Don’t Forget to VOTE! State of Georgia Primaries - May 20th
May 2014 VOLUME 36, ISSUE 4
139th
GPhA
convention 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, F L
C on v en tion S ch edu l e I nside This Edition
May 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.
Contents
2 Message from Jim Bracewell ......................... 4 Member News .................................................. 5 GPhA New Members....................................... 7 Message from Pamala Marquess .................
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
8
GPhA 2014 Convention Highlights and At-A-Glance ................
12
Region Meetings Recap...........................
14 PharmPAC Supporters ................................18 Continuing Education ............................... 20 GPhA Board of Directors ......................... 28 Industry News ...............................................
www.gpha.org
The Georgia Pharmacy Journal
1
May 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.
Contents
2 Message from Jim Bracewell ......................... 4 Member News .................................................. 5 GPhA New Members....................................... 7 Message from Pamala Marquess .................
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
8
GPhA 2014 Convention Highlights and At-A-Glance ................
12
Region Meetings Recap...........................
14 PharmPAC Supporters ................................18 Continuing Education ............................... 20 GPhA Board of Directors ......................... 28 Industry News ...............................................
www.gpha.org
The Georgia Pharmacy Journal
1
MESSAGE
• Pharmacists Mutual Insurance Company • Pharmacists Life Insurance Company • Pro Advantage Services®, Inc.
from Pamala Marquess
NEVER, EVER QUIT!
let our experts
do the math
I
f there were a single word to describe what pharmacists need during tough times, it would be PERSEVERANCE. As I have traveled the country representing you at national, state and local pharmacy meetings, I have heard some amazing stories about Pamala Marquess pharmacists who have persevered through incredible difficulties, overcame daunting GPhA President obstacles, and have risen above personal and professional challenges. I can relate to these difficulties, obstacles and challenges every day in my pharmacy. During this year’s legislative session, GPhA fought hard for Georgia’s citizens, battling for patient access to medications prescribed by their physicians, patient access to immunizations administered by pharmacists, and for broader access to pharmacist proDuring this year’s viders. We did not win the battle for Georgia patients this year but we legislative session, will NEVER, EVER QUIT! We can follow the lead of our colleagues in Tennessee who passed GPhA fought hard legislation to increase patient access to medication with a MAC bill for Georgia’s and Wisconsin who passed a pharmacist provider status bill. Several citizens. other states have been successful with legislation and I am confident that Georgia will be too! We will begin our work now informing patients, consumer groups and all the Georgians whose lives are impacted by this lack of access to medications. We will spread the good news that healthcare costs decrease when a pharmacist is involved in patient education. If someone were to ask me to pick one word that best describes my road to success as a pharmacist, I wouldn’t hesitate to say perseverance. Persist no matter what. Endure discomfort. Request help. Steadfastly hold on to your beliefs and values. Envision triumph. Very consistently keep at it. Embrace adversity as your teacher. Refuse to give up. Enjoy and celebrate every tiny bit of progress!
d/b/a Pharmacists Insurance Agency (in California) CA License No. 0G22035
Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment. Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.
Hutton Madden
800.247.5930 ext. 7149 404.375.7209
800.247.5930 www.phmic.com
Let’s all join together for our profession and the patients of Georgia!
Pam
Pamala S. Marquess Find us on Social Media:
2
The Georgia Pharmacy Journal
Not licensed to sell all products in all states.
MESSAGE
• Pharmacists Mutual Insurance Company • Pharmacists Life Insurance Company • Pro Advantage Services®, Inc.
from Pamala Marquess
NEVER, EVER QUIT!
let our experts
do the math
I
f there were a single word to describe what pharmacists need during tough times, it would be PERSEVERANCE. As I have traveled the country representing you at national, state and local pharmacy meetings, I have heard some amazing stories about Pamala Marquess pharmacists who have persevered through incredible difficulties, overcame daunting GPhA President obstacles, and have risen above personal and professional challenges. I can relate to these difficulties, obstacles and challenges every day in my pharmacy. During this year’s legislative session, GPhA fought hard for Georgia’s citizens, battling for patient access to medications prescribed by their physicians, patient access to immunizations administered by pharmacists, and for broader access to pharmacist proDuring this year’s viders. We did not win the battle for Georgia patients this year but we legislative session, will NEVER, EVER QUIT! We can follow the lead of our colleagues in Tennessee who passed GPhA fought hard legislation to increase patient access to medication with a MAC bill for Georgia’s and Wisconsin who passed a pharmacist provider status bill. Several citizens. other states have been successful with legislation and I am confident that Georgia will be too! We will begin our work now informing patients, consumer groups and all the Georgians whose lives are impacted by this lack of access to medications. We will spread the good news that healthcare costs decrease when a pharmacist is involved in patient education. If someone were to ask me to pick one word that best describes my road to success as a pharmacist, I wouldn’t hesitate to say perseverance. Persist no matter what. Endure discomfort. Request help. Steadfastly hold on to your beliefs and values. Envision triumph. Very consistently keep at it. Embrace adversity as your teacher. Refuse to give up. Enjoy and celebrate every tiny bit of progress!
d/b/a Pharmacists Insurance Agency (in California) CA License No. 0G22035
Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment. Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.
Hutton Madden
800.247.5930 ext. 7149 404.375.7209
800.247.5930 www.phmic.com
Let’s all join together for our profession and the patients of Georgia!
Pam
Pamala S. Marquess Find us on Social Media:
2
The Georgia Pharmacy Journal
Not licensed to sell all products in all states.
M E M B E R
Is a Politically Inactive Pharmacist an Oxymoron, or Just a Moron?
- Notice to the GPhA Membership From the GPhA Bylaws Committee The GPhA Bylaws committee will have proposed revisions of the
T
here is not one pharmacist in the US Congress. Nor, one in the US House of Representatives or the US Senate. I may not be the sharpest tack in the box but the lack of a pharmacy professional in either one of these entities may be a clue as to what is wrong with Congress, specifically when it comes to the pharmacist being undervalued in healthcare. All of this could change at the May 20th election. However, it is up to pharmacists to make it happen and so comes my question: Is a politically inactive pharmacist an oxymoron or just a moron? Wikipedia tells us that an oxymoron (from Greek ὀξύμωρον, “sharp dull”) is a figure Jim Bracewell of speech that juxtaposes apparently contradictory elements. Boy, don’t you just love the Executive Vice President Greeks? Can a professional Pharmacist be inactive politically? No. How can you be a professional and not accept your responsibility for protecting and enhancing your profession? It was the politically active pharmacists who took action and founded the professional Association of Pharmacy in Georgia. Take some time to read our history in the About GPhA section of gpha.org. The future of the profession depends heavily upon the level of advocacy by it’s professionals. On May 20th, politically active pharmacists can put a pharmacist in the US Congress and make it happen in this election! Do you live in the First Congressional District? If so, you owe it to Tuesday, May 20th is yourself, your career and the pharmacy profession to get out and vote in 20th election. the most important the IfMay you do not live in the First Congressional District you can still make election day in a difference. I bet you know someone that lives in Savannah, Brunswick, Waycross, Jesup or the many little towns that make up the southeast coastGeorgia history. al First Congressional District of Georgia. You can call them today and tell Get out and vote! them about the race that can put a pharmacist in Congress. By the way, moron is a term that once was used in psychology to denote mild intellectual disability. Today it is most commonly used as an insult and not as a psychological term. To close here are a few of my favorite Oxymora: 1. Found Missing 2. Obedient Cat 3. Government Organization 4. Clearly Misunderstood 5. Terribly Pleased 6. Political Science 7. Military Intelligence 8. PBM Ethics 9. Extinct Life 10. Microsoft Works P.S. Don’t be an oxymoron and certainly don’t be a moron. Get out and vote on May 20th. n
Jim
4
The Georgia Pharmacy Journal
N E W S
GPhA Bylaws for consideration at the GPhA Annual meeting on Sunday, June29, 2014. These proposed revisions will be posted on the GPhA website - www.gph.org - on or before May 29, 2014 to give you, the membership, at least 30 days to review prior to the annual meeting. Revised bylaws will be presented at the first General Session of the Annual Meeting, an open hearing on them on Saturday, June 28,2014 and voted upon at Annual Meeting on Sunday, June 29, 2014. n
Join us for the 139th GPHA Convention June 26th through the 29th
Help Support AEP Fundraising Efforts T
he Academy of Employee Pharmacists has two fundraising projects that we do at each convention to raise money for AEP events throughout the year. How can you help support these AEP projects? 1.) Purchase the AEP convention T-shirt! Don’t miss your chance to get the most coveted souvenir of the convention - a great gift for your technicians and staff. Shirts can be purchased pre-convention when you register online, or at the AEP booth in the exhibit hall. A great buy for only $20.00! 2.) Play in our annual Academy Cup tennis tournament! - Battle of the Academies! This tournament is a fun round robin format and scores are kept individually and by academies. We are including some “surprises” on the tennis courts
The Georgia Pharmacy Journal
this year so don’t miss out. You don’t need to be a pro - just come and join in the fun!
Prepay with your online registration for $25.00, or pay on-site for $35.00. See you at the Convention! 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
Is a Politically Inactive Pharmacist an Oxymoron, or Just a Moron?
- Notice to the GPhA Membership From the GPhA Bylaws Committee The GPhA Bylaws committee will have proposed revisions of the
T
here is not one pharmacist in the US Congress. Nor, one in the US House of Representatives or the US Senate. I may not be the sharpest tack in the box but the lack of a pharmacy professional in either one of these entities may be a clue as to what is wrong with Congress, specifically when it comes to the pharmacist being undervalued in healthcare. All of this could change at the May 20th election. However, it is up to pharmacists to make it happen and so comes my question: Is a politically inactive pharmacist an oxymoron or just a moron? Wikipedia tells us that an oxymoron (from Greek ὀξύμωρον, “sharp dull”) is a figure Jim Bracewell of speech that juxtaposes apparently contradictory elements. Boy, don’t you just love the Executive Vice President Greeks? Can a professional Pharmacist be inactive politically? No. How can you be a professional and not accept your responsibility for protecting and enhancing your profession? It was the politically active pharmacists who took action and founded the professional Association of Pharmacy in Georgia. Take some time to read our history in the About GPhA section of gpha.org. The future of the profession depends heavily upon the level of advocacy by it’s professionals. On May 20th, politically active pharmacists can put a pharmacist in the US Congress and make it happen in this election! Do you live in the First Congressional District? If so, you owe it to Tuesday, May 20th is yourself, your career and the pharmacy profession to get out and vote in 20th election. the most important the IfMay you do not live in the First Congressional District you can still make election day in a difference. I bet you know someone that lives in Savannah, Brunswick, Waycross, Jesup or the many little towns that make up the southeast coastGeorgia history. al First Congressional District of Georgia. You can call them today and tell Get out and vote! them about the race that can put a pharmacist in Congress. By the way, moron is a term that once was used in psychology to denote mild intellectual disability. Today it is most commonly used as an insult and not as a psychological term. To close here are a few of my favorite Oxymora: 1. Found Missing 2. Obedient Cat 3. Government Organization 4. Clearly Misunderstood 5. Terribly Pleased 6. Political Science 7. Military Intelligence 8. PBM Ethics 9. Extinct Life 10. Microsoft Works P.S. Don’t be an oxymoron and certainly don’t be a moron. Get out and vote on May 20th. n
Jim
4
The Georgia Pharmacy Journal
N E W S
GPhA Bylaws for consideration at the GPhA Annual meeting on Sunday, June29, 2014. These proposed revisions will be posted on the GPhA website - www.gph.org - on or before May 29, 2014 to give you, the membership, at least 30 days to review prior to the annual meeting. Revised bylaws will be presented at the first General Session of the Annual Meeting, an open hearing on them on Saturday, June 28,2014 and voted upon at Annual Meeting on Sunday, June 29, 2014. n
Join us for the 139th GPHA Convention June 26th through the 29th
Help Support AEP Fundraising Efforts T
he Academy of Employee Pharmacists has two fundraising projects that we do at each convention to raise money for AEP events throughout the year. How can you help support these AEP projects? 1.) Purchase the AEP convention T-shirt! Don’t miss your chance to get the most coveted souvenir of the convention - a great gift for your technicians and staff. Shirts can be purchased pre-convention when you register online, or at the AEP booth in the exhibit hall. A great buy for only $20.00! 2.) Play in our annual Academy Cup tennis tournament! - Battle of the Academies! This tournament is a fun round robin format and scores are kept individually and by academies. We are including some “surprises” on the tennis courts
The Georgia Pharmacy Journal
this year so don’t miss out. You don’t need to be a pro - just come and join in the fun!
Prepay with your online registration for $25.00, or pay on-site for $35.00. See you at the Convention! 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
Don’t Forget to VOTE! SUPPORT BUDDY CARTER R.Ph State of Georgia Primaries - May 20th FOR CONGRESS
M E M B E R
N E W S
GPhA Members Experience the Power and Promise of Pharmacy. APhA Annual Meeting in Orlando.
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.
GPhA Deletes at APhA House of Delegates Meeting. Jimmy England, Greg Primuth, Mary Meredith and Bobby Moody.
GPhA members at Georgia APhA Reception. Mike Crooks, Sherri Moody, Bobby Moody and Liza Chapman.
GPhA President Pam Marquess with SC President Steve McElmurray and SC Board member Pam Whitmore at the Georgia APhA Reception.
UGA Dean Oie and Mercer Dean Matthews mingle at Georgia APhA Reception.
Jonathan Marquess, Dana Strickland, and Andre Mackey.
WELCOME
New Members Diane Brown – Fayetteville, GA Walter Williams – Locust Grove, GA Ann Lavoie – Thomaston, GA Jay Ceesay – Fayetteville, GA Eric Goldstein – Acworth, GA James Fries – Winder, GA Mary Hunt – Iron City, GA Phil Barfield – Leesburg, GA Bela Palmer – Marietta, GA Won Kim – Roswell, GA Dennis Long – Atlanta, GA Barbara Wyatt – Eatonton, GA Alexander Purvis – Griffin, GA Robert Hutcherson – Chickamauga, GA
REAL SOLUTIONS. CONSERVATIVE PRINCIPLES.
Charles Livingston – Atlanta, GA Haley Gay – Hahira, GA Josh McCook – Statesboro, GA
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
THE GEORGIA PHARMACY ASSOCIATION
The Georgia Pharmacy Journal
Don’t Forget to VOTE! SUPPORT BUDDY CARTER R.Ph State of Georgia Primaries - May 20th FOR CONGRESS
M E M B E R
N E W S
GPhA Members Experience the Power and Promise of Pharmacy. APhA Annual Meeting in Orlando.
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.
GPhA Deletes at APhA House of Delegates Meeting. Jimmy England, Greg Primuth, Mary Meredith and Bobby Moody.
GPhA members at Georgia APhA Reception. Mike Crooks, Sherri Moody, Bobby Moody and Liza Chapman.
GPhA President Pam Marquess with SC President Steve McElmurray and SC Board member Pam Whitmore at the Georgia APhA Reception.
UGA Dean Oie and Mercer Dean Matthews mingle at Georgia APhA Reception.
Jonathan Marquess, Dana Strickland, and Andre Mackey.
WELCOME
New Members Diane Brown – Fayetteville, GA Walter Williams – Locust Grove, GA Ann Lavoie – Thomaston, GA Jay Ceesay – Fayetteville, GA Eric Goldstein – Acworth, GA James Fries – Winder, GA Mary Hunt – Iron City, GA Phil Barfield – Leesburg, GA Bela Palmer – Marietta, GA Won Kim – Roswell, GA Dennis Long – Atlanta, GA Barbara Wyatt – Eatonton, GA Alexander Purvis – Griffin, GA Robert Hutcherson – Chickamauga, GA
REAL SOLUTIONS. CONSERVATIVE PRINCIPLES.
Charles Livingston – Atlanta, GA Haley Gay – Hahira, GA Josh McCook – Statesboro, GA
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
THE GEORGIA PHARMACY ASSOCIATION
The Georgia Pharmacy Journal
G P h A
C O N V E N T I O N
G P h A
N E W S
2014 GPhA Convention
Register Today! Ju n e 26 -29, 2014 Wyndham Bay Point Resort Panama City Beach, FL To register go to www.gpha.org and click on the Convention Banner or scan the code.
A
s 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. Platinum Sponsor
Gold Sponsor
Highlights
At-A-Glance Introduction of the NEW GPhA Executive Vice President Thursday, June 26 1:00 pm - 3:30 pm Georgia Pharmacy Foundation/Carlton Henderson Memorial Golf Tournament Friday, June 27 8:00 am Academy of Employee Pharmacists Tennis Tournament Friday, June 27 9:00 am Provider Status: Is It Within Our Reach? Friday, June 27 2:00 pm - 3:30 pm Legislative and Regulatory Update Saturday, June 28 10:15 am - 12:15 pm President’s Banquet and Officer Installation Dinner Dance Saturday, June 28 6:30 pm - 11:00 pm Exhibit Hall Opens Thursday, June 26 and Friday, June 27 3:30 pm - 6:00 pm
8
The Georgia Pharmacy Journal
The Georgia Pharmacy Journal
C O N V E N T I O N
Wednesday, June 25 5:30 pm - 7:00 pm Board of Directors Meeting 9:00 pm - 10:00 pm Council of President’s Meeting with Coffee & Dessert Reception
Thursday, June 26, 2014 7:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am- 9:00 am Morning Coffee & Pastries 8:00 am - 10:00 am Drug Abuse & Diversion: How You Can Play a Role in Prevention 8:00 am - 10:00 am Anticoagulation: Not Just Warfarin 10:15 am - 11:15 am The Busy Practitioners Guide to Effective Communication in Pharmacy Practice 10:15 am - 11:15 am Aromatherapy - An Introduction to Essential Oil and their Therapeutic Uses 10:15 am - 11:15 am Updates in Diabetes: Understanding the Standards of Medical Care in Type II Diabetes 1:00 pm - 3:30 pm First General Session: Introduction of the New GPhA Executive Vice President 2014 Prescription Drug Monitoring Update 3:30 pm - 6:00 pm Exhibit Hall Open with Student Sponsor/VIP Lounge 7:30 pm Mercer Alumni Dinner
N E W S
7:30 pm UGA Alumni Dinner
Friday, June 27 8:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am - 9:00 am Morning Coffee & Pastries 8:00 am GA Pharmacy Foundation/ Carlton Henderson Memorial Golf Tournament 9:00 am AEP Tennis Tournament 8:00 am - 9:00 am What You Always Wanted to Know About Teratogens, but were Afraid to Ask 9:15 am - 10:15 am Hot Topics & Trends in Pharmacy Law 10:30 am - 12:30 pm Diabetes, Part II: Star-Rated Medications 10:30 am - 12:30 pm Immunization/OSHA Update CPE 2:00 pm - 3:30 pm Second General Session: Provider Status: Is It Within Our Reach? 3:30 pm - 6:00 pm Exhibit Hall Opens 6:00 pm - 7:00 pm PharmPAC Reception (by invitation)
Saturday, June 28 7:00 am - 8:00 am Compounding Breakfast 7:00 am - 9:00 am Morning Coffee & Pastries
9
G P h A
C O N V E N T I O N
G P h A
N E W S
2014 GPhA Convention
Register Today! Ju n e 26 -29, 2014 Wyndham Bay Point Resort Panama City Beach, FL To register go to www.gpha.org and click on the Convention Banner or scan the code.
A
s 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. Platinum Sponsor
Gold Sponsor
Highlights
At-A-Glance Introduction of the NEW GPhA Executive Vice President Thursday, June 26 1:00 pm - 3:30 pm Georgia Pharmacy Foundation/Carlton Henderson Memorial Golf Tournament Friday, June 27 8:00 am Academy of Employee Pharmacists Tennis Tournament Friday, June 27 9:00 am Provider Status: Is It Within Our Reach? Friday, June 27 2:00 pm - 3:30 pm Legislative and Regulatory Update Saturday, June 28 10:15 am - 12:15 pm President’s Banquet and Officer Installation Dinner Dance Saturday, June 28 6:30 pm - 11:00 pm Exhibit Hall Opens Thursday, June 26 and Friday, June 27 3:30 pm - 6:00 pm
8
The Georgia Pharmacy Journal
The Georgia Pharmacy Journal
C O N V E N T I O N
Wednesday, June 25 5:30 pm - 7:00 pm Board of Directors Meeting 9:00 pm - 10:00 pm Council of President’s Meeting with Coffee & Dessert Reception
Thursday, June 26, 2014 7:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am- 9:00 am Morning Coffee & Pastries 8:00 am - 10:00 am Drug Abuse & Diversion: How You Can Play a Role in Prevention 8:00 am - 10:00 am Anticoagulation: Not Just Warfarin 10:15 am - 11:15 am The Busy Practitioners Guide to Effective Communication in Pharmacy Practice 10:15 am - 11:15 am Aromatherapy - An Introduction to Essential Oil and their Therapeutic Uses 10:15 am - 11:15 am Updates in Diabetes: Understanding the Standards of Medical Care in Type II Diabetes 1:00 pm - 3:30 pm First General Session: Introduction of the New GPhA Executive Vice President 2014 Prescription Drug Monitoring Update 3:30 pm - 6:00 pm Exhibit Hall Open with Student Sponsor/VIP Lounge 7:30 pm Mercer Alumni Dinner
N E W S
7:30 pm UGA Alumni Dinner
Friday, June 27 8:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am - 9:00 am Morning Coffee & Pastries 8:00 am GA Pharmacy Foundation/ Carlton Henderson Memorial Golf Tournament 9:00 am AEP Tennis Tournament 8:00 am - 9:00 am What You Always Wanted to Know About Teratogens, but were Afraid to Ask 9:15 am - 10:15 am Hot Topics & Trends in Pharmacy Law 10:30 am - 12:30 pm Diabetes, Part II: Star-Rated Medications 10:30 am - 12:30 pm Immunization/OSHA Update CPE 2:00 pm - 3:30 pm Second General Session: Provider Status: Is It Within Our Reach? 3:30 pm - 6:00 pm Exhibit Hall Opens 6:00 pm - 7:00 pm PharmPAC Reception (by invitation)
Saturday, June 28 7:00 am - 8:00 am Compounding Breakfast 7:00 am - 9:00 am Morning Coffee & Pastries
9
C O N V E N T I O N
N E W S
8:00 am - 5:00 pm GPhA Registration
2:15 pm - 2:30 pm Tellers Committee Meeting
8:00 am - 10:00 am Hypertension 101: Clinical Pearls for the Community Pharmacist
2:30 pm - 3:30 pm Resolutions Committee Meeting
8:00 am - 10:00 am STAR Ratings 101
3:15 pm - 4:15 pm Issues of Cultural Competency in Pharmacy
10:15 am - 12:15 pm Third General Session: Legislative and Regulatory Update
3:15 pm - 4:15 pm Insulin Therapy: Optimizing the use of Insulin in Patients with Type II Diabetes
12:30 pm - 1:45 pm ASA Luncheon & Annual Business Meeting
3:15 pm - 4:15 pm Compounding CPE
12:30 pm - 1:45 pm AIP Wholesaler Appreciation Luncheon 12:30 pm - 1:45 pm ACP Luncheon & Business Meeting 12:30 pm - 1:45 pm AEP Luncheon & Business Meeting 12:30 pm - 1:45 pm AHP Luncheon & Business Meeting 2:00 pm Election Closes 2:00 pm - 3:00 pm AIP CPE 2:00 pm - 3:00 pm 2014 Brown Bag Patient Counseling Competition 2:00 pm - 3:00 pm Asthma Management: Focus on Patient-Centered Care
6:00 pm - 6:30 pm President’s Reception
Pharmacy School Alumni Dinners
Mercer University College of Pharmacy Alumni & Friends Dinner Thursday, June 26, 2014 7:30 p.m. The Shrimp Boat Restaurant 1201 Beck Avenue Panama City, FL 32401
6:30 pm - 11:00 pm President’s Banquet & Officer Installation Dessert Reception & Dance
Sunday, June 29 8:00 am - 8:30 am Interfaith Sunrise Service 9:00 am - 9:30 am Annual Meeting 9:30 am - 11:30 am New Drug Update 2014: A Formulary Approach 9:30 am - 10:30 am Update in the Management of Hyperlipidemia: Was it Worth the Wait? 10:00 am - 11:00 am 2014-2015 GPhA BOD Meeting
University of Georgia College of Pharmacy Alumni & Friends Dinner Thursday, June 26, 2014 7:30 p.m.
Sign-up for the Alumni Dinners will be provided at the Alumni Dinner registration table at GPhA’s 139th Convention.
Play the Course That Jack Built. th
5
AN
NUAL
Georgia Pharmacy Foundation
CARLTON HENDERSON MEMORIAL GOLF TOURNAMENT You work hard and you really care about your future in the pharmacy profession. That’s why you support The Georgia Pharmacy Association and attend the GPhA Convention. But you also deserve time to get out, enjoy one of the fantastic amenities at the convention and support a very worthy cause The Georgia Pharmacy Foundation Student Scholarship Program. Designed by the great Jack Nicklaus himself, this course is one of the best in Northwest Florida. So take a break and join us on the course that Jack built because as they say, “all work and no play makes Jack a dull boy.”
50 Year Service Award
Have you or a fellow pharmacist you know served 50 years as a pharmacist?
If so, we would like to acknowledge your dedication to the profession by awarding a “50 Year Pharmacist” plaque at the Annual Convention at the Wyndham Bay Point Resort in Panama City Beach, Florida. Please email Tei Muhammad at tmuhammad@gpha.org with your name or the name of the peer you would like to honor, or call Tei directly at (404) 419-8115.
10
2014 GPhA Convention
1
G P h A
Friday, June 27, 2014 The Nicklaus Course at Bay Point Resort | Panama City Beach, FL The Georgia Pharmacy Journal
C O N V E N T I O N
N E W S
8:00 am - 5:00 pm GPhA Registration
2:15 pm - 2:30 pm Tellers Committee Meeting
8:00 am - 10:00 am Hypertension 101: Clinical Pearls for the Community Pharmacist
2:30 pm - 3:30 pm Resolutions Committee Meeting
8:00 am - 10:00 am STAR Ratings 101
3:15 pm - 4:15 pm Issues of Cultural Competency in Pharmacy
10:15 am - 12:15 pm Third General Session: Legislative and Regulatory Update
3:15 pm - 4:15 pm Insulin Therapy: Optimizing the use of Insulin in Patients with Type II Diabetes
12:30 pm - 1:45 pm ASA Luncheon & Annual Business Meeting
3:15 pm - 4:15 pm Compounding CPE
12:30 pm - 1:45 pm AIP Wholesaler Appreciation Luncheon 12:30 pm - 1:45 pm ACP Luncheon & Business Meeting 12:30 pm - 1:45 pm AEP Luncheon & Business Meeting 12:30 pm - 1:45 pm AHP Luncheon & Business Meeting 2:00 pm Election Closes 2:00 pm - 3:00 pm AIP CPE 2:00 pm - 3:00 pm 2014 Brown Bag Patient Counseling Competition 2:00 pm - 3:00 pm Asthma Management: Focus on Patient-Centered Care
6:00 pm - 6:30 pm President’s Reception
Pharmacy School Alumni Dinners
Mercer University College of Pharmacy Alumni & Friends Dinner Thursday, June 26, 2014 7:30 p.m. The Shrimp Boat Restaurant 1201 Beck Avenue Panama City, FL 32401
6:30 pm - 11:00 pm President’s Banquet & Officer Installation Dessert Reception & Dance
Sunday, June 29 8:00 am - 8:30 am Interfaith Sunrise Service 9:00 am - 9:30 am Annual Meeting 9:30 am - 11:30 am New Drug Update 2014: A Formulary Approach 9:30 am - 10:30 am Update in the Management of Hyperlipidemia: Was it Worth the Wait? 10:00 am - 11:00 am 2014-2015 GPhA BOD Meeting
University of Georgia College of Pharmacy Alumni & Friends Dinner Thursday, June 26, 2014 7:30 p.m.
Sign-up for the Alumni Dinners will be provided at the Alumni Dinner registration table at GPhA’s 139th Convention.
Play the Course That Jack Built. th
5
AN
NUAL
Georgia Pharmacy Foundation
CARLTON HENDERSON MEMORIAL GOLF TOURNAMENT You work hard and you really care about your future in the pharmacy profession. That’s why you support The Georgia Pharmacy Association and attend the GPhA Convention. But you also deserve time to get out, enjoy one of the fantastic amenities at the convention and support a very worthy cause The Georgia Pharmacy Foundation Student Scholarship Program. Designed by the great Jack Nicklaus himself, this course is one of the best in Northwest Florida. So take a break and join us on the course that Jack built because as they say, “all work and no play makes Jack a dull boy.”
50 Year Service Award
Have you or a fellow pharmacist you know served 50 years as a pharmacist?
If so, we would like to acknowledge your dedication to the profession by awarding a “50 Year Pharmacist” plaque at the Annual Convention at the Wyndham Bay Point Resort in Panama City Beach, Florida. Please email Tei Muhammad at tmuhammad@gpha.org with your name or the name of the peer you would like to honor, or call Tei directly at (404) 419-8115.
10
2014 GPhA Convention
1
G P h A
Friday, June 27, 2014 The Nicklaus Course at Bay Point Resort | Panama City Beach, FL The Georgia Pharmacy Journal
S P R I N G
M
DODGE
COFFEE
GRADY
COLQUITT
THOMAS
EVANS
BRYAN
CHATHAM
LIBERTY APPLING
LONG WAYNE
McINTOSH
PIERCE WARE
COOK
BROOKS
EFFINGHAM
BULLOCH
TATTNALL
BACON
ATKINSON
BERRIEN MITCHELL
LANI
SEMINOLE
DECATUR
JEFF DAVIS
HILL BEN HILL IRWIN
TIFT
BAKER
MILLER
CANDLE
TELFAIR
TURNER WORTH
R
EN
TREUTL
BS
EARLY
LEE
DOUGHERTY
LAURENS
KLEY
BLEC
WILCOX
CRISP
TERRELL
CALHOUN
EMANUEL
PULASKI
DOOLY
SUMTER
SCREVEN
JOHNSON
ELER WHE
RANDOLPH CLAY
N
USTO
BURKE
JENKINS
WILKINSON
HO
RICHMOND
TOOM
TER
QUITMAN
MACON
WASHINGTON
TWIGGS
H
COLUMBIA
JEFFER -SON
MONTGOMERY
WEBS
STEWART
MARION
EY SCHL
CHATTAHOOCHEE
BIBB PEAC
TAYLOR
MUSCOGEE
JONES
MONROE CRAWFORD
WIN
CK
CO
AS
GL
BALD
UPSON
TALBOT
WAR RE
HANCOCK
CLINCH
BRANTLEY
CHARLTON
GLYNN
CAMDEN
ES
HARRIS
PIKE
OLN
O
FERR
N
JASPER PUTNAM
ER
HER IWET MER
TROUP
HABE RSHA
ROCK DALE
SPALDING
LINC
WILKES
TALIA
UFFIE
NEWTON NEWTON
BUTTS
M E E T I N G S
ELBERT
GREENE
MORGAN
HENRY
E FAYETT
COWETA
HEARD
CLAYTON
McD
CARROLL
ON FULT
R E G I O N
HART
OGLETHORPE
KE
NEE
WALTON
DEKALB
FU LTOFU NLTO
LAS
UG
DO
CLAR
OCO
LOW ND
MU MURR RRAY AY
N
HARALSON
IN
MADISON
BARROW
GWINNETT GWINNETT
KL
AN
FR
JACKSON COBB
S P R I N G
STEPHENS
BANKS
HALL
FORSYTH
CHEROKEE
PAUL DING
POLK
WHITE SO
N
M E E T I N G S
RABUN
UNION LUMPKIN
DAW
PICKENS
BARTOW
FLOYD
TOWNS
FANNIN GILMER
GORDON
LAMAR
DADE
WHITF IELD
CATOOSA
WALKER CHATTOOGA
R E G I O N
ECHOLS
Candidates from Region 2 for the GPhA nomination to the GA Board of Pharmacy are Jeff Sikes, Keith Dupree, Teresa Dockery, and Zachery Tomberlin (not in picture) with Region 2 President Ed Dozier.
Region 2: Stephen Chromi receives $20 from GPhA Chair Robert Hatton for having the GPhA App on his phone.
Region 6: Hanna Head was the winner of the $20 GPhA App award at the Region 6 Meeting.
Region 8: State Senator Buddy Carter speaks to the attendees at the Region 8 Meeting.
Region 8: GPhA President-Elect Bobby Moody presents $20 to Chad McDonald, who had the GPhA App on his phone.
Region 8: GPhA President-Elect Bobby Moody, GPhA President Pam Marquess and Region 8 President Michael Lewis.
Region 9: Region 9 President Amanda Westbrooks presents the iPad door prize to Mark Parris.
Region 5: GPhA Chair Robert Hatton, Region 5 President Shelby Biagi and GPhA 2nd VP Lance Boles.
Region 10: Region 10 had five GPhA Board Members in attendance. (L-R) Lindsey Welch, Robert Hatton, Flynn Warren, Chris Thurmond and Eddie Madden.
Region 10: Hope Foskey is awarded $20 for having the GPhA Mobile App on her phone.
Region 12: Region 12 Officers and GPhA Chair Robert Hatton.
Region 12: Robert Hatton presents the $20 App Award to Ria Mathews.
Region 12: Attendance was great at the Region 12 Meeting.
REGION MEETINGS RECAP
T
he leadership of the Georgia Pharmacy Association made their rounds throughout the state to each of the 12 GPhA Regions. A lot has happened this year regarding the pharmacy profession and this was an opportunity for members to catch up, network, and earn continuing education hours. Pharmacists and Technicians were able to gain a better understanding of how to become involved in the legislative process that effects patient care and pharmacy practice, review current state legislation and regulation of pharmacy, engage in discussions regarding these pieces of legislation and regulations, and review the CMS Star Rating program and its impact on pharmacy. GPhA would like to thank everyone who attended the meetings. Your dedication and hard work will help expand the scope of the pharmacy profession. n
12
Region 2: President Ed Dozier, Region 2 PAC Board member Keith Dupree and Randy Carver.
Region 4: GPhA First VP Tommy Whitworth presents the $20 GPhA App award.
Region 2: GPhA Chair of Board Robert Hatton with Region 2 member and friend Greg Drake.
Region 4: GPhA First VP Tommy Whitworth, Region 4 PAC Director Bill McLeer and Region 4 President Nic Bland.
The Georgia Pharmacy Journal
The Georgia Pharmacy Journal
13
S P R I N G
M
DODGE
COFFEE
GRADY
COLQUITT
THOMAS
EVANS
BRYAN
CHATHAM
LIBERTY APPLING
LONG WAYNE
McINTOSH
PIERCE WARE
COOK
BROOKS
EFFINGHAM
BULLOCH
TATTNALL
BACON
ATKINSON
BERRIEN MITCHELL
LANI
SEMINOLE
DECATUR
JEFF DAVIS
HILL BEN HILL IRWIN
TIFT
BAKER
MILLER
CANDLE
TELFAIR
TURNER WORTH
R
EN
TREUTL
BS
EARLY
LEE
DOUGHERTY
LAURENS
KLEY
BLEC
WILCOX
CRISP
TERRELL
CALHOUN
EMANUEL
PULASKI
DOOLY
SUMTER
SCREVEN
JOHNSON
ELER WHE
RANDOLPH CLAY
N
USTO
BURKE
JENKINS
WILKINSON
HO
RICHMOND
TOOM
TER
QUITMAN
MACON
WASHINGTON
TWIGGS
H
COLUMBIA
JEFFER -SON
MONTGOMERY
WEBS
STEWART
MARION
EY SCHL
CHATTAHOOCHEE
BIBB PEAC
TAYLOR
MUSCOGEE
JONES
MONROE CRAWFORD
WIN
CK
CO
AS
GL
BALD
UPSON
TALBOT
WAR RE
HANCOCK
CLINCH
BRANTLEY
CHARLTON
GLYNN
CAMDEN
ES
HARRIS
PIKE
OLN
O
FERR
N
JASPER PUTNAM
ER
HER IWET MER
TROUP
HABE RSHA
ROCK DALE
SPALDING
LINC
WILKES
TALIA
UFFIE
NEWTON NEWTON
BUTTS
M E E T I N G S
ELBERT
GREENE
MORGAN
HENRY
E FAYETT
COWETA
HEARD
CLAYTON
McD
CARROLL
ON FULT
R E G I O N
HART
OGLETHORPE
KE
NEE
WALTON
DEKALB
FU LTOFU NLTO
LAS
UG
DO
CLAR
OCO
LOW ND
MU MURR RRAY AY
N
HARALSON
IN
MADISON
BARROW
GWINNETT GWINNETT
KL
AN
FR
JACKSON COBB
S P R I N G
STEPHENS
BANKS
HALL
FORSYTH
CHEROKEE
PAUL DING
POLK
WHITE SO
N
M E E T I N G S
RABUN
UNION LUMPKIN
DAW
PICKENS
BARTOW
FLOYD
TOWNS
FANNIN GILMER
GORDON
LAMAR
DADE
WHITF IELD
CATOOSA
WALKER CHATTOOGA
R E G I O N
ECHOLS
Candidates from Region 2 for the GPhA nomination to the GA Board of Pharmacy are Jeff Sikes, Keith Dupree, Teresa Dockery, and Zachery Tomberlin (not in picture) with Region 2 President Ed Dozier.
Region 2: Stephen Chromi receives $20 from GPhA Chair Robert Hatton for having the GPhA App on his phone.
Region 6: Hanna Head was the winner of the $20 GPhA App award at the Region 6 Meeting.
Region 8: State Senator Buddy Carter speaks to the attendees at the Region 8 Meeting.
Region 8: GPhA President-Elect Bobby Moody presents $20 to Chad McDonald, who had the GPhA App on his phone.
Region 8: GPhA President-Elect Bobby Moody, GPhA President Pam Marquess and Region 8 President Michael Lewis.
Region 9: Region 9 President Amanda Westbrooks presents the iPad door prize to Mark Parris.
Region 5: GPhA Chair Robert Hatton, Region 5 President Shelby Biagi and GPhA 2nd VP Lance Boles.
Region 10: Region 10 had five GPhA Board Members in attendance. (L-R) Lindsey Welch, Robert Hatton, Flynn Warren, Chris Thurmond and Eddie Madden.
Region 10: Hope Foskey is awarded $20 for having the GPhA Mobile App on her phone.
Region 12: Region 12 Officers and GPhA Chair Robert Hatton.
Region 12: Robert Hatton presents the $20 App Award to Ria Mathews.
Region 12: Attendance was great at the Region 12 Meeting.
REGION MEETINGS RECAP
T
he leadership of the Georgia Pharmacy Association made their rounds throughout the state to each of the 12 GPhA Regions. A lot has happened this year regarding the pharmacy profession and this was an opportunity for members to catch up, network, and earn continuing education hours. Pharmacists and Technicians were able to gain a better understanding of how to become involved in the legislative process that effects patient care and pharmacy practice, review current state legislation and regulation of pharmacy, engage in discussions regarding these pieces of legislation and regulations, and review the CMS Star Rating program and its impact on pharmacy. GPhA would like to thank everyone who attended the meetings. Your dedication and hard work will help expand the scope of the pharmacy profession. n
12
Region 2: President Ed Dozier, Region 2 PAC Board member Keith Dupree and Randy Carver.
Region 4: GPhA First VP Tommy Whitworth presents the $20 GPhA App award.
Region 2: GPhA Chair of Board Robert Hatton with Region 2 member and friend Greg Drake.
Region 4: GPhA First VP Tommy Whitworth, Region 4 PAC Director Bill McLeer and Region 4 President Nic Bland.
The Georgia Pharmacy Journal
The Georgia Pharmacy Journal
13
I N D U S T R Y
N E W S
I N D U S T R Y
GPhA Member Buddy Carter, R.Ph, Wins APhA Hubert Humphrey Award G
“If we don’t change the way Washington is being
eorgia Senator Buddy Carter, RPh, was selected for the Hubert H. Humphrey Award at the 2014 APhA Annual Meeting in Orlando, Florida. The Hubert H. Humphrey Award was established in 1978 to recognize APhA members who have made major contributions in government and/or legislative service at the local, state, or national level. Carter was selected in recognition of his commitment to community and public service in the state of Georgia. In addition to working as a community pharmacist and pharmacy owner, Carter served his community as City Councilman and Mayor and later served in the Georgia House of Representatives. He was elected to the state Senate in 2009 There is not a single and has announced his candidacy for the U.S. House of Representatives. Pharmacist serving in Carter is a Republican representing Congress. to change Senate DistrictIt’s 1. time He represents Bryan CountyPlease and portions of Chatham that. support Buddy and Liberty counties. Carter R.Ph for Congress. Senator Carter serves as Chairman of buddycarterforcongress.com/donate/ the Public Safety Committee and is also a member of the Appropriations, Health and Human Services and Higher EducaWith all of the major changes tion committees. Senator Carterin brings wealth ofcare govtaking place theahealth ernment experience to his Senate posiindustry, now more than ever, tion. He served the City of Pooler with we must have our planpharmacists ning and zoning from 1989 to 1993 and with the city council from 1994 to voices heard. 1995. Senator Carter is a native of Savannah and graduated from nearby Garden City’s Robert W. Groves High School in 1975. He earned an Associate’s Degree from Young Harris College in 1977 and a Bachelor’s of Science in Pharmacy from Harris College and The Coastal Bank. There is no higher priority than endthe University of Georgia in 1980. Senator Carter and his wife, Amy, ing the sea of debt and deficits being have three adult sons: Joel ( wife Megan), created by the federal government. Our Barrett and Travis and two granddaugh- federal debt has doubled to more than ters Mary Margaret and Adelaide. He is a $17 trillion since President Obama took pharmacist with Carter’s Pharmacy, Inc. office, and it’s growing by $2.25 Billion every day. and is a Methodist. SOLUTIONS. We need a Congress with the backSenator Carter currentlyREAL serves on the CONSERVATIVE bone to say no to deficit spending and board of trustees for the Mighty Eighth PRINCIPLES. Air Force Heritage Museum, Young say yes to cutting. We need a more conCorporate 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
run, it will forever ruin the America we grew up in. Cutting spending, balancing the budget and dramatically reducing income taxes are the prescription America needs. We need to return America…
SUPPORT BUDDYback CARTER R.Ph to America.” – Buddy Carter FOR CONGRESS
servative Congress that will consistently oppose tax increases. As a conservative Georgia Senator, Buddy strongly supported efforts to cut government spending by billions. When the recession devastated our national economy, he voted to cut spending to balance our state budget rather than raise taxes. Buddy Carter opposes tax increases to solve deficit spending because he knows that the real problem is overspending, not lack of revenue. We do need major spending cuts, but we also need economic growth to fi x our current national debt problem. To create economic growth, Buddy will support major tax relief plans that will transform our current, failing income tax. Either the Fair Tax or the Flat Tax would be a major improvement and both would create major economic growth. Only with major tax reform can we get long term and sustainable economic growth in America again. To create economic growth, Buddy will support major tax relief plans that will to change our current, failing income tax system and replace it with either a Flat Tax or a Fair Tax system. The Fair Tax or the Flat Tax would be a major improvement, and both would create major economic growth. Carter is a long time supporter of the Georgia Pharmacy Association. n
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.
14
PAID FOR BY BUDDY CARTER FOR CONGRESS CARLTON HODGES, TREASURER
The Georgia Pharmacy Journal
N E W S
GPhA Grassroots Advocacy At Its Best C
oncerned about pharmacy issues? See what these involved GPhA members are doing in Congressional District 2 in southwest Georgia. Recently Daryl Reynolds, Ed Dozier, Jay Sharpe and Fred Sharpe sat down with their U S Congressman Sanford Bishop for a one-on-one conversation about healthcare and the role of pharmacy now and in the future. There is an old adage in advocacy that legislators don’t care how much you know until they know how much you care. When have you cared enough about pharmacy issues to take time to meet in your district with your Congressman, your Senator and Representative in the Georgia legislature? Let these members in Albany be an inspiration to you to make time to get involved in correcting the issues pharmacy faces. n
(L to R) Daryl Reynolds, Ed Dozier, Congressman Sanford Bishop, Jay Sharpe and Fred Sharpe discuss pharmacy issues with their US Congressional Representative.
I N D U S T R Y
N E W S
I N D U S T R Y
GPhA Member Buddy Carter, R.Ph, Wins APhA Hubert Humphrey Award G
“If we don’t change the way Washington is being
eorgia Senator Buddy Carter, RPh, was selected for the Hubert H. Humphrey Award at the 2014 APhA Annual Meeting in Orlando, Florida. The Hubert H. Humphrey Award was established in 1978 to recognize APhA members who have made major contributions in government and/or legislative service at the local, state, or national level. Carter was selected in recognition of his commitment to community and public service in the state of Georgia. In addition to working as a community pharmacist and pharmacy owner, Carter served his community as City Councilman and Mayor and later served in the Georgia House of Representatives. He was elected to the state Senate in 2009 There is not a single and has announced his candidacy for the U.S. House of Representatives. Pharmacist serving in Carter is a Republican representing Congress. to change Senate DistrictIt’s 1. time He represents Bryan CountyPlease and portions of Chatham that. support Buddy and Liberty counties. Carter R.Ph for Congress. Senator Carter serves as Chairman of buddycarterforcongress.com/donate/ the Public Safety Committee and is also a member of the Appropriations, Health and Human Services and Higher EducaWith all of the major changes tion committees. Senator Carterin brings wealth ofcare govtaking place theahealth ernment experience to his Senate posiindustry, now more than ever, tion. He served the City of Pooler with we must have our planpharmacists ning and zoning from 1989 to 1993 and with the city council from 1994 to voices heard. 1995. Senator Carter is a native of Savannah and graduated from nearby Garden City’s Robert W. Groves High School in 1975. He earned an Associate’s Degree from Young Harris College in 1977 and a Bachelor’s of Science in Pharmacy from Harris College and The Coastal Bank. There is no higher priority than endthe University of Georgia in 1980. Senator Carter and his wife, Amy, ing the sea of debt and deficits being have three adult sons: Joel ( wife Megan), created by the federal government. Our Barrett and Travis and two granddaugh- federal debt has doubled to more than ters Mary Margaret and Adelaide. He is a $17 trillion since President Obama took pharmacist with Carter’s Pharmacy, Inc. office, and it’s growing by $2.25 Billion every day. and is a Methodist. SOLUTIONS. We need a Congress with the backSenator Carter currentlyREAL serves on the CONSERVATIVE bone to say no to deficit spending and board of trustees for the Mighty Eighth PRINCIPLES. Air Force Heritage Museum, Young say yes to cutting. We need a more conCorporate 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
run, it will forever ruin the America we grew up in. Cutting spending, balancing the budget and dramatically reducing income taxes are the prescription America needs. We need to return America…
SUPPORT BUDDYback CARTER R.Ph to America.” – Buddy Carter FOR CONGRESS
servative Congress that will consistently oppose tax increases. As a conservative Georgia Senator, Buddy strongly supported efforts to cut government spending by billions. When the recession devastated our national economy, he voted to cut spending to balance our state budget rather than raise taxes. Buddy Carter opposes tax increases to solve deficit spending because he knows that the real problem is overspending, not lack of revenue. We do need major spending cuts, but we also need economic growth to fi x our current national debt problem. To create economic growth, Buddy will support major tax relief plans that will transform our current, failing income tax. Either the Fair Tax or the Flat Tax would be a major improvement and both would create major economic growth. Only with major tax reform can we get long term and sustainable economic growth in America again. To create economic growth, Buddy will support major tax relief plans that will to change our current, failing income tax system and replace it with either a Flat Tax or a Fair Tax system. The Fair Tax or the Flat Tax would be a major improvement, and both would create major economic growth. Carter is a long time supporter of the Georgia Pharmacy Association. n
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.
14
PAID FOR BY BUDDY CARTER FOR CONGRESS CARLTON HODGES, TREASURER
The Georgia Pharmacy Journal
N E W S
GPhA Grassroots Advocacy At Its Best C
oncerned about pharmacy issues? See what these involved GPhA members are doing in Congressional District 2 in southwest Georgia. Recently Daryl Reynolds, Ed Dozier, Jay Sharpe and Fred Sharpe sat down with their U S Congressman Sanford Bishop for a one-on-one conversation about healthcare and the role of pharmacy now and in the future. There is an old adage in advocacy that legislators don’t care how much you know until they know how much you care. When have you cared enough about pharmacy issues to take time to meet in your district with your Congressman, your Senator and Representative in the Georgia legislature? Let these members in Albany be an inspiration to you to make time to get involved in correcting the issues pharmacy faces. n
(L to R) Daryl Reynolds, Ed Dozier, Congressman Sanford Bishop, Jay Sharpe and Fred Sharpe discuss pharmacy issues with their US Congressional Representative.
I N D U S T R Y
N E W S
I N D U S T R Y
The Talk... Teaching Children About Money M
oney management (including cash flow control, investment management, philanthropic philosophy and the proper use of debt) is a set of learned behaviors dealing with the earning, borrowing, saving, spending and sharing of money. An individual’s attitude, behaviors and values are learned and incorporated into their approach to life and money management. Children learn these behaviors and develop a set of values whether or not they are purposefully taught. The only question a parent or guardian must face is whether or not they will actively participate in the teaching process that can be guided in a positive direction, or left by chance. In particular, children that are set to inherit significant wealth need knowledge and good sense to make the decisions that accompany such an inheritance. The vast number of questions and the lack of definitive answers could explain recent survey results indicating that parents feel it is easier to talk to kids about drugs than it is about money.
When do I begin?
Studies show that marketers start targeting children as early as age two! Consider ignoring the age and maturity level of the child (advertisers certainly do) and begin when the parents are ready. Start at your child’s birth and take time to develop a plan, working together to prepare for the teaching effort. Sending mixed messages will undermine efforts to pass along responsible habits and values. Work with advisors to determine and document your attitudes toward productivity, stewardship, philanthropy, spending, saving and borrowing and refine into a values statement to use as a set of goals. The older our children get, the more difficult the process, but the important news is that it is never too late to
16
encourage people to be accountable.
What do I teach?
Once goals are determined and set, identify certain skills you wish to teach that will equip your child to develop good values and become financially literate: • How and when to talk about money • How to save • How to spend • How to budget • How to invest • How to borrow Personalize this list by considering the level of wealth and discussing subjects such as philanthropy and entrepreneurship. Explain the difference between “I need” and “I want.” And communicate that all family members contribute to family financial health.
How do I teach it?
Assemble a team of one to five family members and friends who can offer information and experiences that will add to your child’s financial education. Actively encourage their participation and communication about money matters and the processes they use to address issues. As your child ages and matures, consider expanding the group to include professional advisors and individuals you feel will help reinforce the values you wish to convey. Your financial advisor, trust officer, tax preparer, attorney, and others can each add to your child’s observations and experiences. Children learn not only by listening but by watching the behaviors of their mentors and by personal experience. • Guide and supervise, don’t direct and dictate • Compliment good behaviors • Use mistakes as a teaching opportunity • Be consistent, fair and willing to listen
• Be a good example • Conduct regular family financial meetings
What about an allowance? A job?
An allowance is one of the most common and most effective ways to teach children about money. Determine the amount by listing the anticipated cost for which it will be used, which forces you to determine what you expect your child to pay for. Revisit the budgeted amount annually. When children are able to work with you to list and rank their needs in importance, they should be allowed input into determining the amount. Allow children to spend the allocated portion as they wish, subject to other limits—e.g., excessive junk food— of course. It may be difficult to watch your child buy something that is “overpriced garbage,” but even this can be a learning experience on how to become a better consumer. Allow the child to understand and live with the consequences. Do not rush to replenish assets that have been depleted due to poor choices. Parents must be prepared to stay with the process or they will miss this tool’s potential for teaching. As children get older and express an interest in earning more money, consider making available additional jobs around the home for an agreed amount. Earning money outside the home can provide children with a sense of freedom and pride. Offer to help manage their earnings by assisting them in opening an account at an appropriate financial institution.
How do I tell my child about the family wealth?
Wealthy parents have the additional burden of communicating information about family wealth. Consistent com-
The Georgia Pharmacy Journal
munication is the key to letting children know that the family is financially fortunate. Children of any age can be reminded that the family is not simply entitled to wealth; it was earned as the result of someone’s hard work. Young children can be regularly reminded of how fortunate their family is and that some are not so fortunate. Stories about the hard work and struggles of their parents, grandparents, etc. can be shared. Older children can be told that they should not focus strictly on a career’s earning potential, but to focus on their passion. Children of wealthy families may face other burdens such as concerns regarding personal abilities (I got the job only because of my parents’ connection), relationships (I’m liked only because my family is rich) and the gravity of money management mistakes (I don’t want to be the one who lost the family fortune). Teaching children about money and giving them the skills to deal with the benefits and burdens of wealth may be the most valuable inheritance you can provide.
N E W S
Conclusion
Good money management skills can provide individuals a foundation for happiness, stability and independence. Poor money management skills may lead to the stress and anxiety that accompanies excessive financial obligations and the dissipation of wealth. Begin building a team of trusted “information sources.” Start with like-minded family members. Expand the group to include your financial advisor and add other professionals
(attorney, accountant, tax preparer, insurance professionals, etc.) when appropriate. Introducing the process to children at a very young age, both with words and actions, is optimal, and communicating at an age-appropriate level with children of any age can help. Providing the knowledge and a framework for dealing with future financial issues will give them the means to preserve and steward the wealth they receive. n
Key Takeaways • Advertisers begin targeting children as early as age 2; therefore, financial education should begin as early as possible. For older children, it is never too late to require financial responsibility. • Children learn more from their mistakes than from their successes. It may be difficult to watch your child buy “overpriced garbage,” but even this can be a learning experience on how to become a better consumer. At UBS, we work to provide our family clients with the latest thinking and best practices. For more information about teaching your children about money, please contact Wile Consulting Group at UBS.
Inspiring confidence GPhA/UBS Wealth Management Program We know pharmacists think about much more than prescriptions. You think about your future and retirement, making the right financial decisions for your family, and helping your employees so their future looks confident too. UBS provides GPhA with exclusive UBS benefits for the complexities of your life and pharmacy. Contact us today and let us help you plan with confidence. Wile Consulting Group UBS Financial Services Inc. 3455 Peachtree Road NE, Suite 1700 Atlanta, GA 30326 ubs.com/team/wile
Harris Gignilliat, CIMA®, CRPS® Vice President–Wealth Management Institutional Consultant, Retirement Plan Consultant 404-760-3301 harris.gignilliat@ubs.com
We will not rest As a firm providing wealth management services to clients, we offer both investment advisory and brokerage services. These services are separate and distinct, differ in material ways and are governed by different laws and separate contracts. For more information on the distinctions between our brokerage and investment advisory services, please speak with your Financial Advisor or visit our website at ubs.com/workingwithus.UBS Financial Services Inc., its affiliates and its employees are not in the business of providing tax or legal advice. Clients should seek advice based on their particular circumstances from an independent tax advisor. CIMA® is a registered certification mark of the Investment Management Consultants Association, Inc. in the United States of America and worldwide. Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®. ©UBS 2014. All rights reserved. UBS Financial Services Inc. is a subsidiary of UBS AG. Member FINRA/SIPC. 7.00_Ad_7.5x4.875_AX0220_WileConsultingGrp2 GphA
I N D U S T R Y
N E W S
I N D U S T R Y
The Talk... Teaching Children About Money M
oney management (including cash flow control, investment management, philanthropic philosophy and the proper use of debt) is a set of learned behaviors dealing with the earning, borrowing, saving, spending and sharing of money. An individual’s attitude, behaviors and values are learned and incorporated into their approach to life and money management. Children learn these behaviors and develop a set of values whether or not they are purposefully taught. The only question a parent or guardian must face is whether or not they will actively participate in the teaching process that can be guided in a positive direction, or left by chance. In particular, children that are set to inherit significant wealth need knowledge and good sense to make the decisions that accompany such an inheritance. The vast number of questions and the lack of definitive answers could explain recent survey results indicating that parents feel it is easier to talk to kids about drugs than it is about money.
When do I begin?
Studies show that marketers start targeting children as early as age two! Consider ignoring the age and maturity level of the child (advertisers certainly do) and begin when the parents are ready. Start at your child’s birth and take time to develop a plan, working together to prepare for the teaching effort. Sending mixed messages will undermine efforts to pass along responsible habits and values. Work with advisors to determine and document your attitudes toward productivity, stewardship, philanthropy, spending, saving and borrowing and refine into a values statement to use as a set of goals. The older our children get, the more difficult the process, but the important news is that it is never too late to
16
encourage people to be accountable.
What do I teach?
Once goals are determined and set, identify certain skills you wish to teach that will equip your child to develop good values and become financially literate: • How and when to talk about money • How to save • How to spend • How to budget • How to invest • How to borrow Personalize this list by considering the level of wealth and discussing subjects such as philanthropy and entrepreneurship. Explain the difference between “I need” and “I want.” And communicate that all family members contribute to family financial health.
How do I teach it?
Assemble a team of one to five family members and friends who can offer information and experiences that will add to your child’s financial education. Actively encourage their participation and communication about money matters and the processes they use to address issues. As your child ages and matures, consider expanding the group to include professional advisors and individuals you feel will help reinforce the values you wish to convey. Your financial advisor, trust officer, tax preparer, attorney, and others can each add to your child’s observations and experiences. Children learn not only by listening but by watching the behaviors of their mentors and by personal experience. • Guide and supervise, don’t direct and dictate • Compliment good behaviors • Use mistakes as a teaching opportunity • Be consistent, fair and willing to listen
• Be a good example • Conduct regular family financial meetings
What about an allowance? A job?
An allowance is one of the most common and most effective ways to teach children about money. Determine the amount by listing the anticipated cost for which it will be used, which forces you to determine what you expect your child to pay for. Revisit the budgeted amount annually. When children are able to work with you to list and rank their needs in importance, they should be allowed input into determining the amount. Allow children to spend the allocated portion as they wish, subject to other limits—e.g., excessive junk food— of course. It may be difficult to watch your child buy something that is “overpriced garbage,” but even this can be a learning experience on how to become a better consumer. Allow the child to understand and live with the consequences. Do not rush to replenish assets that have been depleted due to poor choices. Parents must be prepared to stay with the process or they will miss this tool’s potential for teaching. As children get older and express an interest in earning more money, consider making available additional jobs around the home for an agreed amount. Earning money outside the home can provide children with a sense of freedom and pride. Offer to help manage their earnings by assisting them in opening an account at an appropriate financial institution.
How do I tell my child about the family wealth?
Wealthy parents have the additional burden of communicating information about family wealth. Consistent com-
The Georgia Pharmacy Journal
munication is the key to letting children know that the family is financially fortunate. Children of any age can be reminded that the family is not simply entitled to wealth; it was earned as the result of someone’s hard work. Young children can be regularly reminded of how fortunate their family is and that some are not so fortunate. Stories about the hard work and struggles of their parents, grandparents, etc. can be shared. Older children can be told that they should not focus strictly on a career’s earning potential, but to focus on their passion. Children of wealthy families may face other burdens such as concerns regarding personal abilities (I got the job only because of my parents’ connection), relationships (I’m liked only because my family is rich) and the gravity of money management mistakes (I don’t want to be the one who lost the family fortune). Teaching children about money and giving them the skills to deal with the benefits and burdens of wealth may be the most valuable inheritance you can provide.
N E W S
Conclusion
Good money management skills can provide individuals a foundation for happiness, stability and independence. Poor money management skills may lead to the stress and anxiety that accompanies excessive financial obligations and the dissipation of wealth. Begin building a team of trusted “information sources.” Start with like-minded family members. Expand the group to include your financial advisor and add other professionals
(attorney, accountant, tax preparer, insurance professionals, etc.) when appropriate. Introducing the process to children at a very young age, both with words and actions, is optimal, and communicating at an age-appropriate level with children of any age can help. Providing the knowledge and a framework for dealing with future financial issues will give them the means to preserve and steward the wealth they receive. n
Key Takeaways • Advertisers begin targeting children as early as age 2; therefore, financial education should begin as early as possible. For older children, it is never too late to require financial responsibility. • Children learn more from their mistakes than from their successes. It may be difficult to watch your child buy “overpriced garbage,” but even this can be a learning experience on how to become a better consumer. At UBS, we work to provide our family clients with the latest thinking and best practices. For more information about teaching your children about money, please contact Wile Consulting Group at UBS.
Inspiring confidence GPhA/UBS Wealth Management Program We know pharmacists think about much more than prescriptions. You think about your future and retirement, making the right financial decisions for your family, and helping your employees so their future looks confident too. UBS provides GPhA with exclusive UBS benefits for the complexities of your life and pharmacy. Contact us today and let us help you plan with confidence. Wile Consulting Group UBS Financial Services Inc. 3455 Peachtree Road NE, Suite 1700 Atlanta, GA 30326 ubs.com/team/wile
Harris Gignilliat, CIMA®, CRPS® Vice President–Wealth Management Institutional Consultant, Retirement Plan Consultant 404-760-3301 harris.gignilliat@ubs.com
We will not rest As a firm providing wealth management services to clients, we offer both investment advisory and brokerage services. These services are separate and distinct, differ in material ways and are governed by different laws and separate contracts. For more information on the distinctions between our brokerage and investment advisory services, please speak with your Financial Advisor or visit our website at ubs.com/workingwithus.UBS Financial Services Inc., its affiliates and its employees are not in the business of providing tax or legal advice. Clients should seek advice based on their particular circumstances from an independent tax advisor. CIMA® is a registered certification mark of the Investment Management Consultants Association, Inc. in the United States of America and worldwide. Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®. ©UBS 2014. All rights reserved. UBS Financial Services Inc. is a subsidiary of UBS AG. Member FINRA/SIPC. 7.00_Ad_7.5x4.875_AX0220_WileConsultingGrp2 GphA
*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.
Thanks to All Our Supporters Diamond Level
$4,800 minimum pledge *Scott Meeks, R.Ph. *Bryan Scott, R.Ph. *Fred Sharpe, R.Ph
Titanium Level
$2,400 minimum pledge *Ralph Balchin, R.Ph. T. M. Bridges, R.Ph. 12/14 *Ben Cravey, R.Ph. *Michael Farmer, R.Ph. *David Graves, R.Ph. *Raymond Hickman, R.Ph. *Robert Ledbetter, R.Ph. *Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph. *Jeff Sikes, R.Ph. *Danny Smith, R.Ph. *Dean Stone, R.Ph. *Tommy Whitworth, R.Ph.
Platinum Level
$1,200 minimum pledge Thomas Bryan, Jr. 12/14 *Larry Braden, R.Ph. *William Cagle, R.Ph. *Hugh Chancy, R.Ph. *Keith Chapman, R.Ph. *Dale Coker, R.Ph. *Billy Conley, R.Ph. *Al Dixon Jr., R.Ph. *Ashley Dukes, R.Ph. Patrick Dunham, R.Ph. 3/15 *Jack Dunn Jr., R.Ph. *Neal Florence, R.Ph. 18
*Andy Freeman *Robert Hatton, Pharm.D. Ted Hunt, R.Ph.12/14 *Ira Katz, R.Ph. J. Thomas Lindsey, R.Ph. 4/15 Jeff Lurey, R.Ph. 5/14 *Eddie Madden, R.Ph. *Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D. *Kenneth McCarthy, R.Ph. *Ivey McCurdy, Pharm. D *Drew Miller, R.Ph. *Laird Miller, R.Ph. *Jay Mosley, R.Ph. *Sujal Patel, Pharm D *Mark Parris, Pharm.D. *Allen Partridge, R.Ph. *Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14 *Benjamin Stanley, Pharm.D. *Danny Toth, R.Ph. *Christopher Thurmond, Pharm.D. *Alex Tucker, Pharm.D. Lindsay Walker, R.Ph. 6/14 Henry Wilson, Pharm.D. 11/14
Gold Level
$600 minimum pledge James Bartling, Pharm.D. 6/14 *William Brewster, R.Ph. *Liza Chapman, Pharm.D. *Mahlon Davidson, R.Ph. *Angela DeLay, R.Ph. *Keith Dupree, R.Ph *Stewart Flanagin, R.Ph. *Kevin Florence, Pharm.D.
*Kerry Griffin, R.Ph. *Michael Iteogu, R.Ph. *Joshua Kinsey, Pharm.D. *Dan Kiser, R.Ph. *Allison Layne, C.Ph.T Lance LoRusso 6/14 Michael McGee, R.Ph. 4/15 *Sheila Miller, Pharm.D. *Robert Moody, R.Ph. *Sherri Moody, Pharm.D. *William Moye, R.Ph. *Anthony Ray, R.Ph. *Jeffrey Richardson, R.Ph. *Andy Rogers, R.Ph. *Wade Scott, R.Ph. *Michael Tarrant *James Thomas, R.Ph. Zach Tomberlin, Pharm.D. 4/15 *Mark White, R.Ph. *Charles Wilson Jr., R.Ph.
Silver Level
$300 minimum pledge *Renee Adamson, Pharm.D. Larry Batten, R. Ph. 11/14 Lance Boles, R.Ph. 8/14 Robert Cecil, R.Ph. 3/15 Laura Coker, Pharm D 6/14 *Ed Dozier, R.Ph. *Greg Drake, R. Ph. *Terry Dunn, R.Ph. *Marshall Frost, Pharm.D. *Amanda Gaddy, R. Ph. *Johnathan Hamrick, Pharm.D. *Willie Latch, R.Ph *Hilary Mbadugha, Pharm.D. The Georgia Pharmacy Journal
Highlight denotes new and increased contributors.
*Kalen Manasco, Pharm.D. Max Mason, R.Ph. 3/15 *William McLeer, R.Ph. *Sheri Mills, C.Ph.T. *Richard Noell, R.Ph. *Darby Norman, R.Ph. *Cynthia Piela, R.Ph. *Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14 *Kristy Pucylowski, Pharm.D. *Edward Reynolds, R.Ph. *Ashley Rickard, Pharm D. *Brian Rickard, Pharm D. Flynn Warren, R.Ph. 6/14 Steve Wilson, Pharm.D. 7/14 *William Wolfe, R.Ph. *Sharon Zerillo, R.Ph.
Judson Mullican, R.Ph. 11/14 *Natalie Nielsen, R.Ph. *Mark Niday, R. Ph. *Don Richie, R.Ph. *Amanda Paisley, Pharm.D. Rose Pinkstaff 1/14 *Alex Pinkston IV, R.Ph Don Richie, R.Ph. 11/14 *Corey Rieck Carlos Rodriguez-Feo, R.Ph. 12/14 *Laurence Ryan, Pharm.D. *Olivia Santoso, Pharm. D. James Stowe, R.Ph. 12/14 *Dana Strickland, R.Ph. G.H. Thurmond, R.Ph. 11/14 *Tommy Tolbert, R. Ph. *Austin Tull, Pharm.D.
Bronze Level
Members
$150 minimum pledge Monica Ali-Warren, R.Ph. 6/14 *Shane Bentley, Student *Robert Bowles *Rabun Dekle, R. Ph. Ashley Faulk, Pharm.D. 4/14 James Fetterman, Jr., Pharm.D. 5/14 Becky Hamilton, Pharm.D. 4/15 *Larry Harkleroad, R.Ph. Winton Harris Jr., R.Ph. 6/14 *Amy Grimsley, Pharm.D. *Thomas Jeter, R.Ph. *Henry Josey, Pharm.D. *Brenton Lake, R.Ph. *Tracie Lunde, Pharm.D. *Michael Lewis, Pharm.D. *Susan McLeer, R.Ph. The Georgia Pharmacy Journal
No minimum pledge Claude Bates, R.Ph 6/14 Winston Brock, R.Ph. 6/14 David Carver, R.Ph. 6/14 Marshall Curtis, R.Ph. 6/14 Donley Dawson, Pharm.D. 12/14 John Drew, R.Ph. 6/14 James England, R.Ph. 6/14 Martin Grizzard, R.Ph. 12/14 Christopher Gurley, R. Ph. 6/14 Lise Hennick, R.Ph. 2/15 Marsha Kapiloff, R.Ph. 6/14 Charles Kovarik, R. Ph. 6/14 Ralph Marett, R.Ph. 6/14 Kenneth McCarthy, R.Ph. 6/14 Whitney Pickett, R.Ph. 11/14 Michael Reagan, R. Ph 6/14
Ola Reffell, R.Ph. 6/14 Leonard Reynolds, R.Ph. 6/14 Victor Serafy, R.Ph. 6/14 Terry Shaw, Pharm.D. 5/14 Harry Shurley, R.Ph 6/14 Amanda Stankiewicz, Student 6/14 Benjamin Stanley, R.Ph 6/14 Krista Stone, R.Ph 6/14 John Thomas, R.Ph. 11/14 William Thompson, R.Ph. 6/14 Carey Vaughan, Pharm.D. 6/14 Jonathon Williams R.Ph 8/14 *denotes sustaining members
NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incorrect. afreeman@gpha.org 404-419-8118
PharmPac Board of Directors
Eddie Madden, Chairman Dean Stone, Region 1 Keith Dupree, Region 2 Judson Mullican, Region 3 Bill McLeer, Region 4 Mahlon Davidson, Region 5 Mike McGee, Region 6 Jim McWilliams, Region 7 T.M. Bridges, Region 8 Mark Parris, Region 9 Chris Thurmond, Region 10 Stewart Flanagin, Region 11 Henry Josey, Region 12 Pam Marquess, Ex-Officio Jim Bracewell, Ex-Officio
19
*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.
Thanks to All Our Supporters Diamond Level
$4,800 minimum pledge *Scott Meeks, R.Ph. *Bryan Scott, R.Ph. *Fred Sharpe, R.Ph
Titanium Level
$2,400 minimum pledge *Ralph Balchin, R.Ph. T. M. Bridges, R.Ph. 12/14 *Ben Cravey, R.Ph. *Michael Farmer, R.Ph. *David Graves, R.Ph. *Raymond Hickman, R.Ph. *Robert Ledbetter, R.Ph. *Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph. *Jeff Sikes, R.Ph. *Danny Smith, R.Ph. *Dean Stone, R.Ph. *Tommy Whitworth, R.Ph.
Platinum Level
$1,200 minimum pledge Thomas Bryan, Jr. 12/14 *Larry Braden, R.Ph. *William Cagle, R.Ph. *Hugh Chancy, R.Ph. *Keith Chapman, R.Ph. *Dale Coker, R.Ph. *Billy Conley, R.Ph. *Al Dixon Jr., R.Ph. *Ashley Dukes, R.Ph. Patrick Dunham, R.Ph. 3/15 *Jack Dunn Jr., R.Ph. *Neal Florence, R.Ph. 18
*Andy Freeman *Robert Hatton, Pharm.D. Ted Hunt, R.Ph.12/14 *Ira Katz, R.Ph. J. Thomas Lindsey, R.Ph. 4/15 Jeff Lurey, R.Ph. 5/14 *Eddie Madden, R.Ph. *Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D. *Kenneth McCarthy, R.Ph. *Ivey McCurdy, Pharm. D *Drew Miller, R.Ph. *Laird Miller, R.Ph. *Jay Mosley, R.Ph. *Sujal Patel, Pharm D *Mark Parris, Pharm.D. *Allen Partridge, R.Ph. *Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14 *Benjamin Stanley, Pharm.D. *Danny Toth, R.Ph. *Christopher Thurmond, Pharm.D. *Alex Tucker, Pharm.D. Lindsay Walker, R.Ph. 6/14 Henry Wilson, Pharm.D. 11/14
Gold Level
$600 minimum pledge James Bartling, Pharm.D. 6/14 *William Brewster, R.Ph. *Liza Chapman, Pharm.D. *Mahlon Davidson, R.Ph. *Angela DeLay, R.Ph. *Keith Dupree, R.Ph *Stewart Flanagin, R.Ph. *Kevin Florence, Pharm.D.
*Kerry Griffin, R.Ph. *Michael Iteogu, R.Ph. *Joshua Kinsey, Pharm.D. *Dan Kiser, R.Ph. *Allison Layne, C.Ph.T Lance LoRusso 6/14 Michael McGee, R.Ph. 4/15 *Sheila Miller, Pharm.D. *Robert Moody, R.Ph. *Sherri Moody, Pharm.D. *William Moye, R.Ph. *Anthony Ray, R.Ph. *Jeffrey Richardson, R.Ph. *Andy Rogers, R.Ph. *Wade Scott, R.Ph. *Michael Tarrant *James Thomas, R.Ph. Zach Tomberlin, Pharm.D. 4/15 *Mark White, R.Ph. *Charles Wilson Jr., R.Ph.
Silver Level
$300 minimum pledge *Renee Adamson, Pharm.D. Larry Batten, R. Ph. 11/14 Lance Boles, R.Ph. 8/14 Robert Cecil, R.Ph. 3/15 Laura Coker, Pharm D 6/14 *Ed Dozier, R.Ph. *Greg Drake, R. Ph. *Terry Dunn, R.Ph. *Marshall Frost, Pharm.D. *Amanda Gaddy, R. Ph. *Johnathan Hamrick, Pharm.D. *Willie Latch, R.Ph *Hilary Mbadugha, Pharm.D. The Georgia Pharmacy Journal
Highlight denotes new and increased contributors.
*Kalen Manasco, Pharm.D. Max Mason, R.Ph. 3/15 *William McLeer, R.Ph. *Sheri Mills, C.Ph.T. *Richard Noell, R.Ph. *Darby Norman, R.Ph. *Cynthia Piela, R.Ph. *Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14 *Kristy Pucylowski, Pharm.D. *Edward Reynolds, R.Ph. *Ashley Rickard, Pharm D. *Brian Rickard, Pharm D. Flynn Warren, R.Ph. 6/14 Steve Wilson, Pharm.D. 7/14 *William Wolfe, R.Ph. *Sharon Zerillo, R.Ph.
Judson Mullican, R.Ph. 11/14 *Natalie Nielsen, R.Ph. *Mark Niday, R. Ph. *Don Richie, R.Ph. *Amanda Paisley, Pharm.D. Rose Pinkstaff 1/14 *Alex Pinkston IV, R.Ph Don Richie, R.Ph. 11/14 *Corey Rieck Carlos Rodriguez-Feo, R.Ph. 12/14 *Laurence Ryan, Pharm.D. *Olivia Santoso, Pharm. D. James Stowe, R.Ph. 12/14 *Dana Strickland, R.Ph. G.H. Thurmond, R.Ph. 11/14 *Tommy Tolbert, R. Ph. *Austin Tull, Pharm.D.
Bronze Level
Members
$150 minimum pledge Monica Ali-Warren, R.Ph. 6/14 *Shane Bentley, Student *Robert Bowles *Rabun Dekle, R. Ph. Ashley Faulk, Pharm.D. 4/14 James Fetterman, Jr., Pharm.D. 5/14 Becky Hamilton, Pharm.D. 4/15 *Larry Harkleroad, R.Ph. Winton Harris Jr., R.Ph. 6/14 *Amy Grimsley, Pharm.D. *Thomas Jeter, R.Ph. *Henry Josey, Pharm.D. *Brenton Lake, R.Ph. *Tracie Lunde, Pharm.D. *Michael Lewis, Pharm.D. *Susan McLeer, R.Ph. The Georgia Pharmacy Journal
No minimum pledge Claude Bates, R.Ph 6/14 Winston Brock, R.Ph. 6/14 David Carver, R.Ph. 6/14 Marshall Curtis, R.Ph. 6/14 Donley Dawson, Pharm.D. 12/14 John Drew, R.Ph. 6/14 James England, R.Ph. 6/14 Martin Grizzard, R.Ph. 12/14 Christopher Gurley, R. Ph. 6/14 Lise Hennick, R.Ph. 2/15 Marsha Kapiloff, R.Ph. 6/14 Charles Kovarik, R. Ph. 6/14 Ralph Marett, R.Ph. 6/14 Kenneth McCarthy, R.Ph. 6/14 Whitney Pickett, R.Ph. 11/14 Michael Reagan, R. Ph 6/14
Ola Reffell, R.Ph. 6/14 Leonard Reynolds, R.Ph. 6/14 Victor Serafy, R.Ph. 6/14 Terry Shaw, Pharm.D. 5/14 Harry Shurley, R.Ph 6/14 Amanda Stankiewicz, Student 6/14 Benjamin Stanley, R.Ph 6/14 Krista Stone, R.Ph 6/14 John Thomas, R.Ph. 11/14 William Thompson, R.Ph. 6/14 Carey Vaughan, Pharm.D. 6/14 Jonathon Williams R.Ph 8/14 *denotes sustaining members
NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incorrect. afreeman@gpha.org 404-419-8118
PharmPac Board of Directors
Eddie Madden, Chairman Dean Stone, Region 1 Keith Dupree, Region 2 Judson Mullican, Region 3 Bill McLeer, Region 4 Mahlon Davidson, Region 5 Mike McGee, Region 6 Jim McWilliams, Region 7 T.M. Bridges, Region 8 Mark Parris, Region 9 Chris Thurmond, Region 10 Stewart Flanagin, Region 11 Henry Josey, Region 12 Pam Marquess, Ex-Officio Jim Bracewell, Ex-Officio
19
continuing education for pharmacists Volume XXXII, No. 3
Acute Bacterial Skin and Skin Structure Infections: Review and Update Mona T. Thompson, R.Ph., PharmD Mona T. Thompson has no relevant financial relationships to disclose.
Goal. The goal of this lesson is to provide a review of and update for the treatment of select acute bacterial skin and skin structure infections that are commonly seen and treated in the community. This lesson reviews treatment recommendations published by the Infectious Disease Society of America (IDSA), and antimicrobials with methicillin-resistant Staphylococcus aureus (MRSA) activity. Objectives. At the completion of
this activity, the participant will be able to: 1. recognize the different types of skin and skin structure infections discussed in this lesson; 2. demonstrate an understanding of the emergence of communityassociated methicillin-resistant Staphylococcus aureus (CA-MRSA) in acute bacterial skin and skin structure infection; 3. identify empiric antimicrobial treatment options for impetigo, erysipelas, nonpurulent, and purulent cellulitis; and 4. list fundamental prescribing and patient counseling points for the entities discussed.
Introduction
Acute bacterial skin and skin structure infections (ABSSSI), previously referred to as uncomplicated and complicated skin and skin structure infections (SSTI), present as a
20
wide spectrum of disease. Disease may range from mild to severe, and includes impetigo, abscess, erysipelas, cellulitis, necrotizing fasciitis, and other soft tissue infections. Soft tissue refers to tissues that connect, support, or surround other structures and organs of the body that are not bone. Examples of soft tissue include muscle, tendons, fat, and blood vessels. The mechanism of such infections varies and may result secondary to minor or major abrasions, wounds, trauma, animal or human bites, or surgical site infections, among others. ABSSSI are typically caused by gram-positive pathogens, including Staphylococcus aureus (S. aureus) and ß-hemolytic streptococci. However certain gram-negative and anaerobic bacteria are also found in polymicrobial infections. Over the past decade, widespread emergence of community-associated [also referred to as acquired] methicillinresistant S. aureus (CA-MRSA) has been reported. Previously, MRSA infections were limited to hospitalacquired infections or from other nosocomial sources. While most uncomplicated SSTI can be successfully treated in the outpatient setting, complicated infections or those due to resistant organisms require intravenous treatment and/or hospitalization. Several newer intravenous antibiotics with MRSA coverage are available for the treatment of ABSSSI and include ceftaroline fosamil, daptomycin, linezolid, and telavancin. Outpatient parenteral
antimicrobial therapy (OPAT) may be an option in select patients to prevent or shorten hospitalizations, decrease readmission rates, and reduce nosocomial infections and complications. Complicated skin and skin structure infections are one of the most common infections treated with parenteral antibiotics outside of the hospital. The major types of skin and soft tissue infections that will be discussed in this lesson include impetigo, abscess, cellulitis, and erysipelas. With the exception of impetigo, treatment recommendations will be directed toward adults.
Impetigo
Impetigo is a contagious superficial bacterial skin infection commonly seen throughout the world. Its peak incidence is among children aged two to five years, but it can affect older children and adults. Impetigo occurs more frequently in tropical or subtropical climates, but is also prevalent in northern climates during the summer months. Impetigo can occur as a result of either 1) bacterial invasion of previously normal skin, or 2) streptococcal colonization of intact skin followed by inoculation secondary to minor skin trauma, insect bites, etc. Risk factors include poverty, crowded living conditions, poor hygiene, and underlying scabies. Impetigo generally occurs on exposed parts of the body such as the face, especially around the nose and mouth, and on the arms
The Georgia Pharmacy Journal
or legs. Handwashing remains an important measure in reducing the spread among children. The disease presents as multiple localized lesions that are either non-bullous or bullous, ranging from the size of a dime to a quarter. With both forms, the lesions enlarge and progress from papules to vesicles and pustules. Over about one week, the lesions break down leaving a brown crust and possibly depigmented areas. Systemic symptoms are usually absent, but regional lymphadenitis may occur in non-bullous impetigo. Ecthyma is a more extreme and less common form of impetigo where the infection invades a deeper layer of the skin. Impetigo is almost exclusively caused by Staphylococcus aureus and/or ß-hemolytic streptococci (primarily Group A). Since the 1990s, S. aureus has emerged as the most common pathogen involved in impetigo (70 percent of cases). A smaller number of cases are also due to CA-MRSA. Bullous impetigo is caused by strains of S. aureus that produce a toxin causing cleavage in the superficial skin layer. Group A streptococcus (GAS) that causes impetigo can also enter the respiratory tract resulting in strep throat. While impetigo and strep throat are mild illnesses due to GAS, “invasive GAS disease,” which is severe and life threatening, can also occur when it enters other parts of the body such as blood, lungs, and muscle. Poststreptococcal glomerulonephritis and rheumatic fever following impetigo have also been described. The goal of treatment includes relieving discomfort, improving cosmetic appearance of the lesions, preventing further spread of the infection both in the patient and to others, and preventing recurrence. Topical therapy is recommended over systemic therapy in cases where only a small number of nonbullous lesions are present. Mupirocin 2 percent ointment (Bactroban®) has a labeled indication for impetigo, with directions
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to apply to the affected area three times a day. According to the IDSA 2011 MRSA infection treatment recommendations, mupirocin 2 percent ointment can be used in children with minor skin infections such as impetigo. Fusidic acid cream is also effective, however, it is not available in the U.S. A third topical agent, retapamulin (Altabax®), also carries an FDA-approved indication for children (nine months of age and older) and adults. This agent is the first member in a new class of antibacterial agents called pleuromutilins. Retapamulin only needs to be applied twice daily, compared to three times a day with mupirocin. However, it is more expensive and is not FDA-approved for the treatment of MRSA due to mixed results in clinical trials. Advantages of topical therapy include delivery of high concentrations of drug to only infected tissue, minimization of systemic absorption and toxicity, and avoidance of altering gastrointestinal flora. The use of topical agents in limited impetigo may also minimize antibacterial resistance. Oral antibiotics should be initiated in patients who do not tolerate a topical antibiotic, or in those with more extensive or systemic disease. The use of penicillin for primary treatment of GAS is no longer recommended. Since S. aureus now accounts for most cases, penicillinase-resistant penicillins or first-generation cephalosporins such as dicloxacillin, cephalexin, and amoxicillin/clavulanate are preferred. Clindamycin, an option for penicillin-allergic patients, is also appropriate. Macrolides are no longer adequate therapy due to resistant strains of S. aureus or S. pyogenes. Fluoroquinolones should also be excluded since MRSA resistance to this class is extensive. In communities with a high prevalance of CA-MRSA, agents such as clindamycin, trimethoprimsulfamethoxazole (TMP-SMX), and tetracyclines may be used. Note that tetracyclines should not be
used in children less than eight years of age. Duration of treatment is based on clinical improvement, while seven days is considered sufficient in most cases.
Abscess
An abscess is a collection of pus within the dermis or subcutaneous tissues. Patients will present with nodules and surrounding erythema. The presence of an abscess is significant as it differs from cellulitis, and is more likely to be due to S. aureus. Abscesses are treated primarily by incision and drainage. Therefore, it is important that they are distinguished from cellulitis. Antibiotic therapy is recommended for abscesses when associated with severe or extensive disease (involving multiple sites of infection), or rapid progression along with cellulitis; signs and symptoms of systemic illness; comorbidities or immunosuppression; extremes of age; abscess in an area difficult to drain (face, hand, and genitals); septic phlebitis; and lack of response to incision and drainage alone.
Cellulitis and Erysipelas
Cellulitis and erysipelas are diffuse, acute, spreading infections of the dermis. These infections present with edema and redness, are warm to touch, and sometimes cause inflammation of the regional lymph nodes. Systemic symptoms are usually mild, but can include fever, tachycardia, confusion, hypotension, and leukocytosis. While the terms cellulitis and erysipelas may be used interchangeably by physicians, there are distinguishing features. Erysipelas is a non-complicated form of cellulitis and is almost always a streptococcal infection (and occasionally S. aureus) that involves the superficial layers of the dermis. It is characterized by well-demarcated, raised areas of vivid erythema. Erysipelas is more common in infants, young children, and older adults, and more frequently affects the lower extremities. Prompt diagnosis and treatment corresponds
21
continuing education for pharmacists Volume XXXII, No. 3
Acute Bacterial Skin and Skin Structure Infections: Review and Update Mona T. Thompson, R.Ph., PharmD Mona T. Thompson has no relevant financial relationships to disclose.
Goal. The goal of this lesson is to provide a review of and update for the treatment of select acute bacterial skin and skin structure infections that are commonly seen and treated in the community. This lesson reviews treatment recommendations published by the Infectious Disease Society of America (IDSA), and antimicrobials with methicillin-resistant Staphylococcus aureus (MRSA) activity. Objectives. At the completion of
this activity, the participant will be able to: 1. recognize the different types of skin and skin structure infections discussed in this lesson; 2. demonstrate an understanding of the emergence of communityassociated methicillin-resistant Staphylococcus aureus (CA-MRSA) in acute bacterial skin and skin structure infection; 3. identify empiric antimicrobial treatment options for impetigo, erysipelas, nonpurulent, and purulent cellulitis; and 4. list fundamental prescribing and patient counseling points for the entities discussed.
Introduction
Acute bacterial skin and skin structure infections (ABSSSI), previously referred to as uncomplicated and complicated skin and skin structure infections (SSTI), present as a
20
wide spectrum of disease. Disease may range from mild to severe, and includes impetigo, abscess, erysipelas, cellulitis, necrotizing fasciitis, and other soft tissue infections. Soft tissue refers to tissues that connect, support, or surround other structures and organs of the body that are not bone. Examples of soft tissue include muscle, tendons, fat, and blood vessels. The mechanism of such infections varies and may result secondary to minor or major abrasions, wounds, trauma, animal or human bites, or surgical site infections, among others. ABSSSI are typically caused by gram-positive pathogens, including Staphylococcus aureus (S. aureus) and ß-hemolytic streptococci. However certain gram-negative and anaerobic bacteria are also found in polymicrobial infections. Over the past decade, widespread emergence of community-associated [also referred to as acquired] methicillinresistant S. aureus (CA-MRSA) has been reported. Previously, MRSA infections were limited to hospitalacquired infections or from other nosocomial sources. While most uncomplicated SSTI can be successfully treated in the outpatient setting, complicated infections or those due to resistant organisms require intravenous treatment and/or hospitalization. Several newer intravenous antibiotics with MRSA coverage are available for the treatment of ABSSSI and include ceftaroline fosamil, daptomycin, linezolid, and telavancin. Outpatient parenteral
antimicrobial therapy (OPAT) may be an option in select patients to prevent or shorten hospitalizations, decrease readmission rates, and reduce nosocomial infections and complications. Complicated skin and skin structure infections are one of the most common infections treated with parenteral antibiotics outside of the hospital. The major types of skin and soft tissue infections that will be discussed in this lesson include impetigo, abscess, cellulitis, and erysipelas. With the exception of impetigo, treatment recommendations will be directed toward adults.
Impetigo
Impetigo is a contagious superficial bacterial skin infection commonly seen throughout the world. Its peak incidence is among children aged two to five years, but it can affect older children and adults. Impetigo occurs more frequently in tropical or subtropical climates, but is also prevalent in northern climates during the summer months. Impetigo can occur as a result of either 1) bacterial invasion of previously normal skin, or 2) streptococcal colonization of intact skin followed by inoculation secondary to minor skin trauma, insect bites, etc. Risk factors include poverty, crowded living conditions, poor hygiene, and underlying scabies. Impetigo generally occurs on exposed parts of the body such as the face, especially around the nose and mouth, and on the arms
The Georgia Pharmacy Journal
or legs. Handwashing remains an important measure in reducing the spread among children. The disease presents as multiple localized lesions that are either non-bullous or bullous, ranging from the size of a dime to a quarter. With both forms, the lesions enlarge and progress from papules to vesicles and pustules. Over about one week, the lesions break down leaving a brown crust and possibly depigmented areas. Systemic symptoms are usually absent, but regional lymphadenitis may occur in non-bullous impetigo. Ecthyma is a more extreme and less common form of impetigo where the infection invades a deeper layer of the skin. Impetigo is almost exclusively caused by Staphylococcus aureus and/or ß-hemolytic streptococci (primarily Group A). Since the 1990s, S. aureus has emerged as the most common pathogen involved in impetigo (70 percent of cases). A smaller number of cases are also due to CA-MRSA. Bullous impetigo is caused by strains of S. aureus that produce a toxin causing cleavage in the superficial skin layer. Group A streptococcus (GAS) that causes impetigo can also enter the respiratory tract resulting in strep throat. While impetigo and strep throat are mild illnesses due to GAS, “invasive GAS disease,” which is severe and life threatening, can also occur when it enters other parts of the body such as blood, lungs, and muscle. Poststreptococcal glomerulonephritis and rheumatic fever following impetigo have also been described. The goal of treatment includes relieving discomfort, improving cosmetic appearance of the lesions, preventing further spread of the infection both in the patient and to others, and preventing recurrence. Topical therapy is recommended over systemic therapy in cases where only a small number of nonbullous lesions are present. Mupirocin 2 percent ointment (Bactroban®) has a labeled indication for impetigo, with directions
The Georgia Pharmacy Journal
to apply to the affected area three times a day. According to the IDSA 2011 MRSA infection treatment recommendations, mupirocin 2 percent ointment can be used in children with minor skin infections such as impetigo. Fusidic acid cream is also effective, however, it is not available in the U.S. A third topical agent, retapamulin (Altabax®), also carries an FDA-approved indication for children (nine months of age and older) and adults. This agent is the first member in a new class of antibacterial agents called pleuromutilins. Retapamulin only needs to be applied twice daily, compared to three times a day with mupirocin. However, it is more expensive and is not FDA-approved for the treatment of MRSA due to mixed results in clinical trials. Advantages of topical therapy include delivery of high concentrations of drug to only infected tissue, minimization of systemic absorption and toxicity, and avoidance of altering gastrointestinal flora. The use of topical agents in limited impetigo may also minimize antibacterial resistance. Oral antibiotics should be initiated in patients who do not tolerate a topical antibiotic, or in those with more extensive or systemic disease. The use of penicillin for primary treatment of GAS is no longer recommended. Since S. aureus now accounts for most cases, penicillinase-resistant penicillins or first-generation cephalosporins such as dicloxacillin, cephalexin, and amoxicillin/clavulanate are preferred. Clindamycin, an option for penicillin-allergic patients, is also appropriate. Macrolides are no longer adequate therapy due to resistant strains of S. aureus or S. pyogenes. Fluoroquinolones should also be excluded since MRSA resistance to this class is extensive. In communities with a high prevalance of CA-MRSA, agents such as clindamycin, trimethoprimsulfamethoxazole (TMP-SMX), and tetracyclines may be used. Note that tetracyclines should not be
used in children less than eight years of age. Duration of treatment is based on clinical improvement, while seven days is considered sufficient in most cases.
Abscess
An abscess is a collection of pus within the dermis or subcutaneous tissues. Patients will present with nodules and surrounding erythema. The presence of an abscess is significant as it differs from cellulitis, and is more likely to be due to S. aureus. Abscesses are treated primarily by incision and drainage. Therefore, it is important that they are distinguished from cellulitis. Antibiotic therapy is recommended for abscesses when associated with severe or extensive disease (involving multiple sites of infection), or rapid progression along with cellulitis; signs and symptoms of systemic illness; comorbidities or immunosuppression; extremes of age; abscess in an area difficult to drain (face, hand, and genitals); septic phlebitis; and lack of response to incision and drainage alone.
Cellulitis and Erysipelas
Cellulitis and erysipelas are diffuse, acute, spreading infections of the dermis. These infections present with edema and redness, are warm to touch, and sometimes cause inflammation of the regional lymph nodes. Systemic symptoms are usually mild, but can include fever, tachycardia, confusion, hypotension, and leukocytosis. While the terms cellulitis and erysipelas may be used interchangeably by physicians, there are distinguishing features. Erysipelas is a non-complicated form of cellulitis and is almost always a streptococcal infection (and occasionally S. aureus) that involves the superficial layers of the dermis. It is characterized by well-demarcated, raised areas of vivid erythema. Erysipelas is more common in infants, young children, and older adults, and more frequently affects the lower extremities. Prompt diagnosis and treatment corresponds
21
with a very good prognosis. The infection rarely extends into the deeper layers of the skin and soft tissues. Alternately, cellulitis extends further into the deeper dermis and subcutaneous tissue and has less defined margins. Cellulitis is either purulent or nonpurulent. Purulent cellulitis is defined as cellulitis with associated purulent drainage or exudate in the absence of a drainable abscess. Cellulitis and erysipelas result when organisms enter through breaches in the skin, most often on the lower legs. Other common sites include the upper extremities, trunk, perineum, or head and neck. Predisposing factors for these infections include conditions that make the skin more fragile or make local host defenses weaker. Examples include obesity, previous cutaneous damage, edema from venous insufficiency or lymphatic obstruction, and prior radiation therapy. The break in skin may be due to trauma, pre-existing skin infections such as impetigo, ulceration, or eczema among others. The breaks can be so small that they are not clinically apparent. Surgical procedures that disrupt lymphatic drainage (e.g., axillary node dissection for breast cancer) increase the risk of cellulitis. Blood culture results are positive in fewer than 5 percent of cases. Other potential sources for culture include peripheral blood, needle aspirates, and skin biopsies. Surgical specimens in cases with purulence, abscess, or necrosis may be cultured, but many cases are nonpurulent. Traditionally, cellulitis and erysipelas were managed empirically with agents that covered ßhemolytic streptococci and methicillin-sensitive S. aureus (MSSA). For classic erysipelas, penicillin has remained first-line therapy. However, because these two infections can be difficult to distinguish, they are often treated the same. In 2005, IDSA released guidelines for SSTI, listing the following antibacterials as suitable agents
22
Table 1 Risk factors for associated pathogens in cellulitis* Reported risk factors for MRSA • Previous history of hospitalization or surgery within the past year • Residence in a long term care facility within the past year • Hemodialysis • Previous MRSA infection or colonization • Recent antibiotic use • Contact sports • Patient report of “spider bite” • Purulent soft tissue infections • Crowded living environments, such as homeless shelters, prisons, etc. • Intravenous drug use • Men who have sex with men • Household contacts with MRSA infection Risk factors associated with other pathogens Diabetic foot infections Often polymicrobial, including gram-positive and gram-negative aerobes and anaerobes Neutropenia Gram-positive, gram-negative including Pseudomonas aeruginosa Intravenous drug use Staphylococcus aureus, Pseudomonas aeruginosa Human bites Polymicrobial mixture of oral anaerobes and aerobes Dog and cat bites Polymicrobial mixture of pathogens derived from the animal and host skin flora
Table 2 Recommended antimicrobial therapy for patients with cellulitis
Outpatient purulent cellulitis Treatment for CA-MRSA
Outpatient nonpurulent cellulitis Treatment for streptococci and MSSA Empiric coverage for CA-MRSA if no response or systemic toxicity
Increasing Prevalence of CA-MRSA
The prevalence of CA-MRSA has increased in the last decade and is currently a prominent cause of
purulent ABSSSI in the United States. Data from a Los Angeles emergency department (ED) indicated that infections from CAMRSA more than doubled within a five-year period in patients presenting with purulent ABSSSI, from 29 percent in 2001 to 64 percent in 2005. CA-MRSA strains are more virulent than health care-associated (HA-MRSA) strains and may carry genes that involve toxins associated with tissue necrosis and more serious disease. CAMRSA skin infections range from cutaneous abscesses to necrotizing fasciitis. CA-MRSA can also cause severe systemic infections including pneumonia and bloodstream infections. Unlike HA-MRSA, many CA-MRSA strains are susceptible to gentamicin, tetracyclines, lincosamides, and TMP-SMX. CA-MRSA refers to MRSA infections that occur in outpatients or within 48 hours of hospitalization, and lack nosocomial exposures such as indwelling device, recent hospitalization, surgery, dialysis, or residence
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Dose
Clindamycin TMP-SMX Doxycycline Minocycline Linezolid
300-450 mg PO TID 1-2 DS tab PO BID 100 mg PO BID 200 mg x 1, then 100 mg PO BID 600 mg PO BID
Cephalexin Dicloxacillin Clindamycin
500 mg PO QID 500 mg PO QID 300-450 mg PO TID
Hospitalized patients with cellulitis Treatment for MRSA Vancomycin
* Derived from retrospective studies; may not discriminate between MRSA and non-MRSA infections. Adapted from Am J Med. 2011;124(12).p1116.
for empiric outpatient treatment: dicloxacillin, cephalexin, or clindamycin. Treatment may also need to be directed to other organisms including gram-negative organisms which can produce cellulitis in certain circumstances. Table 1 lists risk factors for other pathogens that may be involved in cellulitis. At the time of preparing the 2005 guidelines, IDSA did not recognize the role of CA-MRSA in cellulitis and, therefore, did not recommend empiric coverage. However, in 2011, IDSA published their first guideline specifically for the treatment of MRSA with recommendations on the management of some of the most common clinical syndromes encountered including skin and skin structure infections. These two guideline documents are the basis of the recommendations in this lesson.
Antimicrobial
If nonpurulent cellulitis, may consider treatment for streptococci and MSSA with modification to MRSA-active therapy if no response
Linezolid Daptomycin Telavancin Clindamycin
15-20 mg/kg/dose IV every 8-12 hour 600 mg PO/IV BID 4 mg/kg/dose IV QD 10 mg/kg/dose IV QD 600 mg PO/IV TID
Nafcillin or Oxacillin Cefazolin
1-2 g IV every 4 hours 1 g IV every 8 hours
in a long-term care facility. The IDSA document cites a study in which 73 percent of cases of nonpurulent cellulitis tested positive for serology to detect streptococci, indicating that it is still the predominant bacteria for nonpurulent cellulitis. On the other hand, a large study of purulent soft tissue infections in EDs across the U.S. found that 76 percent of cases were due to S. aureus, including 59 percent by CA-MRSA. Hence, 2011 IDSA guidelines provide the following recommendations. 1) For outpatients with purulent cellulitis (e.g., cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess), empiric therapy for CA-MRSA is recommended pending culture results. Listed options include clindamycin, TMPSMX, a tetracycline (doxycycline or
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minocycline), and linezolid. Empiric therapy for infection due to ß-hemolytic streptococci is likely to be unnecessary. 2) For outpatients with nonpurulent cellulitis (e.g., cellulitis with no purulent drainage or exudate and no associated abscess), empiric therapy for infection due to ß-hemolytic streptococci is recommended. Listed options include cephalexin, dicloxacillin, and clindamycin. The role of CAMRSA is unknown in nonpurulent cases, and empiric coverage for CA-MRSA is recommended only in patients who do not respond to ß-lactam therapy or in those who are severely ill. If coverage for both CA-MRSA and ß-hemolytic streptococci is needed, the clinician may prescribe clindamycin or linezolid alone, or TMP-SMX or a tetracycline plus a ß-lactam such as amoxicillin.
Cultures are recommended in patients who have not responded adequately to initial treatment or if there is a concern for a cluster or an outbreak. Five to 10 days of therapy is recommended, but should be individualized based on the patient’s clinical response for both types of cellulitis. Patients with systemic toxicity and/or rapidly progressing or worsening infection despite receiving appropriate oral antibiotics may require inpatient management (i.e., intravenous antimicrobials) and surgical intervention. Hospitalized patients with complicated SSTI, defined as deeper soft tissue infections, surgical/traumatic wound infections, major abscesses, cellulitis, and infected ulcers and burns, should be treated with surgical debridement, broad spectrum antibiotics, and empiric therapy for MRSA pending culture results. Listed options include IV vancomycin, PO or IV linezolid, IV daptomycin, IV telavancin, and IV or PO clindamycin. A beta-lactam antibiotic, such as cefazolin or nafcillin, may be initiated in hospitalized patients with nonpurulent cellulitis and modified to MRSA therapy if there is no clinical response. Table 2 summarizes the recommended antimicrobial therapy for patients with cellulitis.
Recurrent MRSA SSTIs
Health care providers may instruct patients on measures to prevent recurrent MRSA infection such as keeping draining wounds covered with clean, dry bandages; maintaining good personal hygiene with regular bathing and handwashing with soap and water or alcoholbased hand gel; and avoiding the re-use or sharing of personal items that have contacted infected skin. Experts define recurrent disease as two or more separate SSTI episodes at different sites over a six-month period. Environmental hygiene measures, with appropriate detergents or commercially available cleaners, may be used in patients with recurrent infections within a household or commu-
23
with a very good prognosis. The infection rarely extends into the deeper layers of the skin and soft tissues. Alternately, cellulitis extends further into the deeper dermis and subcutaneous tissue and has less defined margins. Cellulitis is either purulent or nonpurulent. Purulent cellulitis is defined as cellulitis with associated purulent drainage or exudate in the absence of a drainable abscess. Cellulitis and erysipelas result when organisms enter through breaches in the skin, most often on the lower legs. Other common sites include the upper extremities, trunk, perineum, or head and neck. Predisposing factors for these infections include conditions that make the skin more fragile or make local host defenses weaker. Examples include obesity, previous cutaneous damage, edema from venous insufficiency or lymphatic obstruction, and prior radiation therapy. The break in skin may be due to trauma, pre-existing skin infections such as impetigo, ulceration, or eczema among others. The breaks can be so small that they are not clinically apparent. Surgical procedures that disrupt lymphatic drainage (e.g., axillary node dissection for breast cancer) increase the risk of cellulitis. Blood culture results are positive in fewer than 5 percent of cases. Other potential sources for culture include peripheral blood, needle aspirates, and skin biopsies. Surgical specimens in cases with purulence, abscess, or necrosis may be cultured, but many cases are nonpurulent. Traditionally, cellulitis and erysipelas were managed empirically with agents that covered ßhemolytic streptococci and methicillin-sensitive S. aureus (MSSA). For classic erysipelas, penicillin has remained first-line therapy. However, because these two infections can be difficult to distinguish, they are often treated the same. In 2005, IDSA released guidelines for SSTI, listing the following antibacterials as suitable agents
22
Table 1 Risk factors for associated pathogens in cellulitis* Reported risk factors for MRSA • Previous history of hospitalization or surgery within the past year • Residence in a long term care facility within the past year • Hemodialysis • Previous MRSA infection or colonization • Recent antibiotic use • Contact sports • Patient report of “spider bite” • Purulent soft tissue infections • Crowded living environments, such as homeless shelters, prisons, etc. • Intravenous drug use • Men who have sex with men • Household contacts with MRSA infection Risk factors associated with other pathogens Diabetic foot infections Often polymicrobial, including gram-positive and gram-negative aerobes and anaerobes Neutropenia Gram-positive, gram-negative including Pseudomonas aeruginosa Intravenous drug use Staphylococcus aureus, Pseudomonas aeruginosa Human bites Polymicrobial mixture of oral anaerobes and aerobes Dog and cat bites Polymicrobial mixture of pathogens derived from the animal and host skin flora
Table 2 Recommended antimicrobial therapy for patients with cellulitis
Outpatient purulent cellulitis Treatment for CA-MRSA
Outpatient nonpurulent cellulitis Treatment for streptococci and MSSA Empiric coverage for CA-MRSA if no response or systemic toxicity
Increasing Prevalence of CA-MRSA
The prevalence of CA-MRSA has increased in the last decade and is currently a prominent cause of
purulent ABSSSI in the United States. Data from a Los Angeles emergency department (ED) indicated that infections from CAMRSA more than doubled within a five-year period in patients presenting with purulent ABSSSI, from 29 percent in 2001 to 64 percent in 2005. CA-MRSA strains are more virulent than health care-associated (HA-MRSA) strains and may carry genes that involve toxins associated with tissue necrosis and more serious disease. CAMRSA skin infections range from cutaneous abscesses to necrotizing fasciitis. CA-MRSA can also cause severe systemic infections including pneumonia and bloodstream infections. Unlike HA-MRSA, many CA-MRSA strains are susceptible to gentamicin, tetracyclines, lincosamides, and TMP-SMX. CA-MRSA refers to MRSA infections that occur in outpatients or within 48 hours of hospitalization, and lack nosocomial exposures such as indwelling device, recent hospitalization, surgery, dialysis, or residence
The Georgia Pharmacy Journal
Dose
Clindamycin TMP-SMX Doxycycline Minocycline Linezolid
300-450 mg PO TID 1-2 DS tab PO BID 100 mg PO BID 200 mg x 1, then 100 mg PO BID 600 mg PO BID
Cephalexin Dicloxacillin Clindamycin
500 mg PO QID 500 mg PO QID 300-450 mg PO TID
Hospitalized patients with cellulitis Treatment for MRSA Vancomycin
* Derived from retrospective studies; may not discriminate between MRSA and non-MRSA infections. Adapted from Am J Med. 2011;124(12).p1116.
for empiric outpatient treatment: dicloxacillin, cephalexin, or clindamycin. Treatment may also need to be directed to other organisms including gram-negative organisms which can produce cellulitis in certain circumstances. Table 1 lists risk factors for other pathogens that may be involved in cellulitis. At the time of preparing the 2005 guidelines, IDSA did not recognize the role of CA-MRSA in cellulitis and, therefore, did not recommend empiric coverage. However, in 2011, IDSA published their first guideline specifically for the treatment of MRSA with recommendations on the management of some of the most common clinical syndromes encountered including skin and skin structure infections. These two guideline documents are the basis of the recommendations in this lesson.
Antimicrobial
If nonpurulent cellulitis, may consider treatment for streptococci and MSSA with modification to MRSA-active therapy if no response
Linezolid Daptomycin Telavancin Clindamycin
15-20 mg/kg/dose IV every 8-12 hour 600 mg PO/IV BID 4 mg/kg/dose IV QD 10 mg/kg/dose IV QD 600 mg PO/IV TID
Nafcillin or Oxacillin Cefazolin
1-2 g IV every 4 hours 1 g IV every 8 hours
in a long-term care facility. The IDSA document cites a study in which 73 percent of cases of nonpurulent cellulitis tested positive for serology to detect streptococci, indicating that it is still the predominant bacteria for nonpurulent cellulitis. On the other hand, a large study of purulent soft tissue infections in EDs across the U.S. found that 76 percent of cases were due to S. aureus, including 59 percent by CA-MRSA. Hence, 2011 IDSA guidelines provide the following recommendations. 1) For outpatients with purulent cellulitis (e.g., cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess), empiric therapy for CA-MRSA is recommended pending culture results. Listed options include clindamycin, TMPSMX, a tetracycline (doxycycline or
The Georgia Pharmacy Journal
minocycline), and linezolid. Empiric therapy for infection due to ß-hemolytic streptococci is likely to be unnecessary. 2) For outpatients with nonpurulent cellulitis (e.g., cellulitis with no purulent drainage or exudate and no associated abscess), empiric therapy for infection due to ß-hemolytic streptococci is recommended. Listed options include cephalexin, dicloxacillin, and clindamycin. The role of CAMRSA is unknown in nonpurulent cases, and empiric coverage for CA-MRSA is recommended only in patients who do not respond to ß-lactam therapy or in those who are severely ill. If coverage for both CA-MRSA and ß-hemolytic streptococci is needed, the clinician may prescribe clindamycin or linezolid alone, or TMP-SMX or a tetracycline plus a ß-lactam such as amoxicillin.
Cultures are recommended in patients who have not responded adequately to initial treatment or if there is a concern for a cluster or an outbreak. Five to 10 days of therapy is recommended, but should be individualized based on the patient’s clinical response for both types of cellulitis. Patients with systemic toxicity and/or rapidly progressing or worsening infection despite receiving appropriate oral antibiotics may require inpatient management (i.e., intravenous antimicrobials) and surgical intervention. Hospitalized patients with complicated SSTI, defined as deeper soft tissue infections, surgical/traumatic wound infections, major abscesses, cellulitis, and infected ulcers and burns, should be treated with surgical debridement, broad spectrum antibiotics, and empiric therapy for MRSA pending culture results. Listed options include IV vancomycin, PO or IV linezolid, IV daptomycin, IV telavancin, and IV or PO clindamycin. A beta-lactam antibiotic, such as cefazolin or nafcillin, may be initiated in hospitalized patients with nonpurulent cellulitis and modified to MRSA therapy if there is no clinical response. Table 2 summarizes the recommended antimicrobial therapy for patients with cellulitis.
Recurrent MRSA SSTIs
Health care providers may instruct patients on measures to prevent recurrent MRSA infection such as keeping draining wounds covered with clean, dry bandages; maintaining good personal hygiene with regular bathing and handwashing with soap and water or alcoholbased hand gel; and avoiding the re-use or sharing of personal items that have contacted infected skin. Experts define recurrent disease as two or more separate SSTI episodes at different sites over a six-month period. Environmental hygiene measures, with appropriate detergents or commercially available cleaners, may be used in patients with recurrent infections within a household or commu-
23
nity, and should be geared toward cleaning high-touch surfaces (i.e., surfaces that come into frequent contact with bare skin such as counters, doorknobs, bath tubs, and toilet seats). Decolonization with mupirocin nasal and/or chlorhexidine topical antiseptic solution may be an option in patients who develop recurrent SSTI despite optimizing wound care and hygiene measures. While oral antimicrobial therapy for decolonization is not routinely recommended, it may be considered if infections recur regardless of measures. However, there are no published data to support the efficacy of decolonization in patients with recurrent MRSA SSTI. The optimal regimen, frequency of application, and duration of therapy are unclear.
Antimicrobials for the Treatment of CA-MRSA in SSTI
Trimethoprim-sulfamethoxazole (TMP-SMX), widely known by the trade names Bactrim™ or Septra®, is prescribed as one to two double-strength tablets orally twice daily for the treatment of MRSA in adults. This agent is not FDA-approved for the treatment of any staphylococcal infection; however, 95 to 100 percent of CAMRSA strains are susceptible to it in vitro and it is an important option for outpatient management of SSTI. TMP-SMX is classified as pregnancy Category C/D, and is not recommended for women in the third trimester of pregnancy (or for children <2 months of age). Caution should be exercised when using this agent in the elderly, especially in those receiving concurrent inhibitors of the renin-angiotensin system and in those with chronic renal insufficiency because of an increased risk of hyperkalemia. Oral tetracycline antibiotics that may be used for MRSA include doxycycline and minocycline. The adult dose for doxycycline is 100 mg orally twice daily. It is FDAapproved for the treatment of SSTI due to S. aureus, but not specifi-
24
cally for those caused by MRSA. For minocycline, a 200 mg oral loading dose is recommended, followed by 100 mg twice daily. These agents have in vitro activity and appear to be effective for this indication, but data are limited and lacking to support use in more invasive infections. Tigecycline (Tygacil®), a derivative of tetracycline, is an FDA-approved intravenous agent for the treatment of complicated SSTIs in adults. However, FDA recently issued a warning to consider alternative agents in patients with serious infections because of an increase in all-cause mortality. Tetracyclines are classified as pregnancy Category D, and are not recommended for children less than eight years of age because of the potential for tooth enamel discoloration and decreased bone growth. Clindamycin, also an acceptable empiric treatment of purulent cellulitis, should be prescribed as 300 to 450 mg orally three times a day. Although not specifically FDA-approved for the treatment of MRSA infection, it has become widely used for the treatment of SSTI. The D zone test is recommended for detection of inducible clindamycin resistance in erythromycin-resistant, clindamycinsusceptible isolates, and is readily available. While Clostridium difficile-associated disease may occur with virtually any antibiotic, it may occur more frequently following clindamycin treatment when compared with other oral agents. Linezolid (Zyvox®) is a grampositive agent that is bacteriostatic against enterococci and staphylococci, and bactericidal against most strains of streptococci. It is of the oxazolidinone class, and exhibits its antimicrobial effect via inhibition of bacterial protein synthesis. Linezolid is active against problematic organisms such as MRSA, penicillin-resistant Streptococcus pneumoniae, and vancomycinresistant enterococci (VRE). Resistance surveillance data indicates that more than 99 percent of S. aureus strains are susceptible to
linezolid. It is FDA-approved for the treatment of complicated SSTIs and nosocomial pneumonia. The dosage is 600 mg orally or IV every 12 hours in children >12 years and adults. Linezolid does not require dosage adjustments in patients with either renal or hepatic impairment. It is rather expensive compared to other oral agents available for CA-MRSA. Adverse effects were observed in some animal studies and there are no adequate, well-controlled studies in pregnant women. Therefore, this agent is classified as pregnancy Category C. Excretion in breastmilk is unknown, thus caution is advised. Linezolid is contraindicated with concurrent use or within two weeks of MAO inhibitors; and in patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, and/or those taking sympathomimetics, vasopressive agents, and dopaminergic agents unless closely monitored for increased blood pressure. Additionally, linezolid should not be administered to patients taking SSRIs, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine or buspirone, unless closely monitored for signs or symptoms of serotonin syndrome. Tyramine, an amino acid that helps regulate blood pressure, is naturally occurring in the body and is found in certain foods. Ingestion of foods rich in tyramine such as aged cheeses, cured meats, fermented cabbage, soy sauce, or broad bean pods, such as fava beans, should be avoided as this can cause sudden and severe high blood pressure. Food that has been improperly stored or spoiled can create an environment where tyramine concentrations may increase. Thrombocytopenia has been reported with linezolid use and may limit its use in patients with pre-existing myelosuppression. Weekly CBC (complete blood count) monitoring is recommended, and the agent should be discontinued in circumstances where myelosuppression occurs or worsens. It has
The Georgia Pharmacy Journal
also been associated with neuropathy and lactic acidosis. Other common adverse events include headache, diarrhea, insomnia, dizziness, rash, nausea, and vomiting. Vancomycin is a glycopeptide that inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization. While its use in ABSSSI does have some limitations, it is the most common choice for parenteral treatment of CAMRSA with nearly 50 years of clinical use. Vancomycin is available in multiple generic formulations, reasonably well tolerated, associated with a low incidence of adverse effects, and is relatively inexpensive. Unfortunately, the susceptibility of MRSA to this antibiotic may be decreasing with increasing reports of clinical failure. The vancomycin breakpoints for susceptible, intermediate, and resistant minimum inhibitory concentrations (MIC) have been reduced in laboratory standards to reflect the changes that have been seen in MRSA vancomycin susceptibility. Studies have indicated that vancomycin tissue penetration is variable. In 2009, the American Society of Health-System Pharmacists (ASHP), IDSA, and the Society of Infectious Diseases Pharmacists jointly issued a consensus statement on the therapeutic monitoring of vancomycin in adults. The panel agreed that antibiotics other than vancomyin should be considered when vancomycin MIC values are >2 mg/L because it is unlikely that effective serum concentrations will be achieved when keeping within therapeutic trough levels. The IDSA MRSA treatment guidelines note that, for most patients with SSTI who have normal renal function and are not obese, 1 gm IV every 12 hours is sufficient. It is recommended that trough serum vancomycin levels always be maintained above 10 mg/L to avoid development of resistance. Additionally, the panel recommends dosing vancomycin at 15 to 20 mg/kg/dose (based on actual body weight and not to exceed 2 gm/ dose) every eight to 12 hours for se-
The Georgia Pharmacy Journal
riously ill patients with MRSA infections and normal renal function. A loading dose of 25 to 30 mg/kg should also be considered in such instances. For these large doses, prolonging the infusion time to two hours, and using an antihistamine may reduce the risk of red man syndrome and possible anaphylaxis. For severe infections, higher trough concentrations of 15 to 20 mg/L are recommended to optimize pharmacodynamics, improve tissue penetration, and prevent resistance development. Serum trough concentrations should be obtained just prior to the fourth dose; monitoring of peak concentrations is not recommended. Vancomycin has long been considered a nephrotoxic and ototoxic agent. Yet, according to the consensus statement, there are limited data suggesting a direct causal relationship between toxicity and specific serum vancomycin concentrations. In summary, trough monitoring is best suited for patients receiving aggressive dosing, those receiving concurrent nephrotoxins, patients with unstable renal function, or those receiving prolonged courses of therapy. There are limited data to support the safety of sustained trough serum vancomycin concentrations of 15 to 20 mg/L. Daptomycin (Cubicin®) is a lipopeptide class antibiotic that disrupts cell membrane function via calcium-dependent binding, resulting in bactericidal activity in a concentration dependent manner. It is FDA-approved for adults with SSTI due to S. aureus among other indications. The dose is 4 mg/kg of total body weight once daily IV for seven to 14 days. The frequency of administration should be reduced to every 48 hours in patients with CrCl <30mL/min. Elevations in creatine phosphokinase (CPK), which are rarely treatment-limiting, have occurred in patients receiving higher doses such as 6 mg/kg for other indications. Patients should be monitored, however, for signs and symptoms of infection with suggested CPK weekly monitoring during therapy. The label recom-
mends more frequent monitoring with current or previous statin therapy, unexplained CPK increases, or renal impairment. Daptomycin may also cause false prolongation of the PT and increase of INR with certain reagents. This agent is classified as pregnancy Category B. Ceftaroline (Teflaro®), the active form of ceftaroline fosamil, is a broad spectrum cephalosporin with potent activity against MRSA. It exerts bactericidal activity by binding to key penicillin binding proteins, with enhanced affinity to several resistant pathogens including MRSA and strains that vancomycin and daptomycin are ineffective against. However, unlike many other new agents discussed in this lesson, ceftaroline is active against common gram-negative and some anaerobic bacteria. For complicated SSTI, the dose is 600 mg IV every 12 hours. Renal dosage adjustments are required for CrCl <50 mL/min. It is the only ß-lactam with activity against MRSA. Telavancin (Vibativ®) is an intravenous lipoglycopeptide that inhibits cell wall synthesis leading to cell membrane depolarization. This powerful agent is bactericidal against gram-positive pathogens including MRSA, as well as vancomycin-intermediate and vancomycin-resistant S. aureus (VISA, VRSA). It is FDA-approved for complicated SSTI in adults dosed at 10 mg/kg IV every 24 hours. It is classified as pregnancy Category C, as adverse developmental outcomes were observed in animal data. Telavancin may prolong the QT interval and should be avoided in patients with a history of QT prolongation or certain cardiac conditions. Caution should also be exercised in patients with renal impairment or in those receiving other nephrotoxic medications. In two clinical trials, nephrotoxicity was more commonly seen in patients treated with telavancin than among those treated with vancomycin. Although renal dysfunction seems reversible upon cessation of therapy, the manufacturer’s label recommends monitoring renal
25
nity, and should be geared toward cleaning high-touch surfaces (i.e., surfaces that come into frequent contact with bare skin such as counters, doorknobs, bath tubs, and toilet seats). Decolonization with mupirocin nasal and/or chlorhexidine topical antiseptic solution may be an option in patients who develop recurrent SSTI despite optimizing wound care and hygiene measures. While oral antimicrobial therapy for decolonization is not routinely recommended, it may be considered if infections recur regardless of measures. However, there are no published data to support the efficacy of decolonization in patients with recurrent MRSA SSTI. The optimal regimen, frequency of application, and duration of therapy are unclear.
Antimicrobials for the Treatment of CA-MRSA in SSTI
Trimethoprim-sulfamethoxazole (TMP-SMX), widely known by the trade names Bactrim™ or Septra®, is prescribed as one to two double-strength tablets orally twice daily for the treatment of MRSA in adults. This agent is not FDA-approved for the treatment of any staphylococcal infection; however, 95 to 100 percent of CAMRSA strains are susceptible to it in vitro and it is an important option for outpatient management of SSTI. TMP-SMX is classified as pregnancy Category C/D, and is not recommended for women in the third trimester of pregnancy (or for children <2 months of age). Caution should be exercised when using this agent in the elderly, especially in those receiving concurrent inhibitors of the renin-angiotensin system and in those with chronic renal insufficiency because of an increased risk of hyperkalemia. Oral tetracycline antibiotics that may be used for MRSA include doxycycline and minocycline. The adult dose for doxycycline is 100 mg orally twice daily. It is FDAapproved for the treatment of SSTI due to S. aureus, but not specifi-
24
cally for those caused by MRSA. For minocycline, a 200 mg oral loading dose is recommended, followed by 100 mg twice daily. These agents have in vitro activity and appear to be effective for this indication, but data are limited and lacking to support use in more invasive infections. Tigecycline (Tygacil®), a derivative of tetracycline, is an FDA-approved intravenous agent for the treatment of complicated SSTIs in adults. However, FDA recently issued a warning to consider alternative agents in patients with serious infections because of an increase in all-cause mortality. Tetracyclines are classified as pregnancy Category D, and are not recommended for children less than eight years of age because of the potential for tooth enamel discoloration and decreased bone growth. Clindamycin, also an acceptable empiric treatment of purulent cellulitis, should be prescribed as 300 to 450 mg orally three times a day. Although not specifically FDA-approved for the treatment of MRSA infection, it has become widely used for the treatment of SSTI. The D zone test is recommended for detection of inducible clindamycin resistance in erythromycin-resistant, clindamycinsusceptible isolates, and is readily available. While Clostridium difficile-associated disease may occur with virtually any antibiotic, it may occur more frequently following clindamycin treatment when compared with other oral agents. Linezolid (Zyvox®) is a grampositive agent that is bacteriostatic against enterococci and staphylococci, and bactericidal against most strains of streptococci. It is of the oxazolidinone class, and exhibits its antimicrobial effect via inhibition of bacterial protein synthesis. Linezolid is active against problematic organisms such as MRSA, penicillin-resistant Streptococcus pneumoniae, and vancomycinresistant enterococci (VRE). Resistance surveillance data indicates that more than 99 percent of S. aureus strains are susceptible to
linezolid. It is FDA-approved for the treatment of complicated SSTIs and nosocomial pneumonia. The dosage is 600 mg orally or IV every 12 hours in children >12 years and adults. Linezolid does not require dosage adjustments in patients with either renal or hepatic impairment. It is rather expensive compared to other oral agents available for CA-MRSA. Adverse effects were observed in some animal studies and there are no adequate, well-controlled studies in pregnant women. Therefore, this agent is classified as pregnancy Category C. Excretion in breastmilk is unknown, thus caution is advised. Linezolid is contraindicated with concurrent use or within two weeks of MAO inhibitors; and in patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, and/or those taking sympathomimetics, vasopressive agents, and dopaminergic agents unless closely monitored for increased blood pressure. Additionally, linezolid should not be administered to patients taking SSRIs, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine or buspirone, unless closely monitored for signs or symptoms of serotonin syndrome. Tyramine, an amino acid that helps regulate blood pressure, is naturally occurring in the body and is found in certain foods. Ingestion of foods rich in tyramine such as aged cheeses, cured meats, fermented cabbage, soy sauce, or broad bean pods, such as fava beans, should be avoided as this can cause sudden and severe high blood pressure. Food that has been improperly stored or spoiled can create an environment where tyramine concentrations may increase. Thrombocytopenia has been reported with linezolid use and may limit its use in patients with pre-existing myelosuppression. Weekly CBC (complete blood count) monitoring is recommended, and the agent should be discontinued in circumstances where myelosuppression occurs or worsens. It has
The Georgia Pharmacy Journal
also been associated with neuropathy and lactic acidosis. Other common adverse events include headache, diarrhea, insomnia, dizziness, rash, nausea, and vomiting. Vancomycin is a glycopeptide that inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization. While its use in ABSSSI does have some limitations, it is the most common choice for parenteral treatment of CAMRSA with nearly 50 years of clinical use. Vancomycin is available in multiple generic formulations, reasonably well tolerated, associated with a low incidence of adverse effects, and is relatively inexpensive. Unfortunately, the susceptibility of MRSA to this antibiotic may be decreasing with increasing reports of clinical failure. The vancomycin breakpoints for susceptible, intermediate, and resistant minimum inhibitory concentrations (MIC) have been reduced in laboratory standards to reflect the changes that have been seen in MRSA vancomycin susceptibility. Studies have indicated that vancomycin tissue penetration is variable. In 2009, the American Society of Health-System Pharmacists (ASHP), IDSA, and the Society of Infectious Diseases Pharmacists jointly issued a consensus statement on the therapeutic monitoring of vancomycin in adults. The panel agreed that antibiotics other than vancomyin should be considered when vancomycin MIC values are >2 mg/L because it is unlikely that effective serum concentrations will be achieved when keeping within therapeutic trough levels. The IDSA MRSA treatment guidelines note that, for most patients with SSTI who have normal renal function and are not obese, 1 gm IV every 12 hours is sufficient. It is recommended that trough serum vancomycin levels always be maintained above 10 mg/L to avoid development of resistance. Additionally, the panel recommends dosing vancomycin at 15 to 20 mg/kg/dose (based on actual body weight and not to exceed 2 gm/ dose) every eight to 12 hours for se-
The Georgia Pharmacy Journal
riously ill patients with MRSA infections and normal renal function. A loading dose of 25 to 30 mg/kg should also be considered in such instances. For these large doses, prolonging the infusion time to two hours, and using an antihistamine may reduce the risk of red man syndrome and possible anaphylaxis. For severe infections, higher trough concentrations of 15 to 20 mg/L are recommended to optimize pharmacodynamics, improve tissue penetration, and prevent resistance development. Serum trough concentrations should be obtained just prior to the fourth dose; monitoring of peak concentrations is not recommended. Vancomycin has long been considered a nephrotoxic and ototoxic agent. Yet, according to the consensus statement, there are limited data suggesting a direct causal relationship between toxicity and specific serum vancomycin concentrations. In summary, trough monitoring is best suited for patients receiving aggressive dosing, those receiving concurrent nephrotoxins, patients with unstable renal function, or those receiving prolonged courses of therapy. There are limited data to support the safety of sustained trough serum vancomycin concentrations of 15 to 20 mg/L. Daptomycin (Cubicin®) is a lipopeptide class antibiotic that disrupts cell membrane function via calcium-dependent binding, resulting in bactericidal activity in a concentration dependent manner. It is FDA-approved for adults with SSTI due to S. aureus among other indications. The dose is 4 mg/kg of total body weight once daily IV for seven to 14 days. The frequency of administration should be reduced to every 48 hours in patients with CrCl <30mL/min. Elevations in creatine phosphokinase (CPK), which are rarely treatment-limiting, have occurred in patients receiving higher doses such as 6 mg/kg for other indications. Patients should be monitored, however, for signs and symptoms of infection with suggested CPK weekly monitoring during therapy. The label recom-
mends more frequent monitoring with current or previous statin therapy, unexplained CPK increases, or renal impairment. Daptomycin may also cause false prolongation of the PT and increase of INR with certain reagents. This agent is classified as pregnancy Category B. Ceftaroline (Teflaro®), the active form of ceftaroline fosamil, is a broad spectrum cephalosporin with potent activity against MRSA. It exerts bactericidal activity by binding to key penicillin binding proteins, with enhanced affinity to several resistant pathogens including MRSA and strains that vancomycin and daptomycin are ineffective against. However, unlike many other new agents discussed in this lesson, ceftaroline is active against common gram-negative and some anaerobic bacteria. For complicated SSTI, the dose is 600 mg IV every 12 hours. Renal dosage adjustments are required for CrCl <50 mL/min. It is the only ß-lactam with activity against MRSA. Telavancin (Vibativ®) is an intravenous lipoglycopeptide that inhibits cell wall synthesis leading to cell membrane depolarization. This powerful agent is bactericidal against gram-positive pathogens including MRSA, as well as vancomycin-intermediate and vancomycin-resistant S. aureus (VISA, VRSA). It is FDA-approved for complicated SSTI in adults dosed at 10 mg/kg IV every 24 hours. It is classified as pregnancy Category C, as adverse developmental outcomes were observed in animal data. Telavancin may prolong the QT interval and should be avoided in patients with a history of QT prolongation or certain cardiac conditions. Caution should also be exercised in patients with renal impairment or in those receiving other nephrotoxic medications. In two clinical trials, nephrotoxicity was more commonly seen in patients treated with telavancin than among those treated with vancomycin. Although renal dysfunction seems reversible upon cessation of therapy, the manufacturer’s label recommends monitoring renal
25
continuing education quiz
function during therapy and after discontinuation. The label also provides recommendations for dosage adjustments in patients with CrCl <50mL/min. Monitoring of serum levels is not available. In December 2013, Cubist Pharmaceuticals announced that FDA had accepted the company’s New Drug Application for its investigational antibiotic, tedizolid phosphate (PO and IV) with priority review. Cubist is seeking FDA approval of tedizolid for the treatment of ABSSSI. If approved, tedizolid will be the second oral FDA-approved antibiotic for the treatment of complicated SSTI caused by MRSA and an alternative to linezolid.
2. Which of the following diseases presents as multiple localized non-bullous or bullous lesions? a. Abscess c. Erysipelas b. Cellulitis d. Impetigo
1. 2. 3. 4. 5.
[a] [a] [a] [a] [a]
[b] [b] [b] [b] [b]
[c] [c] [c] [c] [c]
6. [a] [d] 7. [a] [d] 8. [a] [d] 9. [a] [d] 10. [a]
[b] [b] [c] [d] [b] [c] [d] [b] [b]
11. [a] 12. [a] 13. [a] 14. [a] 15. [a]
[b] [b] [b] [b] [b]
[c] [c] [c] [c] [c]
[d] [d] [d] [d]
I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association. 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.
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.
Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990
9. Which MRSA strain is more virulent and may carry genes that involve toxins associated with tissue necrosis? a. CA-MRSA b. HA-MRSA
Completely fill in the lettered box corresponding to your answer.
Release date: 3-15-14 Expiration date: 3-15-17
(MMDD)
4. An impetigo treatment option for penicillin-allergic patients is: a. cephalexin. c. dicloxacillin. b. clindamycin. d. fluoroquinolones.
7. Cellulitis differs from erysipelas in that cellulitis: a. is almost always due to streptococci. b. involves the superficial layers of the dermis. c. is more common in infants and young children. d. extends into the deeper dermis and subcutaneous tissue.
Program 0129-0000-14-003-H01-P
NABP e-Profile ID____________Birthdate_________
3. Since the 1990s, which pathogen has emerged as most commonly involved in impetigo? a. S. pyogenes c. CA-MRSA b. S. aureus d. Group A Streptococcus
6. Abscesses are primarily treated with antibiotics. a. True b. False
This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.
Email_______________________________________________
8. According to the 2011 IDSA guidelines, which of the following antimicrobials is considered a suitable agent for empiric outpatient treatment of purulent cellulitis? a. Dicloxacillin c. TMP/SMX b. Cephalexin d. Ciprofloxacin
5. Which of the following skin and skin structure infections (SSTIs) is described as a collection of pus within the dermis or subcutaneous tissue? a. Abscess c. Erysipelas b. Cellulitis d. Impetigo
The author, the Ohio Pharmacists Foundation and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the information contained herein. Bibliography for additional reading and inquiry is available upon request.
Name________________________________________________
City, State, Zip______________________________________
1. Acute bacterial skin and skin structure infections are typically caused by: a. gram-positive pathogens. c. anaerobes. b. gram-negative pathogens.
Skin and soft tissue infections are common across all ages. While generally caused by S. aureus and ß-hemolytic streptococci, it is important to note the increasing prevalence of MRSA. Treatment options are expanding. For the most up to date information, refer to the IDSA guidelines.
Program 0129-0000-14-003-H01-P 0.15 CEU
Address_____________________________________________
Acute Bacterial Skin and Skin Structure Infections: Review and Update
Conclusion
Please print.
10. Published data support the efficacy of decolonization in patients with recurrent MRSA SSTI. a. True b. False 11. Trimethoprim-sulfamethoxazole should be used with caution in the elderly because of an increased risk of: a. hypertension. c. hypokalemia. b. hypotension. d. hyperkalemia. 12. Compared to other agents used to treat CA-MRSA, Clostridium difficile-associated disease may occur more frequently following treatment with: a. daptomycin. c. clindamycin. b. linezolid. d. doxycycline. 13. Which of the following agents is FDA-approved for treatment of complicated SSTIs and nosocomial pneumonia? a. TMP-SMX c. Linezolid b. Clindamycin 14. The susceptibility of MRSA to which of the following antibiotics may be decreasing with increasing reports of clinical failure? a. Vancomycin c. Daptomycin b. Linezolid d. Ceftaroline 15. Which of the following agents is active against common gram-negative and some anaerobic bacteria? a. Telavancin c. Daptomycin b. Vancomycin d. Ceftaroline
To receive CE credit, your quiz must be received no later than March 15, 2017. 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.
march 2014
26
The Georgia Pharmacy Journal
The Georgia Pharmacy Journal
27
continuing education quiz
function during therapy and after discontinuation. The label also provides recommendations for dosage adjustments in patients with CrCl <50mL/min. Monitoring of serum levels is not available. In December 2013, Cubist Pharmaceuticals announced that FDA had accepted the company’s New Drug Application for its investigational antibiotic, tedizolid phosphate (PO and IV) with priority review. Cubist is seeking FDA approval of tedizolid for the treatment of ABSSSI. If approved, tedizolid will be the second oral FDA-approved antibiotic for the treatment of complicated SSTI caused by MRSA and an alternative to linezolid.
2. Which of the following diseases presents as multiple localized non-bullous or bullous lesions? a. Abscess c. Erysipelas b. Cellulitis d. Impetigo
1. 2. 3. 4. 5.
[a] [a] [a] [a] [a]
[b] [b] [b] [b] [b]
[c] [c] [c] [c] [c]
6. [a] [d] 7. [a] [d] 8. [a] [d] 9. [a] [d] 10. [a]
[b] [b] [c] [d] [b] [c] [d] [b] [b]
11. [a] 12. [a] 13. [a] 14. [a] 15. [a]
[b] [b] [b] [b] [b]
[c] [c] [c] [c] [c]
[d] [d] [d] [d]
I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association. 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.
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.
Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990
9. Which MRSA strain is more virulent and may carry genes that involve toxins associated with tissue necrosis? a. CA-MRSA b. HA-MRSA
Completely fill in the lettered box corresponding to your answer.
Release date: 3-15-14 Expiration date: 3-15-17
(MMDD)
4. An impetigo treatment option for penicillin-allergic patients is: a. cephalexin. c. dicloxacillin. b. clindamycin. d. fluoroquinolones.
7. Cellulitis differs from erysipelas in that cellulitis: a. is almost always due to streptococci. b. involves the superficial layers of the dermis. c. is more common in infants and young children. d. extends into the deeper dermis and subcutaneous tissue.
Program 0129-0000-14-003-H01-P
NABP e-Profile ID____________Birthdate_________
3. Since the 1990s, which pathogen has emerged as most commonly involved in impetigo? a. S. pyogenes c. CA-MRSA b. S. aureus d. Group A Streptococcus
6. Abscesses are primarily treated with antibiotics. a. True b. False
This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.
Email_______________________________________________
8. According to the 2011 IDSA guidelines, which of the following antimicrobials is considered a suitable agent for empiric outpatient treatment of purulent cellulitis? a. Dicloxacillin c. TMP/SMX b. Cephalexin d. Ciprofloxacin
5. Which of the following skin and skin structure infections (SSTIs) is described as a collection of pus within the dermis or subcutaneous tissue? a. Abscess c. Erysipelas b. Cellulitis d. Impetigo
The author, the Ohio Pharmacists Foundation and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the information contained herein. Bibliography for additional reading and inquiry is available upon request.
Name________________________________________________
City, State, Zip______________________________________
1. Acute bacterial skin and skin structure infections are typically caused by: a. gram-positive pathogens. c. anaerobes. b. gram-negative pathogens.
Skin and soft tissue infections are common across all ages. While generally caused by S. aureus and ß-hemolytic streptococci, it is important to note the increasing prevalence of MRSA. Treatment options are expanding. For the most up to date information, refer to the IDSA guidelines.
Program 0129-0000-14-003-H01-P 0.15 CEU
Address_____________________________________________
Acute Bacterial Skin and Skin Structure Infections: Review and Update
Conclusion
Please print.
10. Published data support the efficacy of decolonization in patients with recurrent MRSA SSTI. a. True b. False 11. Trimethoprim-sulfamethoxazole should be used with caution in the elderly because of an increased risk of: a. hypertension. c. hypokalemia. b. hypotension. d. hyperkalemia. 12. Compared to other agents used to treat CA-MRSA, Clostridium difficile-associated disease may occur more frequently following treatment with: a. daptomycin. c. clindamycin. b. linezolid. d. doxycycline. 13. Which of the following agents is FDA-approved for treatment of complicated SSTIs and nosocomial pneumonia? a. TMP-SMX c. Linezolid b. Clindamycin 14. The susceptibility of MRSA to which of the following antibiotics may be decreasing with increasing reports of clinical failure? a. Vancomycin c. Daptomycin b. Linezolid d. Ceftaroline 15. Which of the following agents is active against common gram-negative and some anaerobic bacteria? a. Telavancin c. Daptomycin b. Vancomycin d. Ceftaroline
To receive CE credit, your quiz must be received no later than March 15, 2017. 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.
march 2014
26
The Georgia Pharmacy Journal
The Georgia Pharmacy Journal
27
GET THE APP! THE GEORGIA PHARMACY ASSOCIATION
2013-2014
Board of Directors The GPhA Mobile App.
Name
Position
Robert M. Hatton
Chair of the Board
Pamala S. Marquess
President
Robert B. Moody President-Elect Thomas H. Whitworth
First Vice President
Lance P. Boles
Second Vice President
Liza Chapman
State At Large
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State At Large
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State At Large
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State At Large
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State At Large
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State At Large
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State At Large
Krista Stone
1st Region President
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2nd Region President
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Nicholas O. Bland
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Ted Hunt
ACP Chair
Sharon B. Zerillo
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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
Contact Association Staff. Share this App with a friend. Association and Industry News. Check out Association events and register.
Connect with the GPhA on facebook. Learn about GPhA services. Connect with friends and associates. Important Advocacy links.
We’re going mobile, leveraging mobile technology to meet member’s communication, education, advocacy, and engagement needs. Available anywhere and anytime you need it.
Search gpha using the App Store or Google Play. Download and You’ve Got the App!
IT’S FREE!
Android
Apple
Tyler Bryant
Thanks ... ...to the many members who support the Georgia Pharmacy Association’s Academy of Independent Pharmacy. We pledge to continue to defend and protect the profession to the best of our ability and we pledge to continue to fight for the economic viability of Independent Pharmacy. AIP Mission Statement: To advance the concept of pharmacy care. To ensure the economic viability and security of Independent Pharmacy; To provide a forum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; To address the unique business and professional issues of independent pharmacies; To develop and implement marketing opportunities for members of the Academy with emphasis on the third party prescription drug program/benefit market; To provide educational programs designed to enhance the managerial skills of Independent Pharmacy Owners and Managers; and, To establish and implement programs and services designed to assist Independent Pharmacy Owners and Managers.
ASP, Mercer University
Tiffany Galloway
ASP, South University
Jessica Kupstas
ASP, UGA
Jim Bracewell
Executive Vice President
The Georgia Pharmacy Journal
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
GET THE APP! THE GEORGIA PHARMACY ASSOCIATION
2013-2014
Board of Directors The GPhA Mobile App.
Name
Position
Robert M. Hatton
Chair of the Board
Pamala S. Marquess
President
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
Renew your membership - join the Association.
Tyler Mayotte
7th Region President
Michael Lewis
8th Region President
Receive Association reminders and updates.
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
Contact Association Staff. Share this App with a friend. Association and Industry News. Check out Association events and register.
Connect with the GPhA on facebook. Learn about GPhA services. Connect with friends and associates. Important Advocacy links.
We’re going mobile, leveraging mobile technology to meet member’s communication, education, advocacy, and engagement needs. Available anywhere and anytime you need it.
Search gpha using the App Store or Google Play. Download and You’ve Got the App!
IT’S FREE!
Android
Apple
Tyler Bryant
Thanks ... ...to the many members who support the Georgia Pharmacy Association’s Academy of Independent Pharmacy. We pledge to continue to defend and protect the profession to the best of our ability and we pledge to continue to fight for the economic viability of Independent Pharmacy. AIP Mission Statement: To advance the concept of pharmacy care. To ensure the economic viability and security of Independent Pharmacy; To provide a forum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; To address the unique business and professional issues of independent pharmacies; To develop and implement marketing opportunities for members of the Academy with emphasis on the third party prescription drug program/benefit market; To provide educational programs designed to enhance the managerial skills of Independent Pharmacy Owners and Managers; and, To establish and implement programs and services designed to assist Independent Pharmacy Owners and Managers.
ASP, Mercer University
Tiffany Galloway
ASP, South University
Jessica Kupstas
ASP, UGA
Jim Bracewell
Executive Vice President
The Georgia Pharmacy Journal
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 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, F L
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.
Go to www.gpha.org and click on the Convention Banner or scan the code below.
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 Platinum Sponsor
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