Endorsed by:**
Guarantee a better
Q Quality y of Life ffor yyour fa family. family.
Life Ins Insurance surance can provide p for your your loved l d ones by: b
3URYLGLQJ FRYHU DJH IRU ÀQDO PHGLF FDO DQG IXQHUDO H[S SHQVHV ͻ 3URYLGLQJ FRYHUDJH IRU ÀQDO PHGLFDO DQG IXQHUDO H[SHQVHV ͻ ding debts outstanding ͻͻ Paying outstand ate for those you car c e about estate care ͻͻ Creating an esta ge funding college ͻͻ Providing colleg
Life insu insurance urance solutio solutions ons fr from om Thee Pharmacistss Life Insuranc ce Company. Company. Insurance For F o r more m ore information, inf o r mat io n, contact co nt ac t your y ou r local lo cal representative: re p re s e n t a t i v e :
Hutton H utton Madden Madden 800.247.5930 8 00.247.5930 eext. xt . 77149 149 6678.714.9198 78.714.9198 www.phmic.com w w w.p h mi c. co m *
32 %R[ $OJRQD ,RZD 32 %R[ $OJRQD , RZD
* This is not a claims claim ms reporting site. You cannot electronically ally report a claim to us. To report a claim, call 800.247.5930. 247.5930. ** Compensated endorsement. Not all products available a in every state. The Pharmacists Pharmacissts Life is licensed in the District of allll states except AK, FL, HI, MA, ME, NH, NJ, NY and VT. Check with your Columbia and al representative or the company for details on coverages and carriers.
7
Departments
Laird Miller, R.Ph., Appointed to the Georgia State Board of Pharmacy FEATURE ARTICLES
9
Board of Pharmacy President’s Message: Comment on the Pharmacist in Charge Responsibilities
10 11 15 23 24
GPhA Members Meet with Their Congressional Delegates VIP Day at the Capitol: February 9 Department of Insurance Complaint Form Senator Buddy Carter Named UGA’s Alumnus of the Year
5 12 14 18 18 22 30 30
NPLC Nomination Form Pharm PAC Contributors Pharm PAC Contribution Card GPhA New Members GPhA Website Tutorial 2012 Award Nomination Form GPhA Board of Directors Masthead
Advertisers 2 10 13 13 17 18 19 20 21 23 23 32
Pharmacists Mutual Companies Frances Cullen, PC Financial Network Associates Melvin Goldstein, P.C. AIP Barbara Cole, Attorney at Law GPhA Convention Information Girls of Pharmacy Leadership Weekend GPhA Workers’ Compensation Logix, Inc. Winter CPE Ski Trip UBS
CPE Opportunity: Head Lice Infestations: Counseling Your Patients
COLUMNS
4 6
President’s Message
For an up-to-date calendar of events, log onto
Editorial
The Georgia Pharmacy Journal
www.gpha.org. 3
December 2011
PRESIDENT’S MESSAGE L. Jack Dunn, Jr., R.Ph. GPhA President
You Can be a VIP in 2012
s the New Year approaches, each pharmacist must determine what kind of pharmacist he or she is going to represent for the New Year. As a pharmacist of this state, are you going to be apathetic or are you going to be an advocate for your profession? Last year the pharmacists of this state were instrumental in the passing of three bills that were vital to our profession. The drug-monitoring bill will give the pharmacist a mechanism to help retard potential abuse of controlled drugs. The second bill, the immunization bill, gave pharmacists the opportunity to further develop the wellness programs in our state by allowing the pharmacist to give flu shots under the protocol of a doctor. The third bill was the annual drug bill. This bill established pseudoephedrine as a schedule V exempt narcotic drug to help impede the methamphetamine labs. As pharmacists, we are always proud of the bills that are passed in the legislature that promote our profession. We also need to be aware of all the bills that were detrimental to our profession that were halted due to our lobbying efforts. An example of aone such bill was adding sales tax to prescription drug costs.
your representatives. It is imperative that our voices be heard so that our profession can continue to grow and prosper.
A
From all the GPhA executive committee, we want to wish everyone a safe and happy holiday season.
As pharmacists, we must be aware of the bills in the legislature that impact our profession. The pharmacists in this state MUST be involved with advocacy. We have set the bar high for our profession; therefore, we must remain involved in all issues that will arise that restrict or could make our profession less valuable. February 9, 2012, is VIP DAY at the Capital. We want you to be a VIP, “a very important pharmacist,” and contact your representative and senator for next year’s meeting. Please, do not hesitate in establishing that important dialogue between you and The Georgia Pharmacy Journal
4
December 2011
Would You Like to Help Jump Start the Future of a Pharmacy Leader? The Georgia Pharmacy Foundation New Practitioner Leadership Conference will expose the attendee to the development of personal and professional leadership skills. This could be a decisive step in the leadership career of a young pharmacy professional. Three Top Desired Qualities of Nominees 1. Leadership potential 2. Active involvement in student activities and or professional organizations 3. Activity in community organizations Nominees may not have practiced more than 10 years in pharmacy. The 2012 class will not exceed 20 in total. Conference Location: Legacy Lodge & Conference Center Lake Lanier Islands, GA Conference Dates: April 13-15, 2012 If there is a person you would like to nominate, please complete the form below and return it by January 23, 2012.
Nominee’s Name: _________________________________________ Address: _______________________________________________ ______________________________________________________ Phone: ________________________________________________ Email: _________________________________________________ Nominator’s Name: ________________________________________ Address:________________________________________________ ______________________________________________________ Phone: ________________________________________________ Email: _________________________________________________ Return to : Georgia Pharmacy Foundation 50 Lenox Pointe Atlanta, GA 30324 Or Fax 404-237-8435 If you need additional information contact Regena Banks at 404-237-8435 or email rbanks@gpha.org. The Georgia Pharmacy Journal
5
December 2011
EXECUTIVE VICE PRESIDENT’S EDITORIAL Jim Bracewell Executive Vice President / CEO
Quotes, Quips and Interesting Thoughts ome years ago, on a whim, I began to keep a list of quotes, quips, and interesting thoughts that I had picked up from friends, various articles, and some observations of my own. I shared my list with my two sons, who were not as impressed because they are still young enough to know more than their Dad. I, however, was undeterred by their critique of my list. This month I am now using the platform you have afforded me as your Executive Vice President to share these “words of wisdom.” You, of course, like my sons, are free to express your comments at jbracewell@gpha.org or you can also share with me your “words of wisdom” to live by. All feedback is welcomed.
It is easier to grow older than it is to grow wiser.
S
No pressure – no diamonds. Don’t wrestle with a pig, you will get dirty and the pig loves it. Failure is an event, not a person. Help me to be the man my dog thinks I am. Don’t pick up pennies in front of a steam roller. There is no saturation of education, new knowledge comes each day. The best way to predict the future is to create it. None of us is as smart as all of us. Destiny is not a chance, it is a choice.
Time and tide wait for no man and neither does Delta.
Friends go and come but enemies accumulate.
Men are like fine wine; they start out as grapes and it is up to some woman to stomp on them until they turn into something acceptable to have dinner with.
Feedback is the breakfast of champions. I wish you and your family a glorious and happy holiday season and a most prosperous New Year. Thank you for the opportunity to serve what I believe is the best professional association in the world, GPhA.
There is no key to happiness, the door is always open. A grudge is a very heavy thing to carry. Growing old is inevitable, growing up is optional.
Jim
You should not confuse your career with your life.
PS: I thank everyone from whom I borrowed a quote or thought. I failed to keep a list of the sources.
A consultant is someone who takes your watch off your wrist to tell you the time. You should never lick a steak knife. Silence is often misinterpreted but never misquoted. He who dies with the most toys is still dead. With a map you can go where others have been, with a compass you can go wherever you want. Time seals, time heals, and time reveals all things. The juice is often not worth the squeeze. The Georgia Pharmacy Journal
6
December 2011
Member News
Laird Miller, R.Ph., Appointed to the Georgia State Board of Pharmacy aird Miller, R.Ph., has been a pharmacist for over three decades. In that time, he has seen and experienced many changes in the profession, and he has served in positions that allowed him to have some influence over those changes. Recently, Governor Nathan Deal appointed Laird to serve on the Georgia State Board of Pharmacy, fulfilling the culmination of a lifelong commitment to pharmacy.
L
We asked Laird to share some thoughts about his board appointment and what it means to him and what he hopes to accomplish through the board. Following are some excerpts of his comments. “I’ve said for years that I feel each pharmacist needs to put something back into their profession. I’ve often written that the difference in a job and a profession is that a profession offers the opportunity to be part of a dynamic group of like-minded people, not just someone who punches a clock for forty years then retires. For those who embrace this concept the rewards are great. It’s like saving money. The more you put in, the more you’ll get out. A profession demands that you give something back, to ensure the viability and prosperity for those who come after you. To me, appointment to the State Board is the crown jewel of service within our profession. It’s a huge honor to receive this appointment, but it’s also a huge responsibility.
sent in my packet of information that each candidate supplies, I included a cover letter saying that I thought great changes are coming in the next three to five years, and that I wanted to be a part of molding pharmacy’s place in that new system, so that our profession is empowered to make Georgians healthier and our profession stronger. I hope that my appointment to the board came about because the administration agrees that all health care professions need to work harder to provide their members with the tools we need to actually improve the quality of life for our citizens. We need to empower people with great knowledge and skills to put their education and their talents to work.”
“Feeling as I do about serving one’s profession, and being able to look in the mirror and see that I am not thirty anymore, I decided that now was the time for me to step up and really serve my profession. I am fortunate enough to have known Governor Deal for years, so I let it be known that I had a desire to serve in this capacity, and the Governor and his staff were kind enough to consider me, and ultimately select me, from among several very qualified candidates. I received support from many pharmacists across the State, from legislators, and from my GPhA and NCPA contacts. I like to think I was selected because I have a real passion for this profession, and over the years, the Governor and his staff have come to know that I believe strongly in what pharmacy can offer. When I
The Georgia Pharmacy Journal
As chairman of GPhA’s Academy of Independent Pharmacy (AIP) for eleven years, Laird was instrumental in fostering changes in pharmacy in Georgia. He has always been a forwardthinker and realizes that pharmacy must adapt to the ongoing changes in the healthcare delivery system and recognizes the contributions that young pharmacists will make to the profession. “Pharmacy, as a profession, has really evolved in the last thirty years,” said Laird. “To me this is good. Much more is expected of us as providers of healthcare. Each generation that graduates
7
December 2011
seems to take the profession to a higher plane of competency and ability. We old pharmacists are good, but the young ones have the skills and the confidence to step up and take their rightful place in this new era of delivery of health services, including pharmacy care. They will take our profession to new heights.”
example, for inspiring me stay involved.” Involvement has been a hallmark of Laird’s career. Not only did he serve as chairman of AIP for eleven years, which also garnered a seat on the GPhA board of directors, but he has also remained on the board of directors of AIP. Laird has served on several of GPhA’s standing committees, and never hesitates to lend a hand when the association needs volunteers. He is a faithful attendee of GPhA’s annual convention and other meetings throughout the year. Laird also serves on the legislative steering committee for the National Community Pharmacists Association (NCPA).
With all the good that can be accomplished, however, Laird also emphasizes that work remains to make pharmacy competitive in the future. He says, “On the downside, the reimbursement issues and the financial stresses force pharmacists to limit time improving outcomes and make it difficult to be able to meet the financial obligations of running a profitable business. Whether we work for others or for ourselves, and across the spectrum of practice settings, we have to deliver the best care we can in a limited amount of time, because for the most part, payers have yet to recognize the value our profession can play in disease management. Prevention and management are concepts still largely foreign to most payers, and unfortunately our compensation is still often tied to the product, and not the service.”
The Georgia Pharmacy Association has recognized Laird’s dedication and commitment to his profession, awarding him the Larry L. Braden Meritorious Service award in 2006, one of the association’s highest honors. The AIP has also recognized Laird, presenting him with the Georgia Independent Pharmacist of the Year award in 2004. He is also the recipient of the University of Georgia’s College of Pharmacy Distinguished Alumni award, presented in 2003, as well as Pfizer’s Visionary Leadership award, also presented in 2003.
And he’s not just spouting rhetoric. As a co-owner of two pharmacies, Medical Park Pharmacy in Gainesville and Jennings Pharmacy in Demorest, Laird has helped to institute services in his pharmacies that seek to serve the patient beyond providing prescriptions: medication therapy management, diabetes training and counseling, assisted living packaging and pediatric compounding.
A graduate of UGA’s College of Pharmacy, Laird has not only been passionate about his profession, but also about his Bulldogs, and can be found most Saturdays in the fall either cursing or cheering them on to victory—usually in the pharmacy with a television in the background.
Laird hasn’t always been an independent pharmacy owner, however, so he is able to understand issues affecting other practice settings as well. As a new pharmacy graduate, Laird’s first job was as an employee pharmacist at an independent pharmacy in Savannah, and later at Revco, a large chain pharmacy. After Revco transferred him to Gainesville, he and his partner and friend, Butch Bowling, decided to open a pharmacy and Medical Park Pharmacy was born, 28 years ago. In early 2011, Butch and Laird, along with Tim Short, bought Jennings Pharmacy. In May, Medical Park Pharmacy moved to a new, larger building. These pharmacist-owners believe the secret to success is the ability to adapt to the ever evolving profession and their dedication to their patients.
Laird’s wish list for the future of pharmacy is extensive, but he believes the possibilities are endless. “I believe that pharmacy, especially in the community setting, needs to step up and take our rightful place on the healthcare team. I believe we have an identity crisis among outsiders who have to deal with us. On the one hand, they know we are knowledgeable, but on the other they’re caught up in the vision of us as providers of product. WE have to demand recognition for the services we can provide. We need to promote the clinical side of our training, as we do the product side. I have no idea what the battle over national health insurance will result in, but I believe that there will be a new paradigm in health care delivery, and this may be our best opportunity to step up and show what our profession can do.
As most successful leaders do, Laird attributes much of his accomplishments to great mentors, who taught him to work hard and to stay involved in the leadership aspect of his chosen profession. He says, “I always think of Bill Little of Athens, my childhood pharmacist, who told me if I worked hard, some day I might find myself making 20-25k per year (this was in the 60s). And I credit Larry Braden for encouraging me to get involved in pharmacy and GPhA; Joe Mengoni for pulling me off the sidelines and encouraging me to step up when AIP was looking for new leadership; and Jeff Lurey, who leads by
“Everyone wants better outcomes for less money. The old system of treating the results of bad health, without enough attention to the causes, is where we need to step in and be problem solvers. One of the things that impresses me about our new Governor is his recognition that four or five disease states consume much of our resources. Diseases like diabetes, high blood pressure, asthma, and the cholesterol related conditions, are opportunities for pharmacy. We see these patients more often than any other member of their health team. In many cases we know them
The Georgia Pharmacy Journal
8
December 2011
better than other health providers. We can, as the Asheville project and our own Dublin and Dalton studies have shown, improve patient health, and reduce total health expenditures in the process. We need to step up and seize the day, and proliferate pharmacy care. Funds are limited right now, and governments struggle with how to pay for increasing health costs. I believe that our state is going to be open to new ideas, and we need to come up with some new ways to achieve success.”
to be sure that as therapies or conditions change, the patient’s medication regimens are being reviewed and if need be, updated. Our board, just like everyone from legislators to that smallest company buying health insurance for its employees, needs to do everything we can to make sure pharmacists are able to do what they spent years studying and training to do— helping the complete healthcare team manage patients. “I am very excited to be a part of the Board of Pharmacy. I have a lot to learn being the ‘new guy.’ Several of the current members have already reached out to try to get me up to speed as I prepare to attend my first meeting. I’ve known many of these board members for years, and have great respect for them and what they do on behalf of the citizens of Georgia and for pharmacists in all practice settings. I hope I can live up to the high standard of professionalism that they exhibit each time they gather on our behalf.”
As a new member of the State Board of Pharmacy, Laird realizes he has much to learn on his latest venture, but his hopes are that the board will assist in ensuring the viability of the pharmacy profession in Georgia. He says, “I hope in the coming years we will see pharmacists becoming more central in patient care. Using technology to share information in the time-tested triad of patient, physician and pharmacist can yield better outcomes, and we need to make that happen. We need to be in on the development phase of ACOs and other patient care structures. As we develop the patient care side of pharmacy, we need to keep in mind that central to our profession will always be the mentality of the ‘right drug for the right patient at the right time, used in the right way.’ MTM and adherence are a great way to further the cause. Adherence is the first step in improving outcomes, and we don’t need new rules or regulations or laws to make it happen. MTM is an ongoing way
We have no doubt that Laird will exemplify that standard of professionalism as a member of the State Board of Pharmacy, just as he has in every other area of the profession. The Georgia Pharmacy Association wishes Laird much success and offers sincerest appreciation for his commitment to pharmacy.
Board of Pharmacy News
Board of Pharmacy President’s Message: Comment on the Pharmacist in Charge Responsibilities Bill Prather, R.Ph. President, Georgia Board of Pharmacy a. Code 26-4-41 says “(29) ‘Pharmacist in Charge’ means a pharmacist currently licensed in this state who accepts responsibility for the operation of a pharmacy in conformance with all laws and rules pertinent to the practice of pharmacy and the distribution of drugs and who is personally in full and actual charge of such pharmacy and personnel.”
that your pharmacy is “in conformance with all laws and rules pertinent to the practice of pharmacy and the distribution of drugs.”
G
If you allow overbearing supervisors, managers, owners, etc. to put you in a bad position concerning Georgia laws and board rules, remember as PIC your license is the one on the line. In these days of “pill mills” and other schemes to distribute schedule narcotics in an unethical manner, the board will be looking very, very closely at what the PIC knew or should have known. If you have questions on this or other pharmacy issues that come under board purvue please do not hesitate to contact the board office at 478-207-2440.
The Georgia Board of Pharmacy has become aware that many pharmacists in Georgia are unaware of the responsibilities that are involved with being “PIC.” As PIC you should be aware that the stance of the board is that by definition, you either knew or should have known about problems that occur in the pharmacy, whether they be of a legal or ethical nature. Why? Because it is your job and your responsibility as PIC. Take a moment and reread the legal definition above. It is your job to put into place whatever checks and balances you deem necessary to be sure
The Georgia Pharmacy Journal
Phone is OK but email is better.
9
December 2011
GPhA NEWS
GPhA Members Meet with Their Congressional Delegates Recently, Congressman Phil Gingrey stopped by Lacey Drugs in Acworth, GA, to see first-hand what goes on in a pharmacy. Congressman Rob Woodall visited with employees and customers of Duluth Rexall during a recent trip home from DC.
s members of Congress are coming home for the holidays or any other time, they are making time to visit with their constituents and GPhA is working to make sure that they are visiting with Georgia pharmacists to learn the truth about PBMs and how Congress can help with these problems.
A
If you are interested in helping host or meet with your Congressman contact Andy Freeman at afreeman@gpha.org.
At left: Larry Braden, R.Ph., discusses issues of importance with Congressman Phil Gingrey and Ben Flanagan, R.Ph., during a recent stop by Congressman Gingrey at Lacey Drug in Acworth, GA.
Your license is your livelihood. Protect it!
Frances Cullen PC Professional Licensing Attorney (404) 806-6771 6771 phone (404) 806-7319 fax www.francullen.com
Above: Lynda D. Alley, R.Ph., welcomes Congressman Rob Woodall to her pharmacy, Duluth Rexall.
The Georgia Pharmacy Journal
10
Practice devoted solely to the representation of licensed professionals Over 20 years of experience with licensed professionals, Georgia Boards, GDNA & DEA Former Assista tant nt District Attorney Former Assistant Attorney General Criminal & License Defense
December 2011
2012 VIP Day at the Capitol Save-the-Date
Notice to all Pharmacists and Pharmacy Technicians: All members and potential members are welcome to attend. Register online today at www.gpha.org or by calling 404-231-5074. When: Thursday, February 9, 2012 Where: The Georgia Railroad Freight Depot - Freight Room 65 Martin Luther King, Jr., Drive, S.E. Atlanta, Georgia 30334 Schedule of Events: *NOTE: This schedule is tentative. We will continue to update you as it becomes more permanent. 6:00 a.m.: Registration & Exhibit Hall Opens with Coffee 6:30 a.m.: GPhA Attendee Orientation 7:00 a.m.: Breakfast with Your Legislator(s) 8:00 a.m.: Presentation of GPhA Legislator of the Year Award & Closing Remarks 9:15 a.m.: Group Photo on the Capitol Steps 10:00 a.m.: Tour the Georgia Capitol Building Special GPhA Recognitions to be made by Georgia House and Senate Members Wear your white coat to make our presence more effective! Parking directions available online. If you have any questions, please contact Sarah Bigorowski at sbigorowski@gpha.org or 404-418-8126.
The Georgia Pharmacy Journal
11
December 2011
Current Pharm PAC Members Titanium Level ($2400 minimum pledge) T.M. Bridges, R.Ph. Ben Cravey, R.Ph. Michael E. Farmer, R.Ph. David B. Graves, R.Ph. Raymond G Hickman, R.Ph. Robert A. Ledbetter, R.Ph. Jeffrey L. Lurey, R.Ph. Marvin O. McCord, R.Ph. Scott Meeks, R.Ph. Judson Mullican, R.Ph. Mark Parris, Pharm.D. Fred F. Sharpe, R.Ph. Jeff Sikes, R.Ph. Dean Stone, R.Ph., CDM Platinum Level ($1200 minimum pledge) Barry M. Bilbro, R.Ph. Robert Bowles, Jr., R.Ph., CDM, Cfts Jim R. Bracewell Larry L. Braden, R.Ph. William G. Cagle, R.Ph. Hugh M. Chancy, R.Ph. Keith E. Chapman, R.Ph. Dale M. Coker, R.Ph., FIACP Jack Dunn, Jr. R.Ph. Neal Florence, R.Ph. Andy Freeman Martin T. Grizzard, R.Ph. Robert M. Hatton, Pharm.D. Ted Hunt, R.Ph. Alan M. Jones, R.Ph. Ira Katz, R.Ph. Hal M. Kemp, Pharm.D. J. Thomas Lindsey, R.Ph. Brandall S. Lovvorn, Pharm.D. Eddie M. Madden, R.Ph. Jonathan Marquess, Pharm.D., CDE, CPT Pam Marquess, Pharm.D.
Kenneth A. McCarthy, R.Ph. Drew Miller, R.Ph., CDM Laird Miller, R.Ph. Cynthia K. Moon Jay Mosley, R.Ph. Allen Partridge, R.Ph. Houston Lee Rogers, Pharm.D., CDM Tim Short, R.Ph. Danny Toth, R.Ph. Tommy Whitworth, R.Ph., CDM Gold Level ($600 minimum pledge) James Bartling, Pharm.D., ADC, CACII Larry Batten, R.Ph. Liza G. Chapman, Pharm.D. Mahlon Davidson, R.Ph., CDM James Gordon Elrod, R.Ph. Kevin M. Florence, Pharm.D. Robert B. Moody, R.Ph. Sherri S. Moody, Pharm.D. William A. Moye, R.Ph. Jeffrey Grady Richardson, R.Ph. Andy Rogers, R.Ph. Daniel C. Royal, Jr., R.Ph. Michael T. Tarrant Silver Level ($300 minimum pledge) Renee D. Adamson, Pharm.D. Chandler M. Conner, Pharm.D. Terry Dunn, R.Ph. Marshall L. Frost, Pharm.D. Johnathan Wyndell Hamrick, Pharm.D. Michael O. Iteogu, Pharm.D. James E. Jordan, Pharm.D. Willie O. Latch, R.Ph. W. Lon Lewis, R.Ph. Kalen Porter Manasco, Pharm.D. Michael L. McGee, R.Ph. William J. McLeer, R.Ph.
Albert B. Nichols, R.Ph. Richard Noell, R.Ph. William Lee Prather, R.Ph. Sara W. Reece, Pharm.D., BC-ADM, CDE Edward Franklin Reynolds, R.Ph. Sukhmani Kaur Sarao, Pharm.D. David J. Simpson, R.Ph. James N. Thomas, R.Ph. Alex S, Tucker, Pharm.D. Flynn W. Warren, M.S., R.Ph. William T. Wolfe, R.Ph. Bronze Level ($150 minimum pledge) Monica M. Ali-Warren, R.Ph. Fred W. Barber, R.Ph. John R. Bowen, R.Ph. Michael A. Crooks, Pharm.D. William Crowley, R.Ph. Charles Alan Earnest, R.Ph. Randall W. Ellison, R.Ph. Mary Ashley Faulk, Pharm.D. Amanda R. Gaddy, R.Ph. Ed Kalvelage John D. Kalvelage Steve D. Kalvelage Marsha C. Kapiloff, R.Ph. Joshua D. Kinsey, Pharm.D. Brenton Lake, R.Ph. William E. Lee, R.Ph. Michael Lewis, Pharm.D. Ashley Sherwood London Charles Robert Lott, R.Ph. Max A. Mason, R.Ph. Amanda McCall, Pharm.D. Susan W. McLeer, R.Ph. Mary P. Meredith, R.Ph. Rose Pinkstaff, R.Ph. Leslie Ernest Ponder, R.Ph. Kristy Lanford Pucylowski, Pharm.D. Leonard Franklin Reynolds, R.Ph.
If you made a gift or pledge to Pharm PAC in the last 12 months and your name does not appear above, please contact Andy Freeman at afreeman@gpha.org or 404-419-8118. Donations made to Pharm PAC are not considered charitable donations and are not tax deductible. The Georgia Pharmacy Journal
12
December 2011
Pharm PAC Contributors’ List Continued Laurence Neil Ryan, Pharm.D. Richard Brian Smith, R.Ph. Charles Storey, III, R.Ph. Archie Thompson, Jr., R.Ph. Marion J. Wainright, R.Ph. Jackie White Carrie-Anne Wilson Steve Wilson, Pharm.D. Sharon B. Zerillo, R.Ph.
Your financial plan may need another look. This ad entitles you to:
A CUP OF COFFEE, AND
A SECOND OPINION. I would be happy to give you my opinion – without obligation. And the coffee is on me.
Members (no minimum pledge) John J. Anderson, Sr., R.Ph. Mark T. Barnes, R.Ph. Henry Cobb, III, R.Ph., CDM Carleton C. Crabill, R.Ph. Wendy A. Dorminey, Pharm.D., CDM David M. Eldridge, Pharm.D. James Fetterman, Jr., Pharm.D. Charles C. Gass, R.Ph. Christina Gonzalez Christopher Gurley, Pharm.D. Ann R. Hansford, R.Ph. Joel Andrew Hill, R.Ph. Carey B. Jones, R.Ph. Susan M Kane, R.Ph. Emily Kraus Carroll Mack Lowrey, R.Ph. Tracie Lunde, Pharm.D. Roy W. McClendon, R.Ph.
MICHAEL T. TARRANT t *OEFQFOEFOU 'JOBODJBM 1MBOOFS TJODF t 'PDVTJOH PO 1IBSNBDZ TJODF t 1IBSN1"$ 4VQQPSUFS t 4QFBLFS "VUIPS
Financial Network Associates 1117 Perimeter Center West, Suite N-307 "UMBOUB (" t '/"QMBOOFST DPN t NJLF!'/"QMBOOFST DPN
Securities, certain advisory services and insurance products are offered through INVEST Financial Corporation */7&45 t Member FINRA/SIPC, and affiliated insurance agencies. INVEST is not affiliated with Financial Network Associates, Inc. INVEST does not provide tax or legal advice. Other advisory services may be offered through Financial Network Associates, Inc., a registered investment advisor. i.ad.9343.0000.00000
.FMWJO . (PMETUFJO 1 $ " 5 5 0 3 / &@@@ : "5 - "8 3PTXFMM 4USFFU .BSJFUUB (FPSHJB
Tom E. Menighan, R.Ph., MBA, ScD, FAPhA
Darby R. Norman, R.Ph. Christopher Brown Painter, R.Ph. Steve Gordon Perry, R.Ph. Victor Serafy, R.Ph. James E. Stowe, R.Ph. James R. Strickland, R.Ph. Celia M. Taylor, Pharm.D. Leonard E. Templeton, R.Ph. Heatwole C. Thomas, R.Ph. Erica Lynn Veasley, R.Ph. William D. Whitaker, R.Ph. Elizabeth Williams, R.Ph. Jonathon Williams, Pharm.D.
5FMFQIPOF 'BY XXX NFMWJONHPMETUFJO DPN
„ 1SJWBUF QSBDUJUJPOFS XJUI BO FNQIBTJT PO SFQSFTFOUJOH IFBMUIDBSF QSPGFTTJPOBMT JO BENJOJTUSBUJWF DBTFT BT XFMM BT PUIFS MFHBM NBUUFST „ 'PSNFS "TTJTUBOU "UUPSOFZ (FOFSBM GPS UIF 4UBUF PG (FPSHJB BOE $PVOTFM GPS QSPGFTTJPOBM MJDFOTJOH CPBSET JODMVEJOH UIF (FPSHJB #PBSE PG 1IBSNBDZ BOE UIF (FPSHJB %SVHT BOE /BSDPUJDT "HFODZ „ 'PSNFS "ENJOJTUSBUJWF -BX +VEHF GPS UIF 0GGJDF PG 4UBUF "ENJOJTUSBUJWF )FBSJOHT
The Georgia Pharmacy Journal
13
December 2011
Join Pharm PAC Today! Pharm PAC is GPhA's Political Action Committee, providing the resources for the association to lobby and advocate on behalf pharmacy. GPhA leads the way in influencing pharmacy-related legislation in Georgia. There are two ways in which to become a member. Once you have completed this form please mail it to Pharm PAC, 50 Lenox Pointe, NE, Atlanta, GA 30324. Name: __________________________________________________ Address: _________________________________________________ Phone#: _________________________________________________ Email Address: ____________________________________________
Circle the Level in which you would like to participate with a monthly contribution:
Titanium ($200/month) Platinum ($100/month) Silver ($25/month)
Gold ($50/month)
Bronze ($12.50/month)
Or If you wish to make a one time contribution write the amount you wish to contribute here: _____________________________________________ If you are making a monthly contribution you will be contacted for additional information to set up your monthly contribution. If you are making a one time payment please mail your check in with your form.
The Georgia Pharmacy Journal
14
December 2011
A Community Pharmacists Alert Are your patients having problems with their PBMs? Earlier this year, the Department of Insurance implemented rules and regulations overseeing Pharmacy Benefit Managers in Georgia. If a patient comes into your pharmacy with problems involving PBM’s, they now have an opportunity to complain about the issue. Please give them this form to complete and send in to the Insurance Commissioner’s Office. If there is not sufficient room on the form they may attach a separate page explaining what problem they are having with their PBM. Here are two examples of complaints that have been reported to GPhA: I am forced to use mail order. I have not received my medicines and I am out of my prescription and my health is being harmed. My insurance PBM requires a prior authorization for my medication, so my pharmacist could not fill my prescription. I must come back to get my medicine after the PBM has approved my doctor’s prescription for my medicine. You have asked for help for your patients problems with PBMs interfering with good patient care. Now is there is a place to voice those complaints rather than just to you at the pharmacy counter. Change only happens with PBMS with a level of noise is loud enough to get their attention. Help your patients get the can of healthcare they need and deserve. Please use the complaint form attached when mailing or faxing their insurance issues to the Department. • Clearly state the full name of the PBM against whom the patient is lodging their complaint. (Do not abbreviate the company’s name as this may cause delays in identifying the correct company.) • The completed form must be signed and dated. • Attach copies of pertinent documents to support their complaint. • Have your patient keep the originals for their records and only send copies to DOI. • Mail or fax (not both) the completed form and all documents to: Mailing address: Georgia Insurance Commissioner’s Office Consumer Services Division 2 Martin Luther King, Jr., Drive Suite 716, West Tower Atlanta, GA 30334 Fax: (404) 657-8542 Upon receipt of their complaint, a case will be created and assigned to an investigator in the Consumer Services Division. Your patient will receive an acknowledgement letter stating their case number and the name of their investigator. Once a response is received from the PBM, the investigator will notify your patient with a written response. Please allow adequate time for the process.
The Georgia Pharmacy Journal
15
December 2011
OFFICE OF INSURANCE AND SAFETY FIRE COMMISSIONER COMMISSIONER OF INSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER•COMPTROLLER GENERAL
Ralph T. Hudgens, Commissioner 2 Martin Luther King Jr., Dr., Suite 716, West Tower, Atlanta, GA 30334 Phone: 404-656-2070 â—Š TDD: 404-656-4031 â—Š Fax: 404-657-8542 E-mail: Consumer@oci.ga.gov CONSUMER COMPLAINT FORM
www.oci.ga.gov
CONSUMER SERVICES
GID-CS-CF-1 2&7
Type of Insurance: Automobile
Homeowners
Life & Annuity
x
Accident & Health
Commercial
Miscellaneous
FOR OFFICIAL USE ONLY: FIELD INVESTIGA503 INCIDENT GROUP:
OPEN / CLOSED DATE SOURCE: DISPOSITION:
CASE#: REASON: NAIC#:
TYPE:
PLEASE TYPE OR PRINT LEGIBLY IN BLUE OR BLACK INK INSURED INFORMATION
COMPLAINANT INFORMATION Mr.
Mrs.
Ms.
Dr.
___________
NAME: ________________________________________
ADDRESS: _____________________________________ CITY ________________STATE ___________ ZIP ____________ COUNTY: ________________________________________________
(If different from complainant) Mr.
Mrs.
Ms.
Dr.
___________
NAME: ___________________________________________
ADDRESS: ____________________________________________________ CITY ________________STATE ___________ ZIP ________________ COUNTY: ____________________________________________________
HOME PHONE: ___________________________________________ HOME PHONE: _______________________________________________ WORK PHONE: ___________________________________________
WORK PHONE: _______________________________________________ CELL PHONE: ___________________________________________ CELL PHONE: _______________________________________________
EMAIL: __________________________________________________ EMAIL: ______________________________________________________
MY COMPLAINT IS AGAINST THE FOLLOWING INSURANCE COMPANY OR THIRD PARTY ADMINISTRATOR:
AGENCY/ADJUSTER INFORMATION AGENCY NAME: ______________________________________________
COMPANY NAME: ________________________________________ TELEPHONE: _____________________________________________ POLICY/ID NO: ____________________________________________ CLAIM NO.: ______________________________________________
AGENT/ADJUSTER NAME: _____________________________________ ______________________________________________________________ ADDRESS: ___________________________________________________
DATE OF LOSS: __________________________________________
CITY ________________STATE ___________ ZIP _______________
POLICY PERIOD: _________________________________________
PHONE: ______________________________________________________
Briefly describe your issue and clearly state your complaint. Attach supporting documents.
Under rule 120-2-97-.06 of the Department of Insurance I would like to make the following complaint on a Pharmacy Benefit ____________________________________________________________________________________________________________ Manager licensed by the state of Georgia. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Authorization & Release: By signing below, I hereby authorize Commissioner Ralph T. Hudgens and members of his staff to receive and disclose such information, including protected health or financial information, as they may deem necessary and appropriate for purposes of making inquiries into the subject matter contained herein and all matters related thereto. I also specifically authorize the insurer, agent, third party administrator, or other party to release any and all information necessary for the Office of Insurance and Safety Fire Commissioner to investigate the matter contained herein. I further acknowledge that the information contained in this form is accurate to the best of my knowledge. A copy of this request may be shared with any/all parties involved. __________________________________ Date
_____________________________________________________ Signature
This office does not discriminate by race, color, national origin, sex religion, age or disability in employment, programs or services. Disabled persons needing this document in another format can contact the ADA Coordinator for this office at: 2 Martin Luther King Jr. Dr., Suite 620, Atlanta, GA 30334 - Phone 404-656-2056
Page 2 of 2
Reset Form
&
! "#!$" % '( (
GPhA MEMBER NEWS
Welcome to GPhA! The following is a list of new members who have joined Georgia’s premier professional pharmacy association! If you or someone you know would like to join GPhA go to www.gpha.org and click “Join” under the GPhA logo. Individual Pharmacist Members
New Graduate Pharmacist Members
Krystal Staples Bugden, Pharm.D., Newnan Casandra L. Roberts, Pharm.D., Evans Michael Lewis, Pharm.D., Saint Simons Island Janet Spekter, Pharm.D., McDonough Anyasor Vincent Ehule, R.Ph., Riverdale Nancy Martin, R.Ph., Pine Mountain
Travis A. Waldrep, Pharm.D., Pelham Maame K. Dontoh, Pharm.D., Augusta
Pharmacy School Student Members Asha Elizabeth Varghese, Lawrenceville Jason Scott Bauer, Athens Mindy Daniel, Augusta
BARBARA COLE ATTORNEY AT LAW, LLC 539 Green Street, NW Gainesville, GA 30501 678-971-9088 email bcoleattorney@gmail.com www.barbaracoleattorney.com
GPhA WEBSITE NEWS
GPhA Website Tutorial GPhA understands that not everyone has the same level of comfort on the Internet. As a result, GPhA has created an online tutorial on how to use the GPhA website. It features howto’s and tools that you might not be aware of. If you are interested in viewing the GPhA Website Tutorial go to www.gpha.org and click on “GPhA Website Orientation Video.” It takes a moment to load, but will start automatically.
All Aspects of Representation of Health Care Professionals Licensure Medicare Administrative Medicaid Criminal Bankruptcy Compliance State Bar Health Law Section Former Chief Magistrate Judge
We hope you enjoy this brief video, and learn about the tools available to you. The Georgia Pharmacy Journal
18
December 2011
Please save the date for our Georgia Pharmacy Association 137th Annual Convention! Hilton Head Marriott Resort & Spa, Hilton Head Island, SC July 7-11, 2012 GPhA Room Rates: Island View $199 Ocean View $219 Ocean Front $239 To make reservation, call 1-800-228-9290, and mention that you are in the Georgia Pharmacy Association Room Block. The Georgia Pharmacy Journal
19
December 2011
Gather your girlfriends for a weekend of fun, facts, and facials! Register today to ensure your spot at the 2012 Southeastern “Girls of Pharmacyâ€? Leadership Weekend. W eekend. Full registration includes: CE programming, event materials, two breakfasts, and one dinner reception with included drink ticket. Extra reception separately.. tickets can be purchased separately New for 2012! We We have two optional events that you can sign up for with your registration. On Saturday we’ll be having a special cooking demonstration and Inn’s Tickets lunch with one of the Grove Park Inn’ s award-winning chefs. T ickets for this lunch and demo are $60. On Saturday evening we will be hosting a “Sips and Sweetsâ€? wine and dessert pairing event. The cost is $45 per person. Rooms are available at the Grove Park Inn for $144 per night. Call (800) 438today.. 5800 to book your room today You Spa appointments are available for reservation through the Grove Park Inn. Y ou SCPhA’s must be registered for the event to make reservations through SCPhA ’s reserved appointment times. The Spa will offer offer SC Pharmacy Association participants Treatments a 20% discount off off any Massage, Body T reatments and/or Facials. This offer offer will be valid January 20, 2012 - January 22, 2012. This offer offer is not valid on Nail Treatments T reatments and may not be combined with other discounts or packages. Call the today.. spa directly at 828-253-0299 to make your reservations today For questions, please call 803.354.9977. South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is eligible for ACPE FUHGLW VHH ÂżQDO &3( DFWLYLW\ DQQRXQFHPHQW IRU VSHFLÂżF GHWDLOV
1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Ć&#x2018; 53K Ć&#x2018; 7HFKQLFLDQ /LF 5HJ BBBBBB 1DPHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Ć&#x2018; 53K Ć&#x2018; 7HFKQLFLDQ /LF 5HJ BBBBBB NABP E ID ____________________________________ Birth Day (DD)________ Birth Month (MM)__________ Address_____________________________________________________________________________ City, City, State, Zip________________________________________________________________________ Phone__________________ Email______________________________________________________ Registration Fees (Guest registrations DO NOT include CE credit but do cover meal function costs): Ć&#x2018; )XOO 3DUWLFLSDWLQJ 6WDWH $VVRFLDWLRQ 0HPEHU Z &( Ć&#x2018; )XOO 3DUWLFLSDWLQJ 6WDWH $VVRFLDWLRQ 0HPEHU Z &( 6WDWH Ć&#x2018; *$ Ć&#x2018; .< Ć&#x2018; 1& Ć&#x2018; 6& Ć&#x2018; 71 Ć&#x2018; 9$ 6WDWH Ć&#x2018; *$ Ć&#x2018; .< 6WDWH Ć&#x2018; *$ Ć&#x2018; .< Ć&#x2018; 1& Ć&#x2018; 6& Ć&#x2018; Ć&#x2018; .< Ć&#x2018; 1& Ć&#x2018; 6& Ć&#x2018; 71 Ć&#x2018; 9 71 Ć&#x2018; 9$ $ Ć&#x2018; )XOO 1RQ 0HPEHU Z &( Ć&#x2018; )XOO 1RQ 0HPEHU Z &( Ć&#x2018; )XOO *XHVW UDWH QR &( LQFOXGHV DOO PHDOV Ć&#x2018; )XOO *XHVW UDWH QR &( LQFOXGHV DOO PHDOV *XHVW RI BBBBBBBBBBBBBBBBBBBBBBBBBBBB Ć&#x2018; $GGLWLRQDO )ULGD\ 1LJKW 'LQQHU 5HFHSWLRQ 7LFNHWV HDFK 4W\ BBBBBBB [ BBBBBB Ć&#x2018; $GGLWLRQDO )ULGD\ 1LJKW 'LQQHU 5HFHSWLRQ 7LFNHWV HDFK 4W\ BBBBBBB [ Ć&#x2018; , ZRXOG OLNH WR DGG D VWXGHQW VSRQVRUVKLS
Optional Events: 6DWXUGD\ /XQFK 'HPR 4W\ 6DWXUGD\ /XQFK 'HPR 4W\ BBBB [ BBBB [ BBBBB 6LSV 6ZHHWV 4W\ BBBBB 6LSV 6ZHHWV 4W\ BBBB [ BBBB [ BBBBB Event PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design): Short Sleeve ($20 each): ___Small ____Medium ____ Large ____ XLarge ____ XXLarge Long Sleeve ($25 each): ___Small ____Medium ____ Large ____ XLarge ____ XXLarge Additional PharmDiva apparel and accessory options are available for purchase at www.pharmdiva.com. www.pharmdiva.com. 7RWDO WR EH FKDUJHG BBBBBBB0HWKRG RI 3D\PHQW Ć&#x2018; &KHFN &KHFN BBBBBBBBB 7 RWDO WR EH FKDUJHG BBBBBBB0HWKRG RI 3D\PHQW Ć&#x2018; &KHFN &KHFN BBBBBBBBB Please make checks payable to SCPhA 3OHDVH FKDUJH P\ Ć&#x2018; 9LVD 3OHDVH FKDUJH P\ Ć&#x2018; 9 LVD Ć&#x2018; Ć&#x2018; $0(; Ć&#x2018; 0DVWHU&DUG $0(; Ć&#x2018; 0DVWHU&DUG Ć&#x2018; 'LVFRYHU &UHGLW &DUG BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB ([S 'DWHBBBBBBBBBB &&9 BBBBBB
&DQFHOODWLRQ 3ROLF\ <RX PXVW QRWLI\ 6&3K$ &DQFHOODWLRQ 3ROLF\ <RX PXVW QRWLI\ 6&3K$ LQ ZULWLQJ DW OHDVW ÂżYH EXVLQHVV GD\V EHIRUH WKH PHHWLQJ WR EH HOLJLEOH IRU D UHIXQG PLQXV D SURFHVVLQJ RX PXVW QRWLI\ 6&3K$ LQ ZULWLQJ DW OHDVW ÂżYH EXVLQHVV GD\V EHIRUH WKH PHHWLQJ WR EH HOLJLEOH IRU D UHIXQG PLQXV D SURFHVVLQJ LQ ZULWLQJ DW OHDVW ÂżYH EXVLQHVV GD\V EHIRUH WKH PHHWLQJ WR EH HOLJLEOH IRU D UHIXQG PLQXV D SURFHVVLQJ IHH 1R UHIXQGV ZLOO EH JLYHQ IRU ODWH FDQFHOODWLRQV RU QR VKRZV 3OHDVH QRWH WKDW WKH WKUHDW RI LQFOHPHQW ZHDWKHU VKDOO QRW EH VXIÂżFLHQW WR RYHUULGH RXU policy.. cancellation policy
Return to SCPhA at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207. You You can also register online at www.scrx.org. www.scrx.org.
The Georgia Pharmacy Journal
20
December 2011
Call for awards nominations... The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA 137th Annual Convention in 2012. A brief description and criteria of each award is included below. 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 1, 2012. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at GPhA’s 137th Annual Convention at the Hilton Head Marriott Resort & Spa on Hilton Head Island.
Bowl of Hygeia Award 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 Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of GPhA’s 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.
Innovative Pharmacy Practice Award 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.
2012 Awards Nomination Form Bowl of Hygeia
Distinguished Young Pharmacist
Innovative Pharmacy Practice Award
Nominee’s 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 1, 2012 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.
The Georgia Pharmacy Journal
22
December 2011
Member News
Sen. Buddy Carter, R.Ph., Named UGA’s Alumnus of the Year Carter is serving his first full term as a Republican senator, representing Senate District I, which includes Bryan County and portions of Chatham and Liberty counties. He was successful this year in getting the drug monitoring bill passed, as well as making pseudoephedrine an OTC product that can only be sold in pharmacies.
ore than 250 College of Pharmacy alumni and their families attended the recent Homecoming tailgate; 70 of that number made up the five reunion classes of 2006, 2001, 1996, 1991 and 1986.
M
The highlight of the Homecoming event was the presentation of Distinguished Alumnus and Distinguished Service awards to Senator Earl L. “Buddy” Carter (‘80) of Pooler and Marjorie Phillips of Augusta, respectively. Carter was selected for the 2011 Distinguished Alumnus Award for his work in promoting the profession of pharmacy and in supporting the College of Pharmacy. He is a practicing pharmacist with Carter’s Pharmacy and a new member of the College’s Pharmacy Advisory Board. He also funded the Senator Buddy Carter Distinguished Pharmacy Leadership Endowment.
20th Annual Winter CE Seminar
Westin Riverfront Resort & Spa at Beaver Creek Mtn. in the Vail Valley-Avon, CO
January 8-11, 2012
15 hours of CE 7-9 am & 4:30-6:30 pm Full, "First Tracks" and other CE registration options Gondola at Ski Valet door Social dinner & reception; Lodging, rental & lift discounts. Visit www.copharm.org to JOIN US!
admin@copharm.org
303-756-3069
"As a first time attendee, this program FAR exceeded my expectations. Its no wonder you’re celebrating the 20th one next year.” ....2011 guest
The Georgia Pharmacy Journal
23
December 2011
continuing education for pharmacists Volume XXIX, No. 9
Head Lice Infestations: Counseling Your Patients Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio and J. Richard Wuest, R.Ph., PharmD, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio Dr. Thomas A. Gossel and Dr. J. Richard :XHVW KDYH QR UHOHYDQW ÀQDQFLDO UHODWLRQships to disclose.
Goal. The goal of this lesson is to review head lice infestations and their management, with emphasis on key points of information to pass along to patients. Objectives. At the conclusion of
this lesson, successful participants should be able to: 1. recognize the cause and triggers, epidemiology and prevalence, pathogenesis, and clinical impressions of head lice infestations; 2. demonstrate an understanding of the mechanism of action and major adverse events associated with the drugs used in treating head lice infestations; 3. select nonpharmacologic measures that are reported to control head lice infestations; and 4. exhibit knowledge of information relative to the prevention and management of head lice infestations to convey to patients and/or their caregivers. Head lice infestation has been known since antiquity. Described in ancient Egyptian and Greek medical texts, head lice have been a source of irritation and disgust for thousands of years. Its prevalence is not known today, since the reporting of infestations is not mandatory. The U.S. Centers for Disease Control and Prevention
The Georgia Pharmacy Journal
)QUUGN
9WGUV
(CDC) estimates that six to 12 million infestations occur each year in the United States. Health authorities report that the number of cases is increasing each year, primarily because of emerging treatment resistance. Infestations have annual combined direct and indirect costs in the United States estimated to be as high as $1 billion. Although head lice are not vectors of human disease, and WKHUHIRUH SRVH QR VLJQLÀFDQW KHDOWK risk, their presence can lead to substantial psychological frustration, discomfort, parental anxiety, embarrassment for both children and parents, and unnecessary absence from school and work. Preventive and therapeutic practices, along with the “no-nit” policy of excluding infested children from school, can DOVR LQGXFH VLJQLÀFDQW VRFLDO VWUHVV
Head Lice
The insects are ectoparasites of humans, that is, they live on the surface of the host’s body. An infestation of lice is termed pediculosis. A pediculicide is an agent that kills lice.
24
Head lice appear as tiny yellow-brown to dark gray “spots” measuring approximately 1 to 3 mm in length, about the size of a sesame seed. Their physical features cannot be distinguished by the unaided eye, but can be viewed with ease with a strong magnifying glass in good lighting. Insects DUH HORQJDWHG DQG ÁDW ZLWK WKUHH pairs of clawed legs adapted for grasping hair shafts for stability when feeding. Their cylindrical shape enables them to move freely among dense hair growth. The insects live in the hair of the scalp and neck and are not usually found elsewhere on the body. Mature lice are wingless. They neither hop, MXPS QRU Á\ IURP RQH LQGLYLGXDO WR another, although there are reports that combing dry hair can build up VXIÀFLHQW VWDWLF HOHFWULFLW\ WR SK\VLcally eject an adult louse from an infested scalp. Lice breathe through seven pair of spiracles, one pair on the thorax and six on the abdomen. These spiracles can open and close in response to wetting and may remain closed for up to 12 hours without injury to the insect. The blood-sucking insects depend solely upon human blood for nutrition; thus, they are hematophagous. Their saliva contains an anticoagulant that is introduced under the skin of the infested host during feeding, which prolongs their feeding period; lice may remain attached to the same site for several days while they continue
December 2011
Table 1 Patient information for head lice detection Dry combing for detection 1. Straighten and untangle the dry hair using an ordinary comb. 2. Once the comb moves freely through the hair without dragging, VZLWFK WR D ÀQH WRRWK FRPE 3. Comb the hair from the scalp down, being sure to raise the comb near the end of the hair so as not to miss detection of lice. 4. After each stroke, examine the teeth of the comb for living lice. 5. A magnifying glass will be helpful to distinguish lice and eggs from debris (e.g., dandruff). 6. Continue combing the hair section by section until the whole head of hair is combed through. Wet combing for detection 1. Wash the hair in the normal way with ordinary shampoo. 2. Rinse out the shampoo and put on ordinary conditioner. 3. Comb the hair with a normal comb to untangle and straighten. When the hair is untangled, switch to the detection comb. 4. Place the teeth of the detection comb into the hair at the roots, so that the comb touches the scalp. 5. Draw the detection comb through to the tips of the hair. 6. Comb systematically working around the head. 7. Check the comb for lice after each stroke by wiping both sides on a tissue. 8. After all the hair has been thoroughly combed, rinse out the conditioner. 9. While the hair is still wet, use an ordinary comb to untangle and straighten it again. 10. Repeat detection combing in the rinsed hair to check for any lice which might have been missed the ÀUVW WLPH
to feed, generally every four to six hours. Head lice engorged with blood may appear reddish-brown in color. In most climates, they survive only 15 to 20 hours off the host. Head lice are transmitted primarily by direct contact with an infested person. Outbreaks occur in greater numbers in August, then
The Georgia Pharmacy Journal
LQFUHDVH VLJQLÀFDQWO\ ZKHQ VFKRROV reopen, and continue to increase with onset of autumn. Infestation occurs primarily in children at all elementary grade levels and whenever children assemble, and in communal living conditions. Members of households with infested children are also at risk. Head lice are transmitted indirectly from wearing clothing that has been in contact with infested apparel on school coat racks. They are also spread by sharing combs, hair brushes and scarves of children infected with lice. Bed linens and headrests on chair and couch backs are other sources of indirect contact. Infestation may also be acquired by direct contact with the head of an infested person, commonly during play. Infestations are twice as common in girls than in boys, perhaps due to their greater willingness than boys to share personal hair-grooming aids. Hair length or frequency of shampooing are not important criteria. Lice infestations are widespread throughout the world and discriminate neither on socioeconomic status nor personal hygiene. Caucasians are infested more often than non-Caucasians, perhaps because of African-Americans’ greater use of pomades and the characteristics of lice that make them better adapted to grasp the more cylindrical hair shafts of Caucasians. Eggs. Lice eggs, or their empty egg casings (nits) are small, spherical or oval protrusions about the size of the period at the end of this sentence. Nits appear translucent; after hatching in seven to 10 days, they appear initially as yellowishZKLWH VSRWV WKDW DUH ERQGHG ÀUPO\ onto the hair shaft by a sticky substance secreted by the female insect. Bonding is strong enough to protect nits from being dislodged by ordinary washing or combing. Each female louse can produce apSUR[LPDWHO\ ÀYH WR VL[ HJJV GDLO\ over her 30 to 35 day lifespan. A typical infestation may involve 10 to 30 adult lice at any one time but the range is large. Juvenile lice (nymphs) take about six to 10 days
25
to grow into adulthood. Nymphs will molt three times as they transform into sexually mature adults.
Clinical Manifestations
Itching is the principal symptom, appearing in response to histamine DQG RWKHU LQÁDPPDWRU\ VXEVWDQFHV including the proteinaceous salivary secretion released following the insect’s bite. Itching may persist a week or longer, even after the lice have been eradicated. %LWH UHDFWLRQV DUH FODVVLÀHG into four phases: phase I is noted by lack of clinical symptoms; phase II entails papules (small elevations of the skin) with moderate itching; phase III consists of wheals (smooth, slightly elevated dermal elevations, which are redder or paler than surrounding areas) immediately following a bite with subsequent delayed papules and intense itching; and phase IV is characterized by smaller papules with mild itching. The phases presumably are related to evolution of immune sensitivity and adherence. Notably, new bites may cause reactivation of older, healed bitten DUHDV $Q LQÁDPPDWRU\ UHDFWLRQ to lice saliva or anticoagulant has been suggested as the most likely cause of the bite reactions. If lice infestation is not treated, intense itching with vigorous scratching may incite secondary bacterial or fungal infection. Impetigo and furunculosis (boils) may be outcomes. Uncommonly, in heavily infested and untreated patients, the hair can become tangled with exudates, predisposing the area to fungal infection, resulting in a malodorous mass. Countless lice and nits can be found under the entangled hair mass.
Detection
Most experts agree that before treatment begins, there must be SRVLWLYH LGHQWLÀFDWLRQ RI D OLYH louse. Although itching and the presence of eggs or nits attached to the hair raises suspicion, only GHWHFWLRQ RI D OLYH ORXVH FRQÀUPV infestation. Dandruff, dried hairspray, lint, sand and hair casts,
December 2011
which have all been mistaken for eggs and nits, are much more easily removed. Detection is best achieved usLQJ D ÀQH WRRWK FRPE VSDFLQJ RI teeth less than 0.3 mm) to systematically check all areas of the scalp and hair. Both dry and wet detection combing (Table 1) have been shown to be better for detecting head lice than simple direct visual inspection. Whether or not wet combing is better than dry combing remains controversial. The length of time required for each is largely dependent on hair length and density. A wet combing session will take longer, perhaps up to 30 minutes, than dry combing, up to ÀYH PLQXWHV LI GRQH SURSHUO\ Nits remain attached to hair shafts for as long as six months. Human hair grows at a rate of approximately 1 cm/month. As the hair grows, the bonded nits move away from the scalp. After two to three months, empty nits become more visible, especially on dark hair. Appearance of nits several months after a treatment can lead to a false-positive diagnosis of an active infestation because most people cannot differentiate between viable eggs and nits and assume that if eggs or nits are present the child must also have lice. Therefore, treatment is initiated.
Treatment
The goals of treatment are to kill the insects and their eggs, and control symptoms of infestation such as itching and secondary infection. When infestation is determined, every member of the household and all other close-contacts should be examined carefully and completely. An OTC antipruritic cream containing an antihistamine, local anesthetic or hydrocortisone may be applied topically and is usually VXIÀFLHQW WR FRQWURO LWFKLQJ 6HYHUH itching may require stronger therapy or use of systemic antipruritics. Treatment of secondary infection includes topical application of an appropriate antibiotic or antifungal agent. Infections that fail to heal within seven days or worsen should
The Georgia Pharmacy Journal
be evaluated by a physician. Their treatment may require systemic anti-infectives. Current guidelines still recommend use of OTC pediculicides in most cases, usually with a maximum of two applications. Physician involvement usually is recommended if lice are not eradicated after WKH ÀUVW WZR DWWHPSWV
Pyrethroids
Pyrethrins. Commercial preparations of pyrethrins consist of a mixture of substances obtained IURP ÁRZHUV RI WKH SODQW Chrysanthemum cinerariaefolium. This mixture contains substances identiÀHG DV HVWHUV RI FKU\VDQWKHPLF acid and pyrethric acid, and three alcohols. Pyrethrins (0.33 percent) in combination with piperonyl butoxide (4 percent) is a commonly used treatment for self-management of head lice. Piperonyl butoxide is included with pyrethrins because it potentiates the insecticide’s action, by suppressing the insect’s oxidative degradation mechanism. This combination of ingredients is, therefore, synergistic. Contact time with pyrethrins is prolonged and the kill rate is increased. Pyrethrins kill insects by disrupting ion transport mechanisms at their nerve membranes. Affected insects experience convulsions, paralysis and death. None of the natural pyrethrins are completely ovacidal because developing insects within newly laid eggs lack a QHUYRXV V\VWHP IRU WKH ÀUVW IRXU days. About 20 to 30 percent of HJJV UHPDLQ YLDEOH DIWHU WKH ÀUVW treatment. Successful treatment requires reapplication seven to 10 days later to kill newly emerged nymphs hatched from eggs that survived. Products (Table 2) containing pyrethrins/piperonyl butoxide are safe for human use when used correctly. The drugs are not absorbed appreciably following topical application. Small quantities that may enter the blood will be metabolized rapidly. Although the rigorous testing
26
currently required by FDA was not SHUIRUPHG IRU S\UHWKULQV ZKHQ ÀUVW marketed, systematic review of the safety of pyrethrins-containing products reveals only minor adverse reactions. Adverse effects are rare when products are used as directed, with contact dermatitis WKH PRVW IUHTXHQWO\ UHSRUWHG DIÁLFtion. Since pyrethrins are obtained from natural plant origin, allergic rhinitis, wheezing and coughing, and asthma attacks may be precipitated in individuals sensitive to ragweed. Inhaled pyrethrins may cause nausea and vomiting, and rarely, muscle paralysis and death. Most reports of clinical toxicity with synergized pyrethrins can be traced to solvents, typically petroleum distillates, in the preparation. Permethrin. Permethrin is a synthetic pyrethroid that has been altered chemically to provide better stability with exposure to light and heat. It is believed to act by the same mechanism as pyrethrins. Acticin (and others) 5 percent is marketed as a treatment for scabies, but not head lice. It has been used in an effort to overcome relative resistance to permethrin 1 percent. Unfortunately, permethrin-resistant lice may be resistant over a wide range of doses. Permethrin has low toxicity in mammals since it is poorly absorbed and inactivated rapidly by ester hydrolysis. Like pyrethrins, permethrin is contraindicated in persons hypersensitive to chrysanthemums or synthetic pyrethroid. Adverse effects include temporary itching, burning, stinging, numbness and pain, but these are rare. Permethrin should not be used on infants because of the greater permeability of their skin, and their reduced ability to metabolize it. Permethrin is retained on the hair after an initial application and thereby has “residual action” for two to three weeks, although retreatment at one week is still widely recommended. Currently, permethrin 1 percent is considered E\ PDQ\ WR EH WKH SUHIHUUHG ÀUVW line treatment for head lice infestation.
December 2011
Table 2 Agents for management of head lice Generic name Permethrin
Dosage Form Liquid Spray
Strength 1% 0.4% 0.5%
Pyrethrins with piperonyl butoxide
Trade name Nix, and generics Pronto A-200, RID
OTC OTC
Liquid Shampoo
0.3%/2% 0.3%/3% 0.33%/4%
Tisit Tisit A-200, Clear, Licide Pronto, RID, Pyrinyl Plus, and generics
Gel
0.3%/3%
Tisit Blue, Innogel Plus A-200
0.33%/4%
Availability OTC OTC
%HQ]\O DOFRKRO
/RWLRQ
8OHVÀD
5[
Lindane
Liquid Shampoo
1% 1%
generics generics
Rx Rx
Malathion
Lotion
0.5%
Ovide and generics
Rx Rx
Spinosad
Suspension
0.9%
Natroba
Rx
Lindane
/LQGDQH DŽ EHQ]HQH KH[DFKORULGH is an organochloride marketed in a 1 percent concentration liquid and shampoo. It is absorbed rapidly across the exoskeleton of insects. As a gamma-aminobutyric acid (GABA) inhibitor, and with neurotoxic properties similar to DDT, lindane causes excess CNS stimulation in, and ultimate death of, the ectoparasite. It has low ovacidal activity, and resistance has been reported worldwide for many years. About 10 percent of topically applied lindane is absorbed. It concentrates in adipose tissue and the brain of humans. Small amounts may persist within the brain for up to two weeks following topical use. Absorption through the louse exoskeleton occurs much more efÀFLHQWO\ WKDQ WKURXJK KXPDQ VNLQ Lindane is reported to cause CNS stimulation, nausea and vomiting, lethargy, disorientation, restlessness and convulsions in humans. Toxic symptoms are often the result of misuse of the product. The use of lindane for treat-
The Georgia Pharmacy Journal
ment of lice or scabies was banned in California in 2002 due to concern about neurotoxicity and negative effects on the environment. It is available elsewhere by prescription only. Some would argue that this agent is seldom an appropriate choice since other, safer agents are available and the ovacidal effect of lindane appears to be inferior to that of other agents.
Malathion
This pediculicide (Ovide, and others) is an organophosphate (acetylcholinesterase inhibitor) insecticide that is safe and effective for treatment of head lice, and is ovacidal. Malathion causes respiratory paralysis in the arthropod by causing accumulation of acetylcholine at its nicotinic receptor sites. It is toxic within three seconds of application to both lice and their eggs. Human toxicity is minimal when the product is used as directed because absorbed malathion LV GHWR[LÀHG UDSLGO\ /HVV WKDQ percent of the drug applied to the skin is absorbed.
27
Some people ÀQG WKH PDODWKLRQ product objectionable due to its unappealing odor and need for prolonged (eight to 12 hours) application time. The product’s vehicle, 78 percent isopropyl alcohol, LV ÁDPPDEOH 7KH alcohol contributes VLJQLÀFDQWO\ WR WKH HIÀFDF\ RI WKH product. Patients should be warned to avoid lighted cigarettes, open ÁDPHV DQG HOHFtric heat sources. Because of these restrictions, malathion is considered a second-line agent.
Benzyl Alcohol
One of the latest approvals to treat head lice is a lotion containing benzyl alcohol 5 percent in minHUDO RLO 8OHVÀD $OWKRXJK EHQ]\O alcohol is present in other products as an excipient, it has not previously been approved as a new drug. Lice exposed to benzyl alcohol lose the ability to close their respiratory spiracles. The lotion vehicle also obstructs their airways to cause asphyxiation. Benzyl alcohol is not ovacidal. Benzyl alcohol is generally well tolerated, with eye irritation and contact dermatitis reported. Also reported is that preterm neonates injected intravenously with products containing benzyl alcohol have developed a “gasping syndrome” with CNS depression, metabolic acidosis and respiratory distress, sometimes progressing to neurological deterioration and cardiovascular collapse.
Spinosad
The newest pediculicide, spinosad (Natroba), is a nonsynthetic,
December 2011
fermentation product of the bacterium, Saccharopolyspora spinosa, discovered in 1982 from soil in an abandoned rum distillery. The insecticide has been used on outdoor ornamentals, lawns, vegetables and fruit trees to control most insects. Spinosad alters the function of nicotinic acid and GABA-gated ion channels in a manner consistent with the observed neuronal excitation. Spinosad does not interact with known binding sites for other nicotinic or GABA-ergic insecticides. These data indicate that spinosad acts through a unique insecticidal mechanism. After a period of hyperexcitation, lice become paralyzed and die, with death within one to two days following ingestion of the substance. Spinosad is not acutely toxic to mammals and is nonhazardous by oral, dermal, ocular and inhalational routes. In long-term mammalian studies, it did not cause tumors, neurotoxicity, embryotoxicity, fetal toxicity or teratogenicity.
Resistance
With misdiagnosis of head lice and/ or misuse of chemical pediculicides, the question of drug resistance has emerged as an important issue in recent years. Early studies showing that pyrethrins, permethrin and malathion were equally effective in treating head lice infestations may no longer be clinically relevant in communities with resistant lice. The current prevalence of resistance in the United States is therefore unknown. To slow the emergence of resistance, therapeutic agents can be rotated.
Mechanical Removal
Lice and nits can be effectively UHPRYHG PDQXDOO\ ZLWK D Ă&#x20AC;QH tooth comb. They can also be SLFNHG RII RQH E\ RQH XVLQJ Ă&#x20AC;QJHUV or tweezers. While some sources may recommend that the hair be back-combed because of the angle of the attached nit relative to the hair shaft, it is recommended that the hair be combed outward from the scalp.
The Georgia Pharmacy Journal
There is increased interest in treating head lice infestation by removing the insects and their eggs solely with combing, in part due to the emerging fear that lice are becoming increasingly resistant to chemical pediculicides, and as an alternative to pediculicides for children two years of age and younger. Moreover, the potential for toxicity when chemical pediculicides are misused has helped popularize the use of these combs. Plastic combs may break, especially with heavy nit infestation in thick hair, and some parents may complain that LW LV GLIĂ&#x20AC;FXOW WR PRYH WKH FRPEV through dense hair. Sturdier metal nit combs are available. The use of ample water, conditioner, diluted vinegar or a commercial nit removal system may help with the combing process. Combing alone without wetting the hair is often unreliable. Application of diluted vinegar or commercial preparations containing formic acid 8 percent (Step 2, and others) may aid in nit removal by softening the bonding agent and may improve compliance by making combing easier.
Oral Agents Used Off-Label
A broad-spectrum anti-parasitic, oral ivermectin (Stromectol) has been used off-label for treatment of head lice when other therapies have failed. Given in an oral dose of 200 Âľg/kg, ivermectin effectively kills nymphs and lice, but not eggs. To kill newly hatched nymphs, a second dose is given seven to 10 GD\V DIWHU WKH Ă&#x20AC;UVW GRVH 7UHDWPHQW with ivermectin occasionally is associated with mild, transient side effects such as rash or pruritus, but no serious adverse reactions have been reported. Resistance has not been reported to ivermectin. Combination products containing trimethoprim and sulfamethoxazole (Bactrim, Septra, and others) have also been cited in small observational studies and anecdotal reports, as an alternative to topical pediculicides. This antimicrobial action is believed to kill the symbiotic bacteria in the lice gut, which
28
ultimately kills the lice. However, the potential for allergic reactions and risk for promoting bacterial resistance limit its widespread use for this purpose. Like ivermectin, this treatment is not FDA approved.
Unconventional Treatments
Some people may consider insecticides unacceptable, due to concern about potential adverse effects such as skin irritation and exacerbation of asthma, or consequences for the environment. They may have experienced previous treatment failure when using insecticides, perhaps due to using an ineffective formulation, using the product incorrectly, or having an infestation of resistant lice. Moreover, aerosols, sold for environmental use, can cause severe bronchoconstriction and should never be used on the head. Patients who do not wish to use topical insecticides to treat head lice infestation may try alternate treatments. Unconventional remedies include oil-based treatments, gasoline or kerosene, sulfur, garden LQVHFWLFLGHV GRJ OLFH Ă HD VKDPpoos and head shaving. Shaving the head is an effective means to remove all insects and their nits; however, routine shaving is no longer advocated since modern pediculicides and/or insect removal by combing are effective when used properly. Oil-based remedies such as olive oil are thought to immobilize and suffocate the lice. Lice, includLQJ WKHLU HJJV DUH GLIĂ&#x20AC;FXOW WR NLOO by suffocation. Applying olive oil or petrolatum and covering the head with a shower cap for four to six hours a day for three or four consecutive days may succeed. No reliable data support such claims; however, these substances may be GLIĂ&#x20AC;FXOW WR UHPRYH E\ ULQVLQJ RU shampooing and may be irritating to the eyes and skin. Petrolatum is the preferred treatment for infestation of the eyelashes and eyebrows. It should be rubbed in well.
December 2011
Auxiliary Measures
Fomite (object that does not convey pathology by itself, but can harbor pathogenic organisms that may be transmitted to people) control is a controversial aspect of lice management. Head lice rarely survive off the host for more than a day or so and intensive efforts to treat the environment are often time-consuming, disruptive and perhaps, unwarranted. At the same time, many experts continue to endorse strategies to minimize fomite transmission. The CDC recommends that all clothing and bedding in contact with the infested person during the two days before pediculicide treatment be laundered in hot water (60°C [140°F]) and placed in the dryer using the hot cycle, or dry cleaned. All nonwashable items should be quaranteed in plastic bags for two weeks should any surviving eggs hatch in that time period. Disinfection of combs and brushes in hot water or alcohol is also recommended. Although various home fumigation sprays for use on furniture and environmental insecticide sprays are marketed, little experimental or epidemiologic data on their effectiveness or safety are available to warrant their use.
than directed because of persistent itching. This subjects them to increased risk of adverse effects, including excessive drying of the skin which, in turn, can incite further itching. All topical pediculicides should be rinsed from the hair over a sink, rather than in the shower or bath to limit exposure, and with cool water, in order to minimize absorption due to vasodilatation. By counseling patients on the proper use of pediculicidal products, pharmacists can help decrease the likelihood of resistance and unnecessary treatment exposures. Pediculicidal therapy should only be initiated when head lice is appropriately diagnosed, and thorough directions regarding treatment should always be provided to all caregivers and family members. Strict compliance with a complete regimen will improve the likelihood of eradicating the insects. A valuable source of patient information is the National Pediculosis Association. This group is active in lice prevention education and supplies material that can help parents deal with the condition. This association can be accessed at www.headlice.org.
Patient Information
Pediculicidal products may cause irritation to the eyes and mucous membranes. They should not be used near these areas. Individuals being treated for lice should be observed closely for the presence of nits for eight to 10 days after initial drug application. Persons with lice or nit infestations that remain after two treatments should be evaluated by a physician to determine the source of infestation or reason for treatment failures. Patients should be advised to not confuse hair spray globules, dandruff or other extraneous debris with nits. The former are easily dislodged and brushed DZD\ 1LWV UHPDLQ DWWDFKHG ÀUPO\ as explained earlier. Patients may decide to apply a pediculicide product more often
The Georgia Pharmacy Journal
The authors, 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. This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.
Program 0129-0000-11-009-H01-P Release date: 9-15-11 Expiration date: 9-15-14
CE Hours: 1.5 (0.15 CEU) The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
29
December 2011
2011 - 2012 GPhA BOARD OF DIRECTORS
The Georgia Pharmacy Journal Editor:
Jim Bracewell jbracewell@gpha.org
Managing Editor & Designer:
Kelly McLendon kmclendon@gpha.org
The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2011, 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 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 at www.gpha.org upon request. All advertising and production orders should be sent to the GPhA headquarters as listed above.
Name
Position
Dale Coker Jack Dunn Robert Hatton Pam Marquess Bobby Moody Robert Bowles Hugh Chancy Keith Herist Eddie Madden Jonathan Marquess Tim Short Richard Smith Christine Somers Fred Sharpe Renee Adamson Amanda Gaddy Julie Bierster Ashley Faulk Amanda McCall Larry Batten Kristy Pucylowski Christopher Thurmond Ashley London Ken Eiland Thomas Jeter Josh Kinsey Sonny Rader Ira Katz Gail Lowney Christina Gonzalez John T. Sherrer Michael Farmer Steve Wilson
Chairman 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 Chairman AEP Chairman AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Georgia State Board of Pharmacy Representative Georgia Society of Health Systems Pharmacists Mercer Faculty Representative South Faculty Representative UGA Faculty Rep. ASP Mercer University Rep. ASP South University Rep. ASP UGA Rep. Executive Vice President
Patricia Knowles
GPHA HEADQUARTERS 50 Lenox Pointe, NE Atlanta, Georgia 30324 Office: 404.231.5074 Fax: 404.237.8435
Amy Grimsley Rusty Fetterman Sukh Sarao Negin Sovaidi Annie Tran David Bray Jim Bracewell
www.gpha.org
Print: Star Printing - 770.974.6195
The Georgia Pharmacy Journal
30
December 2011
continuing education quiz
Please print.
Name________________________________________________
Head Lice Infestations: Counseling Your Patients
Address_____________________________________________ City, State, Zip______________________________________ Email_______________________________________________
$FFRUGLQJ WR WKH )RRG DQG 1XWULWLRQ %RDUG WKH UHFRP1.
+HDG OLFH DUH QRW YHFWRUV RI KXPDQ GLVHDVH D 7UXH E )DOVH
1$%3 H 3URÃ&#x20AC;OH ,' BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 2EWDLQ 1$%3 H 3URÃ&#x20AC;OH QXPEHU DW ZZZ 0\&3(PRQLWRU QHW
,QVHFWV WKDW OLYH RQ WKH VXUIDFH RI WKH KRVW·V ERG\ DUH UHIHUUHG WR DV D GHUPRSDUDVLWHV F VFOHURSDUDVLWHV E HFWRSDUDVLWHV
Birthdate____________ 00''
Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990
$OO RI WKH IROORZLQJ VWDWHPHQWV DUH WUXH (;&(37 D HDFK IHPDOH ORXVH FDQ SURGXFH DSSUR[LPDWHO\ Ã&#x20AC;YH WR VL[ HJJV GDLO\ E WKH OLIHVSDQ IRU IHPDOH OLFH LV WR GD\V F QLWV DSSHDU WUDQVOXFHQW G Q\PSKV PROW RQFH LQWR VH[XDOO\ PDWXUH DGXOWV
3LSHURQ\O EXWR[LGH LV LQFOXGHG LQ S\UHWKULQ SURGXFWV EHFDXVH LW VXSSUHVVHV ZKLFK RI WKH IROORZLQJ GHJUDGDWLRQ PHFKDQLVPV RI WKH LQVHFW" D $FHW\OFKROLQHVWHUDVH E *OXFXURQDWLYH F +\DOXURQLGDVH G 2[LGDWLYH
7KH ORXVH ELWH UHDFWLRQ SKDVH WKDW FRQVLVWV RI ZKHDOV LPPHGLDWHO\ IROORZLQJ D ELWH ZLWK VXEVHTXHQW LQWHQVH LWFKLQJ LV D , F ,,, E ,, G ,9
3HUPHWKULQ LV EHOLHYHG WR DFW E\ WKH VDPH PHFKDQLVP as pyrethrins. D 7UXH E )DOVH
:KHWKHU RU QRW ZHW FRPELQJ LV EHWWHU WKDQ GU\ FRPELQJ UHPDLQV FRQWURYHUVLDO D 7UXH E )DOVH 1LWV UHPDLQ DWWDFKHG WR KDLU VKDIWV IRU DV ORQJ DV D RQH PRQWK F VL[ PRQWKV E WKUHH PRQWKV G PRQWKV 3\UHWKULQV DUH REWDLQHG IURP D D]DOHDV F IHYHUIHZ E FKU\VDQWKHPXPV G PLVWOHWRH
10. Lindane is an: D RUJDQREHQ]HQH E RUJDQRFKORULGH
F RUJDQRSKRVSKDWH G RUJDQRVXOÃ&#x20AC;GH
0DODWKLRQ LV DQ D RUJDQREHQ]HQH E RUJDQRFKORULGH
F RUJDQRSKRVSKDWH G RUJDQRVXOÃ&#x20AC;GH
/LFH H[SRVHG WR EHQ]\O DOFRKRO ORVH WKH HIIHFWLYH XVH RI ZKLFK RI WKHLU V\VWHPV D FLUFXODWRU\ F QHUYRXV E PHWDEROLF G UHVSLUDWRU\
&RPSOHWHO\ Ã&#x20AC;OO LQ WKH OHWWHUHG ER[ FRUUHVSRQGLQJ WR \RXU DQVZHU
6SLQRVDG DOWHUV WKH IXQFWLRQ RI D DVFRUELF DFLG F QLFRWLQLF DFLG E K\DOXURQLF DFLG G SDQWRWKHQLF DFLG
>D@ >E@ >D@ >E@ >F@ >G@ >D@ >E@ >F@ >G@ >D@ >E@ >F@ >D@ >E@ >F@ >G@ >D@ >E@ >F@ >G@ >D@ >E@ >F@ >G@ >D@ >E@ >F@ >G@@ >D@ >E@ >F@ >G@ >D@ >E@ >F@ >G@ >D@ >E@ >D@ >E@ >F@ >G@ >D@ >E@ >D@ >E@ >F@ >G@ >D@ >E@ >F@
$SSOLFDWLRQ RI GLOXWH YLQHJDU RU ZKLFK RI WKH IROORZLQJ PD\ DLG LQ QLW UHPRYDO" D %RULF DFLG F (WK\O DOFRKRO E &DVWRU RLO G )RUPLF DFLG
Â&#x2030; I am enclosing $5 for this monthâ&#x20AC;&#x2122;s quiz made payable to: Ohio Pharmacists Association. 5DWH WKLV OHVVRQ ([FHOOHQW 3RRU
'LG LW PHHW HDFK RI LWV REMHFWLYHV" Â&#x2030; yes Â&#x2030; no ,I QR OLVW DQ\ XQPHWBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB :DV WKH FRQWHQW EDODQFHG DQG ZLWKRXW FRPPHUFLDO ELDV" Â&#x2030; yes Â&#x2030; no 'LG WKH SURJUDP PHHW \RXU HGXFDWLRQDO SUDFWLFH QHHGV" Â&#x2030; yes Â&#x2030; no +RZ ORQJ GLG LW WDNH \RX WR UHDG WKLV OHVVRQ DQG FRPSOHWH WKH TXL]" BBBBBBBBBBBBBBBB &RPPHQWV IXWXUH WRSLFV ZHOFRPH
The Georgia Pharmacy Journal
Program 0129-0000-11-009-H01-P 0.15 CEU
6WURPHFWRO HIIHFWLYHO\ NLOOV D Q\PSKV DQG OLFH EXW QRW HJJV E OLFH DQG HJJV EXW QRW Q\PSKV F HJJV DQG Q\PSKV EXW QRW OLFH
7R UHFHLYH &( FUHGLW \RXU TXL] PXVW EH SRVWPDUNHG QR ODWHU WKDQ 6HSWHPEHU $ SDVVLQJ JUDGH RI PXVW EH DWWDLQHG &( VWDWHPHQWV RI FUHGLW DUH PDLOHG )HEUXDU\ $SULO -XQH $XJXVW 2FWREHU DQG 'HFHPEHU XQWLO WKH &3( 0RQLWRU 3URJUDP LV IXOO\ RSHUDWLRQDO 6HQG LQTXLULHV WR RSD#RKLRSKDUPDFLVWV RUJ
31
September 2011 2011 December
Georgia Pharmacy Association 50 Lenox Pointe, NE Atlanta, GA 30324
Introducing the GPhA/UBS Wealth Management Program UBS has agreed to provide all members of the Georgia Pharmacy Association with exclusive access UP ÏOBODJBM TFSWJDFT SFTPVSDFT UISPVHI UIF 8JMF $POTVMUJOH (SPVQ 5IJT OFX HSPVQ SFMBUJPOTIJQ UP ÏOBODJBM TFSWJDFT SFTPVSDFT UISPVHI UIF 8JMF $POTVMUJOH (SPVQ 5IJT OFX HSPVQ SFMBUJPOTIJQ FOBCMFT NFNCFST UP MFWFSBHF UIF WBTU TDBMF PG QSPEVDUT BOE TFSWJDFT BU 6#4 FOBCMFT NFNCFST UP MFWFSBHF UIF WBTU TDBMF PG QSPEVDUT BOE TFSWJDFT BU 6#4 8JUI NPSF UIBO ZFBST PG ÏOBODJBM TFSWJDFT FYQFSJFODF 5IF 8JMF $POTVMUJOH (SPVQ BU 6#4 IBT 8JUI NPSF UIBO ZFBST PG ÏOBODJBM TFSWJDFT FYQFSJFODF 5IF 8JMF $POTVMUJOH (SPVQ BU 6#4 IBT been recognized as one of Barron’s 5PQ 'JOBODJBM "EWJTPST JO UIF DPVOUSZ 5IF 8JMF $POTVMUJOH Barron’ss 5PQ 'JOBODJBM "EWJTPST JO UIF DPVOUSZ 5IF 8JMF $POTVMUJOH Barron’ Group is the endorsed wealth management provider for the Georgia Dental Association and also 1SJDF8BUFSIPVTF$PPQFST 4PVUIFSO %JWJTJPO 5IFZ XJMM SFQMJDBUF UIFTF TBNF PťFSJOHT UP UIF (1I" 1SJDF8BUFSIPVTF$PPQFST 4PVUIFSO %JWJTJPO 5IFZ XJMM SFQMJDBUF UIFTF TBNF PťFSJOHT UP UIF (1I" .FNCFS CFOFlUT JODMVEF .FNCFS CFOFlUT JODMVEF $PNQMJNFOUBSZ ¾ $ ÏOBODJBM QMBOOJOH B L¾ L WBMVF
¾ PNQMJNFOUBSZ ÏOBODJBM QMBOOJOH B L¾ L WBMVF
¾ # OFX L SFUJSFNFOU TBWJOHT QMBO EFTJHOFE #SBOE ¾ SBOE OFX L SFUJSFNFOU TBWJOHT QMBO EFTJHOFE exclusively for GPhA members at a group discount rate "EWJTPSZ ¾ EWJTPSZ BOE JOWFTUNFOU QSPHSBN PťFSFE BU HSPVQ ¾ " BOE JOWFTUNFOU QSPHSBN PťFSFE BU HSPVQ discount rate ¾ 3 QMBOOJOH HVJEBODF JODMVEJOH B SFUJSFNFOU 3FUJSFNFOU ¾ FUJSFNFOU QMBOOJOH HVJEBODF JODMVEJOH B SFUJSFNFOU income replacement system – Lending capabilities with competitive interest rates ¾ ' 'SFF BDDFTT UP 6#4 HMPCBM JOWFTUNFOU SFTFBSDI ¾ SFF BDDFTT UP 6#4 HMPCBM JOWFTUNFOU SFTFBSDI
Harris Gignilliat, CRPS® Vice V ice President–Investments 1FBDIUSFF 3PBE /& 4VJUF 1FBDIUSFF 3PBE /& 4VJUF "UMBOUB (" "UMBOUB (" IBSSJT HJHOJMMJBU!VCT DPN ubs.com/team/wile
Chartered Retir Chartered Retirement ement Plans SpecialistSM and CRPS® ar are e rregistered egistered service marks of the College for Financial Planning®. /FJUIFS 6#4`'JOBODJBM 4FSWJDFT`*OD OPS BOZ PG JUT FNQMPZFFT QSPWJEFT MFHBM PS UBY BEWJDF :PV TIPVME DPOTVMU /FJUIFS 6#4`'JOBODJBM 4FSWJDFT`*OD OPS BOZ PG JUT FNQMPZFFT QSPWJEFT MFHBM PS UBY BEWJDF : PWJEFT MFHBM PS UBY BEWJDF :PV TIPVME DPOTVMU PV TIPVME DPOTVMU XJUI ZPVS QFSTPOBM MFHBM PS UBY BEWJTPS SFHBSEJOH ZPVS QFSTPOBM DJSDVNTUBODFT "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CSPLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE XJUI ZPVS QFSTPOBM MFHBM PS UBY BEWJTPS SFHBSEJOH ZPVS QFSTPOBM DJSDVNTUBODFT "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CSPLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BS F HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT 'PS NPSF JOGPSNBUJPO PO UIF EJTUJODUJPOT CFUXFFO PVS CSPLFSBHF BOE JOWFTUNFOU BEWJTPSZ TFSWJDFT QMFBTF TQFBL XJUI ZPVS 'JOBODJBM "EWJTPS S 'JOBODJBM "EWJTPS EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BSF HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT 'PS NPSF JOGPSNBUJPO PO UIF EJTUJODUJPOT CFUXFFO PVS CSPLFSBHF BOE JOWFTUNFOU BEWJTPSZ TFSWJDFT QMFBTF TQFBL XJUI ZPVS 'JOBODJBM "EWJTPS UIF 8 JMF $POTVMUJOH (SPVQ PS WJTJU PVS XFCTJUF BU VCT DPN XPSLJOHXJUIVT 'JOBODJBM 1MBOOJOH TFSWJDFT BSF QSPWJEFE JO PVS DBQBDJUZ BT B SFHJTUFSFE JOWFTUNFOU BEWJTFS "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT UIF 8JMF $POTVMUJOH (SPVQ PS WJTJU PVS XFCTJUF BU VCT DPN XPSLJOHXJUIVT 'JOBODJBM 1MBOOJOH TFSWJDFT BSF QSPWJEFE JO PVS DBQBDJUZ BT B SFHJTUFSFE JOWFTUNFOU BEWJTFS "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT JO UIF 6 4 XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CS PLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BSF HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT /PUF UP UIF 6TFS '*/3" /"4% JO UIF 6 4 XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CSPLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BSF HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT /PUF UP UIF 6TFS '*/3" /"4% SSFRVJSFT UIBU UIF QSPTQFDUVT PšFS MFHFOE UIF ŖSTU QBSBHSBQI CFMPX CF JO B GPOU TJ[F UIBU JT BU MFBTU UIF TBNF TJ[F BT UIBU VTFE JO UIF NBJO UFYU PG UIF NBSLFUJOH QJFDF BOE JO B EJšFSFOU QSJOU TUZMF TVDI BT CPME PS JUBMJD UZQF 0ODF FRVJSFT UIBU UIF QSPTQFDUVT PšFS MFHFOE UIF ŖSTU QBSBHSBQI CFMPX CF JO B GPOU TJ[F UIBU JT BU MFBTU UIF TBNF TJ[F BT UIBU VTFE JO UIF NBJO UFYU PG UIF NBSLFUJOH QJFDF BOE JO B EJšFSFOU QSJOU TUZMF TVDI BT CPME PS JUBMJD UZQF 0ODF UIJT EJTDMPTVS F UIF QSPTQFDUVT PšFS MFHFOE JT VTFE JO BOZ QVCMJD GBDJOH NBUFSJBMT UIF NBUFSJBMT BSF TVCKFDU UP ŖMJOH XJUI '*/3" /"4% CZ B 4FSJFT 1SJODJQBM UBS Financial Services Inc. is a subsidiary of UBS AG. h 6#4 UIJT EJTDMPTVSF UIF QSPTQFDUVT PšFS MFHFOE JT VTFE JO BOZ QVCMJD GBDJOH NBUFSJBMT UIF NBUFSJBMT BSF TVCKFDU UP ŖMJOH XJUI '*/3" /"4% CZ B 4FSJFT 1SJODJQBM UBS h 6#4 Financial Services Inc. All rights rreserved. eserved. Member SIPC. @ Y @"9 @(JH)