MAR. 2010
Seasonal and H1N1 Influenza Immunizations: Perspective and Guidance for Florida Pharmacists PRSRT STD US POSTAGE PAID TALLAHASSEE, FL PERMIT NO. 801
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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 18 Poster Abstracts 23 Buyer’s Guide
VOL. 73 | NO. 3 MARCH 2010 the official publication of the florida pharmacy association
Features
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FPA Officer and Director Nominations Seasonal and H1N1 Influenza Immunizations: Perspective and Guidance for Florida Pharmacists Ed Hamilton Completes Term as APhA President
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FPA Calendar 2010
March 23 - 25 Pharmacy Legislative Day at the Florida Capital 24
Florida Pharmacists Health Fair
27 - 28 FPA Committee and Council meetings and Board of Directors APRIL 2
19 Advisory Council on Pharmacy Practice - Florida Pharmacy Council post session conference call
31 Memorial Day, FPA Office Closed
sues bearing on pharmacy and newsworthy items
JUNE
journal, it solicits and accepts advertising congru-
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16-18 FPA Clinical Consultant Conference Tampa Airport Marriott
30 - 1 FPA Annual Meeting and Convention, Marco Island Marriott JULY
MAY 2-4 NASPA Leadership Conference Austin, Texas 10 - 12 2010NCPA Legislative Conference Washington, DC 15
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Florida Board of Pharmacy Meeting Tampa, Florida
FPA Office Closed
10 - 14 AACP Annual Meeting Seattle, Washington 30
FPA Legislative Committee Meeting Orlando, Florida
FPA Leadership Retreat
For a complete calendar of events go to www.pharmview.com CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2011 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact Ranada Simmons in the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www. pharmview.com CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (850) 906-9333 U/F — Dan Robinson (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.
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The Florida Pharmacy Today Journal is a
peer reviewed journal which serves as a medium through which the Florida Pharmacy Association
FPA Office Closed (Good Friday)
Legislative session ends
of the Florida Pharmacy Today Journal
26 - 28 ASCP Midyear Clinical Conference Phoenix, Arizona
13 - 14 Florida Board of Pharmacy Meeting Ft. Lauderdale, Florida
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Mission Statements: can communicate with the profession on advances in the sciences of pharmacy, socio-economic is-
of interest to the profession. As a self-supported ent with its expressed mission.
of the Florida Pharmacy Today Board of Directors
The mission of the Florida Pharmacy Today
Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of
the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s
policies and the management of the Journal’s
fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Associa-
tion members to secure appropriate advertising to assist the Journal in its goal of self-support.
Advertisers ASCP.................................................................... 24 Dr. OJO................................................................. 2 Healthcare consultants........................ 3 Kahan ◆ SHIR, P.L.......................................... 14
McKesson.......................................................... 9 PHARMACY PROVIDER SERVICES (PPSC)........................................... 2 philadelphia college.............................. 13 Rx RElief.......................................................... 14
E-mail your suggestions/ideas to dave@fiorecommunications.com
The President’s Viewpoint Guest Columnist KATHY PETSOS, B. Pharm
T
Florida Pharmacy Association Through the Years
he Florida State Pharmaceutical Association (now known as the Florida Pharmacy Association) was founded on June 9, 1887, by a dedicated group of Duval County pharmacists in the Board of Trade Rooms in Jacksonville, Florida. Since its inception, the Association has been a driving force in implementing the highest standards for the practice of pharmacy, the educational requirements for pharmacists and the quality of care for the citizens of Florida. The mission then was much the same as the FPA mission now, which is to serve, represent and assist Florida pharmacists to advance the profession and practice of pharmacy. Dr. Hy Robinson, the first president of the Florida State Pharmaceutical Association, initiated the first important event in Florida’s pharmacy history during his presidential address at the second annual meeting in Tallahassee in 1888. He stated that the current legislation pertaining to dealers in drugs and medicines were useless and that the state needed a Board of Pharmacy. Armed with $500 allocated by the Association members, the Legislative Committee pursued legislation and the Florida Legislature passed a bill in 1889 creating the Florida Board of Pharmacy. Before passage of this legislation, a person wishing to become a pharmacist was required to appear before three physicians in the county in which he lived and pass whatever kind of examination they wished to give him. This new law certainly was a huge step forward to ensure standardization of educational requirements and the competency of pharmacists. The second important event in Flor-
ida’s pharmacy history was the establishment of a School of Pharmacy at the University of Florida on September 10, 1923. In advocating for a School of Pharmacy, President William G. Perry stated, “So we should work for our University School of Pharmacy. Reconstruction of educational methods since the World War has given a new impe-
Armed with $500 allocated by the Association members, the Legislative Committee pursued legislation and the Florida Legislature passed a bill in 1889 creating the Florida Board of Pharmacy. tus to the study of pharmacy, and the ablest thinkers in the calling are unanimous in the belief that higher entrance requirements and more scientific training are necessary to meet the demand for well trained pharmacists.” He appointed a committee to work for the establishment of the school. They were successful in obtaining the necessary appropriations by the Legislature but had to obligate the pharmacists of the state to underwrite any additional amount over $10,000 and up
Kathy Petsos, B. Pharm
to $15,000 to equip the school of pharmacy. The total amount contributed by the Association was $5,104.40 to establish the school. In 1935, a bill sponsored by the Association was passed by the Florida Legislature permitting women to enter the University of Florida College of Pharmacy, which made the College of Pharmacy the first coeducational College at the University. As the University grew and higher academic standards were required of the graduates of the College of Pharmacy, an increased need for educational requirements for practicing pharmacists was identified by the Association. This led to a third important event in Florida’s pharmacy history when President Felix Donatelli recommended in 1966 that continuing education be a prerequisite for pharmacy license renewal. In 1968, the state of Florida passed the first law in the nation making continuing education mandatory for license renewal. MARCH 2 0 1 0
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2009/2010 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.
Norman Tomaka.....................................Chairman of the Board of Directors Karen Whalen...............................................................................................FPA President Don Bergemann.....................................................................................................Treasurer Alexander Pytlarz..................................Speaker of the House of Delegates Dean William Riffee...................Vice Speaker of the House of Delegates Preston McDonald, Director............................................................................ Region 1 Marcus Dodd-o, Director .................................................................................Region 2 Al Tower, Director ..................................................................................................Region 3 Raul N. Correa, Interim Director ................................................................Region 4 John Noriega, Director ......................................................................................Region 5 Chris Lent, Director...............................................................................................Region 6 Kim Murray, Director............................................................................................ Region 7 Joy Marcus, Director...........................................................................................Region 8 Ayala Fishel, Director...........................................................................................Region 9 Peter Iafrate............................................................................................. President FSHP Michael Jackson........................................Executive Vice President and CEO
Florida Pharmacy Today Journal Board Chair Designate....................................... Betty Harris, beejpharm@gmail.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member............................................................. Don Bergemann, don@bceinfo.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member...............................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com
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The next step forward in education came in 1983 with the passage of the Consultant Pharmacist Act. This law allowed for collaboration with physicians under protocol and allowed pharmacists to order lab tests and adjust medications for patients. Then in 1985, the Pharmacist Selfcare Consultant Act was passed by the Association allowing pharmacists to prescribe higher doses of medications available over the counter in lower dosages, i.e. the pharmacist could prescribe 600 mg of Ibuprofen for short-term use. This necessitated increased educational requirements for pharmacists to ensure proper assessment of the patient. In 1998, the Association advocated before the Board of Pharmacy to require that five of the 15 hours needed per year for license renewal be obtained through live sources such as a seminar. The Association was successful as the prevailing view was that the interaction between pharmacists and the networking these type of venues provide is as important to the educational process as the content of the lecture. The last important event in Florida’s Pharmacy history as far as increased educational requirements are concerned was the enactment of the Pharmacist Immunization Services Bill in 2007 by the Florida Legislature. This was a hard fought battle but necessary to the quality of and accessibility to life-saving health care for the citizens of Florida. This has put pharmacists on the front line of caring for patients and increased our role on the health care team. Other initiatives that the Association has undertaken to improve the quality and safety of care to patients are the Quality Related Events Project (2003), Continuous Quality Improvement (2004), Behavioral Health Project with USF (2006), the APhA Diabetes 10 Cities Challenge (2006) and the Technician Registration Law (2008 in collaboration with FSHP). Our Association has a proud legacy of advancing the profession, promoting the highest educational standards for pharmacy practice and improving the quality of care for our patients. n
Executive Insight By Michael Jackson, FPA Executive by michael jackson,Vice RPhPresident/CEO
Your Pharmacist is Critical to a Successful Medical Home Model
A
t the risk of sounding elitist, I will take this opportunity to share with my pharmacist brethren that business as usual is at the frontier of change. We all know that traditional health care is going to be different regardless of what the “Rs” or “Ds” in Washington do. While both significant political parties in our nation’s capital are squabbling over who has the best reform plan, our patients are living in a nightmare of medical misadventure reality. Our current medical model has been built on a foundation of silo management with walls so thick that the only way to deal with the bureaucracy and hurdles is to own your own health care company, self insure or throw up your hands in despair. This was not that much of an issue when the patient had more to say about their health care decision making. With managed care organizations heavily involved in the financing of health care, the medical home model has been driven by dollars with little emphasis on outcomes. This has been apparent with pressure on pharmacy providers to drive critical revenue through increasing volume in the face of declining reimbursement. There is almost a disincentive to take time to actually drill into a patient’s medical history if there is evidence of a clinical problem. Patients admitted to inpatient institutions these days have their stays shortened. This means that they are released into the community with a hope that the right decisions will be made. Sometimes these decisions are executed with less-than-optimal information and without benefit of provider collaboration on the clinical issues. Remem-
ber that our theme this year is collaboration is key. During the FPA’s 2009 annual meeting and convention, we heard a presentation by FPA member Mary Kay Owens. In that presentation, there was a study performed in which the medical costs related to patients whose care was uncoordinated was $15,100 compared to $3,116 for patients whose care was being coordinated. Some of this uncoordinated care behavior included (but was not limited to): ■■ using many different prescribers and pharmacies, ■■ accessing the ER for primary care, ■■ avoidable ER and hospitalization visits, ■■ excessive narcotic use, ■■ excessive and/or duplicative drug use, ■■ excessive and/or random drug changes within therapeutic classes by different prescribers, and ■■ inconsistent drug usage and adherence patterns. Policy discussions in Washington, D.C., and to a lesser extent here in Tallahassee, have begun focusing on a physician-centered medical home model. During the 2009 legislative session, we reported that in Senate Bill 1986 the Agency for Health Care Administration was directed to develop a plan to implement a medical home pilot project that utilizes primary care case management enhanced by medical home networks to provide coordinated and cost-effective care that is reimbursed on a fee-for-service basis. The purpose of the pilot project is to compare the performance of medical home networks with other existing Medic-
Michael Jackson, B.Pharm
aid managed-care models. Language in the bill specifically states that each medical home network SHALL provide pharmacy services in addition to other services. There are published principles for the inclusion of pharmacist services in patient center primary care medical home. We believe that the most successful models will have considerable pharmacist involvement. The principles are as follows: Principles for Inclusion of Pharmacists’ Clinical Services in the Patient-Centered Primary Care Medical Home Consistent with the perspective and recommendations of the Institute of Medicine (IOM), pharmacists’ clinical services that enhance the quality, safety, and effectiveness of medications -the principal treatment modality for the vast majority of chronic diseases -should be considered an integral component of the patient centered primary MARCH 2 0 1 0
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FPA Staff Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200
Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall , ext. 211
Membership Coordinator Ranada Simmons , ext. 110
Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chair Designate........Betty Harris, Lighthouse Point Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member................. Don Bergemann, don@bceinfo.com Member..................................... Joseph Koptowsky, Miami Member...................................... Jennifer Pytlarz, Brandon Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee
This is a peer reviewed publication. ©2010, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. Florida Pharmacy Association
610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web Address: http://www.pharmview.com 8 |
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care medical home. The effective integration of pharmacists’ clinical services within the patient-centered primary care medical home should be based on the following essential principles: Access to pharmacists’ clinical services: provision of pharmacists’ clinical services should be a fundamental component of the patient-centered primary care medical home; Patient-focused collaborative care: development, implementation, and monitoring of medication treatment plans, including an effective system for medication reconciliation that supports patients in their transitions among care settings, should be accomplished through a patient-focused, collaborative process of clinical consultation and decision making that incorporates the synergistic and complementary knowledge and skills of the prescribing professional(s) and pharmacists within the medical home practice; Flexibility in medical home design: innovative and flexible practice structures that integrate pharmacists’ clinical services should be encouraged to meet the needs of individual patients being cared for within the medical home. Incorporation of pharmacists and their services either by their physical presence within the practice or through the design of effective “community linkages” should be considered to meet geographic and practice setting needs and variations; Development of outcome measures: objective measures for assessing the clinical outcomes, safety, and cost-effectiveness of medication use in the population being served by the patientcentered medical home must be a component of the practice’s broader quality performance measurement system; Access to relevant patient information: all members of the medical home patient care team, including pharmacists, must have access to necessary and appropriate patient health and medical records to support and inform their clinical service and decision-making functions. This access must also include the authority and responsibility to input information into these records to facilitate enhanced team-based knowledge and information support for the
respective clinical and decision-making responsibilities of team members; Effective health information technology: expansion and effective use of health information technology must be promoted to support more complete integration of pharmacists as care providers within the medical home practice structure; and Aligned payment policies: payment policies should be aligned to (1) effectively support the medical home, (2) provide reasonable and adequate payment for pharmacists’ clinical services as an element of the scope of services that are eligible for payment to either the providers or the practice, and (3) promote the achievement of higher quality, safer, and more effective therapeutic outcomes from medication use through enhanced provider collaboration. You cannot build a home that can withstand the elements without a solid foundation and a durable roof structure. Such a structure in Florida should include hurricane clips, lots of masonry and wind-resistant windows. In a medical home you need just as much medical protection that can be provided by today’s practicing pharmacist. With high-powered complex medication delivery systems on the market and the clinical issues that can occur from the absence of a comprehensive review by a clinical pharmacist, a medical home model will struggle to achieve its potential for success. Pharmacists who would like to insert themselves into a medical home model that includes medication therapy management services will need to consider spending June 30 – July 4, 2010 with us at our annual meeting in Marco Island. We have over 30 hours of continuing education that will be available with a number of programs geared toward preparing you to provide medication therapy management services. See you in Marco Island. n
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FPA Officer and Director Nominations Although we have just finished the election for a president-elect and directors for the even numbered regions to be installed at the 2010 annual meeting, it is time to start thinking about nominees for the 2010 election since the nomination deadline is September 1 of this year (9/1/10). As the form below indicates, this year we will need candidates for president-elect, treasurer, and directors for the odd numbered regions. Please note that you may nominate yourself. CALL FOR FPA OFFICER AND DIRECTOR NOMINATIONS for 2011 Elections The FPA By-Laws specify that any subdivision or any member in good standing may nominate one person for the office of President-Elect and one person for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The treasurer shall serve a two year term and may succeed to one consecutive term of office in that capacity. Nominees must be Florida registered pharmacists in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Nominees for president-elect should have a good understanding of how the Association functions and should be current on the issues impacting pharmacy. Nominees for treasurer should have good analytical skills and experience and ability in financial management and budget preparation. There are nine regional Board Directors who shall serve two year terms. Nominees must be a Florida registered pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Additionally, Board Directors must be a member of at least one the FPA Unit Associations within their region. Board Directors terms are staggered such that even numbered regions shall be elected in even numbered years and odd numbered regions shall be elected in odd numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annual meeting of the second ensuing year.
FPA CANDIDATE NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION: NAME: ADDRESS:
FOR THE FOLLOWING OFFICE:
(Nomination Deadline September 1, 2010)
q q q
President-Elect Treasurer Board Director Region 1 (Units: Escambia, Okaloosa-Walton, Leon, Alachua) Region 3 (Units: Pasco-Hernando, Pinellas) Region 5 (Units: Hillsborough, Polk) Region 7 (Units: Palm Beach, Gulfcoast) Region 9 (Units: Broward)
NOMINATED BY: NAME: DATE SUBMITTED: SIGNATURE:
MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2010
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SEASONAL IMMUNIZATIONS
Seasonal and H1N1 Influenza Immunizations: Perspective and Guidance for Florida Pharmacists
By April S. Brown, Pharm.D. FPA Member and Immunizing Pharmacist, Palm Beach Atlantic Alumnus
laxis). And, unless pharmacists have been afforded the time to independently research the development of the new H1N1 vaccines, they will have limited information to share with patients. Therefore, many pharmacists (even if not administering vaccinations) may unknowingly provide misguided or incomplete information to patients when asked about H1N1 vaccines, GBS, risk of anaphylaxis from vaccine ingredients, or vaccine safety when patients present with specific concomitant health states. Some adjunctive background and additional information can fill in this gap and allow pharmacists greater confidence when providing information to patients, and to assist in optimal decision-making when administering vaccines. In addressing these concerns individually, first discussion will be given to thimerosal—as one of the greatest concerns for pharmacists is patient allergy to thimerosal. It is beyond the scope of this article to force a conclusion or dissuade a link between thimerosal and ‘health disorders;’ however, the issues of ‘anaphylaxis’ and other potential ‘health disorders’ from exposure to thimerosal need to be distinctly separated for discussion.
The 2009-2010 season has been marked with the resurgence of a swine influenza virus and the need to mass vaccinate many individuals (not only with one vaccine, but with two). Educational programs are in place for Florida pharmacists to receive certification—and to properly manage vaccine storage and handling, and to submit for billing. Many pharmacists, however, have been largely preoccupied with the fear of anaphylactic reactions, thimerosal, Guillain-Barre Syndrome (GBS), and uncertainty surrounding the H1N1 vaccines. While the topics of anaphylaxis and GBS are broached during educational programming, it is usually from a perspective of screening and management rather than placing focus on the root etiology (GBS), or the real risks (anaphy-
Thimerosal Thimerosal, used as a preservative, is a mercury-containing organic compound (~50% mercury by weight) which is metabolized to ethyl mercury and thiosalicylate. Ethyl mercury is different than methylmercury (in which toxicity occurs through consumption of seafood, through industrial discharge or accidental release into the environment). The two forms have different toxicological profiles an in patient populations, and specific pharmacy/pharmacist protocols may exclude vaccinating certain patient populations (such as pregnant women), it is still important for pharmacists to know the current agency positions regarding use of thimerosal-containing H1N1 vaccines. The statement of the USPHS, Advisory Committee on Immunization Practices (ACIP), American Academy of Pediatrics ( AAP), American Academy of Family Physicians (AAFP), and other experts is that use of vaccines that contain thimerosal is preferable to withholding vaccination. ACIP further states that benefits of influenza vaccination for all recommended groups (including pregnant women and young children) outweigh concerns related to theoretical risks of vaccination with preparations containing thimerosal. AAP further states that the benefits of protecting children (including children at high risk with unMARCH 2 0 1 0
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SEASONAL IMMUNIZATIONS
derlying CNS disorders) outweigh the hypothetical risks associated with the minute amounts of thimerosal contained in currently available influenza vaccine preparations. Anaphylactic Reactions As far as the risk of ‘anaphylaxis’ from thimerosal, pharmacists should be aware of clinical distinctions from vaccine additives which are likely to evoke a sensitivity response, and additives which are likely to elicit anaphylaxis (if underlying patient allergy exists). Thimerosal is used [in low concentrations] not only in vaccines, but in cosmetics, ophthalmic and otolaryngolic medications, antitoxins, topical and intramuscular steroid preparations, and intradermal tests. Thimerosal has two distinctive components, an organic mercury compound and thiosalicylate, both of which are involved in thimerosal allergy. Thimerosal is the fifth most common allergen, according to the North American Contact Dermatitis Group (NACDG). However, the rate of reactivity is 10.2% with a designated clinical relevance of 7.2%, making it one of the ‘least’ clinically relevant of the 65 allergens tested by the NACDG. Most patients with a clinically relevant thimerosal allergy are women with a periorbital dermatitis from thimerosal in eye cosmetics or contact lens solutions. These manifestations are local, delayed-type hypersensitivity reactions. Thimerosal, when administered as components of vaccines, have only extremely rarely been reported to cause generalized reactions manifested as pruritus and an erythematous, maculopapular rash on all four extremities. Even when patch or intradermal tests for thimerosal sensitivity are positive, most individuals do not develop immediate hypersensitivity reactions to thimerosal in vaccines. Further, the Advisory Committee on Immunization Practices (ACIP) states that a history of delayed-type hypersensitivity to thimerosal is not a contraindication to use of vaccines containing thimerosal. Of the approximately 235 million doses of (all) vaccines given annually in the U.S., only 1 dose per million causes anaphylaxis from any vaccine component. Allergic reactions may be caused by the vaccine antigen itself (although this is extremely rare), or to residual animal protein (antigen harvested from chick embryos), antimicrobial agents (neomycin/ polymyxin), preservatives (thimerosal), stabilizers (gelatin), or other vaccine components. Again, while immediate hypersensitivities are rare to thimerosal from vaccines, precaution should be used to identify individuals who have allergies to chicken/egg protein, neomycin, polymyxin, and gelatin—as these are responsible for most immediate, life-threatening anaphylactic reactions. A very thorough screening for these allergies is of pinnacle importance. While unexpected allergies can and do occur, most individuals will know whether they can safely eat eggs or Jell-O and can be screened rather easily. When screening for allergy to neomycin and polymyxin, patients most readily identify these substances when prompted that they are antibiotics found in Neosporin. To reiterate, the risk of anaphylaxis is extremely remote. 12
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Only about 1 vaccination per million will result in anaphylaxis. And, the majority of these reactions are to egg, antibiotic, or gelatin substances—not to thimerosal. Any patient stating an allergy to these components should be referred to an allergist for possible confirmation of IgE, and administration of vaccine in graded doses while the patient is under observation. Guillain-Barre Syndrome GBS is a demyelinating disease where segments of myelin are stripped from their insulating position around nerves. This causes loss of reflexes, muscle weakness, and temporary paralysis (loss of muscle strength). The main symptoms of GBS are symmetrical weakness, numbness, tingling, and prickling. Muscle weakness typically begins distally and is most common in the legs, often spreading proximally to the arms. Pain is experienced in about half of all patients, which is sometimes described as severe with even the slightest of movements—similar to muscular discomfort following strenuous exercise. In the U.S. an estimated 3,000 to 6,000 people develop GBS each year on average, whether or not they received a vaccination. This is about 1 to 2 cases of GBS per 100,000 people. GBS is generally considered an autoimmune disease, with the immune system mistakenly attacking myelin (axons). Symptoms can progress within a matter of hours or days and usually peak with a nadir of muscle weakness within two to four weeks. A plateau with unchanging symptoms follows, and improvement begins within days of the plateau. The recovery period may be as little as a few weeks to several months. About 85% of patients achieve a full and functional recovery from GBS within 6 to 12 months, but others have some degree of extended or permanent nerve damage. Relapse occurs in a small percentage of patients (3-5%). Patients may experience muscle weakness and tingling sensations years after the initial attack. The mortality rate is less than 5% in tertiary care centers with medical professionals who are familiar with GBS management. All GBS cases need to be admitted to a hospital for close observation for respiratory compromise, cranial nerve dysfunction, and autonomic instability (e.g. fluctuations in blood pressure, and cardiac dysrhythmias), and possible need for intubation and mechanical ventilation. Immunotherapy should be initiated early after motor symptoms appear but is unnecessary in mild cases where no motor symptoms are exhibited. There is no cure for GBS. Treatment is supportive and includes plasmapheresis and high-dose IV immunoglobulin (IVIG). Predictors for poor outcome include age greater than 60, rapidly progressing disease, mechanical ventilation for more than one month, and preexisting pulmonary disease. In general, poor long-term prognosis is directly related to the severity of the acute episode and delay in onset of specific treatment. Therefore, pharmacists should be diligent in instructing patients to report any symptoms of muscle weakness accompanied by tingling in the extremities to their health care provider immediately.
SEASONAL IMMUNIZATIONS
In general, literature reviews indicate that, with rare exceptions (e.g. rabies vaccine used in U.S. prior to 1980 in which an association may have been present due to contamination with myelin antigens from the animal tissue which acted as the viral culture media), associations between vaccines and GBS have been largely temporal. While the underlying pathophysiology and etiology of GBS (and its subtypes) are not completely understood, what researchers do know about GBS is that acute infectious illnesses are well-known antecedent events. About two-thirds of all cases of GBS follow an acute respiratory or gastrointestinal/diarrheal infection. GBS symptoms appear several days or weeks after the illness. Infection with the bacterium Campylobacter jejuni is by far one of the most common risk factors for GBS. In one study of 103 patients with GBS, 26% were positive for C. jejuni compared with 2% of household GAPCOM_PHARMJour-12-09:Layout 1 12/17/09 10:27 AM Page 1
contacts and 1% of age-matched controls. 70% of the patients with C. jejuni infection reported a diarrheal illness within 12 weeks of GBS symptoms. The body’s immune system may mistakenly attack itself because the surface of Campylobacter bacteria contains polysaccharides that resemble formations on nerves. This has been called cross-reactivity or ‘molecular mimicry.’ Other microbes confirmed to be associated with GBS in case-controlled studies or found in large number or series include: Cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, HIV, and Mycoplasma pneumoniae. GBS occurs in all age groups (although rarely in infants), and the incidence is fairly uniform with the exception of two peaks. The first occurs in late adolescence/young adulthood, which likely correlates with increased risk of cytomegalovirus and C. jejuni infection. The second peak occurs in the elderly which is postulated to be caused by failing immune suppressor mechanisms. Since it is believed that immune stimulation plays a role in the pathogenesis, and since vaccines have an effect on the immune system it is biologically plausible that immunizations may be associated with subsequent development of GBS. Many researchers continue to look for evidence to support or reject causal associations between various vaccines and GBS. In general, literature reviews indicate that, with rare exceptions (e.g. rabies vaccine used in U.S. prior to 1980 in which an association may have been present due to contamination
GEORGIA CAMPUS – PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
PCOM School of Pharmacy – Georgia Campus SHAPING PHARMACY EDUCATION FOR TOMORROW’S LEADERS PCOM is proud to offer a new Doctor of Pharmacy (PharmD) degree. Providing future pharmacists with the tools for community and hospital practices, long-term and managed care consulting, pharmacy management, research and academia. PCOM School of Pharmacy – Georgia Campus is now accepting applications. For more information, e-mail us at PharmDAdmissions@pcom.edu or apply now at www.pcom.edu Philadelphia College of Osteopathic Medicine’s Doctor of Pharmacy program has applied for accreditation status by the Accreditation Council for Pharmacy Education, 20 North Clark Street, Suite 2500, Chicago, IL 60602-5109, 312/644-3575; FAX 312/664-4652, Web site, www.acpe-accredit.org. For an explanation of ACPE accreditation process, consult the Office of the Dean, or ACPE.
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with myelin antigens from the animal tissue which acted as the viral culture media), associations between vaccines and GBS have been largely temporal. The evidence for a causal association is strongest for the swine flu vaccine that was used in 1976-77. Because a pandemic similar to the swine flu of 1918 was expected in 197677, the government had set an unprecedented goal for immunization and instituted a special surveillance program. This may have contributed to increased physician questioning of muscle weakness or caused physicians to diagnose other neurologic disorders as GBS if patients had documentation of swine flu vaccination. After many analyses, however, most scientists who have studied the data conclude that the 1976 influenza vaccine and GBS were linked. But, most also conclude that if an influenza epidemic had materialized, the level of GBS may well have been considered acceptable in exchange for a lower death rate from influenza. When the threatened pandemic did not materialize the swine-flu vaccination program was abruptly terminated in mid-December 1976. The risk during the 1976-77 season increased by about 1 case per 100,000 vaccinations above the expected background rate. While CDC scientists found a slightly elevated rate of GBS among persons aged 18 to 65 during the 1990-91 influenza season, the only two influenza vaccination seasons (vaccine strains based on the year’s circulating strains) which have been associated with GBS since 1976-77 were 1992-93 and 1993-94.
In a September, 2009 report, epidemiological and outcomes researchers used the Vaccine Adverse Event Reporting System (VAERS) to determine rates of GBS after administration with various vaccines. In the years 1990 to 2005, 1,000 cases of GBS were reported (mean age, 47 years) after vaccination. The highest number (n=632) of GBS cases was observed in subjects receiving influenza vaccine followed by hepatitis B vaccine (n=94). Researchers concluded that death and disability rates were comparable to the reported rates in the general GBS population. Spontaneous reports to VAERS shortly after introduction of quadrivalent conjugated meningococcal vaccine (MCV4) raised concerns of a possible association with GBS. Comparisons with expected rates were inconclusive and the lack of controlled epidemiological studies makes it difficult to draw a conclusion about a causal association. Two vaccines, which the Institute of Medicine (IOM) had previously favored a causal relationship (oral polio vaccine and tetanus toxoid-containing vaccine) have subsequently been found to have no correlation. Large epidemiological studies from immunization campaigns in different countries concluded that earlier data suggesting elevated risk of GBS with oral polio vaccine may have been confounded by coincidental exposure to wild-type poliovirus or an influenza epidemic. Therefore, investigating influenza infection as an antecedent event to GBS, and remembering the concept of molecular mimicry (with configuration differences in natu-
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SEASONAL IMMUNIZATIONS
had serological evidence of recent influenza A infection and nearly 5.5% had evidence of influenza B infection. Eight of the ten influenza A cases occurred during a major influenza season and antibodies specific to the current epidemic strain were seen in nine of these patients. The author concludes that ‘although the occurrence of GBS is rare, natural influenza infection may play an important role in triggering GBS during major influenza outbreaks’. In a later Reuters interview, researchers concluded that ‘GBS is by far more frequent with natural infection that that following influenza vaccine…[and that] The benefit of a large-scale influenza vaccination should also be considered as a means to protect against GBS.’ Whether or not future studies continue to shape the view of the relationship between influenza vaccination and GBS as protective, the current recommendations are congruent. For patients with no history of GBS, the risk of GBS from vaccine is remote and does not outweigh the risk of serious adverse events from influenza infection. H1N1 Vaccines While pharmacists have been aware that younger individuals are target groups for H1N1 vaccination, the CDC statistics also pose some interesting points for consideration. The following graphs relate patient ‘age’ to H1N1 ‘infection’ rates, ‘hospitalization’ rates, and ‘mortality’ rates. While it is true that the highest infection rates occur in individuals aged 0-24 years, the highest mortality rates occur in individuals aged 25-49 followed by 50-64 years. Florida pharmacists are in a prime position to highlight the importance of vaccination to these age groups. Due to fear of H1N1 vaccines, however, many pharmacists may find that patients are express-
Rate/100,000 Pop by Rate/100,000 Age Group Pop by Age Group Rate/100,000 Pop by Rate/100,000 Age Group Pop by Age Group
While it is true that the highest infection rates occur in individuals aged 0-24 years, the highest mortality rates occur in individuals aged 25-49 followed by 5064 years.
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ral strain vs. inactivated vaccine strain), some additional points of interest may be found in another recent study. This may ultimately change the way health care providers and the public view the risk and relationship between influenza vaccines and GBS. Unlike the VAERS study which studied ‘vaccination’ and GBS, another article published in January, 2009 presents data from French researchers who studied 406 GBS patients and the rate of ‘natural’ influenza infection. The study reports virological evidence that influenza infection is a trigger for GBS, with a frequency related to the level of influenza epidemics. Researchers investigated the monthly incidence of influenza-like illnesses, and also analyzed anti-influenza antibodies. In all, 73 GBS cases were positively linked to influenza infection. Nearly 14%
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ing interest only in receiving seasonal vaccination. Pharmacists should convey that 90.8% of influenza specimens reported to WHO from December 6 to December 12, 2009 were pandemic (H1N1) 2009 influenza strain—not the seasonal strain. Another persuasive comment pharmacists can make to those patients who wish to ‘take their chances,’ is that ‘cold and flu’ season this year means just that. It is possible to become co-infected with seasonal flu, H1N1 flu, rhinovirus, and corona virus all at the same time. Complication and mortality rates increase from co-infection, especially when there are other underlying health conditions. Barring a contraindication, individuals should receive the vaccine if it is available to them. Due to misperceptions regarding H1N1 vaccines in general, it is also important to include a few statements regarding the manufacturing and formulation of these vaccines. Much of the early speculation regarding the H1N1 vaccines was due to initial uncertainty as to whether the U.S. government would opt to choose to use ‘adjuvanted’ formulations for the H1N1 vaccines. However, clinical trials revealed that single-dose traditional formulation vaccines produced adequate antibody response to confer immunity to H1N1. Therefore, NO swine flu vaccines currently being used in the U.S. are adjuvanted formulations. Several other countries, including Canada, have opted to augment their supply with adjuvanted vaccines this season. An adjuvant can be best described as something added to a vaccine to help the body achieve a more robust immune response while being able to use less of the vaccine antigen itself. Using adjuvanted vaccines is good in cases where much vaccine needs to be produced rapidly (such as with swine flu), as the traditional method of growing virus in chick embryos is time consuming. Using adjuvanted vaccines makes the supply stretch to immunize a wider number of people. 16
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There exists decades of information from other countries using certain adjuvanted formulations and the adverse outcome rates are reported not to be statistically different than that of traditional formulations. The issue is that while there is some degree of safety data from other countries for several patient populations, there is no data for use in young children and infants (one of the groups which need greatest protection from swine flu). There is also some continuing debate about specific adjuvants and long-term, immune-mediated events. The adjuvants primarily in question are squalene-containing, oil-in-water formulations. Two of these (M59 from Novartis and AS03 from GSK) are already registered influenza vaccines in other countries, and one other (AF03 from Sanofi Pasteur) has undergone extensive safety testing. Ultimately because adequate immunity was found to be provided by single-dose conventional vaccine formulations, the U.S. had decided to use them for the 2009-2010 season. This may have not been the case if the strain had proven to be more virulent. If the U.S. chooses to use adjuvanted vaccines at a future point in time, the issue of adjuvant selection and safety can be further debated at that time. Another misnomer is that the U.S. Government allowed current H1N1 vaccines to by-pass established approval processes as entirely new entities without appropriate studies. Clinical trials were completed for all H1N1 vaccines prior to approval. The safety information listed on the package inserts are largely based on each U.S. approved manufacturer’s current seasonal influenza formulation. Therefore each U.S. manufacturer’s H1N1 formulation corresponds to the composition of their U.S. seasonal brand —with substitution of the antigen strain only. Adverse outcomes from U.S. H1N1 vaccines have not been, thus far, statistically different than that of seasonal vaccines. The U.S. recall on a limited supply of preservative-free vaccine was not for safety issues, but for slight loss of potency. The recent Canadian recall of Arepanrix, however, a GlaxoSmithKlein (GSK) vaccine (adjuvanted with AS03), was due to an elevated rate of anaphylaxis. The European Medicines Agency (EMEA) is also cautioning practitioners about use of GSK’s Pandemrix (another oil-in-water adjuvanted vaccine), which is causing elevated rates of febrile reactions. As a precaution in general, U.S. health care providers had been advised prior to release of H1N1 vaccine to be vigilant in monitoring and reporting, and researchers are poised to identify any VAERS trends which may reveal any adverse outcome elevations above background rates. Whether or not pharmacists are engaged in the direct administration of vaccines or only respond to queries, it is important to convey accurate and current information to patients—and to offer useful monitoring parameters patients can use ‘post-vaccination.’ This includes educating patients on early symptoms of adverse outcomes (e.g. tingling, muscle weakness) which may warrant further clinical evaluation. While Florida pharmacists may be among the newest health care members to provide vaccinations, our pharmacists can also be the most knowledgeable and best prepared to edu-
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cate patients on the benefits of receiving vaccination, separating fact versus myth on vaccines, and early identification for intervention of adverse outcomes. References Food and Drug Administration. Thimerosal in Vaccines; 2003. www.fda.gov/cber/vaccine/ thimerosal.htm#1/. Accessed December 19, 2009. Magos L, Brown AW, Sparrow S, Bailey E, Snowden RT, Skip WR. The comparative toxicology of ethyl and methyl mercury. Arch Toxicol 1985, 57:260-7. Mahaffey KR, Rice G, et al. An Assessment of Exposure to Mercury in the United States: Mercury Study Report to Congress. Washington, DC: U.S. Environmental Protections Agency; 1997. Document EPA-452/ R097-006. McCormick M, Bayer R, Berg A, et al. Report of the Institute of Medicine. Immunization Safety Review: Vaccines and Autism. Washington, DC: National Academy Press; 2004. Centers for Disease Control and Prevention. Thimerosal in vaccines: a joint statement of the American Academy of Pediatrics and The Public Health Service. MMWR 1999;48:563-5. AHFS. Drug Information [monograph]. Influenza A (H1N1) 2009 Vaccine Inactivated. Vaccines 80:12 (AHFS primary); im100 (VA primary). Oct, 2009. Cox NH, Forsyth A. Thimerosal allergy and vaccination reactions. Contact Dermatitis 1988; 18:229-33. Centers for Disease Control and Prevention. Prevention and Control of Seasonal Influenza with Vaccines. MMWR 2009;58(Early Release):1-52. Aberer W. Vaccination despite thimerosal sensitivity. Contact Dermatitis 1991;24:6-10. Grabenstein JD. Immunologic necessities: Diluents, adjuvants, and Excipients. Hosp Pharm.1996;31:1387-92, 1397-1401.
American Contact Dermatitis Group Patch-Test Results, 1998-2000. Am J Contact Dermat. 2003;14:59-62. Pratt MD, Belsito DV, Deleo VA, et al. North American Contact Dermatitis Group Patch-Test Results, 2001-2002. Dermatitis. 2004;15:17683. Ockenfels HM, Seemann U, Goos M. Contact allergy in patients with periorbital eczema: an analysis of allergens. Dermatology. 1997;195:119-24. Tosti A, Melino M, Bardazzi F. Systemic reactions due to thimerosal. Contact Dermatitis. 1986;15:187-8. Centers for Disease Control and Prevention. General Questions and Answers on GuillainBarre Syndrome (GBS). http://www.cdc. gov/ h1n1 flu/vaccinations/gbs_qa.htm. Accessed December 1, 2009. NINDS. Guillain-Barre Syndrome Fact Sheet. NIH Publication No. 05-2902. http://www.ninds. nih.gov/disorders/gbs/gbs.htm. Accessed November 27, 2009. Rees J, Soudain SE, Gregson NA, Hughes RA. Campylobacter jejuni infection and GuillainBarre syndrome. N Engl J Med 1995;333:13749. Steinberg JS. Guillain-Barre Syndrome: An Overview for the Layperson. 9th ed. Wynnewood, PA: Guillain-Barre Syndrome Foundation International; 2000. Hahn AF. Guillain-Barre Syndrome. Lancet. 1998;352:635-41. Hund EF, Borel CO, Cornblath DR, et al. Intensive management and treatment of severe Guillain-Barre Syndrome. Crit Care Med 1993;21:443-6. Lasky T, Terracciano GJ, Magder L, et al. The Guillain-Barre Syndrome and the 1992-1993 and 1993-1994 influenza vaccines. N Engl J Med. 1998;339:1797-802. Hilleman MR. Cooperation between government and industry in combating a perceived emerging pandemic: The 1976 swine flu vaccination program. JAMA. 1996;275:2413.
Grabenstein JD. Clinical Management of hypersensitivities to vaccine components. Hosp Pharm. 1997;32:77-87.
Safranek TJ, Lawrence DN, Kurland LT, et al. Reassessment of the association between Guillain-Barre syndrome and receipt of swine flu influenza vaccine in 1976-1977:Results of a two-state study. Am J Epidemiol. 1991;133:940-51.
Heidary N, Cohen DE. Hypersensitivity Reactions to Vaccine Components: Thimerosal. Dermatitis. 2005;16:115-20.
Grabenstein JD. Guillain-BarreSyndrome and Vaccination: Usually Unrelated. Hosp Pharm. 2000;36:199-207.
Cox NH, Moss C, Forsyth A. Allergy to nontoxoid constituents of vaccines and implications for patch testing. Dermatitis.1988;18:143-6.
The prognosis and main prognostic indicators of Guillain-Barre Syndrome: a multicentre prospective study of 297 patients. The Italian Guillain-Barre Study Group. Brain 1996;119(pt6):2053-61.
Kelso JM, Li JT, Nicklas RA, et al. Joint Task Force on Practice Parameters for Allergy & Immunology. Adverse reactions to vaccines. Ann Allergy Asthma Immunol. 2009 Oct; 103(Suppl 2):S1-14. Marks JG, Belsito DV, DeLeo VA, et al. North
Ropper AH. The Guillain-Barre syndrome. N Engl J Med 1992;326:1130-6.
Saf. 2009;32(4):309-23. Souayah N, Nasar A, Suri MF, Qureshi AL. Guillain-Barre syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). J Clin Neuromuscul Dis. 2009 Sep;11(1):1-6. Sivadon-Tardy V, Orlikowski D, Porcher R, et al. Guillain-Barre Syndrome and Influenza Virus Infection. Clin Infect Dis. 2009;48:48-56. “Influenza may trigger Guillain-Barre syndrome,� Reuters. January 28, 2009. http:// www.reuters.com/article/idUSTRE50R6IK 20090128. Accessed January 10, 2010. Summary of: WHO Virtual Consultation on the Safety of Adjuvanted Influenza Vaccines. Held by teleconference on June 3 2009 15:3017:30 CET. www.who.int/vaccine_ research/ documents/ Report_on_consultation_on_ adjuvant_safety_2.pdf. Accessed January 6, 2010. Centers for Disease Control. 2009 H1N1 Flu: International Situation Update. Jan 4, 2010, 5:00pm ET. http://www.cdc.gov/h1n1flu / updates/international/. Accessed January 3, 2010. Centers for Disease Control and Prevention. Non Safety-Related Voluntary Recall of Certain Lots of Sanofi-Pasteur H1N1 Pediatric (0.25ml, for 6-35 month olds) Vaccine in Prefilled Syringes Questions & Answers. http://www. cdc.gov/h1n1flu/vaccination/ syringes_qa.htm. Accessed January 3, 2010. Batch of H1N1 vaccine pulled: Manitoba notices spike in severe allergic reactions. The Canadian Press. November 19, 2009, 10:30pm ET. http://www.cbc.ca/health/story/2009/11/19/mancp- flu-vaccine-hold.html. Accessed January 3, 2010. GSK Press Release Issued: Friday 4 December 2009, London UK H1N1 pandemic update on paediatric data for Pandemrix http://www.gsk.com/media/flu/ GSK-statement-H1N1-pandemic-update-onpaediatric-data-for-Pandemrix%204_12_09. pdf. Accessed January 6, 2010.
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Haber P, Sejvar, Mikaeloff Y, SeStefano F. Vaccines and Guillain-Barre syndrome. Drug MARCH 2 0 1 0
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CALL FOR ABSTRACTS FOR POSTER PRESENTATIONS For Florida Pharmacy Students
FLORIDA PHARMACY ASSOCIATION 120TH ANNUAL MEETING AND CONVENTION
June 30 - July 4, 2010 Marco Island Marriott Resort, Golf Club & Spa ♦ Marco Island, Florida Poster Session: Friday, July 1, 2010, 4:30-6:00PM
The FPA Poster Presentations are open to PHARMACY STUDENTS ONLY. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Monday, May 3, 2010. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to: Tian Merren Owens, MS, PharmD, Director of Continuing Education Florida Pharmacy Association 610 N. Adams Street Tallahassee, FL 32301 tmerren@pharmview.com
PLEASE TYPE
Contact Information: Presenter's Name (MUST BE A STUDENT):________________________________________________________________
□ Entry Level Pharm.D. □ Post B.S. Pharm.D. Address: ________________________________________________________________________________________
City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ Abstract Title: ____________________________________________________________________________________ Poster Type:
□Clinical Research □Basic Science Research □Translational Research (Basic Science and Clinical Research)
Primary Author: __________________________________________________________________________________ (Students must be listed first to be considered for the Award. Presenter will be notified by mail of acceptance). Co-Author(s): _________________________________________________________ Student
□YES □NO
Awards:
Posters will be eligible for 1st, 2nd, and 3rd place prizes to be presented at Convention. (Only one prize is given for each winning poster)
Free Registration:
Three entry level students from each Florida College of Pharmacy will be eligible for a complimentary Florida Pharmacy Association Convention Student registration. (Student Registration does not include CE or hotel accommodations) I am interested in being considered for this registration:
College:
□YES
□NO
_____________________________________________________________________________
ABSTRACT FORMAT The abstract form submitted should be the equivalent of one page. The abstract should include: Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions. Abstracts will not be accepted if it is not in this format. Do not include figures or graphs.
Please direct all questions and concerns to:
Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ tmerren@pharmview.com DEADLINE DATE: MONDAY, MAY 3, 2010 18
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Ed Hamilton Completes Term as APhA President At the recently completed American Pharmacists Association (APhA) Annual Meeting and Exposition in Washington, DC, our own, FPA Past President Ed Hamilton completed his term as the APhA president. We congratulate Ed on a successful year and thank him for his willingness to serve our profession. One of the events held during that meeting was a reception for Ed as the outgoing president. That annual event is co-sponsored by APhA and the state association with which the outgoing president is affiliated. This year that was the FPA. The FPA through an ad-hoc committee comprised of the following four past presidents (Don Bergemann, Betty Harris, Kathy Petsos, and Theresa Tolle) raised the FPA co-sponsorship fee privately. Our thanks to the following for their generous contributions: ■■ Pasco-Hernando Pharmacy Association ■■ The Healthcare Acquisitions Group ■■ Clinical Pharmacology Services ■■ Hoye’s Pharmacy Visit our Facebook page to see APhA convention photos.
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Buyer’s Guide florida PHARMACY TODAY
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FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm Drug Information Center Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK 1-800-282-3171 http://ora.umc.ufl.edu/ pcc/fpicjax.htm National Community Pharmacists Association 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax info@ncpanet.org Recovering Pharmacists Network of Florida (407) 257-6606 “Pharmacists Helping Pharmacists”
Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt.
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MAY 26–28, 2010
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