotensin-converting enzyme (ACE) inhibitors, and for the production of vitamins B1, B2, B6, and B12. A dediltiazem, and antiarrhythmics. Several antibiotics have adverse crease in normal GI flora also interferes with enterohepatic recireffects of taste perversion, often described as a bitter or metallic culation and reabsorption of folic acid. taste.

Medications Associated with Smell and Taste Disturbances Administration of products such that contain Antiepileptics (Table 3) acidophilus or saccharomyces might be beneand antificial in inhibiting the loss of intestinal flora, Anticholinergic Agents (Tricyclic Antidepressants, cholinergic but even these seemingly harmless products Antihistamines) agents have may carry risks to older adults with impaired Cardiovascular Medications also been reimmune function. ported to have ACE Inhibitors (Captopril, Enalapril) adverse efBeta Blockers (Labetalol, Propranolol) Increased Nutrient Utilization and Metabfects of dysDiltiazem olism guesia or Antiarrhythmics (Mexiletine, Procainamide, Propafenone) Medications can alter nutrient utilization by dysosmia.

Lithium increasing demand. Oral contraceptives in(Table 3) crease pyridoxine and ascorbic acid require- Antibiotics (Ampicillin, Azithromycin, Clarithromycin, Ciprofloxacin, ments. Corticosteroids increase pyridoxine Metronidazole) and vitamin D requirements. Isoniazid acAntiepileptics (Carbamazepine, Phenytoin) celerates the metabolism of pyridoxine.

There is an increase in catabolism of vitamin Colchicine D 25-hydroxy seen with the anticonvulsants Corticosteroids (Beclomethasone, Fluticasone, Flunisolide) phenytoin, phenobarbital, and primidone.

Also, there is a reduction in conversion of folic acid to its active form, tetrahydrofolate, commonly seen with methotrexate, nitroDrug-Related Physical and Cognitive Impairment furantoin, and trimethoprim. Other medications that antagonize Any medication that has an adverse effect that could potentially folic acid include oral contraceptives, primidone, phenobarbital, decrease an older person’s ability to perform ADLs and IADLs phenytoin, sulfasalazine, triamterene, and isoniazid. independently could place them at nutritional risk depending on their living situation and support system. Anticholinergic effects Increased Nutrient Excretion of medications include dry mouth which can worsen appetite and Nutritional problems can also be caused by medications that inswallowing problems. In addition, anticholinergics can cause crease the excretion of vitamins and minerals by the kidney or delirium and confusion. Hypnotics, opioid analgesics, and anxiliver. There are numerous examples of this. Furosemide, cafolytics all have significant effects on confusion and daytime sedafeine, and corticosteroids Anorexiogenic Medications (Table 2) tion. Lithium can cause a increase urinary excretion tremor which can impair funcof calcium. Diuretics and Selective Serotonin Reuptake Inhibitors (Fluoxetine, Paroxetine, Sertra- tion. Antipsychotics and medcorticosteroids both in- line) ications with dopamine crease urinary excretion Digoxin antagonist properties increase Dopamine agonists (carbidopa/levodopa, pramipexole) of zinc. And although the likelihood of movement disrarely seen in high doses Valproic acid, Divalproex orders. Antihypertensives are in current practice, associated with dizziness, orCholinesterase Inhibitors (Galantamine, Donepezil, Rivastigmine) chronic administration of thostasis, and syncope. DiuretTheophylline 4-5 gm/day of aspirin inics and laxatives may limit Non-Steroidal Anti-Inflammatory Drugs creases vitamin C and ability to shop because of fear Antibiotics potassium excretion. of incontinence. AnticonvulBisphosphonates (Alendronate) sants and dopamine agonists Ferrous Sulfate Medication-Induced may worsen gait impairments.

Anorexia and Gastroin- Calcium Carbonate testinal Effects Nausea and anorexia are common with digoxin, selective serotonin reuptake inhibitors, cholinesterase inhibitors, antibiotics,

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Drug Nutrient Interactions (Table 1) Nutrient deficient Interacting medications Vitamin D Phenytoin, Primidone, Phenobarbital, Corticosteroids, Orlistat, Cholestryamine, Laxative Abuse Phenytoin, Primidone, Cholestyramine, Oral contraceptives, Broad-spectrum antibiotics, Methotrexate, Folic acid Trimethoprim, Nitrofurantoin, Sulfasalazine Iron Antacids, H2 blockers, Proton pump inhibitors, levodopa, tetracycline, cholestryamine Vitamins A&E Orlistat, Cholestryamine, Laxative Abuse Cholestryamine, Laxative abuse, Furosemide, Caffeine, H2 blockers, Proton pump inhibitors, CorticosCalcium teroids Vitamin B12 Cholestryamine, Proton pump inhibitors, H2 blockers, Broad-spectrum antibiotics Thiamine Broad spectrum antibiotics, Aspirin, Black tea Riboflavin Antiretroviral agents, Chlorpromazine Niacin Isoniazid Vitamin K Broad-spectrum antibiotics, Orlistat, Cholestryamine, Laxative Abuse Vitamin C High dose aspirin (4-5 gm/day), Corticosteroids, Oral contraceptives Pyridoxine Broad-spectrum antibiotics, Corticosteroids, Oral contraceptives Zinc Diuretics, Corticosteroids, Zinc SUMMARY Optimal caloric and micronutrient intake is essential for overall well being, maintenance of physical and functional capacities, and prevention of chronic disease in the elderly. Unintended weight loss in this population increases both morbidity and mortality. Medications can play a significant role in the cause of anorexia and malnutrition in the elderly. In addition, medications can alter vitamin and mineral absorption and utilization.

Success nutritional intervention necessitates a multidisciplinary approach with the pharmacist as an essential team member. With the increased use of medications and prevalence of chronic and multiple diseases after age 65, it is crucial that the pharmacist review medication profiles for potential adverse effects, drug-drug interactions, and drug-nutrient interactions. Adjusting medication regimens to minimize adverse effects on appetite, taste perception, cognition, and functional ability is a vital part of any nutritional intervention.

As the elderly population continues to rise, evaluation of the medication-related risks for malnutrition becomes a significant area for pharmacist involvement.

References 1. Johnson LE and Sullivan DH. Nutrition and Failure to Thrive.

Current Geriatric Diagnosis and Treatment. 2004:391-406.

2. Zizza C, Herring A, Domino M, et al. The effect of weight change on nursing care facility admission in the NHANES: Epidemiologic Follow-up Survey. J Clin Epidemiol. 2003;56:906-13.

3. Baker H. Nutrition in the elderly: an overview. Geriatrics.

2007;62(7):28-31.

4. Baker H. Nutrition in the elderly: nutritional aspects of chronic diseases. Geriatrics. 2007;62(9):21-25.

5. Baker H. Nutrition in the elderly: hypovitaminosis and its implications. Geriatrics. 2007;62(8):22-6.

6 Roe DA. Medications and Nutrition in the Elderly. Primary Care.

1994;21(1):135-147.

7 Akamine D, Filho MK, Peres CM. Drug-nutrient interactions in elderly people. Curr Opin Clin Nutr Metab Care.

2007;10(3):304-10.

8. Zervakis J, Schiffman SS. Adverse Taste Side Effects of Cardiovascular Medications. Geriatric Times. 2002;3(1).

9. Doty RL, Bromley SM. Effects of drugs on olfaction and taste.

Otolaryngologic Clinics of North America. 2004;37(6).

10. Micromedex (www.thomsonhc.com) 11. Lexi-comp (http://online.lexi.com) 12. Merck Manual (www.merckmedicus.com) 13. Harrison's Practice (www.merckmedicus.com)

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AAHP Report

AAHP January 2009 Report by: Maggie Miller, President Fall Seminar 2008 The AAHP Fall Seminar was held October 9-10, 2008 at the Harrah’s Casino and Resort in Tunica, Mississippi. The program offered approximately 11 hours of continuing education for pharmacists with an estimate of 130 pharmacists, pharmacy students, and technicians attending the educational event. AAHP appreciates the hard work of Drs. Brandy Owen and Kimberly Watson along with their Committee which served as the primary catalyst for the success of the event.

The following individuals were honored with awards at the Fall Seminar luncheon on Friday October 10: • New Practitioner of the Year - Dr. Marsha Crader (St. Bernard’s Medical Center) • Staff Pharmacist of the Year - Dr. Rena Lacheen (Central Arkansas Veterans Healthcare System) • Clinical Pharmacist of the Year - Dr. Sharon Vire (Central Arkansas Veterans Healthcare System) • Manager of the Year - Dr. Jim Parks (Arkansas Children’s Hospital) • Technician of the Year - Mrs. Pat Wiley (Central Arkansas Veterans Healthcare System) AAHP congratulates each of these individuals for their outstanding contributions to Health-System Pharmacy in Arkansas.

Fall Seminar 2009 Planning continues for the AAHP 2009 Fall Seminar. Drs. Jennifer Priest and Lanita Shaverd are serving as the Fall Seminar Committee Chairs. The event will be held in the Little Rock area in October 2009. We look forward to another successful seminar.

APA 127th APA Annual Convention at the DoubleTree Hotel Drs. Brandy Owen and Kimberly Watson are working with APA for the AAHP sponsored educational event to be held at the Annual APA Convention. Three live continuing education hours are being planned for the attendees.

Advisory Committee for Hospital Pharmacies This Committee under the leadership of Dr. Susan Newton has successfully implemented a policy that no longer requires a daily signature from nurses for narcotic activity nor a discrepancy log as it relates to the usage of automated dispensing machines. The committee worked closely with the State Board of Pharmacy and the Arkansas Health Department. An example of the policy can be found on AAHP website www.aahponline.org Technician Memorandum of Understanding AAHP has signed a memorandum of understanding in conjunction with our national organization: the American Society of Health-System Pharmacists (ASHP). This agreement reflects our commitment to work collaboratively with ASHP in advancing the quality of the pharmacy technician workforce. There will be a survey distributed state-wide to assess current needs and to gather information from pharmacists in regard to this endeavor.

Communication with Members Over the next year AAHP will be contacting health-system pharmacists in Arkansas hoping to improve communication within our profession across the state. The goal is to develop an email list of active members and hospital directors throughout Arkansas for networking and advisement.

AAHP Board Meeting The next AAHP Board Meeting will be held at the Lester E. Hosto Conference Center in Little Rock, Arkansas, on January 16, 2009, at noon.

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Safety Nets

Safety Nets We are all familiar with the term “road rage”. This Safety Net indicates that we may see a good deal of “counter rage” in our own practices. Thank you for your continued support of this column – John Wolfe and Eddie Dunn.

Dr. Jon Wolfe

Dr. Eddie Dunn the prescription and counseled the patient.

In today’s fast-paced world, many people become frustrated – or even angry – when forced to wait. This is especially true in a community pharmacy. At some locations, it is not uncommon for patients to have to wait one hour, or longer, for a prescription to be filled. Pharmacists are struggling to keep up with ever-increasing prescription volumes, and they too are becoming frustrated. They realize that wait times in their pharmacy are unacceptable, but requests for additional pharmacist and/or support staff are often denied at the corporate level.

In the second case, a pharmacy technician in Eastern Arkansas was presented with the pre- Figure Two scription illustrated in Figure Two. As the technician entered the prescription information into the computer, she noticed the quantity of Cefzil® (cefprozil) 250 mg/5 mL to be administered per dose could be interpreted as either “3 cc’s” or “7 cc’s”. [all our readers know the hazards of “cc” as an abbreviation. They also know that is no longer official in the eyes of the United States Pharmacopeia].

When informed about the problem, the pharmacist decided to call the prescriber for clarification. Unfortunately, the nurse stated the prescriber was unavailable and she would have to call the pharmacist back.

When the pharmacist explained the problem to the patient’s mother, she said she understood and would return later that day.

Several hours later, the prescriber’s nurse telephoned the pharmacist and said the prescribed quantity of Cefzil® per dose was 7 “cc’s”. After this, the pharmacist correctly filled the prescription for a ten-day supply [7 mL per dose] and placed it in the “will call” bin. When the patient’s mother picked up the prescription that evening, she was appropriately counseled.

Pharmacists are struggling to keep up with ever-increasing prescription volumes, and they too are becoming frustrated.

In order to keep patient wait times as short as possible, pharmacists must strive for an efficient workflow. Sometimes, however, even the most efficient pharmacy workflow can be interrupted when patients present carelessly written or illegible prescriptions.

Workflow interruptions frequently translate into even longer patient wait times. The following two near-miss cases clearly illustrate this point.

In the first case, the prescription illustrated in Figure One was presented to the pharmacist by a patient suffering from nausea and vomiting.

Even though the pharmacist examined the prescription for Figure One several minutes, he could not interpret the order. He realized the patient was nauseated and needed immediate relief. However, he simply had no alternative but to call the prescriber for clarification. The prescriber’s nurse stated the prescription was written for Reglan® (metoclopramide) 10 mg tablets. After this, the pharmacist quickly filled 14

Fortunately for the patient in the first case, the pharmacist was able to clarify the prescription in a reasonably short period of time. The patient in the second case was not so fortunate. The illegibly written prescription caused the start of the child’s antibiotic therapy to be delayed several hours. It also created an inconvenience for the child’s mother.

Poor prescriber handwriting has the potential to create problems not only for pharmacists but also for caregivers and patients. This old problem produces longer patient wait times. Sometimes, pharmacists receive illegible prescriptions at night after a prescriber’s office has closed. In some instances, the prescriber can be quickly

The Arkansas Pharmacist

reached through an emergency number. In others, we reach an on call physician who did not examine the patient and is unwilling to attempt to clarify the prescription. In these cases, patients are forced to wait until the prescribing physician can be contacted the next day. The pharmacist is always caught in the middle. Tempers may flare. Regardless of the situation, pharmacists must never fill an illegible prescription unless absolute confirmation has been obtained.

fewer problems with poor handwriting. We know, however, that a computer system devised by humans and used by humans will not solve every problem associated with prescription orders. We understand that we will have to create new Safety Nets to ensure that new kinds of errors still only reach ISMP Levels A or B (opportunity for error, or error occurred but did not reach the patient).

In the end there is no absolute solution. The practical matter is that pharmacists will continue to demonstrate their concern for the wellbeing of patients. We will make the unwelcome and difficult telephone calls. We will – for no extra compensation – exert ourselves and our staffs to accommodate the patient. When 95% or more of prescriptions are generated with computer systems, we will see

In Memoriam Harvey Ham, Jr., P.D. Lewisville, AR Joe D. Fenwick, P.D. Fort Smith, AR

The Arkansas Pharmacist

15

A PHARMACY PURCHASING COOPERATIVE

Board of Directors Membership Tony Bari, Jonesboro, AR President Richard Hanry, El Dorado, AR Vice President Arkansas: 89 stores C.A. Kuykendall, Ozark, AR Secretary/Treasurer Missouri: 7 stores Buzz Garner, Mena, AR Eddie Glover, Conway, AR Gayle Fowlkes, Director of Member Services & Recruitment

Pharmacy Partners of America is part of the Compliant Pharmacy Alliance Cooperative(CPA)-the most successful and profitable buying cooperative in the United States- and it’s available exclusively to independent pharmacies.

CPA has more than 650 members nationwide that represents over $1.7 billion in annual purchases. CPA is managed by Ed Heckman R.Ph.

“The contributing Arkansas members of PPA recognize the value of a strong pharmacy association. We are very pleased that our members have made the decision to financially support the Arkansas Pharmacists Association (APA). We are confident APA will continue to represent our best interest on political and professional issues if given the financial and moral support of Arkansas pharmacists.”

Tony Bari, President PPA

Compounding Report Pharmacy Compounding Subject to FDA Approval?

The Facts just Don’t Fit by: Gary Butler, President, APA Compounding Academy The last APA Journal had an excellent article by Don R. McGuire in the Rx and the Law section giving the history and an update on the legal jousting between the FDA and compounding pharmacists over the legality of a part of our profession that has existed since the profession began. Which is right? Obviously we think our side is and the recent court rulings seem to verify that. I found an article of “facts” about the FDA view published by P2C2, a public advocacy branch of the International Academy of Compounding Pharmacists, that I would like to share with you. For those of you who do not know, IACP is compounder’s strongest advocate in both Congress and in the courts system. They deserve our membership and financial support. The article is quite lengthy so I will offer it as a series over the next few journals.

Over the past 15 years, there has been a fundamental disagreement between the U.S. Food & Drug Administration (FDA) and the profession of pharmacy over the legality of compounding. The view espoused by the FDA is that compounding has been illegal since Federal Food, Drug, and Cosmetic (FDC) Act was passed in 1938. The compounding profession disagrees, and the facts concur. Recently, a landmark ruling in Midland, Texas, reinforced the view of the pharmacy profession that compounded medicines are not new, unapproved drugs and, subsequently, it is legal to prescribe and dispense them. The FDA’s lengthy legal briefs against compounding can be boiled down to a very simple argument: that every compounded drug is a new, unapproved drug and, hence subject to FDA oversight. FDA’s argument primarily hinges on one statutory provision in the FDC Act. This provision defines a new drug as “any” drug that is not generally recognized as safe and effective by experts. FDA argues that the word “any” is clear, simple, and unambiguous, and precludes examining any historical facts.

The problem with FDA’s argument is that the courts have repeatedly rejected it even before the Midland decision. Recently, the U.S. Supreme Court reviewed a federal statute that imposed restrictions on individuals who had been convicted by “any” court. The government argued there, as the FDA argues here, that “any” means “every” and there are no exceptions. The Supreme Court rejected the government’s argument in that case, ruling that a Japanese court was not “any” court for purposed of interpreting the law. In other words, the Court said that courts should not read the word “any” literally as meaning each and every, and should not ignore, as the government wanted, Congress’ objectives and the historical context. This is not a new concept. The U.S. Supreme Court in this decision cited another Supreme Court decision involving the word “any”. Thus, FDA’s central argument about how statutes must be interpreted that the phrase “any drug” means every single drug, without qualification flies in the face of judicial precedent going back two centuries.

FDS has cited no facts to support its position. Instead, FDA relies completely on this statutory argument. However, the facts refute FDS’s view.

Fact: In 1938, when Congress passed the FDC Act, hundreds of millions of medications were compounded annually. In fact, the health care system could not have functioned without compounded drugs. As the executive director or the Missouri Board of Pharmacy stated before Congress in 2003, “in fact, until after World War II when drug manufacturing became more prominent, compounding was one of the principle practices use to provide needed drugs to patients.” FDA’s interpretation of the law would have meant a complete breakdown in the delivery of health care in the United States in 1938, when Congress passed the law.

(Stay tuned. I think you will really enjoy these “Facts” that will continue next time)

The Arkansas Pharmacist

17

APA App

Our Wholes 18

The Arkansas Pharmacist

ppreciates

sale Partners

Happy New Year

President Paul Holifield, Pharm.D. Batesville

President-Elect Jan Hastings, Pharm.D. Benton

District I President Kenny Harrison, Pharm.D. Little Rock

District II President Brandon Cooper, Pharm.D. Jonesboro

District III President Danny Ponder, P.D. Mountain Home

District IV President Cliff Robertson, P.D. Texarkana

District V President Lynn Crouse, Pharm.D. Eudora

District VI President Michael Butler, Pharm.D. Hot Springs Village

District VII President John Vinson, Pharm.D. Fort Smith

District VIII President Christy Campbell, P.D. Batesville

Area I Representative Gary “Buzz� Garner, P.D. Mena

Area II Representative Dennis Moore, Pharm.D. Batesville

Area III Representative Gary Bass, Pharm.D. Little Rock

Area IV Representative Mike Stover, Pharm.D. Rison

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The Arkansas Pharmacist

From the Board of Directors

Vice President Mike Smets, P.D. Fort Smith

Past President Stephanie Goodart O’Neal, P.D. Wynne

APA Executive Director Mark Riley, Pharm.D. Little Rock

Consultant Academy President Muncy Zuber, P.D. Heber Springs

Health-System Academy President Maggie Miller, Pharm.D. Batesville

Compounding Academy President Gary Butler, P.D. Hot Springs Village

Board of Health Member John Page, P.D. Fayettevile

AR State Board of Pharmacy Charles Campbell, Pharm.D. Little Rock

UAMS College of Pharmacy Dean Stephanie Gardner Little Rock

Harding College of Pharmacy Dean Julie Hixson-Wallace Searcy

ASP President - Student Member Cristina Easterling Bryant

Treasurer Richard Hanry, P.D. El Dorado

Legal Counsel Harold Simpson Little Rock

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UAMS Report Instilling Professionalism is a Constant, Deliberate Process A Message from UAMS College of Pharmacy Dean Stephanie F. Gardner, Pharm.D., Ed.D.

Educating pharmacy students includes not only providing instruction in the basic and clinical sciences, but also includes promoting their professional development. Professionalism embodies a number of factors: providing patient care in a way that respects and fosters dignity and compassion; developing appropriate relationships with patients and other team members; presenting an appropriate appearance and attitudes, and being actively involved in promoting the profession.

Our students must be able to collaborate with professionals from many disciplines and cultural backgrounds. It is important for them to have skills required in the modern business environment. The attitudes and behaviors that comprise professionalism cannot be learned from a textbook or a single lecture. Rather, they must be actively acquired through the process of professional socialization.

The UAMS College of Pharmacy is responding with professional development initiatives that begin in the first year and continue throughout the students’ course of study. Professional education begins when first-year students receive their white coats, take the Pharmacy Student Oath and are inducted into their Class at the annual White Coat Ceremony. The ceremony is attended by family members, faculty and other pharmacy professionals.

With the establishment of the Business Etiquette Dinner program in the second year, pharmacy students are gaining a necessary understanding of many social skills. Consultants lead the dinner and teach communication and business meal etiquette, appropriate professional dress, and effective introduction techniques. Further topics include business travel, parties, convention and meeting conduct.

The first Business Etiquette Dinner was held last January in Little Rock. Each student received a detailed packet of information and a book of business etiquette for future reference.

A Professional Pinning Ceremony and Luncheon is held annually for third-year students. At the final assembly before entering the experiential rotations that comprise their senior year, students receive lapel pins unique to the UAMS College of Pharmacy. This denotes the students’ advancement from didactic learning to direct patient care. Leaders of the Arkansas Pharmacists Association, the Association of Health Systems Pharmacists and the National Pharmacists Association participate in this milestone event.

Along with professional events, Introductory Pharmacy Practice Experiences (IPPEs) at the College of Pharmacy help students connect the classroom to practice. These structured experiences in the first through third years get students out of the classroom and into the pharmacy earlier, providing 300 hours of experiential education within the curriculum before the fourth year. In addition to dispensing, the IPPE focuses on communication and professionalism.

By modeling professional behavior, our preceptors are a vital component to our curricular focus on professionalism. Students who are exposed to a patient-centered environment early in their education quickly learn how important their communication skills and the development of a pharmacist-patient relationship are in their role as health care providers.

During their fourth year at the UAMS College of Pharmacy, students participate in Advanced Pharmacy Practice Experiences (APPEs). The program consists of nine one-month rotations led by volunteer preceptors. It is during their advanced experiential education that students begin to more fully understand their unique contributions to the healthcare team. The faculty and preceptors are responsible for developing professionals who recognize and support the individual contributions of all team members in achieving optimal patient outcomes.

On the day before commencement, seniors come to campus for a final convocation and luncheon. They receive a one-year membership in the Arkansas Pharmacists Association and are inducted into the Alumni Association. That evening, in a highly meaningful Senior Awards Ceremony, they receive and present awards. They then are symbolically “hooded” with their doctoral regalia by selected faculty members, and take the Oath of a Pharmacist. The convocation ceremony marks the culmination of not only their education, but it also marks their entry into a dynamic profession.

Developing professionalism among future pharmacists is one of the most important and most challenging aspects of pharmacy education. It can only occur if promoted across the curriculum, and made part of every day’s work. That’s why we make it a constant, deliberate process at the UAMS College of Pharmacy.

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The Arkansas Pharmacist

Calendar of Events February 18, 2009 APA Legislative Day Arkanas State Capitol Little Rock, AR APA Legislative Reception Trapnall Hall Little Rock, AR

April 3 - 6, 2009 The APhA Annual Meeting & Exposition Henry B. Gonzalez Convention Center San Antonio, TX May 11 - 13, 2009 NCPA Legislative Conference Hyatt Regency Washington on Capitol Hill

June 11 - 13, 2009 127th APA Annual Convention DoubleTree Hotel Little Rock, AR September 8 - 30, 2009 APA District Meetings October 17 - 21, 2009 NCPA 111th Annual Convention and Trade Exposition Ernest N. Morial Convention Center, New Orleans

2009 APA Annual Convention Mark your calendar now for the 127th APA Annual Convention

June 11-13, 2009 The newly renovated

DoubleTree Hotel Little Rock

The Arkansas Pharmacist

25

Rx and the Law

PHARMACY MARKETING GROUP, INC

AND THE LAW

By Don. R. McGuire Jr., R.Ph., J.D. This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

COMPARATIVE FAULT A prior article in this series discussed the elements of negligence which a plaintiff must prove in order to win their case. This article will discuss what occurs when the plaintiff themselves are also at fault in the case.

Under an older theory, this concept was called Contributory Negligence. This is when the plaintiff failed to act as a reasonable person and contributed to their own injury. We could see this occurring in pharmacy cases when the patient clearly recognizes that the tablets in the vial are incorrect, but takes them anyway. The impact that Contributory Negligence has on a case is dramatic. If the plaintiff contributed in any way to their injury, then they are entitled to no damages at all. There are 4 states and the District of Columbia that still use Contributory Negligence in some form. This harsh result may have been modified in those states.

The harshness of the Contributory Negligence concept has led the rest of the states to adopt a Comparative Negligence, or Comparative Fault, system.

Under this concept, each party is assigned a percentage of fault with the total being 100%. If our patient above was assessed 10% of the fault in their case, then the verdict would be reduced by 10% and they could only collect 90% of their verdict. This is called Pure Comparative Negligence and is the law in 13 states. Remember the previous result under Contributory Negligence would be that the plaintiff would get nothing in this scenario.

One of the possible results under Pure Comparative Fault is that the plaintiff could be 95% at fault, but still recover 5% of the verdict in their case. This possibility has led some legislatures to modify Comparative Fault. This modification can take several different forms, but essentially bars recovery by the plaintiff if 26

their percentage of fault meets or exceeds a certain threshold. In 11 states, this threshold is 49%, while it is 50% in 21 other states.1 In these jurisdictions, a plaintiff who is assigned 51% or more of fault will recover nothing. This is reminiscent of the results under Contributory Negligence.

In many ways, Modified Comparative Fault is a balancing act. The potential results under Contributory Negligence can be seen as unfair to the plaintiff who has only a small percentage of fault. On the other hand, allowing plaintiffs to proceed with cases where they have a high percentage of fault can be seen as unfair to defendants. Modified Comparative Fault attempts to balance the legal system by not encouraging potentially spurious claims, while at the same time, not discouraging legitimate claims.

In many pharmacy cases, the pharmacy or pharmacist wants to highlight the fact that the patient should have recognized that the tablets in the vial appeared different. This is an attempt to place some fault on the patient. While this argument is theoretically a good one, it does not work well in the real world.

First, patients are almost trained to accept, without question, the endless sequence of different generic brands that are dispensed. Secondly, the plaintiff attorney is always quick to point out that if the plaintiff could have recognized the difference, then the trained professional should have been able to recognize the difference also.

Comparative Fault is not always important in pharmacy cases because patients are seldom in a position to seriously contribute to their own injury. However, it can be important in cases where the prescribing 1. This does not include South Dakota. South Dakota permits recovery by the plaintiff when their fault is slight in comparison to the fault of the defendant, but doesn’t assign a percentage to “slight�.

The Arkansas Pharmacist

physician is a co-defendant. In these cases, fault can be apportioned between the patient, the pharmacy, and/or the prescriber. An example would be a case where the patient is prescribed a drug to which they are allergic. There could be fault apportioned to both the prescriber for prescribing inappropriately and the pharmacy for dispensing inappropriately.

The lesson for the pharmacist here is not that they know if Contributory Negligence or Comparative Fault applies in their state. They need to be aware that this concept exists and that in cases where negligence can be proved, there may be additional factors that will deny the plaintiff recovery or that may allow the pharmacy defendant to pay less than the total verdict. Also, be aware that the claims examiner and/or attorney working on your case will take these factors into account as they work to resolve your case.

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

Medicaid Alert E-Prescribing Arkansas Medicaid has recently implemented the E-prescribing solution. E-Prescribing gives providers of Arkansas Medicaid, including hospital systems, access to a Medicaid recipient’s eligibility for Arkansas Medicaid paid pharmacy benefits. E-prescribing allows real-time analysis of the Arkansas Medicaid recipient’s medication history. The medication history provides a true compliance picture for the provider. The history shows what other providers have ordered for the recipient through Arkansas Medicaid. It also allows the provider to see whether previous prescriptions were filled and whether refills were requested at the appropriate time. Each recipient’s medication history includes up to the two years of Arkansas Medicaid history.

The Arkansas Medicaid prescriber will also have the ability to electronically send a prescription directly to the pharmacy of the recipient’s choice. Before sending the prescription a prescriber can determine Arkansas Medicaid’s coverage restrictions. These restrictions include drugs which require prior authorization, quantity limits, age limits, or gender limits. Coverage restriction information is detailed through resource links which is a direct link to criteria documents found on the Arkansas Medicaid Website. Arkansas Medicaid providers will be able to resolve issues at the time they are writing the prescription. The benefits of E-prescribing allow these issues to be identified before the prescription is presented to the pharmacy.

The practice of pharmacy for Arkansas Medicaid providers will be greatly enhanced with the use of E-prescribing through an increase in patient safety, quality of care, and cost effectiveness.

The Arkansas Pharmacist

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Harding Report

Fall 2008 Students and Events The first semester of the first year for the inaugural class is now behind them. During the semester the students have spent many hours in the classroom, but they have participated in other learning opportunities outside the classroom as well. In October, students formed a team and participated in the Susan G. Komen Race for the Cure in Little Rock. For stress relief after their first major exam, students organized an afternoon of bowling. If you check out Facebook, you will find students involved in flag football. On October 24, 2008, Harding University held a building dedication ceremony for the new Center for Health Sciences. Dean, Dr. Julie HixsonWallace, and student, Janice McKean, spoke on behalf of the College of Pharmacy at this inspiring ceremony. The Board of Visitors, an advisory board, comprised of 16 individuals from various aspects of the pharmacy community, were on campus for the dedication.

A luncheon was held for the board members, faculty, staff, and students. In November, students, faculty and staff spent time together at the first annual HUCOP Hotfire Cookout. Thanks to Senator Percy Malone for sponsoring this event and Dr. Jeanie Smith for hosting.

Students have also been involved in providing service throughout the community. When you see them in their white coats, you know they are up to good deeds. Some of those activities included: encouraging high school students in the Upward Bound program by providing education regarding the dangers of caffeine and high sugar levels in soda, serving at the Christian Health Ministry on Sunday afternoons, assisting volunteer physicians, pharmacists and other healthcare providers by ministering to the health needs of White County residents without medical coverage, and various county and city festivals including Homecoming at Harding University.

The inaugural class students are involved with establishing student governance and the first student organization. Student elections for student governance, the Council of Students (COS), will be on December 11. The first professional student organization will be a chapter of the national organization APhA-ASP (American Pharmacists Association- Academy of Student Pharmacists) with election of officers also on December 11.

It has been a smooth and productive beginning for the inaugural class. As they press on to the new semester, we anticipate many good things for and from this group of talented students.

Ms. Carol Kell, Director of Admissions and Dr. Julie Hixson-Wallace, Dean receive the first annual student scholarship from Joe Baker of Pharmacists Mutual.

Dr. Jeff Mercer observes several students performing blood pressure checks.

Students, Faculty, Staff and the Board of Visitors enjoy a luncheon in celebration of the Center for Health Sciences Building dedication.

Dr. Hixson-Wallace spoke on behalf of the College of Pharmacy at the building dedication.

Searcy Mayor, Belinda LaForce, signed a proclamation deeming October 2008 as Pharmacists Month.

Pharmacy and PA students work together on a dissection during an Anatomy and Physiology lab.

28

The Arkansas Pharmacist

Pharmacy in Arkansas On June 7, 1990, the Arkansas Pharmacists Association Board of Directors commissioned an oil painting to be created by artist Judith Boody of Little Rock. The painting was planned to express both the nostalgic reminiscence of Pharmacy and a feeling of the present, combined with a unique feeling of Arkansas Pharmacy. Only 1,000 limited edition lithographs (paper size: 22” x 28” – image size: 18 1/4 x 23”) will be available. All are hand-numbered and signed by the artist.

Please use the form below when ordering.

Quantity __________

Price plus Shipping/Handling $35.00 + $4.00

Name ______________________________________ Address ____________________________________ City_____________________State______Zip ______

Net Price $39.00

Total _______________

Great Gift Idea

Make checks payable to: Arkansas Pharmacists Association Mail to: Arkansas Pharmacists Association 417 South Victory Little Rock, Arkansas 72201

The Arkansas Pharmacist

29

Member Classifieds Pharmacist Needed Assessing appropriate and cost-effective use of medications, committee service, patient rounds, drug information, pharmacokinetics, educational presentations, and decentralized order entry.

Contact Romona McLean, Washington Regional, Fayetteville, 479-463-1102.

Pharmacist Needed Pharmacist needed to work Saturdays 9am-3pm (or even 2 Saturdays/month)!! Independent pharmacy in Van Buren, AR with great tech help, great atmosphere and great extra cash!

E-mail resume to kbarlow@pharmacyexpressvanburen.com, fax 479-474-3131 or call 479-462-1269.

Pharmacist Needed Independant closed door pharmacy in Little Rock. For information call 501-888-7514 or email resume to carepharmacy@msn.com.

Technician Needed Independent pharmacy in Little Rock looking for pharmacy technician with experience in compounding. Position is full time Monday - Friday. Contact Kenny at 501-223-2224 Independent Pharmacies Wanted Independent pharmacist interested in purchasing independent pharmacies in Arkansas. Pharmacies will remain independent after purchase. Purchaser has solid independent pharmacy background.

If interested in selling your pharmacy, please contact Vance at 870 - 897-1204 or via e-mail at VanPark@aol.com.

Technician Needed Immediate opening for full time compounding technician.

Monday - Friday 9:00 a.m. - 5:30 p.m., benefits included. Please call Lynn at 501-374-2207.

Volunteer Pharmacists Needed Shepherd’s Hope Neighbornood Health Clinic is a ministry of Fellowship Bible Church and Oak Forrest United Methodist Church serving uninsured and indigent patients in the South Midtown area of Little Rock. The Clinic is located at 2404 Tyler Street (behind Oak Forrest). The hours of operation are 6:00pm to 8:30pm every Thursday night. Current needs are pharmacists willing to volunteer every 4, 6, or 8 weeks. If you are available to volunteer and help with this ministry, please contact Trey Gardner at 501-425-2469. Thank you!

Pharmacists Needed Full time pharmacists needed in the Hot Springs, Little Rock, and Mt. Home areas. Central Arkansas Veterans Healthcare System has immediate openings for full-time pharmacists in Hot Springs, Little Rock, and Mt. Home, AR. Competitive salary and federal employee benefits. Applicants are eligible for a sign on bonus and to apply for the Employee Debt Reduction Program (school loan reimbursement). For more information and to apply, go to www.usajobs.gov. You may call the VA pharmacy office at 501257-6330, ask for Gigi or Jane for questions.

30

For Sale Laminar Flow Glove Box/Isolator made by Germfree Labs, Inc. Six foot stainless steel 1 or 2 person unit. Certified on 6/12/2008.

Call Jim, Layton or Stan at 501-315-7700 for more information.

IVANRX4U, Inc., Pharmacist Relief Services, Career Placements.

Relief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day off, vacations, emergencies -- ALL your staffing needs. Also seeking pharmacists for full or part-time situations.

Please contact Tracy Byrd, Marketing and Recruiting Director, or Mike Geeslin, President for information regarding current openings throughout Arkansas - temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call 417-888-5166. We welcome your email inquiries, please feel free to contact us at: Ivanrx4u@aol.com or Ivanrx4u-tracy@hotmail.com.

Pharmacist in Charge Wanted Competitive salary with up to 3 weeks paid vacation and major medical coverage plus 401K plan. Great schedule - Monday thru Friday, hours 9:00 a.m. to 6:00 p.m. Contact Alan Tweddell at 870-931-2881 or send resume to: Country Mart Pharmacy, 208 Lincoln Dr., Fredericktown, MO 63645 Positions to be filled in N.E. Arkansas and S.E. Missouri.

Pharmacists Needed Part time pharmacist needed in Danville. Full time pharmacists needed in Hot Springs. Competitive salary with excellent benefit package. No nights or Sundays. Contact Alvin Groves at 479-619-6343.

Relief staffing available through Staff RPh, Inc. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at 501-847-5010 or email staffrph@comcast.net.

Pharmacists Needed Kroger is looking for part-time pharmacist in Hot Springs and a full time pharmacist in Russellville. Please contact Jamie Shoemaker at 501-650-1715 or Julie Dean at 901-765-4204.

Pharmacy for Sale In beautiful North Arkansas. Established in 1974. Family owned with exceptional reputation in dynamic community. Excellent schools, recreational & retirement center, golf courses, lakes, rivers, 2.5 hours from Little Rock, AR; Memphis, TN; and Springfield, MO. Pharmacy is ideally located: a) across from doctor’s complex and new treatment, diagnostic, and emergency facility, b) next door to ophthalmologist and optometrist. Contact Mike Sprague at 512-799-5265.

Pharmacy for Sale North Central Arkansas, owner retiring. Clinic setting next to two MDs & one nurse practioner. Call Charlie at 870-895-2143 days and 870-895-2361 nights.

The Arkansas Pharmacist

Show your pride on the The Arkansas Pharmacy Foundation is pleased to announce the beginning of our Pharmacy Walkway of Honor. The walkway will be composed of bricks on which the names of pharmacists, pharmacies, and other business-related companies (i.e. wholesale, drug, design, computer, etc.) can be placed to show appreciation for the profession of pharmacy. The walkway will be located outside the entrance to the Lester E. Hosto Conference Center. The Foundation will place the first brick in memory of Dr. Lester Hosto.

Please use the form below to personalize your brick(s). Make copies as necessary. Print the name and other information as you would like it to appear on your brick. You have a maximum of three lines per brick with up to 18 characters per line, including spaces.

Please use the ampersand (&) instead of “and� and omit periods.

Personalize your brick here.

1 2 3 Name: ___________________________________________________________________ Address __________________________________________________________________ City ______________________ State ____________________ Zip _________________ Phone (_______)___________________________________________________________ I wish to order ________________ bricks @ $125.00 each for a total of $ ______________ Method of Payment _____ Check, payable to APF _____ Visa ______ Mastercard

_____ Discover _____American Express

Credit card number _____________________________________________________ Expiration Date _______________

Signature ____________________________________________

Your support is sincerely appreciated. Please mail to APF, 417 South Victory, Little Rock, AR 72201 or fax to 501-372-0546 or visit www.arpharmacists.org to order.

Proceeds will help provide funds to sponsor, support and conduct educational programs, thereby promoting the Foundation to efficiently perform the objectives for which it is organized.

The Arkansas Pharmacist

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Pharmacy Time Capsules Pharmacy Time Capsules 2009 (First Quarter) 1984—Twenty-five years ago: • Drug Price Competition and Patent Term Restoration passed.

The major provisions of the law: o expedited the availability of less costly generic drugs by permitting FDA to approve applications to market generic versions of brand-name drugs without repeating the research done to prove them safe and effective. o provided brand-name companies up to five years additional patent protection for new medicines to make up for time in FDA's approval process.

• Schering Corporation budgeted $4 million for first “Ask Your Pharmacist” campaign to encourage the public to ask their pharmacists about their medicines.

1959—Fifty years ago • American Hospital Formulary Service launched by American Society of Hospital (now Health- Systems) Pharmacists.

1934—Seventy-five years ago • The American Pharmaceutical (now Pharmacists) Association headquarters building, the American Institute of Pharmacy, on the National Mall in Washington, DC. was dedicated.

1909—One hundred years ago • Opium Exclusion Act of 1909 prohibited the importation of opium to the United States.

By: Dennis B. Worthen Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America's history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year.

To learn more, check out: www.aihp.org

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Arkansas Pharmacy Foundation FOUR P L AY E R SCRAMBLE Thursday April 16, 2009 Mountain Ranch Golf Club Fairfield Bay, AR Proceeds will be used to endow a UAMS College of Pharmacy Scholarship and present theCharles M. West Award

Corporate Sponsor...

The Arkansas Pharmacist

APA Board of Directors Minutes Minutes Arkansas Pharmacists Association Board of Directors August 7, 2008 Holiday Inn – Fort Smith Members Dr. Paul Holifield-presiding Dr. Kenny Harrison Dr. Brandon Cooper Dr. John Page Dr. Julie Hixson-Wallace Dr. Jan Hastings Dr. Stephanie Goodart-O’Neal Dr. Lynn Crouse Dr. Charlie Campbell Dr. Mike Stover

Dr. Gary Bass Dr. Dennis Moore Dr. Michael Butler Dr. Stephanie Gardner Dr. Mark Riley Dr. Cliff Robertson Dr. Mike Smets Dr. Justin Boyd Dr. Muncy Zuber Mrs. Christina Easterling

Guests and Staff Dr. Richard Hanry - treasurer Harold Simpson – legal counsel Ms. Barbara McMillan Dr. Scott Pace Ms. Debra Wolfe Dr. Billy Gammel

CONSENT ITEMS President Paul Holifield called the meeting to order at 7:30 p.m.

President Holifield asked Dr. Richard Hanry to lead the invocation.

Dr. Jan Hastings made a motion to approve minutes with changes. The motion passed.

Mr. Harold Simpson suggested that he review the Conflict of Interest Policy and the Antitrust Policy of the APA. Dr. Mark Riley reported that the phone-a-thon raised $49,555 for the PAC. The PAC money is used to assist in the association’s lobbying activities.

DISCUSSION ITEMS Convention Report & Program Update Barbara McMillan reported that attendance at the 126th Annual APA Convention was down from the previous year in Rogers. However, she noted that the convention was still a success.

Dr. Scott Pace reported that the Golden Certificate Program will be held Thursday, October 9th at the UAMS College of Pharmacy. The program will provide 6 hrs of continuing education to pharmacists who have held their Arkansas pharmacists license for more than 50 years.

UAMS College of Pharmacy Report Dean Stephanie Gardner reported that 120 new pharmacy students will begin school this fall. The college will have a White Coat Ceremony to welcome the new students. Eight new faculty members have been hired. Dean Gardner also reported that Dr. Donna West has accepted a position to become the department chair at Ole Miss.

Dean Gardner proposed the creation of a committee of practicing pharmacists and the two colleges of pharmacy to review the experiential rotation process to attempt to create standardization between the experiential portions of the two college’s curriculum.

Harding School of Pharmacy Report Dean Julie Hixson-Wallace reported that the school moved into their new building in July. The school has admitted 60 students who will begin classes in August. Forty-seven percent of the students are from Arkansas. Harding will have their next ACPE site visit in March 2009.

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Arkansas Academy of Health-System Pharmacists (AAHP) Report Dr. Justin Boyd reported that the AAHP Fall Seminar will be held October 9th and 10th at the Grand Casino in Tunica, MS. Dr. Maggie Miller will become the new AAHP president in October.

Dr. Boyd also stated that AAHP has been working on creating a narcotic discrepancy log with the Department of Health and the State Board of Pharmacy.

Arkansas State Board of Pharmacy Report Dr. Charlie Campbell reported that the Board is considering modifying the consultant pharmacist requirements during the next legislative session. Dr. Campbell also noted that the disease state management rules are being reviewed and may be modified to modernize the rule, but would still operate under a protocol with a physician.

Dr. Campbell also reported that the concept of consolidating all state regulatory boards into a “Superboard” has been proposed. Dr. Campbell was not supportive of the idea and felt individual boards were necessary to ensure the best possible regulation of the profession and protection of the public safety.

Arkansas Academy of Consultant Pharmacists Dr. Muncy Zuber reported that Dr. Jim Griggs has been elected as president-elect of the Consultant Academy.

Arkansas Board of Health Report Dr. John Page provided statistics reported at the last Board of Health Meeting. He noted that the US ranks 45th in the world in life expectancy and Arkansas ranks 48th in the nation in health rankings.

Dental Dispensing Update Dr. Mark Riley reported that the Arkansas Dental Board has modified their regulations to ensure that a dentist must go before the dental board and demonstrate a need in their community before a permit to dispense would be issued. This language mirrors the rules that the Arkansas Medical Board has in place.

Medicaid Dispensing Fee Update The Centers for Medicare and Medicaid Services has still not provided an answer to the change in the Arkansas Medicaid dispensing fee State Plan Amendment. Dr. Riley reported that Governor Beebe intervened on this issue and sent a letter to acting CMS administrator Kerry Weems supporting the approval of the dispensing fee increase.

CCRx Dr. Riley announced that there will be some changes to their plan designes in 2009. Dr. Riley noted that APA continues to monitor the status of Medicare Part D programs in Arkansas and is currently conducting a survey to evaluate the plans operating in Arkansas.

H.R. 6331 Dr. Riley reported that H.R. 6331 was passed by both the U.S. House and U.S. Senate and vetoed by President Bush.

Congress subsequently overrode the president’s veto to enact the law. The new law provides Prompt Payment for pharmacists under Medicare Part D plans, delays the implementation of Medicare DME Competitive Bidding, and delayed the implementation of the Medicaid AMP pricing. The prompt payment provisions will become effective in January 2010.

PBM Strategy Dr. Riley shared some of his thoughts about pros and cons of running a PBM regulation bill during the 2009 Arkansas Legislative Session. Dr. Riley suggested that the Board discuss further during their discussion of the APA Action Plan.

ACTION ITEMS Financial Report Dr. Richard Hanry reported on the financials of the APA. Dr. Hanry stated the financials of APA were in good shape.

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Dr. Riley also reported on the APA wholesaler income.

Dr. Hastings made a motion to approve the financials. The motions passed.

Miscellaneous Mr. Harold Simpson, APA legal counsel, reviewed the APA anti-trust and conflict of interest policies.

Mr. Simpson made a recommendation to the Board to strike item VI of the APA Antitrust Policy.

Dr. Crouse made a motion to amend the antitrust policy, per Mr. Simpson’s recommendation. Motion passed.

Mr. Simpson also recommended modifications to the APA Conflict of Interest Policy to streamline the policy. Dr. Moore made a motion to amend the conflict of interest policy per Mr. Simpson’s recommendations. The motion passed.

Adjournment A motion was made and seconded to adjourn the meeting at 9:15p.m. The motion passed.

APA Foundation Board August 9, 2008 Dr. Paul Holifield convenes the Foundation Board at 8:35am on 8/9/08.

The Board wished happy birthday to Dr. Stephanie Goodart O’Neal.

The Board made a motion to accept the actions of the Foundation Board. The motion was passed.

A motion was made to adjourn the meeting, motion passed.

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