Dec 2013 GPhA Journal by Georgia Pharmacy Association

december 2013 voluMe 35, issue 12

inside This edition

- Three Wise Men of Georgia - Fall Region Meetings Highlights - Southeastern PRN Conference - Moonâ&#x20AC;&#x2122;s Pharmacy Honored -

December 2013 Editor: Jim Bracewell jbracewell@gpha.org

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2012, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

Contents

2 Welcome New Members...................................3 Message from Jim Bracewell ...........................4 GPhA Calendar of Events................................ 5 Message from Pamala Marquess ...................

All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, officers or members of the Georgia Pharmacy Association. Articles and Artwork Those interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org. Subscriptions and Change of Address The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia. The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offices. POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324. Advertising Advertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org.

GPhA Headquarters 50 Lenox Pointe, NE Atlanta, Georgia 30324 t 404-231-5074 f 404-237-8435

gpha.org

The Georgia Pharmacy Journal

........................

12 16 18

GPhA Region Meeting Highlights............. GPhA Academy News................................................ Moon’s Pharmacy Honored................................

20 Southern PRN Conference.................... 22 Funding Long Term Care...................... 23 Neal Florence Runs for House.............. 24 PharmPac Supporters............................ 26 Continuing Education............................ 28 NCPA Elect National Leaders...............

December 2013 Editor: Jim Bracewell jbracewell@gpha.org

Contents

GPhA Headquarters 50 Lenox Pointe, NE Atlanta, Georgia 30324 t 404-231-5074 f 404-237-8435

gpha.org

The Georgia Pharmacy Journal

........................

12 16 18

GPhA Region Meeting Highlights............. GPhA Academy News................................................ Moon’s Pharmacy Honored................................

MESSAGE

from Pamala Marquess

WELCOME

Is It Time for a Revolution?

New Members

ack in 1767, several years before the revolution, the British Parliament placed “duties” (even then they had other names for taxes) on several items coming into America. Many colonists considered such taxes illegal and protested vigorously, refusing to pay them. After Pamala Marquess much protest, three years later, the British government repealed all the “duties” except for the one on imported tea. GPhA President In 1773, Britain’s East India Company was on the verge of bankruptcy due to having large stocks of tea that it could not sell in England. In an effort to save the company, the British government passed the Tea Act of 1773, which gave the East India Company the right to export its merchandise directly to the American colonies without paying any of the regular taxes that were imposed on the colonial merchants. Given this special consideration, the East India Company could undersell American merchants and monopolize the colonial tea trade. As you can imagine, the colonial merchants were mad-they feared being replaced and bankrupted by a powerful monopoly. More importantly, the Tea Act revived American passions about the issue of taxation “We must be without representation. The colonies responded to this new action by boycotting tea. This tea boycott mobilized large segments of the population, linking proactive to the colonies together in a common experience of mass popular protest. Led by Samuel Adams, Paul Revere and up to 150 others, they disguised promote our themselves as Mohawk Indians, boarded three ships, broke open the tea chests profession and and tossed the tea into Boston harbor. As the news of the “Boston Tea Party” other seaports followed their example and staged similar acts of resisthe services spread, tance. All of this eventually led to the revolution against the British and our we provide.” becoming a free nation. Okay, you say-what does that have to do with pharmacy? I wonder if it is time for us to come together and decide that we are just not going to take it any longer. Not take what, you ask? An issue that I am concerned about is our relationship with the various Pharmacy Benefit Managers(PBM’s). The current favoritism to move our patients to “preferred pharmacies”, the “take it or leave it” contracts and little or no payment for professional services is of great concern to me. We must respond in a positive way to the apparent effort to eliminate face-to-face contact with our patients and stop the perception that patients will never need a local pharmacist. Our profession is recognized as one of the most trusted health care professionals and we must re-emphasize the value of personal patient counseling, the importance of asking and answering questions in person, in a professional setting that comforts and assures our patients. We must not be passive. Some would suggest that we ignore all this-it’s just a phase. I promise you this issue will not go away if we just ignore it! We must be more proactive to promote our profession and the services we provide.

Pam

Your Voice in Pharmacy The Georgia Pharmacy Association strives to be the leading voice for pharmacy in the state of Georgia. We aggressively advocate for the profession by shaping public policy and scope of practice to enhance the value of pharmacy. We take pride in our prestigious history and value our membership for its diversity in all practice settings as well as its dedication to health care. GPhA provides its members with the resources and support needed to advance our profession. As healthcare changes, so do job responsibilities and career tracks may be refocused. GPhA is your career development partner as you address your future in pharmacy. Professional networking, skills training and continuing pharmacy education are key benefits of your GPhA membership. Whether you are a recent Pharmacy school grad or an established pharmacist, there is a place for your voice at GPhA.

Hugh Yawn Mcrae, GA - 11/1/13 John Logan Columbus, GA - 11/1/13 Elizabeth McNeely Bartow, GA - 11/1/13 Chad Brown Hawkinsville, GA - 11/1/13 Susan Preston Broxton, GA -11/6/13 Susan Brooks Dublin, GA - 11/8/13

Associate:

Henry Levine - Peachtree Planning John’s Creek, GA - 11/12/13

Pharmacy Technicians: Kelsey Patterson Blue Ridge, GA - 11/6/13 Judy Tipton McCaysville, GA - 11/4/13

Have you considered GPhA’s new Sustaining Membership? ..........only $14.58 per month Never get another renewal notice! Visit gpha.org and sign up today!

THE GEORGIA PHARMACY ASSOCIATION

Pamala S. Marquess

Active Pharmacists:

50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.org

The Georgia Pharmacy Journal

MESSAGE

from Pamala Marquess

WELCOME

Is It Time for a Revolution?

New Members

Pam

Associate:

Henry Levine - Peachtree Planning John’s Creek, GA - 11/12/13

Pharmacy Technicians: Kelsey Patterson Blue Ridge, GA - 11/6/13 Judy Tipton McCaysville, GA - 11/4/13

Have you considered GPhA’s new Sustaining Membership? ..........only $14.58 per month Never get another renewal notice! Visit gpha.org and sign up today!

THE GEORGIA PHARMACY ASSOCIATION

Pamala S. Marquess

Active Pharmacists:

50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.org

The Georgia Pharmacy Journal

January 2014 Events

High Ground

The reason why GPhA will win the battle to expand pharmacist delivered immunizationa under protocol.

THE GEORGIA PHARMACY ASSOCIATION

Jim Bracewell

Executive Vice President

he battle of Gettysburg was won before it started, when Major General John Buford and his Union cavalry captured and defended the high ground above the town. They were in perfect position to defend attacks from the Confederate army over the course of three days. It was such a strategy that changed history that July, 150 years ago. As a native of Georgia, with family ancestors that fought on the losing side in the battle of Gettysburg, it is easy for me to make the strong case for seizing the high ground like Major General John Buford did at Gettysburg. We should do the same in all of our political challenges. There are a few concepts of battle that relate to a great lobbying strategy and “high ground” is one of them. An offshoot of this concept is “the moral high ground”- the ability to gain support for your position by conveying the ethical superiority of a particular side of an argument. At the Georgia State Capitol, high ground is more about recognizing where the conflict will take place and seizing a position that offers the best chance of success. Has the expansion of the delivery of flu immunizations under protocol improved the state of health in our state? The answer is a resounding YES. This broader scope of practice has also demonstrated the expanded role pharmacists can and should be playing in providing the accessibility of community healthcare for our citizens. What would it mean if just 1,000 or just 100 seniors received the Pneumovax immunization and not be hospitalized with pneumonia? What would it mean if just 1,000 or just 100 seniors received the Zostavax immunization and not suffer a debilitating battle with shingles? What would if mean if just 1,000 or just 100 adults received the Pertussis immunization and avoid the suffering of young children unnecessarily infected with whooping cough? Georgia Pharmacists have seized the high ground in this political campaign to improve the quality of health of the citizens of Georgia. We will win. Georgia will win. Your patients will win. The 2014 Legislative Session is the time to make this step forward for better healthcare in Georgia through preventive immunizations available from your community pharmacist. Pharmacists are capable providers currently in an incapable healthcare system. Can you hear the bugle sounding Charge? I did. Plan now to take an active role in the future of your pharmacy career by joining the GPhA’s strategy to win this issue this legislative session.

SUNDAY

TUESDAY

MONDAY

SATURDAY

WEDNESDAY

THURSDAY

FRIDAY

GPhA Closed

General Assembly Begins

Georgia Board of Pharmacy Meeting

GPhA BOD Meeting January Standing Committee Meetings

Executive Committee Meeting

Jim

The Georgia Pharmacy Journal

January 2014 Events

High Ground

The reason why GPhA will win the battle to expand pharmacist delivered immunizationa under protocol.

THE GEORGIA PHARMACY ASSOCIATION

Jim Bracewell

Executive Vice President

SUNDAY

TUESDAY

MONDAY

SATURDAY

WEDNESDAY

THURSDAY

FRIDAY

GPhA Closed

General Assembly Begins

Georgia Board of Pharmacy Meeting

GPhA BOD Meeting January Standing Committee Meetings

Executive Committee Meeting

Jim

The Georgia Pharmacy Journal

Three Wise Men

Georgia of

Crawford W. Long

Raymond P. Ahlquist

Born: November 1, 1815 Danielsville, Georgia

Born: December 30, 1851 Villa Rica, Georgia

Born: July 26, 1905 Missoula, Montana

Died: June 16, 1878 (aged 63) Athens, Georgia

Died: March 12, 1929 (aged 78) Atlanta, Georgia

Died: April 15, 1983 (aged 78) Augusta, Georgia

Nationality: United States

Fields: Medicine

Spouse: Lucy Elizabeth Howard (1859-1919)

Fields: Pharmacology

Alma mater: University of Georgia, University of Pennsylvania Known for: First use of general anesthesia in surgery.

Asa G. Candler

Known For: Pharmacist, entrepreneur and philanthropist who made Coca-Cola a household name.

Institutions: Medical College of Georgia Known for: Discovered the concept of alpha and beta receptors.

The Georgia Pharmacy Journal

Georgia pharmacists who impacted mankind.

By Flynn Warren, M.S., RPh

ew people can be said to have had an impact on all mankind, yet three Georgia pharmacists have done just that. They are, in chronological order: (1) Crawford W. Long (1815-1878) was a physician and pharmacist who made the first use of general anesthesia to relieve surgical pain; (2) Asa G. Candler (1851-1929), pharmacist, entrepreneur and philanthropist who made Coca-Cola a household name; and (3) Raymond P. Ahlquist (1905-1983), research pharmacist who discovered the concept of alpha and beta receptors. Crawford Williamson Long, MD, RPh, (18151878) was born in Danielsville, Georgia, and graduated from the University of Georgia (UGA) in 1835 with bachelors’ and master’s degrees. A plaque on the outside second floor wall of Old College, UGA’s oldest building, indicates where Long lived during his time on campus. Long was a pharmaceutical and medical apprentice with Dr. Grant in Jefferson, GA, but decided on formal medical education and graduated from the University of Pennsylvania with his MD in 1839. Long interned at hospitals in New York City for 18 months before returning to Jefferson in 1840 to practice with Dr. Grant and soon purchased Grant’s medical practice and pharmacy. In 1852, Long moved to Athens where he owned a pharmacy and practiced medicine.1 Because of Long’s training, he could be licensed as both phy-

The Georgia Pharmacy Journal

sician and pharmacist within Georgia law.2 The United States Internal Revenue Tas Assessment List of 1866 has Long paying taxes as an apothecary and as a physician.3 Nitrous oxide (N2O, laughing gas) parties were popular in the 1830’s and Long was asked to provide the drug for a party. Having no nitrous oxide, Long supplied sulfuric ether instead. Long observed how party goers would fall and injure themselves without feeling pain. James Venable was a regular participant in ether parties and allowed Long to use ether to remove one of two tumors on Venable’s neck on March 30, 1842. Long used ether to remove the second tumor about two months later and also for other procedures, but Long did not publish his work. He had been told by George B. Wood, author of the United States Dispensatory, to be sure of your findings before publishing.4 Dentist William Morton used ether in 1846 to sedate Gilbert Abbott so Dr. John Collins Warren, a founder of the Massachusetts General Hospital (MGH), could remove a cyst from Abbott’s neck on October 16, 1846.5 Despite attempts by Morton and others, Long’s primacy in the use of ether for surgical anesthesia is recognized today. In the Ether Dome at MGH, site of Warren’s and Morton’s first use of ether, the Number One chair is named after Crawford W. Long. MGH states that it is the site of “the first public use of ether”, while acknowledging Long as the first user of the drug.

Three Wise Men

Georgia of

Crawford W. Long

Raymond P. Ahlquist

Born: November 1, 1815 Danielsville, Georgia

Born: December 30, 1851 Villa Rica, Georgia

Born: July 26, 1905 Missoula, Montana

Died: June 16, 1878 (aged 63) Athens, Georgia

Died: March 12, 1929 (aged 78) Atlanta, Georgia

Died: April 15, 1983 (aged 78) Augusta, Georgia

Nationality: United States

Fields: Medicine

Spouse: Lucy Elizabeth Howard (1859-1919)

Fields: Pharmacology

Alma mater: University of Georgia, University of Pennsylvania Known for: First use of general anesthesia in surgery.

Asa G. Candler

Known For: Pharmacist, entrepreneur and philanthropist who made Coca-Cola a household name.

Institutions: Medical College of Georgia Known for: Discovered the concept of alpha and beta receptors.

The Georgia Pharmacy Journal

Georgia pharmacists who impacted mankind.

By Flynn Warren, M.S., RPh

The Georgia Pharmacy Journal

The contribution of Crawford Long certainly made the life of everyone who has had to undergo surgery a more pleasant experience. This early photo shows an operation using ether that took place around 1846. If it were not for anesthesia, few advances in surgery would have been possible. The contribution of Crawford Long certainly made the life of everyone who has had to undergo surgery a more pleasant experience. Crawford Long has been honored in many ways. March 30th is nationally recognized as “Doctor’s Day.” In 1920, Georgia established Long County and in 1926, Georgia chose Long to represent the state in Statuary Hall of the Unied States Capitol Building. A commemorative stamp honoring Long was issued by the United States Post Office in 1940.6 Asa Griggs Candler, RPh (1851-1929), was born in Villa Rica, GA. An entrepreneur from youth, Candler sold mink skins to buy sewing pins which he resold to housewives and at age 15 he had $100. Run over by a wagon as a child, Candler was deaf in one ear for most of his life. Candler wanted to be a physician but the Civil War cost the family their fortune and made college impossible. While John Pemberton is known as the originator of Coca-Cola, it was Asa Candler who “supplied the spark”7 that made “Coke” the most widely recognized brand name in the world. Candler apprenticed to two pharmacist-physicians in Cartersville, GA, in July of 1870. For two years Candler stud-

ied and read medical books at night, still hoping for medical school. Candler decided there was more money to be made as a pharmacist and, in 1873, completed the three years of apprenticeship required for a pharmacist’s license and moved to Atlanta. Candler asked John Pemberton for a job as a pharmacist but was refused. Candler was hired by George Howard but his only pay was a place to sleep. Within four months, Candler had become chief clerk of the pharmacy. In 1875, Candler was a founding member of the Georgia Pharmaceutical Association. A partnership, Hallman and Candler, was formed in 1877 and Candler’s job with Mr. Howard was taken by John Pemberton. In 1878, Candler joined the American Pharmacists Association during its Atlanta Convention.8 John Pemberton came to Atlanta in 1869 known for his soda fountain and medical expertise. Pemberton formulated French Wine of Coca as a “nerve tonic” in 1885. Atlanta went “dry” in 1886, thereby killing sales of the alcoholic French Wine of Coca. Pemberton added kola to replace the alcohol and Coca-Cola was born. On May 8, 1886, Pemberton and Frank M. Robinson walked to Joseph Jacob’s pharmacy and its soda fountain run by Willis Venable. Jacobs

had served his pharmacy apprenticeship under Crawford Long. The first mixing of Coca-Cola syrup with plain water was not palatable but carbonated water was used the second time and Coca-Cola’s place in history was assured. In 1887, Pemberton sold two-thirds of his company to Venable. Candler bought his first share of Coca-Cola from Venable on 4-14-1888, paying $550 for 33% of Coca-Cola. By 8-30-1888, Candler owned 67% of the company personally and the remainder was owned by one of his companies. Three years later, Candler personally owned Coca-Cola and incorporated it as Coca-Cola of Georgia. Candler said he paid $2300 to buy Coca-Cola but made $300 in the process for a net purchase price of $2000.9 Only Candler and Robinson knew the formula for Coca-Cola and one of them personally mixed the secret ingredients. In 1903, Candler taught his son, Charles Howard Candler, the formula. Asa Candler guarded the formula so closely that bottles in the mixing room were labeled in code. The formula was not written down but passed only by word of mouth until the 1970s. Today, the formula is kept in a vault with restricted access at the World of Coca-Cola. Apparently, fewer than 15 people have ever known the formula. Not even the FDA could get the formula despite years of trying.10 By 1896 Coke was sold throughout North America and sales begin in Europe in 1900. Candler battled any imitator and two sons became lawyers to make sure he could challenge imitators. Candler gave up control of Coca-Cola in 1916 and left it to his sons to run. Coca-Cola was sold to outside investors in 1918 for $25 million. Candler said he would not have sold but those who did got a fair price. Ernest Woodruff and his associates bought Coca-Cola in 1919 for $32 million. In 1907 Candler protected the homes of Atlanta citizens during a local depression. In 1917 Candler became mayor of Atlanta and personally paid off the city’s debt and began a Federal Home Administration style program to enable home purchases in Atlanta. Candler funded the building of a hospital in 1920 when

The Georgia Pharmacy Journal

SAVE THIS DATE ON YOUR CALENDAR Thursday, February 27, 2014

VIP DAY Voice In Pharmacy At The State Capitol

No cost to you to participate. Huge cost to your career not to be there.

THE GEORGIA PHARMACY ASSOCIATION

Go to www.gpha.org or Scan the QR Code to Register.

The Georgia Pharmacy Journal

SAVE THIS DATE ON YOUR CALENDAR Thursday, February 27, 2014

VIP DAY Voice In Pharmacy At The State Capitol

No cost to you to participate. Huge cost to your career not to be there.

THE GEORGIA PHARMACY ASSOCIATION

Go to www.gpha.org or Scan the QR Code to Register.

In 1873, Asa Candler completed the three years of apprenticeship required for a pharmacist’s license and moved to Atlanta. It was Candler who “supplied the spark” that made Coca-Cola the most widely recognized brand name in the world. Candler poses here with wife Lucy. his personal tax bill was 8.5% of Atlanta’s tax base. Asa Candler was the only nominee as Atlanta’s “First Citizen” in 1922. Candler died 3-12-1929; an official day of mourning in Atlanta and city flags flew at half mast. A historical oddity almost occurred when the name for a new college in Oxford, GA, had to be chosen in 1836. Georgia Methodists wanted to honor one of their three bishops and named the school Emory College. Bishop Asbury lost but has been honored many times by both Emory and the Methodist Church. The other loser has become, in a way, the most honored of all. He was Bishop Coke (pronounced as “Cook”). The school that has benefitted so greatly from the financial support of Coca-Cola could have started out as Coke College, 50 years before the first Coca-Cola was poured. Asa Candler provided the funds and land to move Emory from Oxford,

GA, to Atlanta and establish Emory University. Candler and his successors at Coca-Cola have provided so much to Emory that it is often referred to as “Coca-Cola University” but actually could have been Coke University. The original site in Oxford is today known as Oxford College, a two-year branch of Emory University.11 Raymond P. Ahlquist , PhD, RPh (19051983) practiced retail pharmacy before becoming a pharmacology researcher who discovered the concept of alpha and beta receptors. This concept has lead to the discovery and use of many different drugs for a host of medical problems. Sir Henry Dale, in the early 1900s, postulated a receptor for epinephrine as a result of the ability of ergot alkaloids to block the excitatory actions of epinephrine. For 40 years the debate centered on whether there were two receptors – one inhibitory and one excitatory – or two mediators. Cannon and Rosenbluth (1939) set forth the theory that epinephrine joined with a tissue receptor to form either Sympathin E(xcitatory) or Sympathin I(nhibitory).12 Ray Ahlquist was born in Missoula, Montana, and received his BS in Pharmacy (1935), MS (1937) and PhD (1940) degrees at the University of Washington. Ahlquist practiced pharmacy in Seattle and was a member of the American Pharmacists Association beginning in 1940. Ahlquist taught at South Dakota State School of Pharmacy from 1940 to 1944 but moved to the University of Georgia School of Medicine, known today as the Medical College of Georgia (MCG) of Georgia Regents University, in 1944. Ahlquist taught at MCG until his death in 1983 and received the institution’s highest academic rank, Charbonnier Professor (of Pharmacology).13 Ahlquist’s experiments that lead to development of the concept of alpha and beta receptors involved six drugs – norepinephrine, nordefrin, dl-epinephrine, l-epinephrine, methylepinephrine, and isoproterenol. Dogs, cats, rats and rabbits were used and were given equimolar and equivalent doses of the drugs. Ergotoxine, dibenzyline and tolazoline were used as sympatholytic agents. The order

of relative drug potency was measured on 22 different organs or structures. In the discussion section of his paper, Ahlquist explained how the concept of two types of adrenotropic receptors is opposed to the concept of two mediators. Epinephrine has the chemical and physical properties to be the only adrenergic mediator. Epinephrine is the most active alpha agent and almost the most active beta agent. Because the dominant belief supported Sympathin E and I, Ahlquist used two pages to explain the differences between that concept and his findings.14 Ahlquist’s paper was rejected by the Raymond Ahlquist taught at South Dakota State School of Pharmacy from 1940 to 1944 but moved to the University of Georgia School of Medicine, known today as the Medical College of Georgia (MCG) In 1944. Ahlquist taught at MCG until his death in 1983 and received the institution’s highest academic rank, Charbonnier Professor (of Pharmacology). Journal of Pharmacology and Experimental Therapeutics. The editor of the American Journal of Physiology was a faculty member at MCG and accepted and published the paper. Ahlquist estimated the cost of the one-year study to have been $3500. His annual salary was $3200 and supplies, drawn from routine stocks, were about $300. No grant funds were involved and no review panels had to approve doing the study. In 1948, there were no beta blocking agents to validate Ahlquist’s findings. Without the ability to both stimulate and block alpha and beta receptors, many pharmacologists were reluctant to accept the new concept. In 1958, dichloroisoprenaline (dichloroisoproterenol) was shown to selectively block sympathetic inhibitory effects on several organs and was called a “beta adrenoreceptor blocking agent.”15 James Black, MD, FRS, of Kings College Medical School (London), lead the team that synthesized propranolol, the first clinically useful beta blocker (1964). Thus, after 20 years of challenges, the

The Georgia Pharmacy Journal

alpha and beta concept became widely accepted. Ahlquist and Black became connected by their research and jointly received awards recognizing their work. In 1976, both received the Ciba Award for Hypertension Research and the Albert Lasker Award for Medical Research. Black received the Nobel Prize in Physiology or Medicine in 1988 “for discoveries of important principles for drug development.” Ahlquist’s work was acknowledged by Black during his acceptance speech16 but Ahlquist had died in 1983 and so could not be honored by the Nobel Committee in 1988. (Note: Nobel

Prizes are only awarded to living recipients. In 2011, Ralph Steinmann was allowed to receive the Nobel Prize in Medicine even though he had died two days before the award was announced but the Nobel Committee was not aware of his death.) Ahlquist served as a consultant to NASA on cardiovascular pharmacology for space flights. Ahlquist was a founder of the American College of Clinical Pharmacology but never received their Abel Award for research. Don Francke and Charles Walton debated with Ahlquist on the differences between clin-

ical pharmacology and clinical pharmacy at a meeting in 1972. When the UGA College of Pharmacy sought to send students to MCG for clinical pharmacy training, Ahlquist was a major supporter. Ahlquist provided office space in the Department of Pharmacology for UGA faculty assigned to Augusta. I consider myself fortunate to have personally known Ahlquist.17 So, we have three Georgia pharmacists who made it possible for people to undergo painless surgery, enjoy a refreshing drink on a hot day and control cardiovascular and other diseases with drugs.

References: 1. Joseph Jacobs. Some personal recollections and private correspondence of Dr. Crawford Williamson Long, discoverer of anesthesia with sulphuric ether. Joseph Jacobs, Atlanta, GA. 1919; 12; 2. Wilson, RC. Drugs and Pharmacy in the Life of Georgia. Foote and Davies, Inc, Atlanta, GA; 1959:217-219; 3. United States Internal Revenue Tas Assessment List of 1866, via Ancestry.com; 4. C.W. and H.R.J. Long, Wholesale and Retail Druggists, Athens, GA. Advertisement from the Southern Banner, Athens, GA 2-15-1854. In: Wilson, RC. Drugs and Pharmacy in the Life of Georgia. Foote and Davies, Inc, Atlanta, GA; 1959:114; 5. Bull, Webster and Bull, Martha. Something in the Ether: A Bicentennial History of Massachusetts General Hospital 1811-2011. Memoirs Unlimited, Beverly, MA; 2011:40-41; 6. Waters KL, Crawford W. Long and his relations to pharmacy. American Journal of Pharmacy. 1958; 130:52-59; 7. Wilson, RC. Drugs and Pharmacy in the Life of Georgia. Foote and Davies, Inc, Atlanta, GA; 1959:224; 8. Watters, P. Coca-Cola: An Illustrated History. Doubleday and Co, Garden City, New York; 1978:1-26; 9. Candler CH. Asa Griggs Candler. Emory University, Atlanta, GA; 1950:95-104; 10. Candler CH. Asa Griggs Candler. Emory University, Atlanta, GA; 1950:119; 11. Hauk GS. A legacy of heart and mind: Emory since 1836. Bookhouse Group Inc, Atlanta, GA, 1999:8; 12. The Encyclopedia Brittanica, on-line edition; 2013; 13. Ahlquist RP. Curriculum Vitae. Ahlquist Collection. Medical College of Georgia Library; 1982; 14. Wenger NK and Greenbaum LM. From adrenoreceptor mechanisms to clinical therapeutics: Raymond Ahlquist, PhD, 1914-1983. Journal of the American College of Cardiology. 1984; 3:419-421; 15. Ahlquist RP. A study of the adrenotropic receptors, The American Journal of Physiology. 1948; 153, No. 3:586-600; 16. Black J. Drugs from emasculated hormones: the principles of syntopic antagonism. Nobel Prize Lecture, December 8, 1988; Stockholm, Sweden; 17. Personal knowledge of the author.

Division of Display Options, Inc.

Compounding Labs Pharmacy Planning & Design

Rx Planning Specialist

Patient Consultation Areas

Roland Thomas

Stocking Lozier Distributor

experience in over 2,000 pharmacies.

Full line of Pharmacy Fixtures Custom Wood Work Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

1-800-321-4344 www.displayoptions.com www � .displayoptions.com �

The Georgia Pharmacy Journal

Division of Display Options, Inc.

Compounding Labs Pharmacy Planning & Design

Rx Planning Specialist

Patient Consultation Areas

Roland Thomas

Stocking Lozier Distributor

experience in over 2,000 pharmacies.

Full line of Pharmacy Fixtures Custom Wood Work Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

1-800-321-4344 www.displayoptions.com www � .displayoptions.com �

GPhA Fall Region Meetings

Highlights!

Georgia is the largest state east of the Mississippi River and it is ever so abundantly clear to your GPhA Executive Committee each Fall as we travel to cities across our great state.

he leadership of the Georgia Pharmacy Association believes it is important to invest time and resources to take the GPhA story to the members in all parts of our state. Your volunteer leaders gave up many days this year to meet with members in a cities all across Georgia. The content of the GPhA presentation at our meetings focused on the legislative issues facing our profession. The Association’s legislative agenda was laid out and critiqued by our members and the upcoming VIP – Voice In Pharmacy Day will set the tone for our clout with the Georgia General Assembly. Issues discussed included a review of how a bill becomes a law and how Pharmacists and patients can become involved in the legislative process. In addition, issues regarding proposed state legislation and the regulation of pharmacy were covered including: • MAC Pricing, • Expanding Immunization, • Pharmacy Accreditation, • HIPPA Rules, and • The Prescription Drug Monitoring Program. The strength of GPhA starts in the towns and cities around the state. GPhA is a member driven association and the Association leaders are proud to have the opportunity to connect with members through these Region Meetings. The Association is only as strong as it’s membership so make plans to get involved and attend the next GPhA meeting in your area. Together, we are the Voice of the Pharmacy Profession in Georgia.

Region 11 President Kalen Manasco welcomes attendees to the October 22 Meeting.

January 17-19, 2014 Omni Grove Park Inn Asheville, NC Partnering State Associations: Georgia ● Kentucky Mississippi ● North Carolina Tennessee ● Virginia Gather your friends for a weekend of fun, facts and facials! Full registration includes 12 hours of CE programming, breakfast on Saturday and Sunday, a dinner reception on Friday, an event t-shirt and gift bag! The Southeastern “Girls of Pharmacy” Leadership Weekend was developed originally for the growing female demographic. With pharmacy schools becoming predominately female, we felt it was important to develop a program specifically tailored to the needs of female professionals. Thus, the Southeastern “Girls of Pharmacy” Leadership Weekend was born! We hope to see you there!

Visit www.scrx.org for more information and specific event details! Need to book your hotel room? Call 800.438.5800 by December 17 to take advantage of our group rate of $152 per night! President Pam Marquess is glad to have former GPhA President (1996-97) and current State Reprersentative Bruce Broadrick attend the October 29 Regioin 7 Meeting in Acworth.

Want first choice of the Spa treatments? We have blocked off various appointment times for all of your favorite spa services. Call 800.438.5800 today to get your first choice of times and services! DON’T FORGET! Spa appointments are 20% off for guests of this event and are available on a first come, first serve basis. In order to receive this discount, you must tell the Spa that you are with the SE Girls of Pharmacy Leadership Weekend! Back by popular demand! After the reception, you can join us for a Paint and Mingle networking experience! At this optional event, you will paint a piece of artwork while getting to know fellow attendees. Take home your art to remember the weekend. No artistic ability required. Register today at www.scrx.org or return the completed registration form (attached) with payment to SCPhA.

Mail: 1350 Browning Rd., Columbia, SC 29210 The GPhA Board Chairman Robert Hatton speaks to a great turn out of Region 6 Meeting attendees on November 5 in Macon.

The Georgia Pharmacy Journal

Fax: 803.354.9207

Email: laura@scrx.org

Questions? Contact SCPhA at 803.354.9977 or email Laura Reid, Director of Events, at laura@scrx.org.

GPhA Fall Region Meetings

Highlights!

Georgia is the largest state east of the Mississippi River and it is ever so abundantly clear to your GPhA Executive Committee each Fall as we travel to cities across our great state.

Region 11 President Kalen Manasco welcomes attendees to the October 22 Meeting.

Mail: 1350 Browning Rd., Columbia, SC 29210 The GPhA Board Chairman Robert Hatton speaks to a great turn out of Region 6 Meeting attendees on November 5 in Macon.

The Georgia Pharmacy Journal

Fax: 803.354.9207

Email: laura@scrx.org

Questions? Contact SCPhA at 803.354.9977 or email Laura Reid, Director of Events, at laura@scrx.org.

GPhA Board Chairman Robert Hatton, Region 6 President Sherri Moody and Region 6 Pharm PAC Director Mike McGee.

GPhA First Vice President Tommy Whitworth presents the program to the Region 4 attendees. Georgia Drugs and Narcotic Director Rick Allen reviews key points of Georgiaâ&#x20AC;&#x2122;s new PDMP Law with attendees at the GPhA Region 9 Meeting.

Pharm PAC Region 4 Director Bill McLeer encourages members to support legislators that support pharmacy.

GPhA President Pam Marquess explains the changes to the 2014 Convention schedule at the Region 9 Meeting.

Region 9 had four former GPhA presidents at their meeting. L-R: Dale Coker (2010-11), Robert Bowles (2008-09), Jack Dunn (2011-12), Rick Allen (GDNA Director) and (back to camera) State Representative Bruce Broadrick (1996-97).

Husband and wife GPhA Board Members Ted Hunt (Chair of the Academy of Consultant Pharmacists) on the left and wife Michelle Hunt (Chair of the Academy of Pharmacy Technicians) on the right visit with GPhA Executive Vice President Jim Bracewell (center) at Region 7 in Actworth on October 29.

The Georgia Pharmacy Journal

Region 9 President Amanda Westbrooks poses with Donald Stiles, winner of the ipod door prize.

The GPhA Region 8 Meeting had a good turnout. Attendees here discuss the fairness and transparency of legislation regarding MAC pricing.

GPhA Pharm PAC Region 9 Director Mark Paris explains how Pharm PAC has made Georgia a great state to practice pharmacy.

The Georgia Pharmacy Journal

L-R: GPhA Region 2 President Ed Dozier, Rep. Ed Rynders, Sen. Freddie Powell Sims and Rep. Buddy Harden.

GPhA Board Chairman Robert Hatton, Region 6 President Sherri Moody and Region 6 Pharm PAC Director Mike McGee.

Pharm PAC Region 4 Director Bill McLeer encourages members to support legislators that support pharmacy.

GPhA President Pam Marquess explains the changes to the 2014 Convention schedule at the Region 9 Meeting.

The Georgia Pharmacy Journal

Region 9 President Amanda Westbrooks poses with Donald Stiles, winner of the ipod door prize.

The GPhA Region 8 Meeting had a good turnout. Attendees here discuss the fairness and transparency of legislation regarding MAC pricing.

GPhA Pharm PAC Region 9 Director Mark Paris explains how Pharm PAC has made Georgia a great state to practice pharmacy.

The Georgia Pharmacy Journal

L-R: GPhA Region 2 President Ed Dozier, Rep. Ed Rynders, Sen. Freddie Powell Sims and Rep. Buddy Harden.

Academy of Student and Academicians News

GPhA Academy of Independant Pharmacy

The APhA-ASP Chapter at the University of Georgia College of Pharmacy has experienced a tremendous amount of growth within the past year. By Leah Stowers and Jessica Kupstas

he APhA-ASP Chapter at the University of Georgia College of Pharmacy has experienced a tremendous amount of growth within the past year. Patient care remains the chapter’s top priority in providing student pharmacists opportunities to serve the community. In April 2013, ASP hosted its largest Multicultural Health Fair ever at Pendergrass Flea Market, screening 124 patients for BMI, blood glucose, and blood pressure. In honor Members are of National Pharmacist’s Month, able to ASP hosted the network 11th Annual Dawlocally with gtoberfest Health Fair on October the Georgia 16 at UGA. ApPharmacy proximately 300 attended Association people the event and over (GPhA). 150 student pharmacists participated in offering immunizations, blood glucose, BMI, blood pressure, and cholesterol screenings. In order to develop inter-professional relationships on campus, APhA-ASP has expanded partnerships for these health fairs to medical students and public health students at UGA. Additionally, student pharmacists invited community partners in asthma and allergy as well as dermatology to help foster the recognition of pharmacists as valuable members of the healthcare team in a community based setting. These events provide student pharmacists with opportunities to serve patients and help improve the health outcomes of

the surrounding community. Students at UGA have also focused on generating a much louder advocating voice for the profession of pharmacy. The APhA-ASP chapter aims to speak up as a collective voice to legislators in order to raise awareness of the value of pharmacists. In preparation for GPhA’s VIP day

in February, UGA students have already begun collaborating on pertinent issues for potential discussion and presentation to our state legislators prior to attendance at the event. Much emphasis has been allocated toward taking action at the state level, with focus on demonstrating innovation at this year’s VIP event.

ASP hosted its largest Multicultural Health Fair ever, screening 124 patients.

Celebrates 20 Years! T

he AIP celebrated its 20th Anniversary at a Luncheon held during the GPhA convention in June. More than 75 people attended the luncheon including all the wholesale partners of AIP. Chairman Drew Miller presided over the meeting and AIP Director Jeff Lurey gave a brief history of AIP. The actual date of AIP’s inception was June 16, 1993. The AIP mission is to advance the concept of pharmacy care to: • Ensure the economic viability and security of Independent Pharmacy; • Provide a forum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; • Address the unique business and professional issues of independent pharmacies; • Develop and implement marketing opportunities for members of the Academy with emphasis on the third party prescription drug program/benefit market; • Provide educational programs designed to enhance the managerial skills of Independent Pharmacy Owners and Managers; and, • Establish and implement programs and services designed to assist Independent Pharmacy Owners and Managers.

Join Us For The AIP Spring Meeting

AIP Board members met July 19-21, 2013 for the AIP Board Retreat in Big Canoe, Georgia.

We would like to thank the many AIP members who have supported the Academy the past 20 years. We pledge to continue to defend and protect the profession to the best of our ability and we pledge to continue to fight for the economic viability of Independent Pharmacy. L-R: Dale Coker is awarded the 2013 Joseph Mengoni AIP Pharmacist of the Year Award by AIP Chairman Drew Miller and Joe Mengoni.

AIP Members Drew Miller, Tommy Whitworth, Robert Hatton, Jack Dunn, Pam Marquess, Bobby Moody and Ira Katz along with GPhA EVP Jim Bracewell meet with Senator Johnny Isakson in Washington, D.C. in April 2013.

March 30, 2014 Macon Marriott & Centreplex • Network with Colleagues • Meet with Partners • Morning & Afternoon Programs ASP hosted 300 attendees at the 11th Annual Dawgtoberfest Health Fair.

The Georgia Pharmacy Journal

See you there! The Georgia Pharmacy Journal

Members gathered at the 2013 AIP Wholesaler Appreciation Luncheon & Business Meeting held at the GPhA Convention.

Academy of Student and Academicians News

GPhA Academy of Independant Pharmacy

The APhA-ASP Chapter at the University of Georgia College of Pharmacy has experienced a tremendous amount of growth within the past year. By Leah Stowers and Jessica Kupstas

ASP hosted its largest Multicultural Health Fair ever, screening 124 patients.

Celebrates 20 Years! T

Join Us For The AIP Spring Meeting

AIP Board members met July 19-21, 2013 for the AIP Board Retreat in Big Canoe, Georgia.

March 30, 2014 Macon Marriott & Centreplex • Network with Colleagues • Meet with Partners • Morning & Afternoon Programs ASP hosted 300 attendees at the 11th Annual Dawgtoberfest Health Fair.

The Georgia Pharmacy Journal

See you there! The Georgia Pharmacy Journal

Members gathered at the 2013 AIP Wholesaler Appreciation Luncheon & Business Meeting held at the GPhA Convention.

Congratulations!

Moon’s Pharmacy

GPhA Member Moon’s Pharmacy Honored As a 2013 Georgia Family Business of the Year Finalist.

PhA member Moon’s Pharmacy, located in Tifton, Ga., was honored as a Georgia Family Business of the Year finalist in the small business category for companies with fewer than 50 employees. The awards are presented by the Cox Family Enterprise Center in the Michael J. Coles College of Business at Kennesaw State University. Since 1991, the Cox Family Enterprise Center has given out the annual awards to honor Georgia-based family-run firms who have successfully combined business with family. Criteria are based on family involvement in the business, innovative business practices or strategies, contributions to the community and business success. Moon’s Pharmacy is a full-service independent pharmacy in Tifton. The business began in 1970 when pharmacist Morgan Moon purchased half of Ranier’s Pharmacy, where Moon had worked as a delivery boy years earlier. Both the Ranier and Moon families worked in partnership until Rainer’s retirement in 1985, when Moon purchased the remainder of the business and changed the name. Moon’s Pharmacy is now operated by Moon’s wife, Cynthia, along with their son, Floyd, and daughters, Claire and Catherine. The 2013 winners and finalists were honored at the 22nd Annual Georgia Family Business of the Year Awards Dinner in November at The Georgia Aquarium. As a longtime member of the Georgia Pharmacy Association and a valued contributor to the pharmacy industry as a whole, the GPhA would like to say congratulations!

Moon’s staff includes Catherine Maraman, Brooke Luke, Stacy Ring, Angel Dutton, Sonal Dass, Amanda Moore, Shea Hall, Cynthia Moon, Claire Moon, Audrey Garrison, Robbie Wilson, Gina Hall, Rhonda Lane, Savannah Driggers, Josie Tawzer, Gene Lovett, Marcy Corkern, Kelli Fowler, Floyd Moon, Kolby Lawrence and Melissa Rhodes. Not pictured are Jonathan Doss, Courtney Beasley, Stephanie Goddard, Macie Chitty and Jim Anderson.

- CPE Standing Committee

Alphabet Soup: The ABCs of the ACO By Michael Crooks, Pharm.D. and Melinda Kezer, R.Ph.

resident Obama signed the Affordable Care Act (ACA) on March 23, 2010 ushering in an array of comprehensive insurance reforms that have already been implemented or will be on January 1, 2014. The aim of the ACA is to improve the health and healthcare of Americans by reducing the number of people without insurance, strengthening primary care and preventive services, and improving the efficiency and efficacy of healthcare delivery. These are achieved through new insurance regulations, enhanced funding for quality improvement and innovation projects, increased reimbursement to primary and rural health care providers and payment incentives through structural changes in health care delivery. An Accountable Care Organization (ACO) is a network of providers and one or more hospitals that share the responsibility for providing care to a minimum of 5,000 Medicare beneficiaries for at least three years. In this transition from fee-for-service health care, providers will receive bundled payments for managing a patient’s condition instead of reimbursement for each procedure or test ordered. ACOs represent a significant change in the delivery and reimbursement of healthcare. When ACOs keep costs low, improve health outcomes and decrease readmission, they receive financial incentives from Medicare in addition to retained cost savings. Patients will not be restricted when choosing providers and may access providers within and outside of an ACO. Sources

Gina Hall helps a customer at Moon’s Pharmacy.

The Georgia Pharmacy Journal

1. http://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/ACO/index.html 2. http://www.kaiserhealthnews.org/ Stories/2011/January/13/ACO-accountable-care-organization-FAQ.aspx 3. http://www.hhs.gov/healthcare/facts/ timeline/timeline-text.html#2012

The Georgia Pharmacy Journal

Real Financial Planning. No Generics. It means having real strategies for all your financial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their families, and their practices. It means working with an independent firm you can trust. For more information view our video at www.fnaplanners.com.

Michael T. Tarrant, CFP® Speaker & Author PharmPAC Supporter Creating Real Financial Planning for over 20 Years

1117 Perimeter Center West, Suite N-307 Atlanta, GA 30338 • 770-350-2455 mike@fnaplanners.com www.fnaplanners.com Securities, certain advisory services and insurance products are offered through INVEST Financial Corporation (INVEST), member FINRA/SIPC, a federally registered Investment Adviser, and affiliated insurance agencies. INVEST is not affiliated with Financial Network Associates, Inc. Other advisory services may be offered through Financial Network Associates, Inc., a registered investment adviser.

Congratulations!

Moon’s Pharmacy

GPhA Member Moon’s Pharmacy Honored As a 2013 Georgia Family Business of the Year Finalist.

- CPE Standing Committee

Alphabet Soup: The ABCs of the ACO By Michael Crooks, Pharm.D. and Melinda Kezer, R.Ph.

Gina Hall helps a customer at Moon’s Pharmacy.

The Georgia Pharmacy Journal

Michael T. Tarrant, CFP® Speaker & Author PharmPAC Supporter Creating Real Financial Planning for over 20 Years

The National Community Pharmacy Association Elect National Leaders

SAVE PHIL THE TURKEY

Two former GPhA Presidents among elected leadership. NCPA

Board of Directors President Mark Riley, Little Rock, Ark. President-Elect John Sherrer, Marietta, Ga. Chairman Bradley Arthur, Buffalo, N.Y. DeAnn Mullins, Lynn Haven, Fla.

Phil the Turkey has been taken hostage by GPhA Executive Vice President Jim Bracewell. (Jim is on the left.)

David Smith, Indiana, Penn. Bill Osborn, Miami, Okla. Brian Caswell, Baxter Springs, Kan. Michele Belcher, Grants Pass, Ore. Immediate Past President Donnie Calhoun, Anniston, Ala.

Officers

he National Community Pharmacy Association at its annual meeting in Orlando, FL this past October elected its 2013-14 national leaders. Among their national leadership are two of the Georgia Pharmacy Association former presidents. John T. Sherrer, GPhA Former President (1988-89) from Marietta, GA

was elected to President Elect of NCPA. Hugh M. Chancy 2005-06 from Hahira, GA was elected First Vice President of NCPA. “What a compliment to the leadership of GPhA to have two former GPhA presidents serving in this national leadership capacity “said GPhA Executive Vice President Jim Bracewell.

First Vice President Hugh Chancy, Hahira, Ga. Second Vice President Jeff Carson, San Antonio, Texas

Jim is planning to release Phil during the Holiday Season if the generous members of GPhA donate at least $6,000 to the Georgia Pharmacy Foundation Annual Fund, supporting Pharmacy Student Scholarships and the New Practitioner Leadership Conference. Any GPhA member who makes a financial donation will be entered in a drawing and Phil will be delivered to the lucky winner as a Holiday Feast, or if you prefer Phil will be released back into the wild. Help SAVE Phil from his hostage situation. Give a tax deductible donation to the Georgia Pharmacy Foundation today.

Third Vice President Lea Wolsoncroft, Birmingham, Ala. Fourth Vice President Jeff Harrell, Ilwaco, Wash. Fifth Vice President Kristen Riddle, Conway, Ark.

NCPA 2013-14 First Vice President Hugh Chancy presents NCPA’s Legislative Committee report to the National Community Pharmacy Association House of Delegates.

NCPA 2013-14 President Elect John Sherrer presents NCPA’s Resolutions Committee report to the National Community Pharmacy Association House of Delegates

The Georgia Pharmacy Journal

Georgia Pharmacy Foundation

To make a donation and enter the drawing Visit www.ghpa.org Scroll down to the Foundation Logo, click on the Logo and click on Donate.

The National Community Pharmacy Association Elect National Leaders

SAVE PHIL THE TURKEY

Two former GPhA Presidents among elected leadership. NCPA

Board of Directors President Mark Riley, Little Rock, Ark. President-Elect John Sherrer, Marietta, Ga. Chairman Bradley Arthur, Buffalo, N.Y. DeAnn Mullins, Lynn Haven, Fla.

Phil the Turkey has been taken hostage by GPhA Executive Vice President Jim Bracewell. (Jim is on the left.)

David Smith, Indiana, Penn. Bill Osborn, Miami, Okla. Brian Caswell, Baxter Springs, Kan. Michele Belcher, Grants Pass, Ore. Immediate Past President Donnie Calhoun, Anniston, Ala.

Officers

First Vice President Hugh Chancy, Hahira, Ga. Second Vice President Jeff Carson, San Antonio, Texas

Third Vice President Lea Wolsoncroft, Birmingham, Ala. Fourth Vice President Jeff Harrell, Ilwaco, Wash. Fifth Vice President Kristen Riddle, Conway, Ark.

NCPA 2013-14 First Vice President Hugh Chancy presents NCPA’s Legislative Committee report to the National Community Pharmacy Association House of Delegates.

NCPA 2013-14 President Elect John Sherrer presents NCPA’s Resolutions Committee report to the National Community Pharmacy Association House of Delegates

The Georgia Pharmacy Journal

Georgia Pharmacy Foundation

To make a donation and enter the drawing Visit www.ghpa.org Scroll down to the Foundation Logo, click on the Logo and click on Donate.

Georgia Pharmacy Foundation Hosts the Southeastern Pharmacy Recovery Network Conference

Deputy Director of GA Drugs and Narcotics Dennis Troughton Sr., Pharm D. describes the issues of Abuse and Diversion of Controlled Substances in Georgia.

Merrill Norton, Pharm D.,D.Ph. , UCCDO-D of the University of Georgia explained why pharmacists have a higher risk for addiction.

GPhA former President (1991-92) Jim Bartling (foreground) and former GPhA President Sharon Sherrer (2007-08) introduce the program “Know Pain, Know Gain” competition to improve patient counseling.

he 18th Annual Southeastern Pharmacy Recovery Network Conference - hosted and sponsored in part by the Georgia Pharmacy Foundation drew attendees from eight southeastern states: Alabama, Georgia, Kentucky, Mississippi, North Carolina, Ohio, Tennessee and Virginia. Students and pharmacy practitioners gathered to learn and share information about addiction issues in the profession including how to intervene for positive outcomes from a disease that affects many members of the pharmacy profession. Former GPhA Presidents Jim Bartling (1992-93) and Richard Smith (1990-91) give generously each year of their volunteer time to coordinate this regional program for the profession. The Georgia Pharmacy Foundation wishes to express gratitude to these sponsors: Marr, Questhouse and Ridgeview Institute for their generous support of this conference.

Charles Broussard RPh, Med, FAPhA energizes the audience as he talks about “Learning from our Past Applying it to our Present and Future”.

Can you tell the team that won the competition?

Chris Jones, Pharm D, MPH Lt. Commander US Public Health reviewed the “Current Trends in Substance Use in the US” with facts and graphs that stunned the audience.

Judges for the competition include presenters Charles Broussard, Brian Fingerson and GPhA former President (1990-91) Richard Smith.

All the winners, the presenters and judges pose for a winner’s circle.

The Georgia Pharmacy Journal

Funding Your Long Term Care Once Education and Underwirting have been discussed, it is important to understand fiunding.

n past articles we have shared with you how critical it is to understand and to be educated on Long Term Care and the planning that goes along with it. Once you understand Long Term Care and what it is---and more importantly what it ISN’T, you may wish to have us determine what your potential coverage options could be as a result of our team exploring the market on your behalf. To effectively do this, we would need to gather the following medical history/ information on both you and (if applicable) your spouse: • 10 Year Medical History • 10 Year Surgical History • Prescription Medication that you have taken or are taking. Ultimately, as described earlier your

including: health and circumstances • Fund Long Term Care with a may ultimately dictate the Single Premium, or solution that we potentially • Fund Long Term Care for a implement for you and your defined period of time. spouse. How you pay can potentialOnce Education and Underwriting have been dis- Ruth Ann McGehee ly be determined after you and cussed, it is important to Manager of Insurance your spouse successfully navigate underwriting. understand funding. Services, GPHA Let us know how we might Right now if you do not have any formal plan of Long Term Care help you further with your Long Term in place, you are likely funding those Care Education and Planning for you, your spouse and your organization. costs at 100%. Please give RuthAnn McGehee a call You may wish to create a plan where this is not the case and where you poten- at 404-419-8173 to set up a no-obligation tially share the risk with an LTC insur- Long Term Care consult. We will look forward to helping you however we can ance carrier. Another component of funding is with our area of expertise or email at how you pay, as there are options for you rmcgehee@gpha.org

Funding Your Long Term Care Once Education and Underwirting have been discussed, it is important to understand funding.

GPhA Member Neal Florence Announces Run for State House Contribute to “Friends of Neal Florence” and help get out the vote on Tuesday, January 7.

eal Florence, a long time GPhA member and leader in the Association, is seeking to fi ll the seat vacated by Rep. Jay Neal, who resigned to accept the Governor’s appointment to lead the Office of Transition, Support and Re-entry, part of the Department of Corrections. Florence has served as the Mayor of Lafayette, GA for 23 years. He and his pharmacist wife Carolyn own and operate Medi-Thrift pharmacy in Lafayette. “I had no plans to seek office following my retirement from the Mayor’s office”, said Neal. “I’ve served this community for over two decades as Mayor and for over three decades as their pharmacist. I firmly believe we need a State Representative focused on serving the people and the community – someone who puts the people above their own interests. I’m not a career politician looking for my next political title, and I’ll put my record as a public servant and a successful small business owner up against anyone looking to run for this seat.” This special election will be decided on Tuesday, January 7, 2014. If you have friends in the area call and ask them to support Neal and while you may not be able to cast a ballot for Neal you can support him by sending a contribution to this important campaign, helping to put another pharmacist in the Georgia State House.

Neal’s Bio: H. Neal Florence was born in Cedartown, Georgia in 1951. Neal graduated from The McCallie School in Chattanooga, TN in 1969. In 1973 Neal earned a B.S. degree in Chemistry and in 1976 a B.S degree in Pharmacy from the University of Georgia. Worked for Rhyne Brothers Pharmacy from 1976 until 1979 when he purchased Regal Pharmacy and started Medi-Thrift Pharmacy which he operates with his wife, Carolyn, who is also a Pharmacist. The Florence’s have two sons, Dr. Mason Florence and Dr. Kevin Florence. Mason and his wife, Rachel M, have two children, Samuel and Caroline. Kevin and wife, Rachel H, have one son, Luke. They all reside in Athens, GA. Professional Afﬁliations: Member GPhA: AIP and past Chairman of Governmental Affairs Committee; Member of N.W. Georgia Pharmacy Association; Member of National Association of Community Pharmacy Civic and Community Highlights: Mayor of LaFayette since 1990; Member of Walker County Board of Health 2002; Member of Walker County Development Authority; Bank of LaFayette Board of Directors since 2003; Past President LaFayette Kiwanis Club 1987-1988; Past member of Northwest Georgia Technical College Board of Directors; Member LaFayette First Baptist Church Awards: In June 2004 Neal received the Bowl of Hygeia Award.

• Pharmacists Mutual Insurance Company • Pharmacists Life Insurance Company • Pro Advantage Services®, Inc.

let our experts

d/b/a Pharmacists Insurance Agency (in California) CA License No. 0G22035

do the math

Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment. Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.

Hutton Madden

800.247.5930 ext. 7149 404.375.7209

800.247.5930 www.phmic.com

Give the Pharmacy Profession a Holiday Gift by contributing to “Friends of Neal Florence” Mail your checks payable to: Friends of Neal Florence PO Box 791 LaFayette, GA 30728 Find us on Social Media:

The Georgia Pharmacy Journal

Not licensed to sell all products in all states.

GPhA Member Neal Florence Announces Run for State House Contribute to “Friends of Neal Florence” and help get out the vote on Tuesday, January 7.

• Pharmacists Mutual Insurance Company • Pharmacists Life Insurance Company • Pro Advantage Services®, Inc.

let our experts

d/b/a Pharmacists Insurance Agency (in California) CA License No. 0G22035

do the math

Hutton Madden

800.247.5930 ext. 7149 404.375.7209

800.247.5930 www.phmic.com

The Georgia Pharmacy Journal

Not licensed to sell all products in all states.

*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.

Thanks to All Our Supporters Diamond Level

$4,800 minimum pledge *Scott Meeks, R.Ph. *Fred Sharpe, R.Ph

Titanium Level

$2,400 minimum pledge *Ralph Balchin, R.Ph. T.M. Bridges, R.Ph. 12/14 *Ben Cravey, R.Ph. *Michael Farmer, R.Ph. *David Graves, R.Ph. *Raymond Hickman, R.Ph. Ted Hunt, R.Ph. 1/14 *Robert Ledbetter, R.Ph. *Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph. Loren Pierce, R.Ph. 12/13 *Jeff Sikes, R.Ph. *Danny Smith, R.Ph. *Dean Stone, R.Ph. *Tommy Whitworth, R.Ph.

Platinum Level

$1,200 minimum pledge Jim Bracewell 9/14 *Larry Braden, R.Ph. *William Cagle, R.Ph. *Hugh Chancy, R.Ph. *Keith Chapman, R.Ph. *Dale Coker, R.Ph. *Billy Conley, R.Ph. *Al Dixon Jr., R.Ph. *Ashley Dukes, R.Ph. *Jack Dunn Jr., R.Ph. *Neal Florence, R.Ph. 26

*Andy Freeman *Robert Hatton, Pharm.D. *Ira Katz, R.Ph. Thomas Lindsay, R.Ph. 5/14 *Eddie Madden, R.Ph. *Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D. *Kenneth McCarthy, R.Ph. *Ivey McCurdy, Pharm. D *Drew Miller, R.Ph. *Laird Miller, R.Ph. *Jay Mosley, R.Ph. *Sujal Patel, Pharm D *Mark Parris, Pharm.D. *Allen Partridge, R.Ph. Jeff Lurey, R.Ph. 4/14 *Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14 *Benjamin Stanley, Pharm.D. *Danny Toth, R.Ph. *Christopher Thurmond, Pharm.D. *Alex Tucker, Pharm.D. Lindsay Walker, R.Ph. 6/14 Henry Wilson, Pharm.D. 11/14

Gold Level

$600 minimum pledge James Bartling, Pharm.D. 6/14 *William Brewster, R.Ph. *Liza Chapman, Pharm.D. Carter Clements, Pharm. D. 12/14 *Mahlon Davidson, R.Ph. *Angela DeLay, R.Ph. *Benjamin Dupree, Sr., R.Ph *Stewart Flanagin, R.Ph. *Kevin Florence, Pharm.D.

*Kerry Griffin, R.Ph. *Michael Iteogu, R.Ph. *Joshua Kinsey, Pharm.D. *Dan Kiser, R.Ph. *Allison Layne, C.Ph.T Lance LoRusso 6/14 *Sheila Miller, Pharm.D. *Robert Moody, R.Ph. *Sherri Moody, Pharm.D. *William Moye, R.Ph. *Anthony Ray, R.Ph. *Jeffrey Richardson, R.Ph. *Andy Rogers, R.Ph. Daniel Royal Jr., R.Ph. 3/14 *Michael Tarrant *James Thomas, R.Ph. Zach Tomberlin, Pharm.D. 4/14 *Mark White, R.Ph. *Charles Wilson Jr., R.Ph.

Silver Level

$300 minimum pledge *Renee Adamson, Pharm.D. Larry Batten, R. Ph. 11/14 Lance Boles, R.Ph. 8/14 Laura Coker, Pharm D 6/14 Patrick Cook, Pharm.D. 1/14 *Ed Dozier, R.Ph. *Greg Drake, R. Ph. *Terry Dunn, R.Ph. *Marshall Frost, Pharm.D. *Amanda Gaddy, R. Ph. *Johnathan Hamrick, Pharm.D. *Willie Latch, R.Ph *Hilary Mbadugha, Pharm.D. *Kalen Manasco, Pharm.D. The Georgia Pharmacy Journal

Highlight denotes new and increased contributors.

*William McLeer, R.Ph. *Sheri Mills, C.Ph.T. Albert Nichols, R.Ph. 2/14 *Richard Noell, R.Ph. *Cynthia Piela *Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14 *Kristy Pucylowski, Pharm.D. *Edward Reynolds, R.Ph. *Ashley Rickard, Pharm D. *Brian Rickard, Pharm D. Flynn Warren, R.Ph. 6/14 Steve Wilson, Pharm.D. 7/14 *William Wolfe, R.Ph. *Sharon Zerillo, R.Ph.

*Natalie Nielsen, R.Ph. *Mark Niday, R. Ph. *Don Richie, R.Ph. *Amanda Paisley, Pharm.D. *Alex Pinkston IV, R.Ph Don Richie, R.Ph. 11/14 *Corey Rieck *Laurence Ryan, Pharm.D. *Olivia Santoso, Pharm. D. *Dana Strickland, R.Ph. G.H. Thurmond, R.Ph. 11/14 *Tommy Tolbert, R. Ph. William Turner, R.Ph 1/14 *Austin Tull, Pharm.D.

Bronze Level

No minimum pledge Claude Bates, R.Ph 6/14 Winston Brock, R.Ph. 6/14 David Carver, R.Ph. 6/14 Marshall Curtis, R.Ph. 6/14 John Drew, R.Ph. 6/14 James England, R.Ph. 6/14 Martin Grizzard, R.Ph. 6/14 Christopher Gurley, R. Ph 6/14 Marsha Kapiloff, R.Ph. 6/14 Charles Kovarik, R. Ph. 6/14 Carroll Lowery, R.Ph. 6/14 Ralph Marett, R.Ph. 6/14 Kenneth McCarthy, R.Ph. 6/14 Whitney Pickett, R.Ph. 11/14 Michael Reagan, R. Ph 6/14 Ola Reffell, R.Ph. 6/14 Leonard Reynolds, R.Ph. 6/14 Victor Serafy, R.Ph. 6/14 Terry Shaw, Pharm.D. 5/14

$150 minimum pledge Monica Ali-Warren, R.Ph. 6/14 *Shane Bentley, Student *Robert Bowles *Rabun Deckle, R. Ph. Ashley Faulk, Pharm.D. 4/14 James Fetterman, Jr., Pharm.D. 4/14 Charles Gass, R.Ph. 1/14 *Larry Harkleroad, R.Ph. Winton Harris Jr., R.Ph. 6/14 *Amy Grimsley, Pharm. D *Thomas Jeter, R.Ph. *Henry Josey, R.Ph *Brenton Lake, R.Ph. *Tracie Lunde, Pharm.D. *Michael Lewis, Pharm.D. Max Mason, R.Ph. 6/14 *Susan McLeer, R.Ph. Judson Mullican, R.Ph. 11/14 The Georgia Pharmacy Journal

Members

Harry Shurley, R.Ph 6/14 Amanda Stankiewicz, Student 6/14 Benjamin Stanley, R.Ph 6/14 Krista Stone, R.Ph 6/14 John Thomas, R.Ph. 11/14 William Thompson, R.Ph. 6/14 Carey Vaughan, Pharm.D. 6/14 Jonathon Williams R.Ph 8/14

NOTICE:

Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incorrect. afreeman@gpha.org 404-419-8118

*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.

Thanks to All Our Supporters Diamond Level

$4,800 minimum pledge *Scott Meeks, R.Ph. *Fred Sharpe, R.Ph

Titanium Level

Platinum Level

Gold Level

Silver Level

Highlight denotes new and increased contributors.

Bronze Level

Members

NOTICE:

Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incorrect. afreeman@gpha.org 404-419-8118

continuing education for pharmacists Volume XXXI, No. 10

Melanoma-Targeted Therapy: Focus on Mekinist and Tafinlar Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio Dr. Thomas A. Gossel has no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on melanoma and its treatment with targeted therapy, with focus on two new drugs, dabrafenib (Tafinlar®) and trametinib (Mekinist™). Objectives. At the completion of this activity, the participant will be able to: 1. recognize signs, symptoms, and key features of melanoma, including information on its prevalence; 2. recognize important therapeutic uses for the new drugs and projected benefits over other approved medications for melanoma; 3. select the indication(s), pharmacologic action(s), clinical application(s), and the mode and other considerations for administration of the drugs; 4. demonstrate an understanding of adverse effects and toxicity, warnings, precautions, contraindications, and significant drug-drug interactions reported for each agent; and 5. choose important patient information to convey to patients and/or their caregivers.

Introduction

Melanoma is a highly aggressive cancer and remains a major health problem worldwide. An estimated 76,690 adults, 45,060 men and 31,630 women, in the United States will be diagnosed

with melanoma in 2013. Of these, 9,480 deaths (6,280 men and 3,200 women) will be attributed to this cancer. Worldwide, 48,000 melanoma-related deaths occur each year. Although melanoma tumors account for less than 5 percent of all skin cancers, it is the most pathologic skin cancer, and is responsible for the majority of skin cancer deaths. It is the fifth most common cancer among men, and the seventh most common cancer in women. Twice as many women than men are diagnosed with melanoma before age 40; after 40, predominance shifts to men. By age 80 and older, the mortality rate in men is three times higher than in women. Melanoma mortality rates are 23 times higher in Caucasians than African-Americans. The Annual Report to the Nation on the Status of Cancer, 1975 to 2009, shows that overall cancer death rates continued to decline in the United States among persons of both genders, among all major racial and ethnic groups, and for all of the most common cancer sites including lung, colon and rectum, female breast, and prostate. The report also shows that death rates continued to increase during the latest time period (2000 through 2009) for melanoma (among men only), and for cancers of the liver, pancreas, and uterus. The increase in melanoma over the past 30 years is approximately 4 percent annually.

Melanoma

The onset of melanoma occurs

when melanocytes, the skin’s pigment-producing cells, begin to grow uncontrollably. Skin is comprised of two layers: an outer layer, epidermis, and deeper layer, the dermis. Melanocytes are found in the deeper areas of the epidermis. The cancer can invade deep into the dermis to invade lymph and blood vessels, and metastasize to other sites of the body. At the time of diagnosis, the initial treatment is determined by the thickness of the tumor, and more often, by whether the disease has metastasized to regional or distant lymph nodes or to other areas of the body. Four major types of melanoma can be categorized as follows. •Superficial spreading melanoma is usually flat and irregular in shape and color, with different shades of black and brown. It is the most common melanoma in Caucasians and the most common type overall. •Nodular melanoma usually starts as a raised area appearing dark blackish-blue or bluish-red. Some are devoid of any color. •Lentigo maligna melanoma is most common in sundamaged skin on the face, neck, and arms. The areas are usually large and flat, and tan with areas of brown. This melanoma is common in the elderly. •Acral lentiginous melanoma usually occurs on the palms, soles, or under the nails. This is the least common melanoma, occurring most often in African-Americans. Melanoma most often appears on the skin of the trunk (back and

The Georgia Pharmacy Journal

Table 1 New drugs for melanoma Generic (Proprietary) Name

Distributor

Indication

Dose*

Dosage Form

Most Common Adverse Reactions

Dabrafenib (Tafinlar)

GlaxoSmithKline

Unresectable or metastatic melanoma with BRAFV600E mutation

150 mg orally twice daily

50, 75 mg capsules

hyperkeratosis, headache, pyrexia, arthralgia, papilloma, alopecia, palmarplantar erythrodysesthesia syndrome

Yes

Trametinib (Mekinist)

GlaxoSmithKline

Unresectable or metastatic melanoma with BRAFV600E or BRAFV600K mutation

2 mg orally once daily

0.5, 1, 2 mg tablets

rash, diarrhea, lymphedema

*Recommended dose for most patients

chest) in men and legs in women, but can occur anywhere on the body. Rarely, it appears in the mouth, or in the iris or retina of the eye. Other sites of involvement include the head and neck, skin under the fingernails, soles of the feet or palms of the hands, vagina, esophagus, anus, urinary tract, and small intestine. It may develop from a pre-existing mole. The median age at diagnosis is the early 50s, but melanoma occurs with greater frequency than many other cancer types in young adults as well. Risk Factors. Some factors that favor melanoma development include: •fair skin, blue or green eyes, or red or blond hair; •sunny climates or high altitudes, •a history of one or more severe sunburns during childhood; •use of tanning devices; •close relatives with a history of melanoma; •certain types of moles (atypical or dysplastic) or multiple birthmarks; •weakened immune system due to disease or medication. Symptoms. These may include a mole, sore, lump, or growth on the skin, which can be a sign of melanoma or other skin cancer. A sore or growth that bleeds or

The Georgia Pharmacy Journal

Med Guide±

±Status at the time of publication

changes color may also be a sign of skin cancer. The “ABCDE rule” may help people remember possible symptoms of melanoma. Asymmetry: The shape of half of the abnormal area differs from the other half. Borders: The edges of the growth appear ragged, notched, blurred, or in some manner, irregular. Color: Color changes from one area to another are apparent, with shades of tan, brown, or black, and sometimes white, gray, red, or blue. A medley of colors may appear within a lesion. Diameter: The spot is usually larger than 6 mm in diameter – about the size of a pencil eraser; however, the lesion may be smaller (<5 mm) when first discovered. Evolution: The cancer keeps changing appearance, including size, shape, or color. When it develops in a pre-existing mole, the texture of the mole may change to become hard or lumpy. Prognosis. Most patients with early-detected melanoma can be cured after surgery, with a fiveyear survival rate of 91 percent. Overall survival depends upon numerous influences including thickness of the primary tumor, whether or not lymph nodes are involved, or if melanoma cells have

metastasized to distant sites. For melanoma remaining localized to the site where it originated, the five-year survival rate is 98 percent. The five-year survival rates for melanoma that has spread only to nearby lymph nodes or to distant sites in the body, are 82 percent and 15 percent, respectively. Melanoma survival statistics must always be interpreted with caution, though. The data are based on information obtained from thousands of melanoma patients in the United States each year. The actual risk for a particular individual may differ greatly because survival statistics are measured in five-year intervals, and the data may not represent recent pharmacotherapeutic advances in treatment of the particular cancer. Targeted therapy for melanoma introduced during the past couple years may greatly modify survival statistics.

Treatment

Patients with thin cutaneous melanoma usually have a good prognosis following surgical resection, but prognosis remains poor for those who present with, or develop, metastatic malignant melanoma (stage IV disease). Overall survival for melanomas averages less than 12 months. Treatment recommendations

continuing education for pharmacists Volume XXXI, No. 10

Introduction

Melanoma is a highly aggressive cancer and remains a major health problem worldwide. An estimated 76,690 adults, 45,060 men and 31,630 women, in the United States will be diagnosed

Melanoma

The onset of melanoma occurs

The Georgia Pharmacy Journal

Table 1 New drugs for melanoma Generic (Proprietary) Name

Distributor

Indication

Dose*

Dosage Form

Most Common Adverse Reactions

Dabrafenib (Tafinlar)

GlaxoSmithKline

Unresectable or metastatic melanoma with BRAFV600E mutation

150 mg orally twice daily

50, 75 mg capsules

hyperkeratosis, headache, pyrexia, arthralgia, papilloma, alopecia, palmarplantar erythrodysesthesia syndrome

Yes

Trametinib (Mekinist)

GlaxoSmithKline

Unresectable or metastatic melanoma with BRAFV600E or BRAFV600K mutation

2 mg orally once daily

0.5, 1, 2 mg tablets

rash, diarrhea, lymphedema

*Recommended dose for most patients

The Georgia Pharmacy Journal

Med Guide±

±Status at the time of publication

Treatment

for melanoma have remained nearly unchanged for the past 40 years. The mainstay of treatment for advanced melanoma has focused on the use of the chemotherapeutic drug dacarbazine (DTIC-Dome), approved for this indication in 1976, which leads to a median survival of eight to 10 months. Polychemotherapy containing cisplatin (Platinol) and dacarbazine, or combination of carboplatin (Paraplatin) and paclitaxel (Taxol), may benefit 20 to 40 percent of patients. The impact on disease-free or overall survival with chemotherapy has never been shown in randomized trials. However, these therapies do have substantial persisting toxic effects. Biochemotherapy, a combination of interleukin-2 (aldesleukin, Proleukin) and/or interferon-alpha (Intron A), along with chemotherapeutic agents such as dacarbazine, cisplatin and vinblastine (Velban), has demonstrated a high response rate although this has not translated into improved survival. Such combinations are associated with increased toxicity.

Targeted Therapy

Several key pathways and genes involved in melanoma have been recently identified, and form the basis for intensive research into the pathology of the cancer. These advances have allowed clinicians to begin to classify melanoma into specific molecular subtypes based upon the tumor’s genetic characteristics. As a result, the treatment plan may be tailored or personalized to the patient. This approach, referred to as targeted therapy, is designed to target specific genes or pathways that contribute to melanoma cell growth. A major research focus is, therefore, directed to continued development of new therapies that target specific molecular pathways and genes that are abnormal or activated in melanoma. Ongoing research has shown that approximately 50 percent of patients with melanoma have a mutated BRAF gene. A BRAF (or B-RAF) gene makes a pro-

tein kinase called BRAF, which is involved in sending signals in cells and in cell growth. This gene may be mutated in many types of cancer, including melanoma, which signals a change in the BRAF protein. In turn, this can increase the growth and spread of cancerous cells. This discovery was a major advancement in the treatment of melanoma. Targeted therapies can slow the growth of melanoma cells by inhibiting the mutated gene. The first BRAF inhibitor, sorafenib (Nexavar), had limited efficacy in melanoma, and the benefit appeared to be unrelated to the mutation status of the tumor, raising doubts in the early days about the relevance of BRAF mutation in melanoma. That doubt was to be short-lived, however. A major breakthrough in targeted therapy for melanoma was FDA’s approval of vemurafenib (Zelboraf) in August 2011. Vemurafenib is an orally-administered BRAF inhibitor specifically indicated for patients with melanoma whose tumors have the V600E mutation in their BRAF gene, referred to as BRAFV600E. The second most common BRAF mutation, V600K, along with V600E, account for 95 percent of BRAF mutations found in patients with melanomas. Since so many patients with melanoma have this type of mutation, a mutation that does not occur in normal cells, drug action directed toward the defective gene would be a logical means to achieve control. In an early clinical trial with metastatic melanoma patients whose tumors were positive for the mutated BRAFV600E gene, vemurafenib shrunk the tumors in the majority of those patients and extended their survival. Based on those findings, vemurafenib was approved for standard use in patients with locally advanced Stage III melanoma that cannot be excised by surgery, or for patients with Stage IV melanoma, provided their melanoma has the mutated BRAFV600E gene. The results of that early clinical trial stimulated further research into other compounds

shown to possess anti-BRAFV600E activity. These drugs are emerging as standard of care in patients with metastatic melanoma carrying the noted oncogenic mutation.

at these sites, or to the direct effect of the UV carcinogen on specific alterations in the commonly mutated BRAF genes.

The New Drugs

Indication and Use. Tafinlar (TAFF-in-lar) is a potent kinase inhibitor of mutated BRAF, indicated for treatment of patients with unresectable or metastatic melanoma with BRAFV600E mutation as detected by an FDA-approved test. It is not indicated for treatment of patients with wild-type BRAF melanoma. Wild-type is the term used for the typical form of a gene as it was first observed in nature or in the wild. It means that the gene is normal, without detectable mutation. Dabrafenib has a response rate and progression-free survival rate similar to that of vemurafenib, but shows a moderately improved toxicity profile. Dabrafenib has good activity in patients with brain metastases, which are common in advanced melanoma, and associated with a poor prognosis and greatly impaired quality of life. Dabrafenib was studied in 250 patients (60 percent male) with a BRAFV600E gene mutationpositive metastatic or unresectable melanoma. Patients were randomly assigned to receive dabrafenib or the chemotherapeutic drug, dacarbazine. Those who received dabrafenib experienced a delay in tumor growth that was 2.4 months later than those receiving dacarbazine. Mechanism of Action. Dabrafenib is an inhibitor of some mutated forms of BRAF kinases. As stated earlier, some mutations in the BRAF gene, including those that result in BRAFV600E mutation, can result in constitutively activated BRAF kinases that may stimulate tumor cell growth. Safety. The most common adverse reactions (≥20 percent) noted in clinical trials included thickening of the skin (hyperkeratosis), headache, fever, joint pain, noncancerous skin tumors, alopecia, and palmar-plantar erythrodysesthesia syndrome (persistent tingling in

In late-May, 2013, FDA approved two additional drugs, Tafinlar and Mekinist (Table 1), for patients with advanced (metastatic) or unresectable (cannot be removed by surgery) melanoma. Both drugs were approved for use with provision that the mutated gene is present, identified with the THxID™ BRAF kit, a companion diagnostic that confirms if a patient’s melanoma cells contain the defective V600E or V600K mutation. Information on the FDA-approved test for detection of BRAF mutations in melanoma may be accessed at www.fda.gov/CompanionDiagnostics. UV Influence. The anatomic site of primary melanoma is associated with distinct features in the melanoma genome that relate to the amount of ultraviolet (UV) radiation exposure at the anatomic location. For example, melanomas arising on mucosal surfaces of the upper respiratory tract or anogenital regions that are not exposed directly to UV radiation are associated with low rates of BRAF mutations, pegged at 3 to 14 percent. In contrast, melanomas on the trunk that are associated with intermittent UV radiation exposure have the opposite pattern of mutation, with approximately 70 percent having the mutated BRAF gene. Melanomas arising in anatomic locations on the head and neck that are exposed to chronic UV light exposure also show the high rate of BRAFV600E mutations. Therefore, the histologic classification of melanomas according to site of origin – cutaneous nonacral, cutaneous acral, and mucosal melanomas – predicts the frequency of mutations that are benefitted by the new targeted therapies. What remains less clear is whether this benefit is secondary to inherent biologic differences in melanocytes

The Georgia Pharmacy Journal

Dabrafenib (Tafinlar)

The Georgia Pharmacy Journal

the palms and soles that may progress to severe pain and discomfort). The most serious adverse effects reported in patients receiving dabrafenib included an increased risk of skin cancer (cutaneous squamous cell carcinoma), fevers that may be complicated by hypotension, severe rigors (shaking chills), dehydration, kidney failure, and hyperglycemia requiring changes in diabetes medication or the need to start medication to control diabetes. Warnings, Precautions and Contraindications. The following warnings and precautions are listed: •New primary cutaneous malignancies including squamous cell carcinoma, keratoacanthoma, and melanoma: perform dermatologic evaluations prior to initiation of therapy, every two months while on therapy, and for up to six months following discontinuation of Tafinlar. In one trial, the incidence of new primary malignant melanomas was 2 percent for patients treated with dabrafenib, with no new cases following treatment with chemotherapy. •Tumor promotion in BRAF wild-type melanoma: increased cell proliferation can occur with BRAF inhibitors. This is a paradoxical activation of kinase signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAFV600E mutation status prior to initiation of Tafinlar. •Serious febrile drug reactions: these are defined as serious cases of fever, or fever of any severity accompanied by hypotension, rigors or chills, dehydration, or renal failure in the absence of another identifiable cause. Withhold Tafinlar for fever ≥101.3oF, or if complicated fever occurs. •Hyperglycemia: monitor serum glucose levels in patients with pre-existing diabetes or hyperglycemia. •Uveitis and iritis: monitor patients routinely for visual symptoms.

•Glucose-6-phosphate dehydrogenase (G6PD) deficiency: Tafinlar contains a sulfonamide moiety, which confers a potential risk for hemolytic anemia in patients with G6PD deficiency. Closely monitor for hemolytic anemia. •Embryofetal toxicity: can cause fetal harm. Advise females of childbearing age that Tafinlar may render hormonal contraceptives less effective, and an alternative method of contraception should be used during treatment, and for four weeks after. There are no contraindications listed. Drug Interactions. Potential drug interactions include: •Concurrent administration of strong inhibitors (e.g., ketoconazole, nefazodone, clarithromycin, gemfibrozil) of CYP3A4 or CYP2C8 is not recommended. •Concurrent administration of strong inducers (e.g., rifampin, phenytoin, carbamazepine, phenobarbital, St John’s Wort) of CYP3A4 or CYP2C8 is not recommended. •Drugs that increase gastric pH (e.g., proton pump inhibitors, H2-receptor antagonists, antacids) may alter the solubility of dabrafenib, and reduce its bioavailability, thus decreasing dabrafenib concentrations. •Concomitant use with agents that are sensitive substrates of CYP3A4, CYP2C8, CYP2C9, CYP2C19, or CYP2B6 (e.g., warfarin, dexamethasone, or hormonal contraceptives) may result in loss of efficacy of these agents. Administration and Dosing. Before initiating therapy, the presence of BRAFV600E mutation in tumor specimens must be confirmed. The recommended dose is 150 mg orally twice daily, until disease progression or unacceptable toxicity occurs. Doses should be taken approximately 12 hours apart, at least one hour before or two hours after a meal. A missed dose can be taken up to six hours prior to the next dose. Tafinlar capsules should not be opened or crushed, and should be stored at 25oC (77oF),

Targeted Therapy

shown to possess anti-BRAFV600E activity. These drugs are emerging as standard of care in patients with metastatic melanoma carrying the noted oncogenic mutation.

at these sites, or to the direct effect of the UV carcinogen on specific alterations in the commonly mutated BRAF genes.

The New Drugs

The Georgia Pharmacy Journal

Dabrafenib (Tafinlar)

The Georgia Pharmacy Journal

Table 2 Patient counseling information for Tafinlar Inform patients: •to read the Medication Guide before starting Tafinlar, and to reread it each time the prescription is filled; •that this medication increases the risk of developing new skin malignancies. Advise them to contact their doctor right away if any new lesions or changes in existing lesions on their skin; •Tafinlar causes fever, including serious febrile drug reactions. Instruct patients to contact their doctor if they experience a fever while taking this drug; •Tafinlar can impair glucose control in diabetic patients resulting in the need to increase intensive hypoglycemic treatment. Advise patients to contact their doctor to report symptoms of severe hyperglycemia; •Tafinlar may cause a certain type of anemia in patients with glucose6-phosphate dehydrogenase (G6PD) deficiency. Advise patients with known G6PD deficiency to contact their doctor to report signs or symptoms of anemia or hemolysis; •women of child bearing age that the use of Tafinlar during pregnancy has not been studied in humans. Tafinlar should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Patients should report pregnancies to their doctor as soon as possible; •that nursing mothers should talk to their doctor about the best way to feed the infant, weighing the risks and benefits of the drug to the mother; •that female patients should use highly effective non-hormonal contraception during treatment and for four weeks after treatment; •males are at increased risk for infertility due to drug-induced impaired spermatogenesis; •to take the drug exactly as their doctor and pharmacist recommend, at least one hour before or two hours after a meal.

with excursions permitted to 15o to 30oC (59o to 86oF). Tafinlar capsules contain 50 mg or 75 mg dabrafenib. Patient Counseling Information. An FDA-approved Medi-

cation Guide must be dispensed with each prescription and refill for Tafinlar and patients should be urged to read it carefully. Specific points for counseling are summarized in Table 2.

Trametinib (Mekinist)

Indication and Usage. Mekinist (MEK-in-ist) is a kinase inhibitor indicated for the treatment of unresectable or metastatic melanoma with BRAF V600E or V600K mutations as detected by an FDA-approved test. Mekinist is not indicated for treatment of patients who have received prior BRAFinhibitor therapy. Mekinist was studied in 322 patients with metastatic or unresectable melanoma with the V600E or V600K gene mutation. Patients were randomly assigned to receive either Mekinist or chemotherapy. Those who received Mekinist had a delay in tumor growth that was 3.3 months later than those on chemotherapy. Patients who previously used Tafinlar or other inhibitors of BRAF did not appear to benefit from Mekinist, and were ineligible for the trial. Mechanism of Action. Trametinib is a potent, but reversible, inhibitor of mitogen-activated extracellular signal regulated kinase 1 (MEK1), and MEK2 activation and of MEK1 and MEK2 kinase activity. Thus, its mechanism of action differs from that of dabrafenib. MEK proteins are upstream regulators of the extracellular signal-related kinase (ERK) pathway, which promotes cellular proliferation. BRAFV600E mutations result in constitutive activation of the BRAF pathway which includes MEK1 and MEK2. Trametinib inhibits BRAFV600 mutation-positive melanoma cell growth in vitro and in vivo. Safety. The most common adverse reactions (≥20 percent) for trametinib shown in clinical trials include rash, diarrhea, and lymphedema. Serious adverse reactions included cardiomyopathy, retinal pigment epithelial detachment, retinal vein occlusion, interstitial

lung disease, and serious skin toxicity that resembled severe acne. The most serious adverse reactions included heart failure, lung inflammation, skin infections, and loss of vision. Warnings, Precautions and Contraindications. The following warnings and precautions are listed: •Cardiomyopathy defined as cardiac failure, left ventricular dysfunction, or decreased left ventricular ejection fraction (LVEF): re-assess LVEF after one month of treatment, and evaluate approximately every two to three months thereafter. •Retinal pigment epithelial detachment (RPED), often bilateral and multifocal, occurring in the macular region of the retina: perform ophthalmologic evaluation for any visual disturbances. Withhold Mekinist if RPED is diagnosed, and discontinue if no improvement is noted after three weeks. •Retinal vein occlusion (RVO) that may lead to macular edema, decreased visual function, neovascularization, and glaucoma: discontinue drug and provide immediate treatment. •Interstitial lung disease (ILD): withhold drug for new, progressive, or unexplained pulmonary symptoms or findings, such as cough, dyspnea, hypoxia, or infiltrate. Permanently discontinue drug for treatment-related ILD or pneumonitis. •Serious skin toxicity including rash, dermatitis, acneiform rash, palmar-plantar erythrodysesthesia syndrome, and erythema: monitor for skin toxicities and for secondary infection. Discontinue for intolerable Grade 2; or Grade 3 or 4 rash not improving within three weeks despite interruption of Mekinist therapy. •Embryofetal toxicity: can cause fetal harm: advise females of childbearing age of the risk to the fetus, and to use highly effective contraception during treatment with Mekinist and for four months after treatment.

The Georgia Pharmacy Journal

Table 3 Patient counseling information for Mekinist Inform patients: •that this medication can cause heart problems, and to immediately report any signs or symptoms of heart failure to their doctor; •that this medicine causes severe visual disturbances that can lead to blindness. Tell patients to contact their doctor if they experience any changes in their vision; •that Mekinist can cause lung disease. Advise patients to contact their doctor as soon as possible if they experience shortness of breath; •that Mekinist often causes skin toxicities including severe rash. Advise them to contact their doctor for progressive or intolerable rash; •that Mekinist can raise blood pressure. Advise them to monitor their blood pressure and contact their doctor if they develop symptoms of hypertension; •that the drug causes diarrhea that can be severe. Inform patients of the need to contact their doctor if severe diarrhea occurs during treatment; •to take the tablets at least one hour before or two hours after a meal; •women of child bearing age that the use of Mekinist during pregnancy has not been studied in humans. The drug should be used during pregnancy only after weighing potential benefit/risks. Patients should report pregnancies to their doctor as soon as possible; •that nursing infants may experience serious adverse reactions if the mother is taking Mekinist. Discontinue nursing while taking the drug; •that female patients should use highly effective contraception during treatment and for four months after treatment; •to take the drug exactly as their doctor and pharmacist recommend.

There are no contraindications listed. Drug Interactions. No formal clinical trials have been conducted to evaluate human cytochrome P450 enzyme-mediated drug interactions. Administration and Dosing. The recommended dose is 2 mg orally once daily until disease pro-

The Georgia Pharmacy Journal

gression or unacceptable toxicity. Patients should take the medication at least one hour before or two hours after a meal, and should not take a missed dose within 12 hours of the next dose. Tablets should be stored at 2o to 8oC (36o to 46oF); protected from freezing, moisture, and light; and dispensed in their original bottles. The desiccant should not be removed and the tablets should not be placed in pill boxes or envelopes. Mekinist tablets contain 0.5 mg, 1 mg, or 2 mg of trametinib. Patient Counseling Information. Specific points for counseling are summarized in Table 3.

Drug Combinations

One study suggests that the combination of two targeted drugs, dabrafenib and trametinib, may delay progression of advanced melanoma longer than dabrafenib alone. This defends the notion that a combination of targeted drugs for melanoma is more effective and less toxic than a single targeted drug. As noted previously, dabrafenib and trametinib target different components of a cell signaling pathway that has been altered in melanoma by the BRAFV600E mutation. Single drugs that block BRAF activity shrink melanoma, but the tumors inevitably develop resistance that nullifies further drug action. Researchers hoped that adding a second drug with a different target would slow development of resistance along with disease progression. Initially, researchers enrolled 85 patients in a randomized phase II trial to determine the combination’s safety and the doses to be employed. The researchers then randomly assigned 162 patients to one of three treatment groups: dabrafenib alone, dabrafenib plus a low dose of trametinib, or dabrafenib plus a higher dose of trametinib. Patients whose cancer progressed with dabrafenib alone were permitted to add the higher dose of trametinib to their treatment regimen. The patients who received the

higher dose of trametinib along with dabrafenib had a median progression-free survival of 9.4 months, compared with 5.8 months for those receiving dabrafenib alone. After one year of follow-up, 41 percent of the group receiving the higher-dose of trametinib plus dabrafenib showed no disease progression, compared with 9 percent of those who received dabrafenib alone. Overall, 79 percent of patients in the higher-dose combination group were alive after one year. The researchers commented that they had never previously encountered a 12-month survival of that extent in metastatic melanoma. Moreover, cutaneous toxicities seen with the individual drugs were significantly reduced when the drugs were combined. Adverse effects differed between the treatment groups, and patients in all arms of the trial frequently required temporary or permanent dose reductions. More patients receiving dabrafenib alone (19 percent) developed a secondary squamous-cell skin cancer than patients receiving the higher-dose combination (7 percent), although this difference was not statistically significant. Most patients in the higher-dose combination group (71 percent) experienced fever, compared with a minority of those receiving dabrafenib alone (26 percent).

Good Advice Concerning Melanoma

The American Cancer Society recommends professional skin examinations every year for persons over 40 years of age, and every three years for individuals ages 20 to 40 years. Other actions to reduce the incidence of melanoma are shown in Table 4. An excellent, easy-to-read article entitled Melanoma can be recommended to patients to aid their understanding of the cancer. It includes extensive information on prevention, staging, and treatment, and is available at www.cancer.net/ print/19251. The article will also

with excursions permitted to 15o to 30oC (59o to 86oF). Tafinlar capsules contain 50 mg or 75 mg dabrafenib. Patient Counseling Information. An FDA-approved Medi-

cation Guide must be dispensed with each prescription and refill for Tafinlar and patients should be urged to read it carefully. Specific points for counseling are summarized in Table 2.

Trametinib (Mekinist)

The Georgia Pharmacy Journal

Drug Combinations

Good Advice Concerning Melanoma

Table 4 Skin cancer prevention advice •Examine the skin once a month. Call your doctor if you notice any changes. •Reduce exposure to sunlight. UV radiation is most intense between 10 a.m. and 4 p.m. Protect the skin by wearing wide-brimmed hats, closelyknit long-sleeved shirts, and long skirts or pants. •Apply a high-quality sunscreen with sun protection factor (SPF) ratings of at least 15, even when going outdoors for only a short time. •Apply a large amount of sunscreen on all exposed areas, including ears, nose, and feet. •Look for sunscreens that block both UVA and UVB radiation. •Use a waterproof formula. •Apply sunscreen at least 30 minutes before going outside and reapply it frequently, especially after swimming. •Use sunscreen in winter and on cloudy days. •Wear sunglasses to protect the skin around the eyes. •Avoid surfaces that reflect light, such as water, sand, concrete, and white-painted areas. •Be aware that the dangers are greater closer to the start of summer. •Be aware that skin burns faster at higher altitudes. •Avoid sunlamps, tanning beds, and tanning salons. •Children should be protected from the sun because severe sunburns in childhood may greatly increase the risk of melanoma in later life. •Have any new or unusual lesions or a progressive change in a lesion’s appearance (size, shape, or color, etc.) evaluated promptly by a physician.

ate new and exciting pathways for treating melanomas.

The author, the Ohio Pharmacists Foundation and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the information contained herein. Bibliography for additional reading and inquiry is available upon request.

Melanoma-Targeted Therapy: Focus on Mekinist and Tafinlar

Address_____________________________________________

This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.

2. The median age at diagnosis of melanoma is: a. early 40s. c. early 50s. b. late 40s. d. late 50s.

Program 0129-0000-13-010-H01-P Release date: 10-15-13 Expiration date: 10-15-16

CE Hours: 1.5 (0.15 CEU)

3. Before the advent of targeted therapy for melanoma, the mainstay of treatment was: a. dacarbazine. c. interleukin-2. b. paclitaxel. d. interferon-alpha.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

4. The second most common BRAF mutation is: a. V600B. c. V600E. b. V600K. d. V600M. 5. A major breakthrough in targeted therapy for melanoma was: a. Intron A. c. Proleukin. b. Platinol. d. Zelboraf. 6. A potential drug-drug interaction is reported with Tafinlar and all of the following EXCEPT: a. strong CYP inhibitors. b. strong CYP inducers. c. proton pump inhibitors. d. highly protein-bound drugs. 7. Tafinlar doses should be withheld with fever of: c. 100.9oF. a. 99.5oF. b. 100.2oF. d. 101.3oF.

Completely fill in the lettered box corresponding to your answer. 1. 2. 3. 4. 5.

[a] [a] [a] [a] [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] 6. [a] [d] 7. [a] [d] 8. [a] [d] 9. [a] [d] 10. [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] [d] [d] [d] [d]

11. [a] 12. [a] 13. [a] 14. [a] 15. [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] [d] [d] [d] [d]

 I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

Overview and Summary

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor) 2. Did it meet each of its objectives?  yes  no If no, list any unmet_______________________________ 3. Was the content balanced and without commercial bias?  yes  no 4. Did the program meet your educational/practice needs?  yes  no 5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

Melanoma is a highly aggressive malignant tumor with the potential to metastasize from a relatively small primary tumor. Prevention and early detection of primary melanomas are vital to the treatment of this cancer. These two new drugs provide targeted therapies that cre-

The Georgia Pharmacy Journal

Program 0129-0000-13-010-H01-P 0.15 CEU

Name________________________________________________

City, State, Zip______________________________________

1. All of the following are true about melanoma EXCEPT: a. mortality rates are higher in Caucasians than AfricanAmericans. b. by age 80, the mortality rate is three times higher in men than in women. c. it is the most common skin cancer. d. acral lentiginous melanoma is the least common type.

aid pharmacists in their review of the cancer and understanding of melanoma.

continuing education quiz

Please print.

Email_______________________________________________ NABP e-Profile ID*__________________________________ *Obtain NABP e-Profile number at www.MyCPEmonitor.net.

Birthdate____________

(MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990

8. All of the following are true about dabrafenib EXCEPT: a. good activity in patients with brain metastases. b. same mechanism of action as trametinib. c. a common adverse reaction is hyperkeratosis. d. no contraindications are noted. 9. If a dose of Tafinlar is missed, it may be taken up to how many hours prior to the next scheduled dose? a. One c. Four b. Two d. Six 10. One of the most serious adverse reactions reported with Mekinist is: a. hyperglycemia. c. lung inflammation. b. kidney failure. d. severe rigors. 11. Which of the following drugs is/are not approved for treatment of patients who have received prior BRAF-inhibitor therapy? a. Dabrafenib c. Both dabrafenib and trametinib b. Trametinib d. Neither dabrafenib nor trametinib 12. Which of the following drugs is/are approved for use only if the mutated BRAF gene is present? a. Mekinist c. Both Mekinist and Tafinlar b. Tafinlar d. Neither Mekinist nor Tafinlar 13. Which of the following drugs place males at increased risk for infertility due to impaired spermatogenesis? a. Mekinist c. Both Mekinist and Tafinlar b. Tafinlar d. Neither Mekinist nor Tafinlar 14. Patients should be counseled that which of the following drugs may cause severe visual disturbance that can lead to blindness? a. Mekinist c. Both Mekinist and Tafinlar b. Tafinlar d. Neither Mekinist nor Tafinlar 15. To help prevent skin cancer, all of the following are true EXCEPT: a. use sunscreen with an SPF rating of at least 50. b. apply sunscreen at least 30 minutes before going outside. c. sun toxicity potential is greater closer to early summer. d. severe sunburn in childhood increases the risk of melanoma in later life. To receive CE credit, your quiz must be received no later than October 15, 2016. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to opa@ohiopharmacists.org.

october 2013

ate new and exciting pathways for treating melanomas.

Melanoma-Targeted Therapy: Focus on Mekinist and Tafinlar

Address_____________________________________________

This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.

2. The median age at diagnosis of melanoma is: a. early 40s. c. early 50s. b. late 40s. d. late 50s.

Program 0129-0000-13-010-H01-P Release date: 10-15-13 Expiration date: 10-15-16

CE Hours: 1.5 (0.15 CEU)

3. Before the advent of targeted therapy for melanoma, the mainstay of treatment was: a. dacarbazine. c. interleukin-2. b. paclitaxel. d. interferon-alpha.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Completely fill in the lettered box corresponding to your answer. 1. 2. 3. 4. 5.

[a] [a] [a] [a] [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] 6. [a] [d] 7. [a] [d] 8. [a] [d] 9. [a] [d] 10. [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] [d] [d] [d] [d]

11. [a] 12. [a] 13. [a] 14. [a] 15. [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] [d] [d] [d] [d]

 I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

Overview and Summary

The Georgia Pharmacy Journal

Program 0129-0000-13-010-H01-P 0.15 CEU

Name________________________________________________

City, State, Zip______________________________________

aid pharmacists in their review of the cancer and understanding of melanoma.

continuing education quiz

Please print.

Email_______________________________________________ NABP e-Profile ID*__________________________________ *Obtain NABP e-Profile number at www.MyCPEmonitor.net.

Birthdate____________

(MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990

october 2013

Georgia Pharmacy Association

2013-2014 BOARD OF DIRECTORS Name

Position

Robert M. Hatton Pamala S. Marquess Robert B. Moody Thomas H. Whitworth Lance P. Boles Liza Chapman Terry Forshee David Graves Joshua D. Kinsey Eddie Madden Laird Miller Chris Thurmond Krista Stone Ed S. Dozier Renee D. Adamson Nicholas O. Bland Shelby Biagi Sherri S. Moody Tyler Mayotte Michael Lewis Amanda Westbrooks Flynn Warren Kalen Manasco Ken Von Eiland Ted Hunt Sharon B. Zerillo John Drew Drew Miller Michelle Hunt Leah Stowers John T. Sherrer Michael E. Farmer Al McConnell Megan Freeman Amy C. Grimsley Rusty Fetterman Lindsey Welch Tyler Bryant Tiffany Galloway Jessica Kupstas Jim Bracewell

Chair of the Board President President-Elect First Vice President Second Vice President State At Large State At Large State At Large State At Large State At Large State At Large State At Large 1st Region President 2nd Region President 3rd Region President 4th Region President 5th Region President 6th Region President 7th Region President 8th Region President 9th Region President 10th Region President 11th Region President 12th Region President ACP Chair AEP Chair AHP Chair AIP Chair APT Chair ASA Chair Foundation Chair Insurance Trust Chair Board of Pharmacy Chair GSHP President Mercer Faculty Representative South Faculty Representative UGA Faculty Representative ASP, Mercer University ASP, South University ASP, UGA Executive Vice President

Keeping Independents Independent Dear Jeff, Jennie and I want to thank you for your recent intervention to help us retire and to

Melvin M. Goldstein, P.C.

keep our pharmacy independent. When we made our decision to sell Warwick

AT T O R N E___ Y AT L AW

Drugs, you were our first contact. You

248 Roswell Street Marietta, Georgia 30060

Is it time to sell your pharmacy?

Telephone 770/427-7004 Fax 770/426-9584 www.melvinmgoldstein.com

Do you want to own your own pharmacy or buy another pharmacy?

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency n Former Administrative Law Judge for the Office of State Administrative Hearings

acted quickly and professionally to find a buyer in 5 days! We joined AIP at its inception. We have participated in its programs, utilized the extensive information network and treasured our relationships with exceptional people, like you. We wish the best for all of you and the role you all play in our healthcare future. If we can ever be of assistance, please call on us. Thanks again; our best regards to all. Sincerely yours, Cliff Hilliard, RPH, PHD

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 jlurey@gpha.org

Georgia Pharmacy Association

2013-2014 BOARD OF DIRECTORS Name

Position

Keeping Independents Independent Dear Jeff, Jennie and I want to thank you for your recent intervention to help us retire and to

Melvin M. Goldstein, P.C.

keep our pharmacy independent. When we made our decision to sell Warwick

AT T O R N E___ Y AT L AW

Drugs, you were our first contact. You

248 Roswell Street Marietta, Georgia 30060

Is it time to sell your pharmacy?

Telephone 770/427-7004 Fax 770/426-9584 www.melvinmgoldstein.com

Do you want to own your own pharmacy or buy another pharmacy?

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 jlurey@gpha.org

Georgia Pharmacy Association

50 Lenox Point NE Atlanta, GA 30324

It’s more than just investing. We’re pleased to partner with GPhA to bring our comprehensive services to members as the endorsed wealth management provider for the association. Through the UBS/Georgia Pharmacy relationship, GPhA members have exclusive access to financial services resources through the Wile Consulting Group. This group relationship enables members to leverage the vast scale of products and services at UBS. We distinguish ourselves with a robust service model, comprehensive benefits, diligent research, quality performance and competitive pricing.

Member benefits include – Complimentary financial planning (a $5k–$10k value)

Please contact us today to start exploring your options.

– Brand new 401(k) retirement savings plan designed exclusively for GPhA members at a group discount rate

Harris Gignilliat, CRPS® Vice President–Wealth Management 3455 Peachtree Road NE, Suite 1700 Atlanta, GA 30326 404-760-3301 harris.gignilliat@ubs.com

– Advisory and investment program offered at group discount rate – Retirement planning guidance, including a retirement income replacement system – Lending capabilities with competitive interest rates – Free access to UBS global investment research

Visit us online: ubs.com/team/wile

Ed Wile named to Barron’s Top 1,000 Financial Advisors for 2013 and the Wile Consulting Group named one of the top 100 Retirement Plan Advisors for 2013 by Planadvisor.

Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®. Neither UBS Financial Services Inc. nor any of its employees provides legal or tax advice. You should consult with your personal legal or tax advisor regarding your personal circumstances. As a firm providing wealth management services to clients, we offer both investment advisory and brokerage services. These services are separate and distinct, differ in material ways and are governed by different laws and separate contracts. For more information on the distinctions between our brokerage and investment advisory services, please speak with your Financial Advisor, the Wile Consulting Group, or visit our website at ubs.com/workingwithus. Financial Planning services are provided in our capacity as a registered investment adviser. As a firm providing wealth management services to clients in the U.S., we offer both investment advisory and brokerage services. These services are separate and distinct, differ in material ways and are governed by different laws and separate contracts. ©UBS 2013. All rights reserved. UBS Financial Services Inc. is a subsidiary of UBS AG. Member SIPC. 7.00_8.5x8_AX0313_WilE 0313150 exp3/22/15