The Official Publication of the Georgia Pharmacy Association
Volume 30, Number 12
December 2008
www.gpha.org
NEW PLANS – BETTER RATES – MORE BENEFITS in 2009 Are your individual or group rates increasing? Is your network of providers shrinking? Are your COBRA benefits ending? Do you need a quote?
OPEN ENROLLMENT CONTINUES THRU DECEMBR 19, 2008
Call or e-mail TODAY to schedule a time to discuss your health insurance needs and see if The Insurance Trust can bring you back in 2009!
CALL Trevor Miller – Director of Insurance Services 404.419.8107 or e-mail at tmiller@gpha.org
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December 2008
Departments
16
Save the Date
February 18, 2009 Very Involved Pharmacist Day May 12, 2009 Eggs and Issues Breakfast
FEATURE
18 22 24
ARTICLES
10 10 25 30
New Members PharmPAC Contribution Form Journal CE GPhA Board of Directors
2 2 8 10 13 24 31 32
The Insurance Trust Meadowbrook® Insurance Group Pharmacists Mutual Companies Michael T. Tarrant Middle Georgia Relief Services Toliver & Gainer PACE Alliance The Insurance Trust
Advertisers
Pharmacists in the Legislature Pharmacy Schools’ News Pharmacy Profile In Leadership
COLUMNS
4 6
President’s Message Editorial
For an up-to-date calendar of events, log onto
www.gpha.org. The Georgia Pharmacy Journal
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December 2008
PRESIDENTʼS
MESSAGE
Robert Bowles President
Our Door to the Future – Gratitude
Panama and a Panamanian registered nurse served as translators for us. During our flight from Atlanta to Panama, one of our team members had a tooth break off. When we arrived in Colon, the hotel clerk made arrangements for her to go to a dentist’s office that was only a block away. The patient’s husband, a missionary in Panama, the dentist on our team, and the patient walked to the dentist’s office. Fortunately, the Panamanian dentist wanted our dentist to repair the tooth so that he could see how the procedure was done in the United States. When they completed the procedure, they started to walk back to the hotel. The Panamanian dentist quickly stopped them and told them he would have them escorted back to the hotel because it would be
As we have recently observed Thanksgiving, I hope that each of us has taken time to express our gratitude for the many blessings that we enjoy. On November 7 I went on a medical mission trip to Colon, Panama, with 20 other individuals. Certainly as one would expect, this was an incredible opportunity to witness first-hand the conditions and lifestyles of the people in Colon. I had been on a medical mission trip to Honduras in 1987 and was aware of the things that I would probably see. During this time, I had the privilege of supervising the dispensing of medication to those who were seen by one of our physicians. Those on the pharmacy team included a 69-year-old retired gentleman and two high school students. A missionary serving in
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December 2008
Our last day, we were able to spend time at the Panama Canal. It was an incredible opportunity to witness freighters and cruise ships passing through the Panama Canal. This provides a savings of approximately three weeks on delivery of shipments originating in some countries. I have spent a lot of time reflecting on my time in Panama. I have been reminded of how much we take for granted in the United States. We, as U.S. citizens, enjoy a healthcare system that allows us to receive care that is needed for so many diseases. Most of us do not experience poverty, malnutrition and preventable disease like some areas of Panama. We as pharmacists very often become frustrated with the delivery of pharmaceuticals and the endless measures that we often must attend to in order to take care of our patients. Even with these frustrations, we have been blessed beyond what we deserve. I hope that each of us will take time to spend with our families this holiday season and show appreciation for all of our blessings. Again, I hope that we will never take lightly the privileges that we enjoy by living in the United States. If we have not expressed gratitude for all of this, I would encourage each of us to make a gratitude list. It will truly help us put things in the proper perspective. Gratitude is an important part of living the American Dream and will play an important role as we deal with the issues that lie before us.
unsafe for them to walk back. This was our first experience with the extreme safety measures that we would need to have in place. Our clinics were held in two different locations in Colon. Our clinics were open from 9 a.m. until 4 p.m. on Monday through Wednesday. On Thursday, the clinic was open from 9 a.m. until 1 p.m. The first two days the clinic was held in downtown Colon. On each of these days we dispensed approximately 225 prescriptions each day. We set the clinic up in a church building that was clean and neat. Most of the patients had exposure to the Department of Health Ministry for basic care; therefore, the needs were not as great as we would experience in the next area of Colon where we would set up a clinic. Later on, we found out that there were two gangs that were operating within a short distance of the church. On Wednesday, we moved the clinic to an area of Colon that was much different. In this area, we witnessed more malnutrition, the need for more anthelminics and the usual hypertension, diabetes, and arthritis medications. On the third day of our clinic, we dispensed 534 prescriptions and on the 4th day which was only a half day, we dispensed 418 prescriptions. We were warned that security was even more critical as we went into the village that was about 10 miles from Colon. In fact, the first day that we were there, someone broke into a school building and shots were fired. Soon we noticed two armed guards outside of our clinic.
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December 2008
EXECUTIVE
VICE
PRESIDENTʼS
EDITORIAL
Jim Bracewell Executive Vice President / CEO
A Holiday Gift For You! Finding the right gift for a friend or family member is a major challenge today, so much so that a whole business and industry of Gift Cards has come into being. The idea is that the receiver of the gift card can use the money associated with the card to purchase a gift of their own choosing. As your Executive Vice President I would like to give you a gift to express my appreciation for the opportunity to serve this profession so I would like to give you a gift like a gift card that would allow you to choose something that would mean the most to you. To select your gift you will need to go to www.gpha.org, the official website of the Georgia Pharmacy Association. The Georgia Pharmacy Journal
6
What are some of the selections at www.gpha.org ? 1. A direct link to all members of the GPhA Board of Directors and their emails. 2. A direct link to the Georgia Board of Pharmacy and national pharmacy associations. 3. The Georgia Pharmacy Journal Online. Your association’s website is your 411 of information for the profession of pharmacy in Georgia and it is a gift of knowledge for you. I hope you will make it your home page or at least save as one of your favorites. Merry Christmas and Happy New Year and if you have read this far go to the GPhA website and check out these fours items in this order. December 2008
1) Georgia Pharmacy Journal Online Edition 2) Continuing Education Articles 3) GPhA Convention Page and 4) Pharmacy Legislative Day. On each page there will be a number and on the next page the next number and these four numbers in the order in which they are listed will be the last four digits of a Georgia pharmacist’s license belonging to a GPhA member. This
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pharmacist wins a free registration to the GPhA Annual Convention and two round trip tickets on Delta Airlines to anywhere in the continental United States. If you are the holder of the Georgia pharmacist’s license listed on the GPhA website email me immediately at jbracewell@gpha.org to redeem your prize. Look for the winner’s name at the end of this article next month.
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December 2008
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December 2008
AIP Spring Meeting April 25-26, 2009
Sea Palms Resort, St. Simons Island, GA Come relax in the lush oasis that is Sea Palms Resort. Take a walk under ancient live oaks, where the ocean air mixes with a soft marsh breeze. Bike on the beach, play golf, tennis or just relax on your balcony overlooking the island's natural beauty. Sea Palms Resort offers the perfect setting for our AIP Spring Meeting. Our spring meeting will offer continuing education, time to meet with our vendors, an AIP Business Session to discuss issues impacting independent pharmacy, time to network with other AIP Pharmacies and catch up with old friends. Plan on attending and bring your family for a weekend to be remembered.
AIP has negotiated a special room rate of $139 (Deluxe) and special pricing on other accommodations (accommodation choices include hotel-style deluxe guest rooms, executive studios with kitchenette and fully furnished one to three bedroom suites with scenic sun deck or screened porch). To guarantee that you receive this special rate and to ensure you get a room please make your reservation as soon as possible. Sea Palms has more amenities than any other property on St. Simons Island and is just minutes from the beach. With twenty seven holes of golf, three swimming pools, three rubico clay tennis courts, a fitness center and sauna, sandpit volleyball court, bike rentals and horseshoes, the recreational opportunities are boundless. We are very excited about this year’s AIP Spring Meeting. We will give you more details as the time nears. Make your plans now to attend.
Please call 1.800.841.6268 for reservations (Ask for the AIP room block)
Georgia Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
• CE opportunities • AIP Business Meeting • Social and Cocktails with our Partners Registration: (For Planning Purposes Please Fill Out and Return)
Memberʼs Name: __________________________Nickname (for badge): __________________________
GA R.Ph. License No:___________ Pharmacy Name: _________________________________________
Address: _____________________________________________________________________________
Phone:(____)____________ Fax:(____)_____________ E-mail Address: __________________________
Please circle the following: Academy Member? Yes No GPhA™ Member? Yes No
**If Spouse/Guest is attending please print his/her name: ______________________________________ Nickname (for badge): ___________________ Is the above guest a member of GPhA? Yes____ No ____
Please Fax Registration to 404.237.8435
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December 2008
Welcome to GPhA!
Financial Planning for Georgia’s Pharmacists
The following is a list of new members who have joined Georgiaʼs premier professional pharmacy association!
Michael T. Tarrant
Jean B. Cox, Dunwoody
Mary Beck Griffenhagen, R.Ph., Fort Valley
Charles D. Griffin, R.Ph., Eatonton
Independent Strategies and Customized Solutions for Building Wealth & Security
Sidney Collier Hardy, R.Ph., Dublin John R. Hunt, Atlanta
Brian Johnson, Atlanta
Lindsey Michelle, Lovvorn
Kreslyn B. Odum, Sandersville
Financial Network Associates 1117 Perimeter Center West, Suite N-307 Atlanta, GA 30338 • 770.350.2455 mike@fnaplanners.com www.fnaplanners.com
Tikeeya Pelzer, Blythewood, SC Lauren Riley, Atlanta
Michael J. Romanzo, R.Ph., Mahwah, NJ
Securities, certain advisory services and insurance products are offered through INVEST Fi nanci al Co rpo rati o n (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.
Natalya A. Rozenberg, Lawrenceville Kelly Silvers, Adairsville, GA Steven R. Stein, Marietta
50 Lenox Pointe, NE Atlanta, GA 30324
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December 2008
UP
COMING
EVENTS
16th YEA
Do you know a future
leader?
R
NOMINATION FORM FOR THE 2009 GPhA NEW PRACTITIONER LEADERSHIP CONFERENCE
April 17-19, 2009
Sea Palms Golf & Tennis Resort, St. Simons Island, GA
The 2008 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of 20 practitioners will be chosen to attend the Conference.
Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by GPhAĘźs Executive Committee based on the following criteria:
(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations; (3) Community activities; (4) Clarity and vision in response to application questions.
I would like to nominate the following individual to attend the 2009 New Practitioner Leadership Conference:
Name: ___________________________________________________________ Designation: ________________
(R.Ph., Pharm.D., etc.)
Works for: ____________________________________________________________________________________
Address: _____________________________________________________________________________________
[ ] Home or [ ] Work _____________________________________________________________________________
________________________________________________ State: ______ ZIP: _____________
Telephone: (Work) (_____) __________________ (Home) (_____) _____________________
(Fax) (_____) ____________________ E-mail: __________________________________________
Nominaed by: _______________________________________________________ Designation: _______________
Address: _____________________________________________________________________________________ ____________________________________________________________State: _______ Zip: ________
Tel. (______) ____________________ E-mail: _______________________________________________________ Please return this Nomination Form to: GPhF, New Practitioner Leadership Nomination Attention: Regena Banks 50 Lenox Pointe, Atlanta, GA 30324 Or, you may FAX this Nomination Form to: 404.237.8435 If you have questions, please contact Regena Banks at GPhF: PLEASE RETURN BY Direct # 404.419.8121 • Email: rbanks@gpha.org JANUARY 30, 2009 Thank you in advance for your assistance.
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December 2008
UP
COMING
EVENTS
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December 2008
GPhA
MEMBERS
IN
THE
NEWS
Representative-elect Buddy Harden, R.Ph.,
All of Crisp County is included in the district, former Executive Vice President of the Georgia and Gibbs was a narrow winner there with 3,592 Pharmacy Association, won his bid for State House votes to Harden’s 3,469. Gibbs also took a in the 147th district. This seat was formerly held majority of the Dooly County votes, gaining 1,316 while Harden polled 1,207. by Johnny Floyd. Harden’s total vote count in the Harden picked up 3,391 additional votes in five counties, portions of which are included in Houston County; 1,357 in Pulaski and 659 in the district, was 10,083 or 56.6 percent. His Worth. Gibbs’ totals in those counties were 1,597 Democratic challenger, Roy Gibbs garnered a total in Houston, 946 in Pulaski and 281 in Worth. of 7,732 votes or 43.4 percent. Melody Sheffield, PharmD., Public Service Associate at the University of Georgia, and Merrill Norton, R.Ph., presented the Annual Substance Abuse Workshop at the UGA College of Pharmacy in October.
Ten Faculty/Residents Join College of Pharmacy This Fall
Ten new faculty and residents joined the University of Georgia College of Pharmacy during fall semester—three faculty and four residents in the Department of Clinical and Administrative
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Pharmacy, two faculty in the Department of Pharmaceutical and Biomedical Sciences and one faculty in the Office of Experience Programs. New to Clinical and Administrative Pharmacy program are Virginia Fleming, a clinical assistant professor who earned a Doctor of Pharmacy degree at UGA in 2006, then completed a pharmacy practice residency at the Medical College of Georgia and an internal medicine specialty residency at the University of Texas, Brackenridge Hospital. Michael Neville, a clinical associate professor, had previously been a clinical
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December 2008
associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and a clinical pharmacist at Emory University Hospital. He graduated in 1992 from UGA and completed a general clinical residency at Emory University Hospital before joining the Emory faculty. He most recently was director of Emory Healthcare’s Department of Pharmaceutical Science’s PGY-1 Residency Program. Rahul Jain, earned a Ph.D. in Economics at the State University of New York at Buffalo in 2006 and completed a postdoctoral fellowship at the University of Maryland School of Pharmacy. His research interests are pharmacoeconomics and health policy. The new residents are Courtney Blackwell, who has undertaken a community practice residency in Athens, and Weng Man Lam and Kacy Schulman, whose residencies in pediatrics and in pharmacy practice, respectively, are located at the Medical College of Georgia. New faculty in Pharmaceutical and Biomedical Sciences include Rajgopal
Govindarajan, an assistant professor who earned a Ph.D. in biochemistry and molecular biology at the University of Nebraska Medical Center, and completed a postdoctoral fellowship in pharmaceutics at the University of Washington. His special interests are anti-cancer and anti-HIV Nucleoside Drugs, pharmacokinetics of drug transport and toxicology. Mandi Murph, also an assistant professor, earned a Ph.D. in biology at Georgia Tech in 2005, followed by a postdoctoral position at M.D. Anderson Cancer Center in Houston. Whitney Unterwagner, formerly director of Experiential Education at Mercer University College of Pharmacy and Health Sciences, joined the Office of Experience Programs as a public service associate. She is regional coordinator for Columbus and Northwest Georgia and coordinator of first-year introductory pharmacy practice experience. She earned a Doctor of Pharmacy degree from Virginia Commonwealth University in 1999.
ScriptPro S/P 200 – Central Server and 1 S/P Station
Leroy Toliver, Pharm.D., R.Ph., J.D. • Professional Licensure Disciplinary Proceedings • Medicaid Recoupment Defense • Challenges in Medicaid Audits • OIG List Problems • SCX or Other Audits
Installed July 2006 – currently not in use. Owner financing options available.
Leroy Toliver has been a Georgia Registered Pharmacist for 34 years. He has been a practicing attorney for 25 years and has represented numerous pharmacists and pharmacies in all types of cases. Collectively, he has saved his clients millions of dollars.
E-mail inquiries: andyjask@dhsinc.us The Georgia Pharmacy Journal
Lawyer and Pharmacist
Toliver and Gainer, LLP 942 Green Street, SW Conyers, GA 30012-5310 altoliver@aol.com 770.929.3100
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December 2008
GPhA
MEMBERS
IN
THE
NEWS
The Clarkesville Drug Compounding Pharmacy Opens Excerpts from an article in The Northeast Georgia by Ricky Shaw
David and Donna Ledbetter, owners of Clarkesville Drug located on West Louise Street, recently added Clarkesville Drug Compounding Pharmacy to their business. The state-of-the-art compounding facility is located in the newly-remodeled Clarkesville Drug location that has been described as “homey and patient friendly.” “We have upgraded our facility to better serve the community and our patients,” said David Ledbetter. “We are all about helping doctors to help their patients and this facility will help us do even better.” The compounding lab is equipped with the latest equipment to manufacture drugs that are not commonly available in a manufactured dosage form. “Commonly available drugs do not meet everyone’s needs,” said Ledbetter. “We are able to compound special formulations to help with special needs that don’t come in manufactured dosages. Working with the patient’s doctor we are able to help the patient better fill their particular needs.” He said Clarkesville Drug has been in business for more than 19 years and his pharmacists and staff remain committed to providing the highest level of service to their patrons, whom the Ledbetters refer to as patients, never customers.
The Georgia Pharmacy Journal
Clarkesville Drug Compounding Pharmacy staff: Casey, Donna, David, Deborah and Diana
The Ledbetters have a combined 69 years of experience in the independent pharmacy business. “Personalized service is what we do best,” said Ledbetter. “We are about serving our patients and we have a staff here that loves their jobs and loves what they do.” He said the company’s mission is to serve God and the community by providing professional services, while dispensing medications at everyday low prices.
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In addition to compounding pharmacy Clarksville Drug also offers: •
•
Physician-ordered immunizations including Zostavax, Influenza, Pneumococcal, Tetanus/Diphtheria, Tet/Dipth/Pertusis, Hepatitis A and B, Meningococcal and Gardasil Hormone replacement therapy
•
A competitive generic drug program that is comparable to large discount stores
•
A bilingual pharmacy technicians
• •
Specialized medications for specialized patient needs A drive-through window
December 2008
GA S PV hE A T UH PE D ADTAET E
Become a part of GPhA’s grassroots team and support your profession!
February 18, 2009
Very Involved Pharmacist Day Georgia State Capital
– – May 12, 2009
Eggs and Issues Breakfast Washington, D.C.
Check www.gpha.org and future issues of the Georgia Pharmacy Journal for more information about these and other important upcoming events.
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December 2008
GPhAʼS U P2D0 A0 T9 E L E G I S L A T I V E
AGENDA
Pharmacy Benefit Managers, legislation, and we will see the Licensure & Regulation – Senate voting on this bill in 2009.
Stuart Griffin, GPhA’s Director of Governmental Affairs, is meeting with Senator Ralph Hudgens (District 47–R), Senator Jack Murphy (District 27–R), Senator Lee Hawkins (District 49–R) and Senator Ed Harbison (District 15–R) regarding this piece of legislation. These legislators are the leaders for PBM legislation in the Senate. Our concern in the Senate is the support of the Lieutenant Governor. At the end of September, Griffin and Cindy Shepherd, GPhA’s contract lobbyist, met with the Lt. Governor to express our sense of urgency on this issue and its importance to the pharmacy community and our patients. Griffin has been in contact with Senator Tommie Williams (District 19–R), the Senate majority leader, to arrange for PBM expert Gerry Purcell to speak to the entire legislature on the effects of PBMs to our nation’s health care system. This will be taking place at the Biennial Institute in Athens between December 7 and 9. Stuart and the GPhA leadership are confident that we will be able to answer the Lt. Governor’s reservations about this PBM
GPhA is also confident we will gain much more Senate support for this bill after Gerry Purcell speaks at the Biennial Institute.
Editor’s Note: The Georgia General Assembly convenes early in January 2009 to begin the 2009 legislative session. Pharmacists can refer to this article as they interact with legislators.
Epilepsy, Restricted PrescripImmunization Legislation – No tions, – On Friday, August 29,
changes to immunization authority will be made until the 2009 legislative session. Pharmacists currently are able to administer immunizations with a valid prescription order for each vaccine administered. With the realization of this, we are able to take a careful approach to the legislation supported by the Medical Association of Georgia. MAG has penned draft legislation for addressing immunization and GPhA feels as if there is room in this legislation to ensure that pharmacists retain the ability to administer immunizations under protocol, an aspect of their profession for which they are well trained.
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Senator Lee Hawkins led a study committee on generic substitution. The meeting went well with all interested parties agreeing there is no need for new legislation but rather to further emphasize the current mechanism of brand necessary. Representative Sharon Cooper (District 41–R) may reintroduce legislation like HB 127 as well as similar generic substitution bills covering other NTI drugs. With the current understanding the Senate conveys about these bills increasing the cost of medication, another vehicle to enforce brand necessary may be sought. If you have question about specific pharmacy related issues and their treatment in the House or the Senate please contact GPhA Director of Government Affairs, Stuart Griffin by phone at 404.419.8118 or by email at sgriffin@gpha.org.
December 2008
PHARMACISTS
IN
THE
LEGISLATURE
The longest serving pharmacist in the legislature is Representative Bobby Eugene Parham, R.Ph., of Milledgeville. He is a retired pharmacist and former owner of Medical Arts . Parham, R.Ph Bobby Eugene Pharmacy in Milledgeville. He is a 1963 graduate of the University of Georgia with a B.S. in Pharmacy. In an effort to serve his community, he ran for Baldwin County Commissioner in 1969 and was overwhelmingly elected. In 1975, he ran for and won in Georgia’s House of Representatives. He has been serving in that seat for 33 years and plans to continue serving the citizens of the state of Georgia. Another elected GPhA member-pharmacist is Representative Larry J. “Butch” Parrish, R.Ph., of Swainsboro. Representative Parrish has been serving the people of Georgia since 1985. h. R.P h, ris Par h” Larry J. “Butc He graduated from the University of Georgia with a B.S. in Pharmacy in 1964, and began practicing pharmacy in Swainsboro in 1965. Parrish ran for and was elected to the Swainsboro City Council. He served three three-year terms, and then decided to run for a seat in the House of Representatives in 1985. He won and has been in public service ever since. Representative Ron Stephens, R.Ph., of Garden City, began his career in the legislature 11 years ago, after completing five years on the Garden City City Council. Representative Stephens is a s, R.Ph. Ron Stephen
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1978 Mercer University Southern School of Pharmacy graduate with a B.S. in Pharmacy. Representative Stephens is the owner of Quick Rx Drugs, Inc., which operates several community pharmacies in the Savannah area. Representative Earl L. “Buddy” Carter, R.Ph., of Pooler, is a 1980 graduate of the University of Georgia with a B.S. Pharmacy. He is the owner of Omnicare, Inc., and Carter’s Earl L. “B uddy” Carte r, R.Ph. Pharmacy, Inc., which are located in Pooler and Garden City. Before being elected to the House of Representatives in 2004, Carter was the Mayor of Pooler from 1996 to 2004 and prior to that he was on the Pooler City Council from 1993-1995. The latest addition to the roster of pharmacists in the state legislature is Representative-Elect Oren H. “Buddy” Harden, Jr., R.Ph., Harden was decisively Oren H. “Buddy” Harden, Jr. elected to the House in November of 2008, and will begin serving his term in the January of 2009. Graduating from the University of Georgia in 1962 with a B.S. in Pharmacy, he spent many years as a community pharmacist. In 1993, he served as the president of GPhA and then as Executive Vice President of GPhA from 1996 to 2006. Harden is not a newcomer to public service, having also served as the Mayor of Sylvester and on the Georgia State Board of Pharmacy.
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December 2008
Help Make GPhA the Most Powerful Grassroots Force in Georgia
2008 - 2009 Grassroots Sign-Up Form
Please complete and return via fax to GPhA at 404.237.8435 Your Name: ________________________________________________________________ Preferred Address: ___________________________________________________________
City, State Zip Code: _________________________________________________________
Preferred Phone(s): __________________________________________________________ Email Address: ____________________________________ Fax:______________________
How do you prefer to receive legislative information? (Select One) Email
Fax
Which of the following activities are you willing to perform to assist GPhA始s legislative efforts? Write A Letter
Phone Call
Personal Visit
Testify On A Bill
Have you made a financial contribution to the campaign of any legislator in the past 4 years? If yes, please complete the form below. For nature of relationship, indicate how you know the legislator (business, childhood friend, college, church, civic, family, campaign volunteer, etc.). Yes
No
Your Legislators
*** Confidential - For GPhA File Only *** Legislator始s Name Amount Nature of Relationship
State Representative: ________________________________________________________________ State Senator: ______________________________________________________________________
US Representative: __________________________________________________________________
US Senator: ________________________________________________________________________
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December 2008
Call for awards nominations... The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA 134th Annual Convention in 2009. A brief description and criteria of each award is included. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 9, 2009. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at GPhA’s 134th Annual Convention at the Marriott Sawgrass in Ponte Vedra Beach, FL. Bowl of Hygeia Award (sponsored by Wyeth-Ayerst)
Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has an outstanding record of service to the community which reflects will on the profession.
Distinguished Young Pharmacist Award (sponsored by Pharmacist Mutual)
Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of GPhAʼs most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate in association and community activities, and 2) To annually recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programs or activities and community service projects.
Call for nominations GPhA 134th Annual Convention 2009
Innovative Pharmacy Practice Award (sponsored by NASPA/GPhA)
This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.
2009 Awards 2009 Bowl of Hygeia
Distinguished Young Pharmacist
Innovative Pharmacy Practice Award
Nomineeʼs Full Name _______________________________________________ Nickname ___________________
Home Address _________________________________________ City _______________ State _____ Zip ______
Practice Site __________________________________________________________________________________
Work Address __________________________________________ City _______________ State _____ Zip ______
College/School of Pharmacy _____________________________________________________________________ List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities: _____________________________________________________________________________________________
_____________________________________________________________________________________________
Supporting information: _________________________________________________________________________ _____________________________________________________________________________________________
Submitted by (optional): _________________________________________________________________________ Submit this form completed by March 9, 2009 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324. Complete this form online at www.gpha.org.
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December 2008
GPhA
MEMBERS
IN
THE
For Immedia te Release
Pamala Ma rq
NEWS
PRESS REL EASE
uess Named Mercer Univ and Health ersity Colle Sciences De ge of Pharm an’s Award acy Winner
In recognitio n of her ex Marquess, ceptional s Pharm.D., ervice to th was award e school, P University C ed the Dea amala ollege of Ph nʼs Award o armacy and Matthews. f M e rc er Health Scie nces by De “Pam Marq an H.W. “Te uess is an d” innovative incredible p methods in harmacist. the practice Her passio profession,” n and of pharmac said Robert y make her Bowles, pre Association a leader in ou sident of th . “Pam has r e Georgia P tremendous success in harmacy insights tha whatever s t enable he he does an r to be a d she is alw knowledge ays willing with others to .” share her Marquess is a 1 9 9 3 graduate o of Pharmac f Mercer Un y and Healt iversity Coll h Sciences pharmacy. ege with a docto She and he rate of r h usband, Jo Pharm.D., nathan Marq CDM, CDE , jointly own uess, Marietta Dru three pharm gs of Marie acies: East tta, Woods Woodstock tock Pharm , and McKe ac nzie Drugs resident of of Lilburn. M y of Acworth wit arquess is h her husba and Madiso a nd and two n. children, W ill
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December 2008
GEORGIA
PHARMACY
SCHOOLSʼ
NEWS
Georgia Pharmacy Foundation Awards Scholarships to Mercer University College of Pharmacy and Health Sciences’ Students In October 2008, the Georgia Pharmacy Foundation presented the Carlton Henderson Scholarship, the Regina Baird Scholarships, and the Neil L. Pruitt, Sr. Entrepreneurial Scholarship to four deserving Mercer University College of Pharmacy and Health Sciences’ students. Hillary Volsteadt of Tucson, Arizona, and Trey Rump of Chattanooga, Tennessee, were both awarded Regina Baird Scholarships based on their scholarship and faculty recommendation. The Regina Baird Scholarships were named in honor of Mrs. Regina Baird, who was one of the Georgia Pharmacy Association’s (GPhA) first full-time staff members. She served as the Executive Secretary of GPhA for many years, and was a leader not only in GPhA, but also in pharmacy associations throughout the Southeast. This scholarship was established in her memory to help student pharmacists in the pursuit of their education. Two students from each of the pharmacy schools in Georgia are selected to receive $1,000 each. Neelam Patel of Sylvester, Georgia, was awarded the Carlton Henderson Scholarship based on her recommendation by a faculty committee at Mercer University. The Carlton Henderson Scholarship was named in honor of Mr. Carlton Henderson, who was one of GPhA’s long time staff members. He served in the pharmacy industry until his death and was a The Georgia Pharmacy Journal
valuable staff member of the association for many years. His love for pharmacy and especially for Mercer University knew no boundaries. This scholarship was established in his memory to help deserving student pharmacists in their pursuit of education. One student from each school receives $1,000 for the Carlton Henderson Scholarship. Laura Coker of Canton, Georgia, was awarded the Neil L. Pruitt, Sr. Entrepreneurial Scholarship based on the recommendation by faculty members at Mercer University and Coker’s demonstration of entrepreneurial abilities. Laura Coker is the daughter of GPhA’s First Vice President, Dale Coker, R.Ph. The Neil L. Pruitt, Sr. Entrepreneurial Scholarship was named in honor of Neil L. Pruitt, Sr., R.Ph., who was one of the association’s most loyal and supportive members. He served the pharmacy profession in many arenas until his death. His innovative ideas and entrepreneurial spirit were known nationally. This scholarship was established in his memory to help student pharmacists who have demonstrated entrepreneurial abilities. One student pharmacist from each of the three Georgia schools of pharmacy will be selected to receive this $1,000 scholarship.
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December 2008
Can You Answer CMS Part D Audit?
Medicare Part D requires prescription plans to assure continuous quality improvement and your participation via third party contracts necessitates adherence to these directives. Are you aware that there is language in most contracts mandating the implementation and use of a verifiable, documented pharmacy quality assurance program? Part D quality assurance requirements under CMS section 423.153©.
The following are examples of language from Pharmacy Network Contracts:
Caremark: “Pharmacy agrees to implement utilization management and quality assurance programs dictated by Caremark” (Pharmacy Responsibilities Item 14). CIGNA HealthCare (Connecticut General Life Insurance Company): “Pharmacy shall establish internal medication error identification and reduction systems” (Services, Section 3.b). Community Care Rx (CCRx; Member Health): “Pharmacy will abide by, and all services will be provided in accordance with CMS guidelines applicable to Part D” (provider responsibilities Section 3). “Member Health shall routinely monitor performance of the Pharmacy per Member Health audit policies” (Miscellaneous Provisions, Section 4). Coventry Advantra Rx (Coventry Health Care, Inc.) Utilization Management: “Pharmacy agrees to comply with Utilization Management programs, credential Verification Programs, Quality Management programs, Provider Sanction Programs and other similar programs.” Express Scripts, Inc.: “Have in place systems to reduce medication errors” (Description of Service Components, Section II.20 (iii)). WHI Walgreen’s Health Initiatives: “Pharmacy will institute practices that will ensure the reduction of medication errors” (Quality Assurance, Section 4).
Pharmacy Quality Commitment (PQC) will provide such a program and allow you to answer: Yes, I am in compliance. I do have and use a nationally recognized continuous quality assurance program!
Make your purchase today! For more information call 1.866.365.7472 or visit www.pqc.net. or Sid Anderson, GPhA Member Service Director at 404.419.8115
(Evaluation of Medicare Part D PDP contacts provided by Ed Heckman, R.Ph. of PAAS National for South Carolina Pharmacy Association.)
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December 2008
PHARMACY
PROFILE
IN
LEADERSHIP
Alex Tucker, Pharm.D. GPHA REGION 1 PRESIDENT
What advice can you offer someone coming into this profession?
Get involved in the association and politics. The association offers you the opportunity to network with colleagues and allows you access to valuable information. GPhA is looking out for the profession of pharmacy and we have to stand together to have our voices heard. GPhA also affords you the opportunity to become involved in politics, and get to know your legislators.
What accomplishment are you most proud of?
Birth of my five-month-old, it took a lot of work getting him here.
What do you think has been the most significant change/advancement in pharmacy?
What type of pharmacy do you practice and where?
I am an employee at the independent pharmacy of Richmond Hill Pharmacy in Richmond Hill, Georgia.
Who is your role model/mentor?
Ben Chapman would be my mentor when it comes to patient care. He opened this pharmacy and people respect him as a true health care provider. Al Dixon would be my mentor for his business knowledge. They do not teach you much about the business side of pharmacy in pharmacy school.
Technology – everything from robotics to e-prescribing. Count, lick and stick has gone away which affords the patients time with the pharmacists they would not have had in the past. With a great support staff, the pharmacist can focus on counseling, which becomes the most important part of the practice of pharmacy.
Professionally, if you could change something, what would it be?
I would like to have the ability to negotiate contracts.
What do you enjoy most about your job?
The diversification in the practice of pharmacy is the most appealing part. Dealing with the public can be a challenge, but it is rewarding. It is gratifying to know the public values pharmacists as health care providers, and as an independent community pharmacist I get to spend more time with patients thanks to a great support staff.
What is the hardest part of your job? Insurance Companies!
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Middle Georgia Pharmacy Relief Services Pharmacy Staffing for: • Chain & Independent Pharmacy • Clinic & Hospital Pharmacy • Specialty & Long Term Care Pharmacy • Over 30 years Rx Experience Call 478-552-7220 AL Curry, R.Ph. Email: MidGaPharmRS@aol.com Tennille, GA 31089 www.middlegeorgiapharmacyreliefservices.com
December 2008
Editors Note: Due to a mix-up there was an error in the November 2008 Journal that resulted in a key chart being left out of the layout. If you are interested in taking the Journal CE please visit the GPhA website to obtain access to the November Journal CE in its entirety.
Gossel
Thomas A. Gossel, R.Ph., Ph.D. Professor Emeritus Ohio Northern University Ada, Ohio
J. Richard Wuest, R.Ph., PharmD Professor Emeritus University of Cincinnati Cincinnati, Ohio
Wuest
ADHD and Its Treatment in Children and Adolescents Goal.
The goal of this lesson is to explain attention-deficit/ hyperactivity disorder (ADHD) in children and adolescents with focus on its pathogenesis, clinical characteristics and confirmation, and its treatment.
Objectives. At the conclusion of
this lesson, successful participants should be able to: 1. recognize historical events and epidemiologic information relevant to ADHD; 2. identify symptomatology that characterizes ADHD and the principles that govern its clinical confirmation and management; and 3. select from a list specific nonpharmacologic and pharmacologic measures that are reported to modify signs and symptoms of ADHD. Attention-deficit/hyperactivity disorder (ADHD) affects approximately 4 to 12 percent of children and adolescents, and persists throughout adulthood. It is the most commonly diagnosed psychiatric condition of childhood and adolescence. ADHD persists into adulthood in up to 60 percent of diagnosed cases, with 4 to 5 percent
of adults worldwide affected. It is, thus, a major public health problem because of associated morbidity and disability across the lifespan of affected persons. Annual medical costs of affected individuals are 50 to 75 percent higher than expenses for nonaffected persons. Overall costs of illness are estimated to be upwards of $40 billion annually in the United States alone.
Background
Although ADHD was first described in 1845, it was not until 1902 that a description was published. ADHD can lead to serious longterm effects including impairment of major life activities and premature morbidity. Persons with ADHD may exhibit underachievement and disruptive behavior in school, as well as antisocial and criminal behavior. They typically have unsafe driving habits, and are twice as likely to use tobacco. Males are reportedly affected more often than females (2:1 to 3:1 ratio). These numbers can be deceptive because females with ADHD may be diagnosed less
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frequently since many of them have the inattentive (i.e., less disruptive) form. Many girls are not diagnosed until middle school or later.
Pathogenesis
Although the precise cause of ADHD is unknown, a deficiency in central stores of the neurotransmitters dopamine and norepinephrine has been implicated. These deficits are associated with both genetics and environmental influences. Recent imaging studies have failed to find evidence of gross brain damage in children with ADHD. In the 1970s, it was hypothesized that the core problem in hyperkinetic children was one of inattention. This led in 1980 to adoption of the new diagnostic label attention-deficit disorder. Since the symptoms of ADHD respond well to treatment with central stimulants, and because these drugs enhance the availability of dopamine, the dopamine hypothesis has captured the attention of many researchers. The dopamine hypothesis proposes that ADHD is caused by an inadequate supply of dopamine in the CNS. Dopamine plays a major role in
December 2008
initiating purposeful movement and increasing motivation and alertness, behaviors that are often noted when a child with ADHD responds positively to stimulant therapy. The dopamine hypothesis has thus influenced much of the recent research into the cause(s) of ADHD. Genetic Influence. The fact that ADHD runs in families lends strong support to the theory that heredity is an important risk factor. Ten to 35 percent of children with ADHD have a first-degree relative with a past or present history of ADHD. Approximately one-half of parents with ADHD have a child with the disorder. Studies suggest that ADHD is among the most familial (affecting other members of the family) of psychiatric disorders. Research to identify specific abnormal genes has concentrated on two: a dopamine-receptor gene on chromosome 11 and the dopaminetransporter gene on chromosome 5. Evidence is mounting that children with ADHD have genetic variations in one of the dopamine-receptor genes. Several studies have found evidence for abnormalities of the dopaminetransporter gene in children with very severe forms of ADHD. While the high heritability of ADHD suggests that it is a “genetic” disorder, it is inaccurate to assert that any single gene is at fault. Rather, some gene variants boost an individual’s susceptibility to environmental triggers. Even though many imaging studies have failed to identify evidence of gross brain damage in ADHD, some have noted that exposure to toxins such as lead, or episodes of fetal oxygen deprivation, may adversely affect dopamine-rich areas of the brain. These findings support the many observations that hyperactivity and inattention of ADHD are more common in children whose mothers smoked or used alcohol during pregnancy (especially during the first trimester), in children with impaired oxygenation leading to fetal distress and low birth weight, in children who have been
exposed to high quantities of lead or carbon monoxide, and in children with infections of the CNS and those with serious head injury. Recently published data have shown that children born to nonsmoking mothers who were exposed to chronic secondhand smoke during pregnancy face serious problems of ADHD and conduct disorder. Some studies have reported that parents of hyperactive children are often overintrusive and overcontrolling, which suggests that parental behavior is another possible risk factor for ADHD. To date, no single mechanism has been identified as the definitive cause of ADHD. It is believed that its development most likely results from combined action of multiple genetic and environmental risk factors.
Clinical Confirmation
There is no laboratory or imaging test, or battery of psychological tests, that reliably confirm the presence of ADHD. Rather, confirmation is based mainly on the patient’s behavior history (Table 1) and elimination of other sources for the troublesome behaviors. ADHD diagnosis is subject to a variety of influences, particularly because it is often first suggested by school teachers (52 percent) and parents (30 percent) rather than health professionals. A diagnosis is first suggested by a primary care physician, child psychiatrist or psychologist in only 14 percent of cases. Regardless of who first suggests that a child may have ADHD, physicians and mental health professionals typically depend on suggestions by parents, teachers and other school personnel in confirming a diagnosis. The DSM IV criteria for ADHD are summarized in Table 2. Most clinicians report they are hesitant to confirm a diagnosis prior to six years of age because of the wide variability in levels of activity that overlap with symptoms of ADHD, and therefore are considered normal in early childhood.
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Treatment
of therapy include Goals controlling symptoms, improving classroom attention and learning ability, enhancing interpersonal relationships and enriching transition to adult life. Pharmacotherapy has been the mainstay of treatment for decades, with hundreds of wellcontrolled clinical trials documenting its usefulness in children, adolescents and adults. The most widely available option for treatment of ADHD, an option supported by a vast literature, are the central stimulants.
Pharmacotherapy Stimulants. First shown to be beneficial for treatment of abnormal behavior more than seven decades ago, central stimulants have become the first-line treatment option for ADHD with benefit attained in 75 to 90 percent of recipients. Their precise mechanism of action in ADHD is not fully understood, although they are believed to increase release of dopamine and/or norepinephrine from presynaptic neurons or inhibit their reuptake. These actions result in increased adrenergic activity. The stimulant drugs exert these actions to various degrees, thus working by slightly different mechanisms of action. Therefore, failure of therapy with one agent does not translate to a class failure and alternate agents within this class often may be administered to the patient’s benefit. The drugs are rapidly absorbed and typically result in an onset of action within 30 minutes. Their action extends over three to six hours. Administration is timed to meet the individual’s school or work schedule, to enhance the person’s ability to pay attention and meet his or her academic or work demands, and to mitigate side effects. Their greatest effects are on symptoms of hyperactivity, impulsivity, and inattention and the associated features of defiance, aggression, and oppositionality. They also improve classroom performance and behavior
December 2008
and promote increased interaction with teachers, parents and peers. Stimulant drugs include mixed amphetamine salts (Adderall, etc.), dextroamphetamine (Dexedrine, etc.), methylphenidate (Ritalin, etc.) and dexmethylphenidate (Focalin). Lisdexamfetamine (Vyvanse) is a prodrug of dextroamphetamine with a longer duration of action. The American Academy of Pediatrics (AAP), working through its Committee on Quality Improvement – Subcommittee on AttentionDeficit/Hyperactivity Disorder, published its Clinical Practice Guidelines for treatment of schoolaged children with ADHD in 2001. AAP determined that there were no clear differences among dextroamphetamine, lisdexamfetamine and methylphenidate. Newer products were not available at the time of guideline development. Subsequent reports suggest that the use of methylphenidate and mixed amphetamine salts are first-line therapy because of ample evidence of their safety and efficacy. Clinical trials consistently document that stimulants reduce the core symptoms of ADHD. Recent trials tend to focus on use of the newer agents to assist with dosing convenience and overall ease of patient care. Advances in dosage formulations such as long-acting agents aid treatment adherence, decrease embarrassment for children in school who must take multiple daily doses, lessen burdens for school staff to administer these doses and decrease the potential for drug diversion and abuse. Long-acting formulations extend the action of these drugs over eight to 12 hours to allow once-daily dosing. Advances in methylphenidate formulations include chewable tablets, oral solution and a patch formulation. The patch (Daytrana) has demonstrated statistically significant reductions in ADHD symptoms for children ages six through 12 years. The patch is worn for nine hours daily. In clinical trials, application site reactions, insomnia,
anorexia and nervousness were the adverse effects most commonly reported leading to discontinuation of therapy. Adverse effects associated with stimulants used in ADHD include appetite suppression with initial weight loss, insomnia, headache, jitteriness and stomach pain. If insomnia is a problem, giving the stimulant earlier in the day, discontinuing the afternoon or evening dosage, or giving an adjunct medication such as a low-dosage antidepressant may help. Other concerns include tic development, growth delay and potential for substance abuse. Mild adverse effects may be partially controlled by reducing the dose or altering the timing of administration. Most adverse effects are mild, recede over time and respond to dose changes. Appetite may fluctuate, usually being low during the middle of the day and more normal by suppertime. Parents may choose to have their child take a “drug holiday” on weekends and vacations to reduce overall exposure, but the utility of this strategy has not been demonstrated. Concerns remain about inhibition of long-term growth; however, most studies conclude that such effects are minimal and of small clinical importance. As with all medication use, risks versus benefits must be weighed. Recent concerns have highlighted the possibility of cardiovascular events with stimulants. In April 2008, the American Heart Association (AHA) released a statement calling for a thorough examination including family history and an electrocardiogram, and routine cardiac monitoring for children and adolescents prescribed stimulant medication for ADHD. The call for closer cardiac monitoring was given to identify the very small number of children and adolescents who may have an undiagnosed cardiac problem. Non-stimulants. Atomoxetine (Strattera) is the newest nonstimulant treatment option for ADHD. It is a selective norepine-
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Table 1 Presentation of ADHD
Reported by child or adolescent • Does not like school or particular subjects or teachers • No close or long-term friends • Conflict with parents • Low self-esteem • Always getting in trouble Reported by parents • Aggression and problems with anger • Difficulty completing tasks • Disorganized, messy • Does not follow directions • Impulsive • Difficulties with school • “Always on the go” • Does not make or keep friends • Socially or emotionally immature • Engages in dangerous activities • “Spaced out” or absentminded • Loses possessions Reported by teachers • Hyperactive • Inattentive, easily distracted • Interferes with others, disrupts class • Underachiever, school failure • Does not listen • Fidgets, will not stay in seat • Blurts out answers, does not consider others • Frequent behavior problems
Adapted in part from Culpepper L. J Clin Psychiatry. 2006;67[suppl 8]:32-37. phrine reuptake inhibitor in presynaptic neurons with less action to reduce dopamine reuptake in the prefrontal lobes. The drug has a slower onset of action than stimulants; thus, effects may not be seen until the end of the first week of treatment. Atomoxetine seems to have a longer duration of action after once-a-day dosing with suggestions of symptom relief during the evening and early-morning hours. A meta-analysis evaluated atomoxetine for safety and tolerability. Following 601 subjects for up to two years of study, only 5.2 percent discontinued medication use because of adverse effects. There were no discontinuations due to tics,
December 2008
Table 2 Summary of DSM-IV* diagnostic criteria for ADHD
Criterion Description A Patients must exhibit 6 to 9 symptoms of inattention or 6 to 9 symptoms of hyperactivity-impulsivity that have persisted for at least 6 months. B Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. C Some impairment from the symptoms is present in 2 or more settings (e.g., at school [or work] and at home). D There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). *Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC, American Psychiatric Association, 1994. Adapted in part from Findling RL, Arnold LE, Greenhill LL, et al. J Clin Psychiatry. 2007;68:1963-1970.
seizures, hepatic toxicity or growth concerns. The most common treatment-emergent adverse effects occurring at 10 percent incidence included cough, decreased appetite, dizziness, fatigue, irritability, upper respiratory tract infection and vomiting. Most effects occurred within three months and tapered off thereafter. Weight and height increased as expected, even though there was an initial weight decrease over the first three months of treatment. Statistically significant changes were noted in pulse rate and both diastolic and systolic blood pressures, but these were consistent with age-expected increases. Atomoxetine labeling contains a warning about the potential for severe liver injury in rare cases. It should be discontinued when there is evidence of jaundice or hepatic injury. The drug also has a black box warning concerning the potential for increased risk of suicidal ideation in children and adolescents being treated for ADHD. Patients starting atomoxetine should be monitored closely for changes in behavior. Compared with stimulants, atomoxetine has relatively low potential for abuse.
Recommendations are as a secondline option following unsuccessful trials with stimulant therapy. Tricyclic antidepressants, once commonly used, have lost favor over the years because of their adverse effect profile; several deaths in the early 1990s were associated with desipramine use. Tricyclics are typically recommended following a poor response with one or more stimulants or atomoxetine. Baseline and periodic electrocardiogram monitoring are needed to assess safety of therapy. Bupropion (Wellbutrin, etc.) has shown modest efficacy in ADHD. Its use may be considered as an option for adjunct therapy in persons who also smoke tobacco or possess underlying depression or bipolar disorder, or those with a history of substance abuse. Because bupropion may induce seizures, the drug should not be used in persons with a seizure history.
Non-pharmacologic Therapies Behavioral Intervention. Behavioral intervention in combination with medication use is the optimal approach to treatment of ADHD. The MTA Study has shown that
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patients with combined medication and behavioral intervention improved in the core areas of ADHD; moreover, family members consistently benefited from this approach. The combined approach to treatment also resulted in less challenging behaviors and permitted reduced doses of medication to be used. Dietary Intervention. Some medical researchers and clinicians have proposed that dietary intervention has potential benefit in treatment of ADHD. Parents may therefore choose to supplement or, in some cases, replace medication with dietary intervention. One commonly promoted intervention is the Feingold diet, in which dietary salicylates, artificial colors, flavors and preservatives are removed from the diet. Other proposed dietary interventions include removing all sugars, adding high-dose vitamin/ mineral supplementation, and supplying essential fatty acids to help alleviate ADHD symptoms. At this point, none of these approaches have been supported by well-designed clinical trials.
Summary and Conclusions
ADHD is a chronic condition with unknown etiology and potentially harmful sequelae if not treated. Central stimulants remain the most widely used therapy. Innovative dosage forms and longer acting agents assist with ease of dosing and improvement of drug adherence, and as a means to discourage abuse and diversion. Stimulant use is not without safety concerns, including the recent call from the AHA to monitor patients for cardiovascular events. Non-stimulant therapies, including atomoxetine and antidepressants, may be of benefit in persons who do not respond adequately to stimulant therapy. The content of this lesson was developed by the Ohio Pharmacists Foundation, UPN: 129-000-08-008H01-P. Participants should not seek credit for duplicate content.
December 2008
Quiz
ADHD and Its Treatment in Children and Adolescents
1 . Whi l e the preci s e caus e o f ADHD i s unkno wn, a defi ci ency i n central s to res o f whi ch o f the fo l l o wi ng s ets o f neuro trans mi tters has been i mpl i cated? a. Norepinephrine and serotonin c. Dopamine and norepinephrine b. Acetylcholine and serotonin d. Acetylcholine and dopamine
a. Focalin b. Ritalin
6 . Adv ances i n l o ng -acti ng o ral do s ag e fo rms o f drug s us ed to treat ADHD hav e s ho wn al l o f the fo l l o wi ng benefi ts EXCEPT: a. significantly increased effectiveness. b. fewer burdens on school staff. c. decreased embarrassment for children in school. d. aiding treatment adherence.
2 . Whi ch o f the fo l l o wi ng pl ay s a majo r ro l e i n i ni ti ati ng purpo s eful mo v ement and i ncreas i ng mo ti v ati o n and al ertnes s when a chi l d wi th ADHD res po nds po s i ti v el y to s ti mul ant therapy ? a. Acetylcholine c. Norepinephrine b. Dopamine d. Serotonin
7 . Whi ch o f the fo l l o wi ng i s a no n-s ti mul ant treatment o pti o n fo r ADHD? a. Focalin c. Strattera b. Ritalin d. Vyvanse
3 . There hav e been fi ndi ng s that s uppo rt the many o bs erv ati o ns that hy peracti v i ty and i nattenti o n o f ADHD are mo re co mmo n i n chi l dren i n al l o f the fo l l o wi ng i ns tances ex cept tho s e: a. whose mothers have diabetes or hypertension. b. with impaired oxygenation leading to fetal distress. c whose mothers smoked during pregnancy. d. with infections of the CNS.
8 . Al l o f the fo l l o wi ng are co mmo n treatment-emerg ent adv ers e effects that o ccur i n pati ents recei v i ng the drug referred to i n ques ti o n # 7 wi th the ex cepti o n o f: a. fatigue. c. irritability. b. seizures. d. dizziness.
4 . Co nfi rmati o n o f the pres ence o f ADHD i s bas ed mai nl y o n: a. laboratory tests. c. psychological tests. b. imaging tests. d. patient behavior history. 5. Whi ch o f the dex tro amphetami ne?
fo l l o wi ng
is
a
pro drug
The Georgia Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ADHD and Its Treatment in Children and Adolescents
Volume XXVI, No. 8 GPhA Code J08-12 Program Number: 142-999-08-008-H01-P CE Hours: 1.5 (0.15 CEUs) Release Date: 12/5/2008 Expiration: 08/15/2011
c. Strattera d. Vyvanse
9 . The drug referred to i n ques ti o n # 7 has a bl ack bo x warni ng fo r i ncreas ed po tenti al ri s k o f: a. bulimia. c. jaundice. b. growth concerns. d. suicidal ideation.
of
1. Select one correct answer per question and circle the appropriate letter below using blue or black ink (no red ink or pencil). 2. Members submit $4, Non-members must include $10 to cover the cost of grading and issuing statements of credit. Please send check or money order only. Note: GPhA Members will receive priority in processing CE. Statements of credit for GPhA members will be mailed within four weeks of receipt of the course quiz.
1. 2. 3. 4. 5.
A A A A A
B B B B B
C C C C C
D D D D D
6. A 7. A 8 A 9. A 10. A
B B B B B
C C C C
D D D D
Mail completed quiz to: GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324 A passing grade of 70% is required for each examination. A person who fails the exam may resubmit the quiz only once at no additional charge. Please check here if you are indicating a change of address ______
Phone # __________________
Name ________________________________________ License Number(s) and State(s) ____________
Address _____________________________________________________________________________
City ____________________________________________________ State __________ Zip __________
How long did this program take to complete? ________________________________________________
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December 2008
2008 - 2009 GPhA BOARD OF DIRECTORS
The Georgia Pharmacy Journal Editor: Jim Bracewell
Name
jbracewell@gpha.org
Sharon Sherrer Robert C. Bowles Eddie Madden Dale Coker Jack Dunn Jim Bracewell Burnis Breland Hugh Chancy Judy Gardner Keith Herist John McKinnon Andy Rogers Tommy Whitworth Alex Tucker Tony Singletary Renee Adamson Bill McLeer Shobhna Butler Bobby Moody Pam Marquess Larry Batten Alissa Rich Chris Thurmond Marshall Frost Ken Eiland Rusty Lee Liza Chapman Debbie Nowlin Tim Short Michelle Bishop Hillary Volsteadt John T. Sherrer Michael Farmer Pat McPherson
Managing Editor: Kelly McLendon
kmclendon@gpha.org
The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2008, 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. 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 who are 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 e-mail the editorial offices as listed above.
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 nonmembers 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 at www.gpha.org upon request. All advertising and production orders should be sent to the GPhA headquarters as listed above.
Cynthia Pangburn Gina Ryan Meagan Spencer Rusty Fetterman Rebecca Cubbedge Brian Buck Walter Williams
GPhA HEADQUARTERS 50 Lenox Pointe, NE Atlanta, Georgia 30324 Office: 404.231.5074 Fax: 404.237.8435
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Position
Chairman of the Board President President Elect First Vice President Second Vice President Executive Vice President/CEO State at Large State at Large State at Large State at Large State at Large State at Large State at Large Region One President Region Two President Region Three President Region Four President Region Five President Region Six President Region Seven President Region Eight President Region Nine President Region Ten President Region Eleven President Region Twelve President ACP Chairman AEP Chairman AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Ex Officio - President, GA Board of Pharmacy Ex Officio - Chairman, GSHP EX Officio Mercer Ex Officio Mercer ASP Ex Officio South Ex Officio South ASP Ex Officio UGA Ex Officio UGA ASP
December 2008
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Sid Anderson sanderson@GPhA.org Toll Free 1.888.871.5590
December 2008
Georgia Pharmacy Journal速 50 Lenox Pointe, N.E. Atlanta, Georgia 30324