Georgia Pharmacy Journal - February 2014 by Georgia Pharmacy Association

February 2014 VOLUME 36, ISSUE 2

VIP DAY VOICE IN PHARMACY DAY

Thursday, February 27, 2014 - Georgia Railroad Freight Depot

Keynote Speaker: Thomas E. Menighan, CEO American Pharmacists Association

An Update On Provider Status Nationwide

Plus: GPhA Named One Of the Top 5 Georgia Association Lobbyists FDA Recommends Discontinuing Products That Contain 325mg or More of Acetaminophen The ABCs of Star Quality Mark Parris Named to BOC Executive Committee

February 2014 Editor: Jim Bracewell jbracewell@gpha.org

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, 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 interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org. SUBSCRIPTIONS AND CHANGE OF ADDRESS The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia. The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offices. POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324. ADVERTISING Advertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org. GPhA Headquarters 50 Lenox Pointe, NE Atlanta, Georgia 30324 t 404-231-5074 f 404-237-8435

Contents

2 Message from Jim Bracewell ......................... 4 Member News .................................................. 5 Welcome New Members................................. 5 Message from Pamala Marquess .................

VIP DAY 12 VOICE IN PHARMACY DAY .........................................

FDA Recommendation -

Discontinue Prescribing Products Containing More Than 325mg of Acetaminophen ................................................ The ABCs of Star Quality ...............................

14 16 17

Mark Parris Named to BOC Executive Committee ..........................

18 Continuing Education ................................ 21 GPhA Board of Directors ......................... 28 PharmPAC Supporters .................................

www.gpha.org

The Georgia Pharmacy Journal

February 2014 Editor: Jim Bracewell jbracewell@gpha.org

Contents

VIP DAY 12 VOICE IN PHARMACY DAY .........................................

FDA Recommendation -

Discontinue Prescribing Products Containing More Than 325mg of Acetaminophen ................................................ The ABCs of Star Quality ...............................

14 16 17

Mark Parris Named to BOC Executive Committee ..........................

18 Continuing Education ................................ 21 GPhA Board of Directors ......................... 28 PharmPAC Supporters .................................

www.gpha.org

The Georgia Pharmacy Journal

MESSAGE

from Pamala Marquess

Committee Work Moves Pharmacy Forward

The Committees of the Georgia Pharmacy Association put forth an amazing

Pamala Marquess

GPhA President

amount of effort in advancing the practice of pharmacy. I would like to thank the committee members for their dedication and contributions to the profession of pharmacy in the state of Georgia. Why is the practice of pharmacy innovative in Georgia? GPhA has a group of dedicated pharmacist members working on pharmacy issues through committee work on

a monthly basis. We met for our January Committee meetings and below is a summary of their yearly charges and initiatives. The following are the Charges for the Continuing Pharmacy Education Committee: 1. Collaborate with the Convention Planning Committee to plan and promote the convention CPE. 2. Assess the needs of GPhA members in relation to CPE. 3. Plan & Promote education and training to establish patient care services for Pharmacists in GA. 4. Provide CPE which supports the Pharmacist Provider status initiative. 5. Provide CPE which supports the ACO Pharmacist initiative. 6. Discuss Leadership CPE for the Women’s Leadership Retreat. 7. Discuss CPE to enhance pharmacist provided patient care services utilizing multi-disciplinary teams. 8. Discuss APhA Certificate Programs and the offerings for 2013-2014.

The following are the Charges for the Governmental Affairs Committee: 1. Collaborate with the four schools of Pharmacy to promote, attend, and involve the students in VIP Day. (Coordinate with Student & Academic Affairs Chair). 2. Set Legislative Strategy to accomplish Legislative Agenda. a. Provider Status b. MAC c. Immunization expansion d. Accreditation/Board of Pharmacy 3. Involve, Invite, Engage!!!! Involve members across the state to Invite Legislators to learn about our issues and Engage their support!!! The following are the Charges for the Third Party Policy Committee: 1. MAC pricing. Collect MAC pricing prescription losses and submit to GPhA for documentation. Goal: 100 documentations of MAC losses. 2. Create a simple MAC description/explanation for use with legislators to explain MAC. 3. Discuss strategy for obtaining Provider Status for Pharmacists with 3rd party providers.

The Georgia Pharmacy Journal

4. Discuss strategy for ACO’s with 3rd party providers. 5. Discuss Accreditation requirements from 3rd party providers. 6. Discuss new HIPAA rules for 3rd party providers. How can GPhA assist? 7. Discuss new tactics of 3rd party audits.

“This work not only contains short term goals but also long term goals to promote the pharmacist’s services, improve patient outcomes, and the pharmacists provider status.”

The following are the Charges for the Public Affairs Committee: 1. Establish a public service campaign that promotes pharmacist provider status. 2. Coordinate at least 2 volunteer opportunities for GPhA members with a health campaign, (ie. Diabetes University, or Susan Komen). Build a GPhA Team of volunteers to attend the event. 3. Identify opportunities for GPhA members to volunteer for public service around the state. 4. Identify opportunities for GPhA awareness/promotion through media outlets. 5. Collaborate with other Health Care Providers in Public Affairs events. 6. Involve New Practitioners and students in volunteer events.

The following are the Charges for the Student & Academic Affairs Committee: 1. Collaborate with the four schools of Pharmacy to promote, attend, and involve the students in VIP Day. 2. Work with student leaders to attend meetings on campus to promote GPhA, convention, and New Practitioner Leadership Conference involvement. 3. Invite students to attend region meetings and share student activities with the group. 4. Invite Residents and students to publish research in the GPhA Journal. 5. Engage members through Facebook and website. 6. Collaborate and Organize for GPhA volunteers to be present at major events on campus, (ie. graduation, white coat, pinning ceremony, with a booth). 7. Develop a “Navigational Packet” for GPhA targeted at New Practitioners. 8. Conduct a seminar on “how to register for the GA Boards” targeted at 4th year students. I know you will agree that we have many volunteers who are critical to the progress and enrichment of GPhA. This work not only contains short term goals but also long term goals to promote the pharmacists services, improve patient outcomes, and the pharmacist provider status. I hope that you will consider joining a committee that you can share your talents with! n

Pam

Pamala S. Marquess

The Georgia Pharmacy Journal

MESSAGE

from Pamala Marquess

Committee Work Moves Pharmacy Forward

The Committees of the Georgia Pharmacy Association put forth an amazing

Pamala Marquess

GPhA President

The Georgia Pharmacy Journal

“This work not only contains short term goals but also long term goals to promote the pharmacist’s services, improve patient outcomes, and the pharmacists provider status.”

Pam

Pamala S. Marquess

The Georgia Pharmacy Journal

M E M B E R

You Control Your Professional Future By Creating Your Professional Future “...their homes destroyed, their buﬀalo gone, the last band of free Sioux submitted to white authority at Fort Robinson, Nebraska. The great horse culture of the plains was gone and the American frontier was soon to pass into history.” - Epilogue from, “Dances With Wolves”

Jim Bracewell

Executive Vice President

he neighborhood pharmacy was permanently closed. Now the pharmacists’ ability to deliver patient care in the community was also gone. The last remnants of the state association disbanded and the practice of pharmacy was soon to pass into history under the authority of government run healthcare. Like the spirit predicted the future for Scrooge in the famous Dickens tale “A Christmas Carol”, so can the future of pharmacy. But just as Scrooge questioned the ghost, do these things have to be? Or can the future that is predicted be changed? I have good news for every pharmacist in Georgia. This does not need to be the future of your career or your profession. On February 27, 2014, you can band with your fellow pharmacists at the State Capitol and hear Tom Menighan Executive Vice President “Our state of the American Pharmacists Association predict a bright future for pharmacy when pharmacists are recognized as healthcare providers by CMS (the Federal and federal Government), because then and only then will pharmacy be on the level of reimgovernment bursement with physicians, nurses, dentists and other healthcare providers. virtually controls Government is of the people, by the people and for the people that participate. healthcare and Our state and federal government virtually controls healthcare and especially especially pharmacy. Our elected representatives cry out for pharmacists to participate in creating their future but all too often pharmacists have been too busy to get pharmacy.” involved. Too busy to participate, too tired to attend a meeting, too little money to pay their association dues so they abdicate their responsibility to their profession and leave it to non-pharmacists to create their future. This is not the case with the leadership of the Georgia Pharmacy Association, but without active members that follow, leadership just becomes a walk in the park. Whether you are an active voice in pharmacy by being a long time active member, a strong contributor to PharmPAC, or have never joined your association nor supported your profession, you create your future in pharmacy either way it goes. I hope to see you February 27, 2014 at Voice In Pharmacy Day. If for some real reason you cannot be there on February 27th, do the next best thing and ask a friend to join GPhA for the future you want in pharmacy. n

Jim

N E W S

Medicare Part D Participants Being Nudged Toward Chain Pharmacies A

By Ed Dozier, GPhA Region 2 President

s a pharmacist, the most important aspects of my profession are the relationships I have with customers and keeping up to date so I can give them the best service possible. Taking care of the customers’ needs is my first tenet. Medicare Part D plans are a way people over 65 can afford medications they might otherwise not. Although the patients pay premiums, the cost is largely supported by taxes we all pay. Most Part D plans have two levels of participation for pharmacies — network and preferred. Customers usually have a lower co-pay at a preferred pharmacy, but their premiums are the same. The plans decide if a pharmacy can be network or preferred. This year, most independent pharmacies were denied preferred status by the plans. Large health care plans and chain pharmacies are engaging in confusing and misleading tactics to steer customers away from their current pharmacy. They make calls and send mail encouraging customers to change to chain or mail order pharmacies. They may even put their logo on the insurance card. This can cause the customer to believe they have no choice but to go to the plan’s pharmacy. You do have a choice. You can go to a network pharmacy. The difference in cost can be justified by better personal service. Pharmacists want to give good customer service, but large corporations often put demands on pharmacists that make personal service difficult, if not impossible. Smaller community pharmacies emphasize customer service and developing a relationship with the customer. This leads to better patient adherence and better outcomes. Patients need to have ready access to their pharmacist. If you and your taxes are paying for

your pharmacy plan, you should be free to choose any participating pharmacy without having to pay a penalty. Any pharmacy willing to participate in a government or corporate-funded plan should be given the opportunity to do so under the same rules as any other pharmacy. A larger pool of providers means

greater choices for customers and increased access to pharmacists. Please write your legislators and let them know you support pharmacy competition in Medicare Part D. n Ed Dozier has been a community pharmacist in Albany since 1972. He currently works with U-Save-It Pharmacy.

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

Steve Freeman - Atlanta, GA Aquila Ingram - Pooler, GA Edie Swaggard-Green - Douglasville, GA Vasavi Thomas - Tucker, GA John Richey - Columbus, GA Elizabeth Carroll - Americus, GA

Associate Kenneth Barngrover - Columbus, GA

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

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

The Georgia Pharmacy Journal

M E M B E R

Jim Bracewell

Executive Vice President

Jim

N E W S

Medicare Part D Participants Being Nudged Toward Chain Pharmacies A

By Ed Dozier, GPhA Region 2 President

Steve Freeman - Atlanta, GA Aquila Ingram - Pooler, GA Edie Swaggard-Green - Douglasville, GA Vasavi Thomas - Tucker, GA John Richey - Columbus, GA Elizabeth Carroll - Americus, GA

Associate Kenneth Barngrover - Columbus, GA

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

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

The Georgia Pharmacy Journal

M E M B E R

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M E M B E R

Call for GPhA Awards! T

he GPhA Awards Committee is seeking nominations for the following awards which will be presented at the 139th GPhA Convention in 2014. 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, 2014. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at the 139th GPhA Convention at the Wyndham Bay Point Resort in Panama City Beach, FL.

Bowl of Hygeia

Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by the 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 exofficio 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

Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of the GPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) To 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

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.

Generation Rx Champions Award

This award is presented annually to a pharmacist who has demonstrated work with prescription drug abuse. This award gives honor to the recipient with a plaque and donates $500 to the charity of the recipients choice. Selection Criteria: 1) Nominee must a have demonstrated a committed effort to reduce prescription drug abuse; 2) Nominee must be a licensed Georgia Pharmacist; 3) Nominee must be a member of the Georgia Pharmacy Association in the year of the selection.

2014 Awards Nomination Form Bowl of Hygeia Champions

Distinguished Young Pharmacist

Innovative Pharmacy Practice

Nominee’s Full Name Home Address

Generation Rx

Nickname City

State

Zip

City

State

Zip

Practice Site Work Address

College/School of Pharmacy List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities: Supporting Information: Submitted By:

Submit this form completed by March 1, 2014 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

The Georgia Pharmacy Journal

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Mercer College of Pharmacy Names New Department Chair GPhA member Dr. Susan Miller, Pharm.D., named chair of the Department of Pharmacy Practice.

long time supporter of the Georgia Pharmacy Association, Dr. Susan Miller was recently named chair in the Department of Pharmacy Practice at Mercer. She also teaches and conducts research in the areas of the practice of pharmacy, geriatric pharmacotherapy, senior care pharmacy, and medical and

professional ethics. She also conducts pedagogical research in areas relevant to pharmacy education. Her previous administrative positions in Mercer’s College of Pharmacy include vice-chair of the Department of Pharmacy for curriculum, associate dean for administration, vice-chair of the De-

Dunaway Shows School Spirit as UGA Cheerleader Rah! Rah! Rah! In 1976 the University of Georgia started a tradition of inviting alumni cheerleaders back to cheer on the field for the first half of Homecoming.

This past year, GPhA member and former GPhA President and Board

Chairman Bill Dunaway was part of the group. Bill graduated from Marietta High in 1957 and cheered at UGA from 1958 to 1961. “Yep, I started cheering at UGA 55 years and 25 lbs. ago,” Dunaway said. With each UGA score Dunaway did the required push-ups for each point. Unfortunately UGA had another bad day. The good news was that Bill only had to do 21 push-ups. In 1973, alumni of the Redcoat Band started performing in a pregame show. Dunaway also performed in 1973 and 1974 since he played in the band also. Not only is Bill an active UGA Alumni and a past president of the GPhA he is also a former Mayor of Marietta (serving two terms), a registered Pharmacist and former owner of Dunaway Drug Stores, an adjunct faculty member and Trustee

The Georgia Pharmacy Journal

Emeritus at Kennesaw State University, and past president of the Georgia Pharmacy Advisory Board. n

partment of Clinical and Administrative Sciences, and chair of the curriculum committee. Dr. Miller is a frequent presenter at pharmacy and academic meetings, and she has authored over 100 publications including 18 book chapters, 32 original research articles, and numerous continuing education publications. Dr. Miller has received teaching awards including the Distinguished Educator Award from the Mercer College of Pharmacy. As well as being a member of The Georgia Pharmacy Association (GPhA) she is a member of the American Association of Colleges of Pharmacy, a graduate of the Academic Leadership Fellow Program of AACP, and a Fellow in the American Society of Consultant Pharmacists. The Georgia Pharmacy Association would like to say congratulations to Dr. Susan Miller, Pharm.D. n

Real Financial Planning. No Generics.

It means having real strategies for all your financial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their families and their practices. It means working with an independent firm you can trust. Michael T. Tarrant, CFP® • Speaker & Author • PharmPAC Supporter • Creating Real Financial Planning for over 20 Years

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • mike@FNAplanners.com Registered Representative of INVEST Financial Corporation, member FINRA/SIPC. INVEST and its affiliated insurance agencies offer securities, advisory services and certain insurance products and are not affiliated with Financial Network Associates, Inc. Other advisory services offered through Financial Network Associates, Inc. ad.10040.110749

M E M B E R

N E W S

M E M B E R

Call for GPhA Awards! T

Bowl of Hygeia

5) The nominee has an outstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist

Innovative Pharmacy Practice

Generation Rx Champions Award

2014 Awards Nomination Form Bowl of Hygeia Champions

Distinguished Young Pharmacist

Innovative Pharmacy Practice

Nominee’s Full Name Home Address

Generation Rx

Nickname City

State

Zip

City

State

Zip

Practice Site Work Address

College/School of Pharmacy List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities: Supporting Information: Submitted By:

Submit this form completed by March 1, 2014 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

The Georgia Pharmacy Journal

N E W S

Mercer College of Pharmacy Names New Department Chair GPhA member Dr. Susan Miller, Pharm.D., named chair of the Department of Pharmacy Practice.

This past year, GPhA member and former GPhA President and Board

The Georgia Pharmacy Journal

Emeritus at Kennesaw State University, and past president of the Georgia Pharmacy Advisory Board. n

Real Financial Planning. No Generics.

SUPPORT BUDDY CARTER R.Ph FOR CONGRESS There is not a single Pharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/ With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES. Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle. PAID FOR BY BUDDY CARTER FOR CONGRESS CARLTON HODGES, TREASURER

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GPhA Named One of the Top Five Georgia Association Lobbyists Top Five Association Lobbyists #1. Georgia Hospital Association #2. Georgia Chamber of Commerce #3. Medical Association of Georgia #4. Georgia Poultry Federation #5. Georgia Pharmacy Association Georgia Beverage Association (Tie) #6. Georgia Association for Career & Technical Education #7. Georgia Association of Realtors #8. Georgia Credit Union Afﬁliates Georgia Association of Educators (Tie) #9. Metro Atlanta Chamber #10. Georgia Association of Convenience Stores County Commissioners of Georgia (Tie)

ames MAGAZINE, Georgia’s only monthly magazine providing readers with in depth political news coverage, has named The Georgia Pharmacy Association as the number five association lobbyist in the state. “The quality lobbyists on the list aren’t just about quality. They’re about excellence,” said James. The GPhA maintains a strong presence on the political scene on behalf of pharmacy, not only during the legislative session but also throughout the year. The association also works to build relationships with policy makers on a state and national level. Go to www.insideradvantage.com to read more. n

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Pharmacists and Technicians Reflecting on to theRegister Past & Awaiting Encouraged a New Year with New Opportunities Now for CPE Monitor M E M B E R

NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE

Nomination Form for the 2014 April 26-28, 2013 New Practitioner Leadership Conference Legacy Lodge & Conference Center May 2 -Islands 4, 2014 Lake Lanier Resort Lake Lanier Islands, GA

The 2014 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference. Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria: (1) Leadership potential; (2) Involvement in college student activities and/or professional organizations; (3) Community activities; (4) Clarity and vision in response to application questions. I Iwould 2014 New Practitioner Leadership Conference: Conference: wouldlike liketo tonominate nominatethe thefollowing following individual individual to to attend the 2013 (Please Print) Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For:

______________________________________________________________________________________

Preferred Mailing Address: _____________________________________________________________________________ _

_______________________________________________________________________________

This address is [ ] Home [ ] Work

_______________________________________________ State: ______ ZIP: _____________

Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________

E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________ Address:

[ ] Home or [ ] Work?________________________________________________________________________________

_________________________________________________________ Tel. (____) __________________

21 20th Year

Year

State: _______

Zip: ___________________

E-mail: ___________________________________________________________

Please return this this Nomination NominationForm Formto: to: Georgia Pharmacy Foundation The Georgia Pharmacy Foundation Attn: Regena Banks Attn: Jim Bracewell 50 Lenox NE 50 Pointe, Lenox Pointe, NE Atlanta, Atlanta, GA 30324 GA 30324

Or, you may FAX this Nomination Form to: 404.237.8435 Or, submit online at WWW.GPHA.ORG

Please Please return by Return18, by2013 January Feb. 14, 2014

you have please contact Regena at GPhF: 404.231.5074- email: Email:jbracewell@gpha.org rbanks@gpha.org If youIf have anyquestions, questions, please contact JimBanks Bracewell: 404-419-8119

The Georgia Pharmacy Journal

N E W S

By: Kari Nemenz and Stephanie Wilcox University School Savannah, GA the Reprinted with permission from CPE South Monitor™ integration is wellof Pharmacy licensees, eventually eliminating

underway and soon all Accreditation his Council for University PharmacyAPhAEduyear’s South cation (ACPE)-accredited providASP Chapter has been inspired! Tweners will require pharmacists and ty-one students attended the 2013 APhApharmacy technicians to submit ASP Midyear Regional Meeting (MRM) their NABP e-Profile ID andenjoyed date of in Birmingham, AL. Students birth (MMDD) in order to obtain debating proposals on policies submitACPE-accredited continuing pharted from other chapters, and all gained education (CPE) for credit. fact, amacy passion for advocating the In future providers have integratofmany the profession. Afteralready returning from ed their are requiring MRM, the systems chapter isand energized for this next and optimistic that we might this year, information. contribute our profession As of presstotime, more than:and community positively. • 950,000 CPE activity records are While attending MRM, the APhAnow stored in the CPE Monitor ASP Chapter President, Tiffany Gallosystem way, a presentation to the re• 120delivered ACPE-accredited providers gion on the chapter’s work CPE with data Parent are actively transmitting University. Parent University is a collabelectronically orative within the community with the • 188,000 pharmacists have created purpose of educating parents and their e-Profiles children on a range of topics including • 103,500 pharmacy technicians have Cough, and Flu, and Heartburn. createdCold e-Profiles TheCPE presentations prepared by members Monitor is a national collaboofrative APhA-ASP and ASHP were givenand at service from NABP, ACPE, Savannah High School followed by a ACPE providers that will allow licensquestion and answer session. We feel our ees to track their completed CPE work with Parent University helps us to credits electronically. It is anticipated inform the parents and young people of that in 2013 the boards of pharmacy our community. will be able to request reports on their This past October during National

Pharmacist Month, over 40 ASP students and alumni attended the American Diabetes Association Step Out Walk for Diabetes. Many members walked inof support In the November edition the of the cause, Pharmacy while othersJournal, performed Georgia health screenings on over 100spelled attendees. Bent Gay’s name was Students screened participants’ incorrectly. We sincerelyblood glucose, blood pressure, and BMI while apologize and again would educating the public on healthy lifestyle liketotoreduce congratulate Mr.diabetes. Gay choices their risk for on being named the Next ASP participates in this event every year, Generation Long-term Carethe and awaits this opportunity to serve Pharmacist the Year. community in such aof positive way while

- CORRECTION -

The Georgia Pharmacy Journal The Georgia Pharmacy Journal

need for printed statements of credit for ACPE-accredited CPE. To obtain an e-Profile ID, licensees may visit www.MyCPEmonitor.net, create an e-Profile, and register for CPE Monitor.

Melvin M. Goldstein, P.C. A T T O R N E___ Y AT

LAW

248 Roswell Street Twenty-one students attended the 2013 APhA-ASP Midyear Regional Marietta, Georgia 30060 Meeting (MRM) in Birmingham, AL.

Telephone

770/427-7004

promoting the profession of pharmacy. local YMCAs to offer health screenings Coming up in 2014 are more events for members770/426-9584 of our community throughFax the chapter will participate in. Many of out the year. The chapter is looking forour members willwww.melvinmgoldstein.com be attending GPhA’s ward to partnering with students in the VIP Day at the capitol in Atlanta, which Physician’s Assistant program at South Private an emphasis is always n a very popularpractitioner event for our with University for the first on time in order to members. Later in March, a group of better develop our inter-professional rerepresenting healthcare professionals in our students will be attending APhA’s lationships. Annual meeting and exposition in Or- asAswell we set our sights on 2014, we anticadministrative cases lando. ASP will continue to partner with ipate a busy and rewarding year. n

as other legal matters

n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency n Former Administrative Law Judge for the Office of State Administrative Hearings 11

Pharmacists and Technicians Reflecting on to theRegister Past & Awaiting Encouraged a New Year with New Opportunities Now for CPE Monitor M E M B E R

NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE

Nomination Form for the 2014 April 26-28, 2013 New Practitioner Leadership Conference Legacy Lodge & Conference Center May 2 -Islands 4, 2014 Lake Lanier Resort Lake Lanier Islands, GA

Works For:

______________________________________________________________________________________

Preferred Mailing Address: _____________________________________________________________________________ _

_______________________________________________________________________________

This address is [ ] Home [ ] Work

_______________________________________________ State: ______ ZIP: _____________

Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________

E-mail: __________________________________________________________

[ ] Home or [ ] Work?________________________________________________________________________________

_________________________________________________________ Tel. (____) __________________

21 20th Year

Year

State: _______

Zip: ___________________

E-mail: ___________________________________________________________

Or, you may FAX this Nomination Form to: 404.237.8435 Or, submit online at WWW.GPHA.ORG

Please Please return by Return18, by2013 January Feb. 14, 2014

you have please contact Regena at GPhF: 404.231.5074- email: Email:jbracewell@gpha.org rbanks@gpha.org If youIf have anyquestions, questions, please contact JimBanks Bracewell: 404-419-8119

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By: Kari Nemenz and Stephanie Wilcox University School Savannah, GA the Reprinted with permission from CPE South Monitor™ integration is wellof Pharmacy licensees, eventually eliminating

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need for printed statements of credit for ACPE-accredited CPE. To obtain an e-Profile ID, licensees may visit www.MyCPEmonitor.net, create an e-Profile, and register for CPE Monitor.

Melvin M. Goldstein, P.C. A T T O R N E___ Y AT

LAW

248 Roswell Street Twenty-one students attended the 2013 APhA-ASP Midyear Regional Marietta, Georgia 30060 Meeting (MRM) in Birmingham, AL.

Telephone

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as other legal matters

VIP DAY VOICE IN PHARMACY DAY

But who advocates for the profession of other pro-pharmacy legislation, every sion informing you of what is going on at pharmacy in Georgia before the General session the GPhA has to fight off legis- the Capitol and what you can do to help. Assembly and the Board of Pharmacy? lation that is harmful to the practice of Do you want to impact the practice The Georgia Pharmacy Association does. pharmacy. This year will probably be no of pharmacy? Do you want to assure GPhA’s legislative team the economic viability of your have their hands full this sesdegree for the future? Do you Pharmacists and pharmacy students from sion working on MAC pricing, want your profession to be across the state will convene at the Georgia more immunizations by pharvalued as part of the future of macists under physician protohealthcare delivery in our state? Freight Depot for breakfast, a speaker, and col, and laying the groundwork Then resolve today to be an aca chance to visit with their legislators. for getting healthcare provider tive advocate for your professtatus for pharmacists. sion through the contribution Don’t miss your BIGGEST chance to be Fixing the problems of MAC of your time, talent and reheard along with your peers at the Capitol! pricing will take up most of sources to that common cause Remember to wear your white coat. our time during the session as of advocacy. strong opposition is expected What a country! And what a from the PBMs that benefit financial- different but we will remain vigilant in privilege it is for pharmacists to be able ly for reimbursing pharmacies at lower our efforts to continue defeating harmful to accept the responsibility for the goverprices than what prescriptions can be legislation. nance of their profession through memWeekly GPhA Legislative Pharm-O- bership and involvement in the Georgia purchased. Besides working on MAC pricing and Grams to members will continue this ses- Pharmacy Association. n PharmPAC is GPhA’s Political Action Committee, providing the resources for the association to lobby and advocate on behalf of pharmacy. Please help protect the pharmacy profession by donating at www.gpha.org/pharmpac

Keynote Speaker: Thomas E. Menighan, CEO, American Pharmacists Association

Join the GPhA on Thursday, February 27, 2014

The Freight Room at The Georgia Railroad Freight Depot 65 Martin Luther King, Jr. Drive, Atlanta, GA 30334

wise man once said, “It matters Where would our country be without tion their government on behalf of their not the issue, social, economic, or politi- such associations as the NAACP, the cause? The late United States Supreme Court cal. Our constitution grants and protects NRA, the Tea Party, and the Sierra Club? our right to assemble and address our With each group I named, you may ap- Justice Thurgood Marshall said: “Millions of Americans speaking common issues before our government.” Tim Russert, “Do you want to impact the practice of pharmacy? in unison is not a corruption of the democratic political the legendary host of SunDo you want to assure the economic viability of process, it is the democratic day’s Meet The Press liked political process.” to often repeat a great quote your degree for the future? Do you want your In the state of Georgia, from his father – “What a profession to be valued as part of the future the General Assembly passcountry!” es the laws that allow the Many pundits like to negof healthcare delivery in our state?” practice of the profession atively label associations as “those powerful special interest groups”, plaud or oppose their ideas but in what of pharmacy in our state. The Georgia as though uniting for a common cause is other country would those people have Board of Pharmacy is provided the powdetrimental to our form of government. the protected right to assemble and peti- er to regulate and license the profession.

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An Update On Provider Status Nationwide The Keynote Speaker at this year’s VIP Day Event is Tom Menighan, CEO of the American Pharmacists Association. Mr. Menighan received his bachelor of science in pharmacy (BSPharm) in 1974 from West Virginia University School of Pharmacy and master of business administration (MBA) in 1990 from Averett College. Prior to his current leadership roles at APhA, he was founder and president of SynTegra Solutions, Inc., founded SymRx, Inc., and developed CornerDrugstore.com©. Throughout his career, Menighan has served advocacy roles within the profession of pharmacy, including president of APhA from 2001 to 2002 and a member of the APhA Board of Trustees between 1995 and 2003. He was a senior staff member of APhA from 1987 to 1992. While on staff as senior director of external affairs, he managed state affairs, public relations, new business development, and practice management issues. His other professional experiences include management of the PharMark Corporation, creator of RationalMed©, and licensor of systems for states to conduct drug utilization review for millions of state Medicaid enrollees. Menighan also founded and was a 20-year Medicine Shoppe owner in Huntington, West Virginia. He is a current partner in Pharmacy Associates, Inc. Mr. Menighan will speak on the important issue of Provider Status and how the legislation affects the pharmacy profession nationwide. n

The Georgia Pharmacy Journal

VIP DAY VOICE IN PHARMACY DAY

Keynote Speaker: Thomas E. Menighan, CEO, American Pharmacists Association

Join the GPhA on Thursday, February 27, 2014

The Freight Room at The Georgia Railroad Freight Depot 65 Martin Luther King, Jr. Drive, Atlanta, GA 30334

The Georgia Pharmacy Journal

I N D U S T R Y

•E M P L O Y M E N T O P P O R T U N I T Y•

N E W S

FDA Recommendation -

Discontinue Prescribing Products Containing More Than 325mg of Acetaminophen T

he FDA recommends health care professionals discontinue prescribing and dispensing prescription combination drug products with more than 325 mg of acetaminophen to protect consumers [1/14/2014] FDA is recommending health care professionals discontinue

prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acetaminophen1 per tablet, capsule, or other dosage unit. There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the

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

added risks for liver injury. Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death. We recommend that health care providers consider prescribing combination drug products that contain 325 mg or less of acetaminophen. We also recommend that when a pharmacist receives a prescription for a combination product with more than 325 mg of acetaminophen per dosage unit that they contact the prescriber to discuss a product with a lower dose of acetaminophen. A two tablet or two capsule dose may still be prescribed, if appropriate. In that case, the total dose of acetaminophen would be 650 mg (the amount in two 325 mg dosage units). When making individual dosing determinations, health care providers should always consider the amounts of both the acetaminophen and the opioid components in the prescription combination drug product. In January 2011 we asked manufacturers of prescription combination drug products containing acetaminophen to limit the amount of acetaminophen2 to no more than 325 mg in each tablet or capsule by January 14, 2014. We requested this action to protect consumers from the risk of severe liver damage which can result from taking too much acetaminophen. This category of prescription drugs combines acetaminophen with another ingredient intended to treat pain (most often an opioid), and these products are commonly prescribed to consumers for pain. More than half of manufacturers have voluntarily complied with our request. However, some prescription combination drug products containing more than 325 mg of acetaminophen per dos-

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age unit remain available. In the near future we intend to withdraw approval of prescription combination drug products containing more than 325 mg of acetaminophen per dosage unit that remain on the market. Cases of severe liver injury have occurred in patients who: • took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period; • took more than one acetaminophen-product at the same time; or • drank alcohol while taking acetaminophen products. Inadvertent overdose from prescription combination drugs containing acetaminophen accounts for nearly half of all cases of acetaminophen-related liver failure in the United States, some of which result in liver transplant or death. Health care providers and pharmacists who have further questions are encouraged to contact the Division of Drug Information at 888.INFO.FDA (888463-6332) or druginfo@fda.hhs.gov. n

Seeking Executive Vice President The Georgia Pharmacy Association is seeking an Executive Vice President. Below is a summary of qualifications, knowledge, and skills. • Bachelor’s degree or higher or equivalent education and experience is required Business administration, pharmacy, or other healthcare related degree is desired. • Certified Association Executive (CAE) designation is desired. • Minimum of three years of experience in association management or equivalent pharmacy leadership experience. • Minimum of five years of experience in a supervisory or management role. • Possess an understanding of and strong interest in the health care industry. • Demonstrable skills in the areas of financial and policy management, strategic planning and project management, and an understanding of the legislative and regulatory process. • Clear, compelling and articulate communicator, both verbal and written, with a variety of internal and external stakeholders. • Experience in mentoring and developing staff and volunteers. • Flexibility to work weekends and evenings as required/needed. To request a full job description and to apply contact Charles Hall, President, Association Services Group: P.O. Box 2945, LaGrange, GA 30241 v. 706-845-9085, f. 706-883-8215, chall@asginfo.net Interested applicants should not directly contact The Georgia Pharmacy Association staff or members of the Board of Directors.

Application DEADLINE – 5:00pm - February 28, 2014

I N D U S T R Y

•E M P L O Y M E N T O P P O R T U N I T Y•

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FDA Recommendation -

Discontinue Prescribing Products Containing More Than 325mg of Acetaminophen T

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The Georgia Pharmacy Journal

Application DEADLINE – 5:00pm - February 28, 2014

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I N D U S T R Y

The ABCs of Star Quality I

By: Bobby Newsome, Pharm.D., PGY-1 Graduate Resident, UGA/Barney’s Pharmacy Emily Murphy, Pharm.D., PGY-1 Resident, SCCP/Barney’s Pharmacy Jake Galdo, Pharm.D., BCPS, CGP, Barney’s Pharmacy/UGA

n the December 2013 issue of The Georgia Pharmacy Journal, Elliot Stogol and Jake Galdo discussed star ratings and how they affect community pharmacy practice. In order to understand these star measures and their effect on practice, we first need to discuss the acronyms of quality measures. The Pharmacy Quality Alliance (PQA), established in 2006, is a “consensus-based, multi-stakeholder membership organization committed to improving health care quality and patient safety with a focus on the appropriate use of medications.” 1Members include wholesalers, chain pharmacies, health technology corporations, schools of pharmacy, pharmacy benefits managers (PBMs),

health insurance plans, pharmaceutical medication use being triple weighted companies, and others. The mission of (highest impact). Therefore, it is expectPQA is to improve patient health with ed that these star measures will quickly higher quality medication management impact community pharmacies due to throughout multiple healthcare settings. pharmacy benefit managers searching The Centers for for ways to improve Medicare and Medtheir quality mea“There are seventeen icaid Services (CMS) sures. Please refer to have partnered with measures of quality used to the previous article, evaluate insurance plans, The CMS Star RatPQA to develop quality measures, known five of which are related to ings, for definition as star ratings, to of these quality meamedication use.” evaluate Medicare sures. Part D plans. There Electronic Qualare seventeen measures of quality used ity Improvement Platform for Plans & to evaluate insurance plans, five of which Pharmacies (EQuIPP) is a data based are related to medication use. All quality portal that allows for a neutral permeasures are not weighted equally, with formance measurement of medication use, which can be used by health insurance plans and community pharmacies. EQuIPP is supported by Pharmacy Quality Solutions (PQS), collaboration between PQA and CECity. For a fee, EQuIPP allows community pharmacies to access their star ratings for the five medication related quality measures and provides a national and state comparator. Succinctly, PQA developed quality measures, which CMS enforces through PBMs. As a community pharmacist, we can access our star ratings through EQuIPP, operated by PSA, owned by PQA. The upcoming GPhA annual convention will feature more information on star ratings, including CE opportunities discussing the pharmacotherapy of many disease states that are currently being measured and ways to improve your pharmacy’s star measures. n References: 1. PQA Mission Statement. http://pqaalliance.org/about/default.asp. Accessed 1/24/2014.

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Drug Thefts Rising After Georgia’s Pill Mill Crackdown P

By Andy Miller, Georgia Health News

harmacy officials say robberies are occurring with greater frequency in Georgia. Ironically, the officials link the increase to the state’s recent success in cracking down on the scourge of “pill mills’’ in the state. Pill mills are clinics or doctor’s offices that prescribe oxycodone and other powerful narcotics without a legitimate medical purpose. A tall man wearing a green baseball cap recently entered a CVS pharmacy in intent on robbery. The man was not looking for cash. Instead, according to police, he demanded that the pharmacist give him Lortab and Percocet painkillers. He then grabbed drug bottles and prescription bags belonging to customers before fleeing the store, police said. Pharmacy officials say such robberies are occurring with greater frequency in Georgia. Ironically, the officials link the increase to the state’s recent success in cracking down on the scourge of “pill mills’’ in the state. Last year, the Georgia General Assembly passed legislation to get rid of pill mills, requiring pain clinics to be licensed by the state medical board and owned by physicians. The state also launched a prescription drug monitoring program, aiming to cut down on the abuse of opioid painkillers. A spokeswoman for state Attorney General Sam Olens said this month that the pain clinic licensing and the drug monitoring program “have reduced the number of rogue pain pill clinics by making such clinics more difficult to operate.’’ The abuse of opioid painkillers is a major national problem. The federal government says prescription painkillers are the nation’s No. 1 drug epidemic. More than 16,000 people die annually in the United States from opioid painkillers

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— more than from heroin and cocaine combined. Laws in Florida and Georgia have made a difference. But unfortunately, when pill mills are eliminated, people who have addictions will look elsewhere for drugs, pharmacy officials say. State Sen. Buddy Carter (R-Pooler), a pharmacist, says the robbery increase is connected to the progress made on the pill mill crackdown. And it’s not just conventional pharmacies. Carter cited an armed robbery of a company in Conyers that provides pharmacy services to nursing homes, among other customers. The increase in robberies, in fact, led the Georgia Drugs and Narcotics Agency in November to issue guidelines to

pharmacists on what to do during such incidents. Pharmacies are keeping lower quantities of controlled drugs on the premises, says Jim Bracewell of the Georgia Pharmacy Association. Anecdotally, he says, armed robberies of pharmacies are increasing. “Hopefully we have driven [pill mills] somewhere else,’’ adds Bracewell. He compares the fight against illegal painkiller abuse to a Whac-a-Mole game, where each time an adversary is “whacked” it only pops up again somewhere else. One solution, he says, is to identify people with addictions and get them into treatment. n

Parris Named to Second Term on Board of Certification Executive Committee M

ark L. Parris, Chairman Elect of AIP and a GPhA member, has recently been named to the Board of Certification/Accredition Executive Committee. Dr. Parris enthusiastically accepted his second term as Member-at-Large, stating, “I’m honored to be chosen by my colleagues to represent both pharmacy and DME in a unique dual role as this year brings many challenges facing both pharmacy and DME. I believe pharmacy accreditation is something we will need in the near future. I’m privileged that BOC is leading the implementation process and assuring the transition ease for each enrolled pharmacy. I look forward to the continued success of BOC as we embark

on the evolving changes in the healthcare industry.” Parris has served BOC as a test development committee volunteer and has been on the Board since 2010. He also serves as Chairman-Elect of the Board of Directors for the Academy of Independent Pharmacy Association in Georgia, where he sits on the Committee of Governmental Affairs. He is President of Parris Medical Services in Blue Ridge, Georgia, a BOC-accredited pharmacy. James L. Hewlett, BOCO, who has served two terms as Vice Chair of the Board, assumed the role of Chair beginning January 1, 2014. Congratulations Mark. n

I N D U S T R Y

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I N D U S T R Y

The ABCs of Star Quality I

By: Bobby Newsome, Pharm.D., PGY-1 Graduate Resident, UGA/Barney’s Pharmacy Emily Murphy, Pharm.D., PGY-1 Resident, SCCP/Barney’s Pharmacy Jake Galdo, Pharm.D., BCPS, CGP, Barney’s Pharmacy/UGA

The Georgia Pharmacy Journal

N E W S

Drug Thefts Rising After Georgia’s Pill Mill Crackdown P

By Andy Miller, Georgia Health News

The Georgia Pharmacy Journal

Parris Named to Second Term on Board of Certification Executive Committee M

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

Volume XXXI, No. 12

Therapeutic Actions and the Genetic Code: Examples of the Application of Pharmacogenetics David F. Kisor, BS, PharmD and Angela J. Smith, PharmD Candidate, Ohio Northern University, Ada, Ohio Dr. David Kisor and Ms. Angela Smith have no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on how differences in genetics can affect patient response to drugs, causing both therapeutic effects and adverse reactions, to help pharmacists provide better medication therapy management. Objectives. At the completion of this activity, the participant will be able to: 1. demonstrate an understanding of pharmacogenetics and its application to pharmacy practice; 2. recognize variations in genes and the nomenclature used to identify variant alleles; 3. identify variation in alleles, diplotypes and metabolic phenotypes which can result in altered therapeutic response and adverse effects in patients; and 4. list examples of drug-gene interactions and interpret how these apply to patients in specific cases.

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Introduction

Not licensed to sell all products in all states.

The term pharmacogenetics (PGt) refers to differences in a given gene that can affect an individual’s response to drugs. The variation in metabolism due to genetics can alter both the therapeutic effect of medications, as well as cause adverse effects. Drug-gene interactions are similar to drug-drug interactions, putting pharmacists

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in a unique position to apply their extensive drug knowledge and proficiently fill a new gap in medication management. DNA is composed of a sequence of nucleotides (the triphosphates of adenine [A], cytosine [C], guanine [G], and thymine [T]), and serves as a “production manual” for the assembly of proteins. In relation to drugs, genes of interest (“pharmacogenetic genes”) are the segments of DNA which code for receptors, transporters, and metabolizing enzymes. There are approximately 25,000 genes in the human genome, i.e., the entirety of DNA, with variations resulting in differences in pharmacodynamics (PD), or how individuals respond to a drug, and pharmacokinetics (PK), or how individuals “handle” a drug with respect to absorption, distribution, metabolism and excretion (ADME). A variant form of a gene, called an allele, may result in altered drug response, due to altered PD or as a result of altered ADME. The most common variation in a gene is the single nucleotide polymorphism or SNP (pronounced “snip”) which is the case where a single nucleotide is replaced in the gene DNA sequence by another nucleotide, such as T replacing C. For instance, the C in position 634 of a gene being replaced by T would be noted as 634C>T. As a SNP produces a variant allele, the variant form of the gene is given a specific designation to differentiate it from the “common” form. The variant

form may result in altered protein function. With reference to the cytochrome P450 (CYP) enzyme family, responsible for metabolizing many drugs, a “star” nomenclature has been adopted, where the most common form of a gene is typically termed the *1 form and variant forms are designated otherwise, such as *2, *3, and so on. It should be noted that a given “*” variant for one gene, such as *17, does not necessarily have the same meaning as a *17 variant for a different gene. For instance, the *17 form of the CYP2C19 gene is a “gain-offunction” form resulting in increased drug metabolism by CYP2C19, whereas the *17 form of the CYP2D6 gene is a “reduced-function” form resulting in decreased drug metabolism by CYP2D6. Different alleles can affect protein function and, as in the case of the CYP enzyme family, this can lead to variability in drug metabolism. Some genetic effects are more drastic than others and, in the more extreme cases, genetic testing may make the difference between therapeutic failure and success, or safety and toxicity. As data supporting the use of genetic testing in drug therapy decision-making accrues, more and more pharmacies are offering services that integrate pharmacogenetics into medication therapy management (MTM) programs. Currently, pharmacogenetic-based dosing guidelines have been pub-

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Volume XXXI, No. 12

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Introduction

Not licensed to sell all products in all states.

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lished for 10 gene-drug pairs: thiopurine methyltransferase (TPMT)thiopurines; cytochrome P450 2C19 (CYP2C19)-clopidogrel; CYP2C9 and vitamin k epoxide reductase subunit 1 (VKORC1)-warfarin; CYP2D6-codeine; human leukocyte antigen B (HLA-B)-abacavir; solute carrier organic anion transporter 1B1 (SLCO1B1)-simvastatin; HLA-B-allopurinol; CYP2D6 and CYP2C19-tricyclic antidepressants (TCAs); HLAB-carbamazepine; and dihydropyrimidine dehydrogenase (DPYD)-5-fluorouracil and capecitabine. Additionally, another five guidelines are under development. Guidelines are available on the pharmacogenomics knowledgebase website (www.pharmgkb.org) and are available as open access publications in Clinical Pharmacology and Therapeutics. Relating a patient’s drug response to genetics defines PGt. Genetic factors represent the underlying variability in response to a drug, notwithstanding environmental factors, diet, pathophysiology, concomitant drug use, and other factors that introduce variability. Table 1 provides examples of druggene interactions and the potential outcome of each interaction. Four specific case examples of the application of pharmacogenetics will be presented.

CYP2D6-Codeine

Cytochrome P450 2D6 (CYP2D6) is a major drug metabolizing enzyme, responsible for metabolizing approximately 20 percent of drugs. There are more than 80 different alleles of the CYP2D6 gene, which can result in a spectrum of CYP2D6 enzyme activity. As an individual receives genetic information from each parent, the combination of alleles (called a diplotype) will impart a certain level of enzyme activity relative to drug metabolism. Each allele inherited by an individual contributes to the phenotype of enzyme activity that is expressed and allows individuals to be classified by a “metabolism phenotype,” such as ultrarapid me-

Table 1

Examples of drug-gene interactions and potential outcomes Gene

Drug

HLA-B

carbamazepine

CYP2C19 clopidogrel

Variant Effect on Allele (SNP)a Proteinb

Effect on PK/PDc

Potential Outcome

HLA-Baltered protein structure

T-cell mediated immune response

Stevens-Johnson syndrome; toxic epidermal necrolysis

*17 (C>T) rs12248560d

increased CYP2C19 enzyme activity

increased increased clearance clopidogrel effect; (conversion)e bleeding

15:02

CYP2D6

codeine

*3 A deleted rs35742686

nonfunctional CYP2D6 enzyme

decreased decreased codeine clearance effect; lack of pain (conversion)f relief

CYP2C9

warfarin

*2 (C>T) rs1799853

decreased CYP2C9 enzyme activity

decreased clearance

increased warfarin effect; bleeding

SNP = single nucleotide polymorphism where one DNA base (adenine (A), cytosine (C), guanine (G), and thymine (T)) replaces another (e.g., such as T replacing C; C>T). bPharmacogenetic proteins include receptors, drug transporters, and drug metabolizing enzymes. c PK/PD = pharmacokinetics/pharmacodynamics. drs number = a specific and consistent identifier of the SNP as found in the SNP database (dbSNP) of the National Center for Biotechnology Information. eThe increased clearance of clopidogrel results in greater conversion to the active metabolite. f The decreased clearance of codeine results in less conversion to morphine, which is largely responsible for the analgesic effects of codeine. a

tabolizer (UM) or poor metabolizer (PM). The classification of an individual by metabolism phenotype has shown to be of consequence when considering the use of codeine. Case Example #1 describes one of the extremes of genetic influence on drug response. This case example illustrates

a lack of drug effectiveness. Neither JS nor his brother underwent simple pharmacogenetic testing relative to CYP2D6 prior to receiving the codeine-containing product. Subsequent testing through a university medical center study showed that JS and his brother were in fact poor metabolizers,

Case Example #1 JS, a 19 y.o. healthy Caucasian male, is a body shop mechanic. JS visited the nearby university medical center emergency department (ED) after slicing his hand on a piece of sheet metal. Following suturing (18 stitches), the hand was bandaged and wrapped. JS was in pain and was complaining that his hand was “throbbing.” He was given acetaminophen/codeine phosphate (300 mg/30 mg) in the ED and provided a prescription for a 72-hour period with the instructions to take 1 to 2 tablets every 4 to 6 hours as needed for pain. At the pharmacy, he asked if this was the same as Tylenol #3 because his younger brother had some prescribed for him after he had his tonsils removed. JS explained that the Tylenol #3 did not help his brother at all, so they “have plenty at home.” The pharmacist explained that prescriptions are for specific individuals, and JS agreed to get the prescription filled for him and not use what was left from his brother’s prescription. The pharmacist also told JS to monitor if the pain medication was working. At 36 hours, JS was still experiencing severe throbbing pain and called the pharmacy. The pharmacist discussed the situation with JS’ family physician, who prescribed an alternative analgesic, which was used by JS with success. In discussion with JS’ family physician, the pharmacist explained that the lack of efficacy of the acetaminophen/codeine combination may have a genetic basis, as neither JS nor his younger brother experienced pain relief with the codeine containing product.

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each with a *3/*4 diplotype (combination of CYP2D6 gene variants inherited from each parent). Having a diplotype that produced nonfunctional CYP2D6 enzymes, neither JS nor his brother had the metabolic capacity to convert codeine (a prodrug) to morphine (the active drug), which is largely responsible for the analgesia produced with acetaminophen/codeine use. The other extreme of CYP2D6 enzyme activity, where excessive amounts of morphine are formed following codeine administration, is seen in individuals who are ultrarapid metabolizers. These individuals are at risk of morphine toxicity due to very efficient conversion of codeine. Additionally, infants who were breastfeeding have tragically died of morphine overdose because their mothers were UMs receiving codeine-containing products. Here, the infants received morphine that was passed onto them in the breast milk. The Clinical Pharmacogenetics Implementation Consortium (CPIC) pharmacogenetic-based dosing guidelines suggest avoiding codeine use in UM and PM individuals due to the potential for toxicity and lack of efficacy, respectively. Finally, in early 2013, the Food and Drug Administration issued a black box warning for the labeling of codeine-containing products, as well as a contraindication to the use of codeine-containing products in children following tonsillectomy and/or adenoidectomy. The aim of this labeling is to try and prevent opioid toxicity and death due to codeine use in children who may be UMs. The therapeutic action, based on an individual’s genetics, would be to use an alternative opioid or a non-opioid analgesic.

HLA-B-Carbamazepine

The human leukocyte antigen (HLA) gene family is responsible for the coding of the HLA complex, a group of proteins which guide the immune system in identifying “foreign” cells. Individuals with the gene variant HLA-B*15:02 are at increased risk of a T-cell-mediated

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immune response, resulting in the potentially life-threatening skin disease of Stevens-Johnson syndrome (SJS; also called erythema multiforme majus) or toxic epidermal necrolysis (TEN). SJS can be expressed as a mild form with the patient experiencing fever, itching, and malaise. Additionally, lesions (macular, papular, hive-like, with or without blisters) may be found symmetrically on the trunk and on upper and lower extremities. The severe form of SJS includes less than 10 percent of the patient’s body surface area (BSA) being necrotic skin. When necrotic lesions extend beyond 30 percent of the BSA, the diagnosis of TEN is made. In addition to mucosa and skin involvement in SJS and TEN, vital organs can also be affected and severe forms result in mortality rates up to 40 percent, most often due to sepsis. It is thought that carbamazepine hypersensitivity is the result of the drug’s metabolites altering cellular proteins. The protein alteration results in the immune system identifying cells as “foreign” and elicits a T-cell mediated immune response, culminating in SJS or TEN. Individuals with the variant HLA-B*15:02 are at increased risk of SJS and TEN when taking carbamazepine. Case Example #2 illustrates the HLA-B-carbamazepine interaction.

Case Example #2 YL is a 17 y.o. Chinese male who is participating in a cultural exchange program with the United States. YL lives with his host family in Southwest Ohio. While attending a college baseball game, YL experiences a generalized tonic-clonic seizure. YL’s airway and head are protected, and the seizure ends after approximately 90 seconds. YL is evaluated and transported by ambulance to the medical center emergency department. There is no documentation that YL has a seizure history, and it was never mentioned by YL or the exchange agency. In discussing treatment options, the pharmacist points out that the Asian population and, in particular, individuals of Han Chinese descent have been shown to have an increased risk of SJS and TEN related to the interaction of HLA-B*15:02 with carbamazepine. With this in mind, alternative treatment options are considered.

The presence of one or two copies (one from each parent) of the variant HLA-B*15:02 allele imparts an increased risk of developing SJS or TEN in patients who are to receive carbamazepine. Table 2 presents the frequencies of HLA-B*15:02 in U.S. Asian populations. It should be noted that oxcarbazepine has also been shown to cause skin reactions in HLAB*15:02 positive individuals. The therapeutic action here, based on

Table 2 The frequency of occurrence of HLA-B*15:02 in U.S. Asian populations compared to the reference population of Han Chinese a Population

Han Chinesec U.S. Asian population 1 U.S. Asian population 2

Frequency (%) of occurrence of HLA-B*15:02b

Total # of individuals tested for HLA-B*15:02

Approximate # of individuals testing “positive” for HLA-B*15:02

13 5

101 358

13 18

1772

Adapted from allelefrequencies.net with the noted Han Chinese frequency for reference Rounded to approximate whole number c Example Han population (Yunnan Province) a b

CYP2D6-Codeine

Table 1

Examples of drug-gene interactions and potential outcomes Gene

Drug

HLA-B

carbamazepine

CYP2C19 clopidogrel

Variant Effect on Allele (SNP)a Proteinb

Effect on PK/PDc

Potential Outcome

HLA-Baltered protein structure

T-cell mediated immune response

Stevens-Johnson syndrome; toxic epidermal necrolysis

*17 (C>T) rs12248560d

increased CYP2C19 enzyme activity

increased increased clearance clopidogrel effect; (conversion)e bleeding

15:02

CYP2D6

codeine

*3 A deleted rs35742686

nonfunctional CYP2D6 enzyme

decreased decreased codeine clearance effect; lack of pain (conversion)f relief

CYP2C9

warfarin

*2 (C>T) rs1799853

decreased CYP2C9 enzyme activity

decreased clearance

increased warfarin effect; bleeding

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HLA-B-Carbamazepine

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Table 2 The frequency of occurrence of HLA-B*15:02 in U.S. Asian populations compared to the reference population of Han Chinese a Population

Han Chinesec U.S. Asian population 1 U.S. Asian population 2

Frequency (%) of occurrence of HLA-B*15:02b

Total # of individuals tested for HLA-B*15:02

Approximate # of individuals testing “positive” for HLA-B*15:02

13 5

101 358

13 18

1772

Adapted from allelefrequencies.net with the noted Han Chinese frequency for reference Rounded to approximate whole number c Example Han population (Yunnan Province) a b

CYP2D6/CYP2C19-Tricyclic Antidepressants

Many drugs are metabolized by multiple cytochrome P450 enzymes such that specific isozyme (e.g., CYP2D6, CYP2C19) genotypes can influence the overall elimination (clearance) of a given substrate drug. Variant forms of the CYP2D6 and CYP2C19 genes produce increased enzyme function. Examples include multiple copies of functional variants as seen in CYP2D6 UM; increased transcription (more RNA is transcribed from DNA, which results in increased production of the enzyme) as exhibited by the CYP2C19*17 gene variant. Conversely, CYP2D6 and CYP2C19 alleles can also produce reducedfunction or loss-of-function enzymes. For example, CYP2D6*4 and CYP2C19*2 are non-functional. The combinations of genetic variability relative to both CYP2D6 and CYP2C19 can influence the ADME and overall concentration versus time profile of substrate drugs and metabolites. Some examples of substrates for CYP2D6 and CYP2C19 include amitriptyline, nortriptyline, imipramine, and other tricyclic antidepressants. Amitriptyline is metabolized to nortriptyline and imipramine is metabolized to desipramine via CYP2C19. Amitriptyline and nortriptyline are metabolized by CYP2D6 to their respective 10-hydroxy metabolites, whereas imipramine and desipramine, also via CYP2D6, are metabolized to their 2-hydroxy metabolites. The hydroxy metabolites are less active than their parent compounds. The overall metabolism of these drugs requires multiple steps, and at each step a different enzyme is introduced into the process. With multiple alleles existing for each

enzyme, this adds a layer of complication and can allow for increased variation in drug metabolism. As mentioned earlier, there are numerous variant alleles of the CYP2D6 gene that contribute to various metabolism phenotypes. With respect to CYP2C19, there are 28 confirmed variant alleles, with the *2, *3, and *17 alleles being most commonly implicated in altered drug metabolism (Table 3). An individual with one “normal” copy of the gene and one copy of either the *2 or *3 alleles would be considered an intermediate metabolizer (IM), whereas an individual with two copies of the *2 or *3 alleles would be considered a PM. A *2/*3 individual would also be a PM, as both of the alleles are loss-of-function forms of the gene. The *17 form is considered a gainof-function allele and individuals with the common form (*1) and the *17 allele, or two copies of the *17 allele, would be considered UM. Certainly the combination of CYP2D6 and CYP2C19 variant genes can be expected to impact drug metabolism, thus influencing an individual’s response to tricyclic antidepressants including amitriptyline and imipramine. Consider Case Example #3. Recall that amitriptyline is converted to nortriptyline via CYP2C19. In this case, the patient is an IM, which is likely the cause of elevated amitriptyline concentrations. Additionally, the patient is a CYP2D6 PM indicating decreased conversion of both amitriptyline and nortriptyline to their respective 10-hydroxy metabolites. The patient’s genetic coding for decreased metabolism relative to the CYP2D6 and CYP2C19 pathways is likely responsible for the adverse effect noted in the above case. The interactions of CYP2D6 and CYP2C19 with tricyclic antidepressants have been evaluated and discussed. With two genes playing an important role in the metabolism of TCAs and both having many variants, predicting potential pharmacokinetic effects and the response to a given TCA can be difficult. The

Case Example #3 JD is a 51 y.o. African American male who presents to his family physician complaining of loss of appetite, fatigue, and apathy. He states he has been having difficulty at work and just “doesn’t sleep well.” He also states that he has been “irritable” and “quick to jump at people.” JD adds that he has been feeling more and more frustrated with day to day life. He confides that he started feeling this way over the past two months after the death of his father, whom he was very close to. JD’s physician makes an initial diagnosis of depression. Being older, the physician is most familiar with the use of the tricyclic antidepressant agents and starts JD on amitriptyline. JD receives 25 mg of amitriptyline BID. After two weeks, JD contacts his physician, complaining of confusion, lack of concentration and vomiting. JD is directed to be taken by his wife to the local hospital emergency department. At the ED, JD is examined, with the EKG showing a prolonged QRS complex with a right bundle branch block. While JD is receiving a relatively low dose of amitriptyline, the diagnosis of amitriptyline toxicity is made. As JD brought his vial of amitriptyline with him, a “pill count” indicates that JD has been following the administration directions. The ED physician calls the pharmacy to check on the generic form of the amitriptyline to see if it is the correct strength. A pharmacist confirms the strength of the tablets and suggests that pharmacogenetic testing be performed to identify the patient’s metabolic phenotype relative to CYP2D6 and CYP2C19. JD provides a cheek swab sample for DNA analysis. The amitriptyline is held and JD is monitored. JD is discharged from the ED with instructions to see his family physician for follow-up. After five days the pharmacogenetic test results are available, indicating that JD is a CYP2D6 poor metabolizer with a *4/*4 diplotype and CYP2C19 intermediate metabolizer with a *1/*2 diplotype. These results explain the adverse reactions being related to amitriptyline overdose, here due to decreased metabolism as compared to the actual dose being considered too high. JD is switched to a selective serotonin reuptake inhibitor (SSRI) and responds well to treatment.

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Table 3 Examples of CYP2C19 alleles, diplotypes, and metabolic phenotypes Functionality Fully functional: *1 (wild type)

Example Diplotypea *1/*2 *2/*2

PMc

Gain-of-function: *17

*2/*17 *1/*1 *1/*17

IM EMd UMe

Combination of alleles (one from each parent) Poor metabolizer e Ultrarapid metabolizer

Intermediate metabolizer Extensive metabolizer

recently published CPIC guidelines can help with the interpretation of such information. Based on the individual’s genetics, the therapeutic action would be to use an alternative to a TCA for treatment of depression.

CYP2C19-Clopidogrel

As previously mentioned, CYP2C19 is a drug metabolizing enzyme which is responsible for metabolizing between 5 and 10 percent of drugs. The CYP2C19 gene has been mostly discussed relative to the drug clopidogrel when considering conversion of this prodrug to its active form. The *1 form is related to normal metabolism, and is also commonly referred to as extensive metabolism. The *2 and *3 alleles, as present in heterozygous individuals (having two different alleles i.e., *1/*2, *1/*3) or homozygous individuals (having two of the same alleles i.e., *2/*2, *3/*3) result in decreased conversion of clopidogrel to its active form. This decreased conversion has been related to increased cardiovascular risk factors in patients having undergone coronary artery stent placement during percutaneous coronary intervention for treatment of acute coronary syndrome (ACS). In 2010, FDA issued a black box warning for clopidogrel stating that it may not be effective for patients with reduced CYP2C19 metabolizing

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Case Example #4

Metabolic Phenotype IMb

Loss-of-function: *2, *3, others

capability. The *17 allele is associated with increased conversion of clopidogrel to its active metabolite, which puts the patient at increased risk for bleeding. Case Example #4 presents an example of a CYP2C19-clopidogrel interaction. Each CYP2C19 gene can be categorized as a gain-of-function, normal function or loss-of-function allele. The combination of two alleles (one from each parent) results in the following expected “metabolizer” phenotypes: ultrarapid, extensive (normal), intermediate or poor (Table 4). The genotypes and expected metabolizer phenotypes have been evaluated relative to clopidogrel use as described by CPIC. The therapeutic action here,

MR is a 52 y.o. Caucasian male. MR is an outpatient visiting the ambulatory care pharmacy to have his prescription for prasugrel filled. He explains that he is “very keen” about taking his prasugrel following the placement of two “tubes” in his “heart arteries.” MR was previously diagnosed with ACS. He had gone to the ED after experiencing dizziness and chest pain. He had two stents placed to prevent coronary artery thrombosis and the consequences of a clot. MR was given a 60 mg loading dose of prasugrel and a prescription with the instructions to take one 10 mg tablet daily. His only other medication is atorvastatin 20 mg daily, being used for hyperlipidemia that was diagnosed five years ago. MR does not have prescription coverage as part of his healthcare insurance and is “shocked” at the price of prasugrel. He asks the pharmacist if there is an alternative drug he can take. The pharmacist suggests MR undergo pharmacogenetic testing, which is more expensive than a single prasugrel prescription, but in the long run will likely save MR a great deal of money. MR agrees to have a pharmacogenetic test done with the results indicating that he is an extensive metabolizer with a CYP2C19 *1/*1 diplotype. The pharmacist contacts MR’s family physician and the prasugrel is changed to clopidogrel 75 mg daily.

Table 4 CYP2C19 alleles as related to expected metabolizer phenotypes

Gene from second parent

an individual’s genetics, would be to use an alternative antiepileptic therapy that does not increase the risk of SJS or TEN in HLA-B*15:02 positive individuals. The CPIC has recently published guidelines related to the HLA-B*15:02-carbamazepine interaction.

gain-of-function allele

Gene from first parent gain-of-function normal function loss-of-function allele allele allele UMa

IMb

normal function allele

EMc

loss-of-function allele

PMd

Ultrarapid metabolizer Extensive metabolizer

Intermediate metabolizer Poor metabolizer

CYP2D6/CYP2C19-Tricyclic Antidepressants

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Table 3 Examples of CYP2C19 alleles, diplotypes, and metabolic phenotypes Functionality Fully functional: *1 (wild type)

Example Diplotypea *1/*2 *2/*2

PMc

Gain-of-function: *17

*2/*17 *1/*1 *1/*17

IM EMd UMe

Combination of alleles (one from each parent) Poor metabolizer e Ultrarapid metabolizer

Intermediate metabolizer Extensive metabolizer

CYP2C19-Clopidogrel

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Case Example #4

Metabolic Phenotype IMb

Loss-of-function: *2, *3, others

Table 4 CYP2C19 alleles as related to expected metabolizer phenotypes

Gene from second parent

gain-of-function allele

Gene from first parent gain-of-function normal function loss-of-function allele allele allele UMa

IMb

normal function allele

EMc

loss-of-function allele

PMd

Ultrarapid metabolizer Extensive metabolizer

Intermediate metabolizer Poor metabolizer

based on the individual’s genetics, would be to use clopidogrel as a less expensive alternative to prasugrel.

Summary

Testing of an individual’s pharmacogenetics is becoming more widely available and published dosing guidelines support its application in many pharmacy settings. Additionally, it is likely within the next five to 10 years that preemptive genetic testing, including partial or whole-genome (all genes) testing, will become a reality. Having the data available at the point of care will aid in the application of PGt. Drug-gene interactions as described by the examples above can be thought of in a similar way to drug-drug interactions. The expertise of pharmacists calls for the profession to embrace PGt as an integral component of medication therapy management. Pharmacists need to be educated about PGt and should expect to educate other healthcare providers and patients regarding drug-gene interactions.

continuing education quiz

Please print.

Therapeutic Actions and the Genetic Code: Examples of the Application of Pharmacogenetics

Address_____________________________________________

1. All of the following are components of DNA EXCEPT: a. adenine. c. thymine. b. cytosine. d. uracil. 2. The most common variation in a gene is the SNP (“snip”) which refers to: a. single nucleotide polymorphism. b. single new protein. c. substituted nucleotide protein. d. slow new polymorphism. 3. With a gene variant that is a “gain-of-function” form, drug metabolism will: a. increase. c. remain the same. b. decrease. 4. Approximately what percent of drugs are metabolized by cytochrome P450 2D6 (CYP2D6)? a. 5 percent c. 20 percent b. 10 percent d. 75 percent 5. Codeine is a prodrug metabolized by what enzyme? a. CYP1A2 c. CYP3A4 b. CYP2C19 d. CYP2D6 6. Individuals who are CYP2D6 poor metabolizers are at risk of morphine toxicity when taking codeine-containing products. a. True b. False 7. When a codeine-containing product is prescribed for a child following tonsillectomy, the therapeutic action is to: a. use the normal pediatric dose. b. use an alternative opioid or a non-opioid analgesic. c. increase the dose to achieve analgesia. d. decrease the dose to avoid toxicity.

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.

Completely fill in the lettered box corresponding to your answer.

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

1. 2. 3. 4. 5.

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

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

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

[d] [d]

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

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

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

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

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

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

[c] [d] [c] [c] [d] [c] [d]

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

Program 0129-0000-13-012-H01-P

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

Release date: 12-15-13

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

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

8. Following administration of carbamazepine, a patient with the HLA-B*15:02 gene variant and necrotic lesions on more than 30% of his body would be diagnosed with: a. SJS. c. TEN. b. MPE. d. erythema. 9. Genetic testing could be considered when initiating carbamazepine to avoid what potentially life-threatening condition? a. Anaphylaxis c. Stevens-Johnson syndrome b. Heart attack d. Stroke 10. What ethnicity has a higher frequency of the HLAB*15:02 allele? a. Asian c. Native American b. African American d. Caucasian 11. Which guideline would you refer to for information about interpretation of genetic testing results? a. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) b. Infectious Disease Society of America (ISDA) c. Adult Treatment Panel III (ATPIII) d. Clinical Pharmacogenetics Implementation Consortium (CPIC) 12. Compared to their parent compound, how active are the hydroxy metabolites of tricyclic antidepressants? a. Same activity c. Less active b. More active 13. When considering conversion of the prodrug clopidogrel to its active form, which gene has been mostly discussed? a. CYP2D6 c. CYP3A4 b. CYP1E2 d. CYP2C19 14. Which of the following is the expected metabolic phenotype for a patient with a normal function allele and a loss-offunction allele in regards to CYP2C19? a. Ultra metabolizer (UM) c. Intermediate metabolizer (IM) b. Poor metabolizer (PM) d. Extensive metabolizer (EM)

15. A patient with coronary artery stents who is an extensive metabolizer with a CYP2C19*1/*1 diplotype can be effectively treated with clopidogrel 75 mg daily. a. True b. False To receive CE credit, your quiz must be received no later than December 15, 2016. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to opa@ohiopharmacists.org.

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based on the individual’s genetics, would be to use clopidogrel as a less expensive alternative to prasugrel.

Summary

continuing education quiz

Please print.

Therapeutic Actions and the Genetic Code: Examples of the Application of Pharmacogenetics

Address_____________________________________________

Completely fill in the lettered box corresponding to your answer.

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

1. 2. 3. 4. 5.

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

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

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

[d] [d]

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

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

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

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

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

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

[c] [d] [c] [c] [d] [c] [d]

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

Program 0129-0000-13-012-H01-P

Release date: 12-15-13

Expiration date: 12-15-16

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.

Program 0129-0000-13-012-H01-P 0.15 CEU

Name________________________________________________

City, State, Zip______________________________________ Email_______________________________________________ NABP e-Profile ID____________Birthdate_________

(MMDD)

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

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COMING

AIP Spring Meeting

SOON!

THE GEORGIA PHARMACY ASSOCIATION

2013-2014

Sunday, March 30, 2014

Board of Directors Name

Position

Robert M. Hatton

Chair of the Board

Pamala S. Marquess

President

Macon Marriott & Centreplex Macon, GA

Robert B. Moody President-Elect Thomas H. Whitworth

First Vice President

Lance P. Boles

Second Vice President

Liza Chapman

State At Large

Terry Forshee

State At Large

David Graves

State At Large

Joshua D. Kinsey

State At Large

Eddie Madden

State At Large

Laird Miller

State At Large

Chris Thurmond

State At Large

Krista Stone

1st Region President

Ed S. Dozier

2nd Region President

Renee D. Adamson

3rd Region President

Nicholas O. Bland

4th Region President

Shelby Biagi

5th Region President

Sherri S. Moody

6th Region President

Tyler Mayotte

7th Region President

Michael Lewis

8th Region President

Amanda Westbrooks

9th Region President

Flynn Warren

10th Region President

Kalen Manasco

11th Region President

Ken Von Eiland

12th Region President

Ted Hunt

ACP Chair

Sharon B. Zerillo

AEP Chair

John Drew

AHP Chair

Drew Miller

AIP Chair

Michelle Hunt

APT Chair

Leah Stowers

ASA Chair

John T. Sherrer

Foundation Chair

Al McConnell

Board of Pharmacy Chair

Megan Freeman

GSHP President

Amy C. Grimsley

Mercer Faculty Representative

Rusty Fetterman

South Faculty Representative

Lindsey Welch

UGA Faculty Representative

Tyler Bryant

ASP, Mercer University

Tiffany Galloway

ASP, South University

Jessica Kupstas

ASP, UGA

Jim Bracewell

Executive Vice President

The GPhA Mobile App

SAVE THE DATE Network with Colleagues

Contact Association Staff. Share this App with a friend.

Meet with Partners

Association and Industry News. Check out Association events and register.

Continental Breakfast & Lunch Provided

Exciting Continuing Education Programs

Renew your membership - join the Association. Receive Association reminders and updates. Connect with the GPhA on facebook. Learn about GPhA services. Connect with friends and associates. Important Advocacy links.

SHOW YOUR SUPPORT GPhA is soon going mobile, leveraging mobile technology to meet member’s communication, education, advocacy, and engagement needs. Mobile isn’t what it used to be, involving small screens and slow connections. Faster mobile devices like smartphones and tablets have increased the opportunity to utilize the mobile medium to better serve association members.

Look for GPhA’s App Release - Coming Soon!

AVA I L A B L E FO R M AC & A N D RO I D

ATTEND THIS YEAR’S AIP SPRING MEETING Registration:

(For Planning Purposes Please Fill Out and Return )

Member’s Name:_______________________________________ Nickname________________________ Pharmacy Name:_______________________________________________________________________ Address:______________________________________________________________________________ E-mail Address (Please Print):_____________________________________________________________ Will you be joining us for lunch (12-1pm)? Yes_____ No_____; # of additional Staff/Guests:____________ Names of Staff/Guests: ___________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

PLEASE FAX BACK TO

(404) 237-8435

COMING

AIP Spring Meeting

SOON!

THE GEORGIA PHARMACY ASSOCIATION

2013-2014

Sunday, March 30, 2014

Board of Directors Name

Position

Robert M. Hatton

Chair of the Board

Pamala S. Marquess

President

Macon Marriott & Centreplex Macon, GA

Robert B. Moody President-Elect Thomas H. Whitworth

First Vice President

Lance P. Boles

Second Vice President

Liza Chapman

State At Large

Terry Forshee

State At Large

David Graves

State At Large

Joshua D. Kinsey

State At Large

Eddie Madden

State At Large

Laird Miller

State At Large

Chris Thurmond

State At Large

Krista Stone

1st Region President

Ed S. Dozier

2nd Region President

Renee D. Adamson

3rd Region President

Nicholas O. Bland

4th Region President

Shelby Biagi

5th Region President

Sherri S. Moody

6th Region President

Tyler Mayotte

7th Region President

Michael Lewis

8th Region President

Amanda Westbrooks

9th Region President

Flynn Warren

10th Region President

Kalen Manasco

11th Region President

Ken Von Eiland

12th Region President

Ted Hunt

ACP Chair

Sharon B. Zerillo

AEP Chair

John Drew

AHP Chair

Drew Miller

AIP Chair

Michelle Hunt

APT Chair

Leah Stowers

ASA Chair

John T. Sherrer

Foundation Chair

Al McConnell

Board of Pharmacy Chair

Megan Freeman

GSHP President

Amy C. Grimsley

Mercer Faculty Representative

Rusty Fetterman

South Faculty Representative

Lindsey Welch

UGA Faculty Representative

Tyler Bryant

ASP, Mercer University

Tiffany Galloway

ASP, South University

Jessica Kupstas

ASP, UGA

Jim Bracewell

Executive Vice President

The GPhA Mobile App

SAVE THE DATE Network with Colleagues

Contact Association Staff. Share this App with a friend.

Meet with Partners

Association and Industry News. Check out Association events and register.

Continental Breakfast & Lunch Provided

Exciting Continuing Education Programs

Look for GPhA’s App Release - Coming Soon!

AVA I L A B L E FO R M AC & A N D RO I D

ATTEND THIS YEAR’S AIP SPRING MEETING Registration:

(For Planning Purposes Please Fill Out and Return )

PLEASE FAX BACK TO

(404) 237-8435

THE GEORGIA PHARMACY ASSOCIATION

50 Lenox Pointe, NE Atlanta, GA 30324

139 th GPh A C on v en tion Ju n e 26 -29, 2014 Wy n dh a m Bay Poi n t R e sort - Pa na m a Cit y Be ach, FL

As healthcare changes, so do job responsibilities and career tracks. The Georgia Pharmacy Association is your development partner as you address your future in pharmacy. Professional networking, skills training and continuing education are key benefits of your GPhA membership. Plan to attend this year’s Convention and take advantage of all the educational and networking opportunities available. Whether you’re a seasoned professional or a first year student, there’s something for you at the GPhA Convention. We’re looking forward to seeing you there.

THE GEORGIA PHARMACY ASSOCIATION 50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.org Proud Sponsor of the 139th GPhA Convention

Book your reservations at the Wyndham Bay Point Today! Room Rate: Run of House (1 King or 2 Double Beds) $189/night + tax with no resort fee. Reservation Line: (866) 269-9165 OR Visit www.gpha.org to be directed to our customized Wyndham link. Reservation Cut-Off: Wednesday, June 4, 2014