The Official Publication of the Georgia Pharmacy Association
January 2009
Congratulations Representative Harden! V olume 31, Numbe r 1
www.gpha.org
NEW PLANS – BETTER RATES – MORE BENEFITS in 2009
Look what’s NEW in 2009...
Reduced Rates Prescription Drug Coverage Dental and Orthodontic Benefits Guaranteed Issue Tterm Life Insurance... up to $150,000 with no underwriting requirements
Call or email TODAY to schedule a time to discuss your health insurance needs.
Trevor Miller – Director of Insurance Services 404.419.8107 or e-mail at tmiller@gpha.org
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January 2009
Departments
16-17 5th Pharmacist Legislator Elected Georgia State Rep. FEATURE
18 22
ARTICLES
Pharmacy Schools’ News
10 20 25 30
New Members PharmPAC Contribution Form Journal CE GPhA Board of Directors
2 2 7 8 20 24 31 32
The Insurance Trust Meadowbrook® Insurance Group PQC Pharmacists Mutual Companies Michael T. Tarrant Toliver & Gainer PACE Alliance The Insurance Trust
Advertisers
Save the Date
COLUMNS
4 6
President’s Message Editorial
For an up-to-date calendar of events, log onto
www.gpha.org.
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January 2009
PRESIDENTʼS
MESSAGE
Robert Bowles President
Looking Forward to a Bright Future It is important for each of you to know the Executive Committee’s agenda and the work that is being done within your Association. Your Executive Committee will be meeting on January 9, 2009. Also, in January, the GPhA standing committees will meet to finalize plans for the balance of this association year. A highly active convention planning committee is already hard at work. This committee is represented by pharmacists from a variety of practice settings. This year’s convention will be held in Ponte Vedra Beach, Florida, from June 20 through June 24 and promises to be packed full of continuing education opportunities for each of the practice settings. This will be the time when Eddie Madden will be installed as the 135th President of the Georgia Pharmacy Association. Start planning now to attend the 2009 convention so you can show your support for Eddie Madden and enjoy time with your fellow pharmacists and pharmacy technicians. The Georgia General Assembly will begin its legislative session on January 12, 2009. While there will be many budget concerns during the session, GPhA will be working diligently to achieve the passage of immunization legislation
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to erase any misunderstandings that may have occurred in relation to pharmacist immunization programs. We have been working with the Medical Association of Georgia on this legislation for the past six months. Sharon Sherrer has chaired the Immunization Task Force and has spent countless hours working toward resolution of this situation. Please take the opportunity to thank Sharon for her leadership in this process. Furthermore, GPhA will be introducing legislation relating to Pharmacy Benefit Mangers. This should provide the tool to mandate that Pharmacy Benefit Managers be registered with the State of Georgia. For too many years, the citizens of Georgia have had nowhere to register a complaint against a Pharmacy Benefit Manager. Finally, Georgia Drugs and Narcotics will be taking the lead on the Drug Monitoring Act legislation. GPhA will be following their lead in this process. This is an opportunity for us to be involved in making sure that Georgia is not an island in relation to the states surrounding it and that it is not a haven for people in surrounding states to come and seek out controlled substances. Our Director of Governmental Affairs, Stuart Griffin, and our contract lobbyist,
January 2009
Cindy Shepherd, are working countless hours on our behalf. Please take time to thank them for their outstanding leadership. At the appropriate time after the introduction of these pieces of legislation, you will be contacted and asked to contact your legislators. Remember, you are a constituent, and it is important for you to let your legislator know your concerns. This will be your opportunity to be involved in the grassroots of politics. Seize the moment for pharmacy! VIP, Very Involved Pharmacist Day at the Capitol will be on February 18. This is an opportunity for each of us to show the power of one voice in pharmacy at the State Capitol. Please make early plans to be present on this important day and wear your white lab coat.
April will be the time for Spring Region Meetings. Start now visiting the GPhA website at www.gpha.org. and plan to know all that is taking place in GPhA. Our Director of Public Affairs, Kelly McLendon, has brought new life to the website and updates it regularly with new information. Be sure and put May 12 on your calendar. This will be the date for our annual Eggs and Issues breakfast in Washington. We need a large delegation as we have the opportunity to meet with our United States Representatives and Senators. It is important for us to communicate our concerns to these elected officials. As I mentioned earlier, plan now to attend the GPhA Annual Convention in Ponte Vedra Beach, Florida, from June 20 through June 24.
CALENDAR OF EVENTS 2009 GPhA Leadership Conference Sheraton Buckhead Hotel, Atlanta
January 10-11, 2009
VIP (Very Involved Pharmacist) Day James H. Floyd Building, Atlanta
February 18, 2009
Southeastern “Girls of Pharmacy� Leadership Weekend Grove Park Inn, Asheville, NC
January 16-18, 2009
Region Meetings
April 21-30, 2009
Eggs and Issues Breakfast Washington D.C.
May 12, 2009
GPhA Convention Jun 20-24, 2009 Sawgrass Golf Resort & Spa, A Marriott Resort, Ponte Vedra Beach, FL
For more information and registration visit www.gpha.org.
Best wishes to each of you as you progress through 2009. The Georgia Pharmacy Journal
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January 2009
EXECUTIVE
VICE
PRESIDENTʼS
EDITORIAL
Jim Bracewell Executive Vice President / CEO
Patient Safety and Protection of Reports of Quality Related Events
GPhA has been at the forefront of promoting the use of quality assurance programs in community pharmacies. It is mandate in contracts covering the dispensing of Medicare Part D prescriptions that every pharmacy owner has signed. DO NOT WAIT FOR AN AUDIT TO PENALIZE YOU FOR NOT ABIDNG BY YOUR CONTRACT AGREEMENT TO DISPENSE PART D PRESCRIPTIONS USING A QUALITY ASSURANCE PROGRAM From day one, former EVP Buddy Harden took the lead in Georgia, encouraging community pharmacies to become compliant with their contracts. Most in Georgia pharmacies are The Georgia Pharmacy Journal
compliant. Others are not compliant or have let the program lapse. January is a great time to get your house in order. Even better the press release above tells how the Pharmacy Quality Commitment program endorsed by GPhA and AIP provides a level of Federal protection for the information collected in your program. If you are not current or do not have a quality assurance program call Sid Anderson at 404.419.8115 and he or his staff will help you become safe and compliant. Don’t dispense prescriptions without being contractually complaint. It will cost you dearly at audit time.
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January 2009
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January 2009
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January 2009
AIP Spring Meeting April 25-26, 2009
Sea Palms Resort, St. Simons Island, GA Come relax in the lush oasis that is Sea Palms Resort. Take a walk under ancient live oaks, where the ocean air mixes with a soft marsh breeze. Bike on the beach, play golf, tennis or just relax on your balcony overlooking the island's natural beauty. Sea Palms Resort offers the perfect setting for our AIP Spring Meeting. Our spring meeting will offer continuing education, time to meet with our vendors, an AIP Business Session to discuss issues impacting independent pharmacy, time to network with other AIP Pharmacies and catch up with old friends. Plan on attending and bring your family for a weekend to be remembered.
AIP has negotiated a special room rate of $139 (Deluxe) and special pricing on other accommodations (accommodation choices include hotel-style deluxe guest rooms, executive studios with kitchenette and fully furnished one to three bedroom suites with scenic sun deck or screened porch). To guarantee that you receive this special rate and to ensure you get a room please make your reservation as soon as possible. Sea Palms has more amenities than any other property on St. Simons Island and is just minutes from the beach. With twenty seven holes of golf, three swimming pools, three rubico clay tennis courts, a fitness center and sauna, sandpit volleyball court, bike rentals and horseshoes, the recreational opportunities are boundless. We are very excited about this year’s AIP Spring Meeting. We will give you more details as the time nears. Make your plans now to attend.
Please call 1.800.841.6268 for reservations (Ask for the AIP room block)
Georgia Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is eligible for ACPE; see final CPE activity announcement for specific details.
• CE opportunities • AIP Business Meeting • Social and Cocktails with our Partners Registration: (For Planning Purposes Please Fill Out and Return)
Memberʼs Name: __________________________Nickname (for badge): __________________________
GA R.Ph. License No:___________ Pharmacy Name: _________________________________________
Address: _____________________________________________________________________________
Phone:(____)____________ Fax:(____)_____________ E-mail Address: __________________________
Please circle the following: Academy Member? Yes No GPhA™ Member? Yes No
**If Spouse/Guest is attending please print his/her name: ______________________________________ Nickname (for badge): ___________________ Is the above guest a member of GPhA? Yes____ No ____
Please Fax Registration to 404.237.8435
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January 2009
Welcome to GPhA!
The following is a list of new members who have joined Georgia始s premier professional pharmacy association!
Houda Aboujamous, Marietta Oluwayemisi Adeyefa, Hampton Olukemi Alabi, Atlanta Michelle Allen, Atlanta Kimberly Anderson, McDonough Sopheap Arslan, Atlanta Jill Augustine, Atlanta Amanda Bates, Tucker Sara J. Becker, Atlanta Jill Bee, Atlanta Allison Bell, Atlanta Ashley Berry, Atlanta Lauren Bess, Flowery Branch Meredith Blalock, Woodstock Kristen Blankenbecler, Chattanooga, TN Erin Blodgett, Atlanta Ebony Blue, Atlanta Robert Boswell, Roswell Brittani Boykin, Manchester Ashlyn Bozeman, Norcross Thomas M Brown, O.P., Fayetteville Will Bryan, Atlanta Erika Bunn, Atlanta Zachary Bush, Atlanta Lauerne Cameron, College Park Emily Carey, Atlanta Kevin Carpenter, Atlanta Melody Castro, Marietta Tanea Chane, Atlanta David Clark, Jacksonville, FL Ryan Clements, St. Marys Anna Cohen, Atlanta Lola Cole, Doraville Christopher Conetta, Johns Creek Steven Core, Marietta Nicholas Cummings, Temple William E. Curl, N. Augusta, SC Jennifer Dejames, Dallas Diana Diaz, Roswell Ann Dinh, Atlanta Danielle Doolittle, Duluth Jackson Dove, Nashville Sara Dunn, Douglasville Carmen Echols, Atlanta Uga Eneyo, Tucker Carolyn Eze, Hiram
Mary A. Faulk, Pharm.D., Macon Rebecca Feng, Atlanta Loam Fessehave, Doraville Carissa Fisher, Alpharetta Adrienne Fitzpatrick, Lithonia Brian Franchio, Sebing, FL Robin Leigh Funderburk, B.S. Brooke Gabel, Atlanta Kevin Garrett, Atlanta Tiffany Gibson, Norcross Ria Gober, Atlanta William A. Griffith, Austell Ruth Haile-Meskale, Atlanta Katherine Hall, Atlanta Areum Han, Atlanta Risa Hiroshima, Atlanta Aimee Hjerpe, Atlanta Sarah Hosey, Sandy Springs Robert Huff, Albany, KY Thanh Huynh, Atlanta Anne Marie Jones, Dunwoody Jonathan Kaup, Fort Recovery, OH Jordan Khail, Atlanta Ashley Khan, Marietta Kent Kicklighter, Atlanta Cimeon Koebel, Atlanta Soranarom Kumsaitong, Alpharetta Sohyun Kwon, Atlanta Moon Lee, Norcross Ni Liming, Atlanta Layne Littlejohn, Americus Joy Locklear, Atlanta Juan Lopez, Atlanta Megan Lord, Covington Mandana Manoucherhri, Decatur Amanda Martinez, Locust Grove Joseph McCoy, Norcross Paul Micheletto, Marietta Roderick Miller, Jonesboro Akanmu Moses, Chamblee Laura Mucci, Southington, CT Ina Muller, Appling Robert Myrick, Atlanta Jason Nash, Smyrna Brian Nelson, Atlanta Michael Nguyen, Tampa, FL
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Stephen Osakue, McDonough Deepa Patel, Lawrenceville Khilna Patel, Stockbridge Neelam Patel, Laurel, MS Sweta Patel, Lithia Springs Lisa Payton, Loganville Tora Peters, Morven Clara Pham, Macon My Quang Pham, Lawrenceville Dorian Pilcher, Douglasville Megan Potts, Atlanta Carmelo Pratico, Tucker Stephenie Powell Ragan, Pharm.D. Lauren Ragsdale, Atlanta Gina G Ravell, Pharm.D., Bixhop Charles Reid, Atlanta James Terrance Reilley, B.S., Atlanta Jason Rich, R.Ph., Canton Asma Rifay, Atlanta Melanie Ringham, Atlanta Jessica Rowe, Norcross Tasha-Gaye Samuels, Atlanta Ben Selph, Atlanta April Sheppard, Atlanta Whitney Simmons, Marietta Tarek Sinno, Atlanta Terry Son, Atlanta Meagan Spencer, Dunwoody Erin Spivey, Powder Springs Suzanne Stepp, Morganton Jonathan Styles, Newport, TN Alana Takeuchi, Atlanta Jeremiah Taylor, Jonesborough, TN Kathy Temple, Stockbridge Bo Thomas, Temple Vinh Tran, Atlanta Anna Vargo, Atlanta Alison Warren, Atlanta Robert Witcher, Atlanta Amanda Wollitz, Atlanta Jean Won, Atlanta Jonathan Wood, Atlanta Erin Woodard, Atlanta Thomas Fredrick Yeargin, B.S., Canton
January 2009
UP
COMING
EVENT
16th YEA
Do you know a future
leader?
R
NOMINATION FORM FOR THE 2009 GPhA NEW PRACTITIONER LEADERSHIP CONFERENCE
April 17-19, 2009
Sea Palms Golf & Tennis Resort, St. Simons Island, GA
The 2008 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of 20 practitioners will be chosen to attend the Conference.
Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by GPhAĘźs Executive Committee based on the following criteria:
(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations; (3) Community activities; (4) Clarity and vision in response to application questions.
I would like to nominate the following individual to attend the 2009 New Practitioner Leadership Conference:
Name: ___________________________________________________________ Designation: ________________
(R.Ph., Pharm.D., etc.)
Works for: ____________________________________________________________________________________
Address: _____________________________________________________________________________________
[ ] Home or [ ] Work _____________________________________________________________________________
________________________________________________ State: ______ ZIP: _____________
Telephone: (Work) (_____) __________________ (Home) (_____) _____________________
(Fax) (_____) ____________________ E-mail: __________________________________________
Nominaed by: _______________________________________________________ Designation: _______________
Address: _____________________________________________________________________________________ ____________________________________________________________State: _______ Zip: ________
Tel. (______) ____________________ E-mail: _______________________________________________________ Please return this Nomination Form to: GPhF, New Practitioner Leadership Nomination Attention: Regena Banks 50 Lenox Pointe, Atlanta, GA 30324 Or, you may FAX this Nomination Form to: 404.237.8435 If you have questions, please contact Regena Banks at GPhF: PLEASE RETURN BY Direct # 404.419.8121 • Email: rbanks@gpha.org JANUARY 30, 2009 Thank you in advance for your assistance.
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January 2009
GEORGIA PHARMACY FOUNDATION
2008-2009
ANNUAL GIVING CAMPAIGN The Georgia Pharmacy Foundation has begun its 7th Annual Giving Campaign for fiscal year ending August 2009. Thank you to everyone who has made a difference with their past gifts. Annual Giving resources have helped make it possible for the Foundation to: •
•
•
Provide financial aid through scholarships to deserving student pharmacists at the three schools of pharmacy in the state of Georgia.
Provide training for future pharmacy leaders through our New Practitioner Leadership Conference.
Provide continuing education, support for Pharmacy Technicians and explore other opportunities for the benefit of our members.
These gifts are vitally important to the continued success of the Foundation because they offer the flexibility to be used to support emerging opportunities and unmet needs when often no other source of funding is available.
If you have not yet made your tax-deductible* gift this year, please do so today. Your support, at any level, is important. It does have an impact! Gifts of any size will be acknowledged with a Charitable Donation receipt for tax purposes. Donations may be made payable to the Georgia Pharmacy Foundation. We also accept Visa, MasterCard, American Express and Discover.
More information about the Foundationʼs programs is available by calling Regena Banks direct at 404.419.8121. You are also invited to contact the Foundation to discuss how we may work together to ensure a sound future for the practice of Pharmacy in the state of Georgia.
Please complete the donation form on the opposite page and return it to the address shown on the bottom of this page. For your convenience you may also visit our website at www.gpha.org under the Foundation link to make your contribution online.
GIVING BACK IS THE BEST WAY TO KEEP OUR PROFESSION GOING FORWARD!
(*As provided by law)
GEORGIA PHARMACY FOUNDATION Attn: Regena Banks 50 Lenox Pointe, NE Atlanta, GA 30324 FAX: 404.237.8435
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January 2009
Yes! I want to help support the good work of the Georgia Pharmacy Foundation by contributing to the 2008-2009 Annual Giving Campaign with my contribution of : [ ] $5,000 or more = President始s Circle
[ ] $1,000 - $2,499 = Centurion
[ ] $250 - $499 = Silver Partner Name
(please print)
Company
[ ] $2,500 - $4,999 = Eagle
[ ] $500 - $999 = Gold Partner
[ ] $100 - $249 = Bronze Partner
[ ] $____ - $99 = Partner
_____________________________________________________________________
(if appropriate):
_________________________________________________________________
Address: ___________________________________________________________________________ City: ________________________________________________ State: ________ Zip: ____________
Telephone: (_____)___________________ Email: __________________________________________ Please specify if you would like to make your donation a gift. If so, please provide name and address of where you would like the In Memory/Honor gift card to be sent: (Please Print) [ ] In Memory of ____________________________________________________________________
[ ] In Honor of ______________________________________________________________________ Send notification to: __________________________________________________________________
Address: ___________________________________________________________________________ [ ] Please check here if you prefer to be listed as an Anonymous contributor in Foundation publications. [ ] Enclosed is my check payable to Georgia Pharmacy Foundation for $__________ OR [ ] Bill my credit card for $____________ AmEx Visa M/C Disc. Card #: _______________________ Security #: ________ Exp.Date: _________ Please provide name as appears on card and the billing address: Name _____________________________________________________________________________ Address: _____________________________________________ State: ________ Zip: ____________
Signature: ____________________________________________ Today始s Date: __________________ Please apply my contribution as indicated: [ ] Foundation to determine where funds are most needed [ ] Foundation Scholarships (Please, minimum of $50.00 for this selection. Thank you)
THANK YOU FOR YOUR CONTINUED SUPPORT OF THE GEORGIA PHARMACY FOUNDATION AND TO THE FUTURE OF THE PROFESSION OF PHARMACY.
Georgia Pharmacy Foundation
50 Lenox Pointe, NE Atlanta, GA 30324 404.231.5074 - Telephone 404.237.8435 - Fax The Georgia Pharmacy Journal
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January 2009
PHARMACY
NEWS
Economy Driving Women to Skimp on Health Care by Trevor Miller, Director of Insurance Services - tmiller@gpha.org
According to a recent Harris Interactive poll released by the National Women’s Health Resources Center, a division of the U.S. Department of Health and Human Services, women are cutting back on their health care due to a faltering economy and the rising costs associated with medical treatments. The poll also suggests that since women are usually the ones taking charge of the household health matters, all members of the family may be suffering. More than 40 percent of the 754 adult women polled said their health had declined in the past year, with most citing stress and weight gain as the cause. Also, 8 in 10 women felt they were prepared or very prepared in terms of their emotional health, but only 42 percent of the women polled felt they were prepared in terms of their financial security. It is important to remember that regular screenings are just as important in hard times as when the economy is thriving. Screenings are an investment in your health. A poor economy is no reason to ignore your health. Early detection of medical problems can save big dollars in the long run. With a visit to your doctor, early detection of elevated blood pressure may be discovered. Doing the little things -- adjusting your diet, cutting back on the intake of salt and getting more daily exercise -- can be healthier and less expensive
than waiting for your blood pressure to elevate to the point at which it can only be controlled with medication. There are many ways to save on health care and the costs associated with it. A good step is to eat less fast food and prepare more healthy meals for ourselves and our families. We can shop for sales in our local grocery stores. Look for the best deals on fruits, vegetables and whole grain foods that will help us prepare healthier meals in our own home. Even when a prescription is written, you always have the right to ask for the generic alternative to save costs too. And as always, EXERCISE MORE! Get up! Get Out! Walk! Stretch! Laugh! You’ll feel better, have more energy and you may even get a better night of sleep. The bottom-line message to women from the poll findings is: "Save in other ways. Don't cut back on your health care."
SOURCES: Elizabeth Battaglino Cahill, R.N., executive director, National Women's Health Resource Center, Red Bank, N.J.; Nieca Goldberg, M.D., director, Women's Heart Program, New York University Langone Medical Center, New York City; September-October 2008, Harris Interactive survey
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January 2009
PHARMACY
NEWS
Do you find yourself remembering a certain patient’s face, smile, laugh, or pain? Can a sentence or phrase bring to mind any of your previous pharmacist experiences? “May I take these medications together?” “The shipment is on back-order.” “Thank you- you saved the day!” “Code blue!” Your experiences have helped mold you into the pharmacist and person you are today. Because these stories are valuable, we invite you to submit your personal pharmacist story for a book being published by the American Pharmacists Association (APhA). We are seeking all types of pharmacy practice stories (humorous, sad, meaningful, amazing, etc) from all areas of pharmacy practice. Stories can be about patients, co-workers, inventory problems, direct patient care, compounding, supervisors, employees, other healthcare personnel, ethical dilemmas, you name it! All submissions will be considered. Any information in the story must be accurate and cannot contain unlawful, obscene, or libelous material; must not infringe any trade name, trademark, or copyright; and must not invade or violate any right of privacy, personal or The Georgia Pharmacy Journal
proprietary right, or other common law or statutory right. Submissions should be between 50 and 1000 words in length. Please include your name, email address, degrees, titles, and institutional affiliation with your submission. Upon request, your name and/ or institutional affiliation may be withheld. Take advantage of this opportunity to share your personal story! Please send your story and any questions to pharmaciststory@hotmail.com. Submission deadline is April 30, 2009. Many Thanks, J. Aubrey Waddell, PharmD, FAPhA, BCOP Associate Professor, University of Tennessee College of Pharmacy Oncology Pharmacist, Blount Memorial Hospital Maryville, TN Joanna Maudlin Pangilinan, PharmD, BCOP Pharmacist, University of Michigan, Comprehensive Cancer Center Ann Arbor, MI
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January 2009
PROFILE
IN
LEADERSHIP
Representative Oren H. “Buddy” Harden, Jr., R.Ph. by Kelly McLendon, Director of Public Affairs - kmclendon@gpha.org On November 4, 2008, Georgia elected its fifth pharmacistlegislator to the ranks of Georgia State Representative, Oren H. “Buddy” Harden, Jr., R.Ph. In the process, the people of Georgia elected a long-time civic and pharmacy leader who has made many contributions to his state through the year. “I have been interested in public service my entire professional career. While practicing pharmacy in Tifton, I was a founder and charter member of ‛CODE 50’, a community organization for drug abuse education, and for that I received the Jaycees Distinguished Service Award. I became very involved in public service in 1970 when I bought into a community pharmacy in Sylvester,” said Harden. Over the 25 years that Harden lived in Sylvester, he served as a Director on the Chamber of Commerce, President of the Kiwanis Club, Chairman of the Worth County Hospital Authority, Member of the Board of Education, and Member of the Downtown Development Authority. Then he was elected Mayor of Sylvester in 1983 and served until 1990. “During that time I was President of the Second District of the Georgia Municipal Association (GMA), and a member of the Board of Directors and the Revenue and Finance Committee of GMA,” said Harden.
The Georgia Pharmacy Journal
In 1997, Harden was hired to be the Executive Vice President and CEO of the Georgia Pharmacy Association. “I believe the ten years I spent as CEO of GPhA will prove to be the most valuable of my years in pharmacy in terms of being the most useful to me as a member of the Georgia House of Representatives. It was during my tenure at GPhA that I was exposed to the political process and had the opportunity to observe and work with outstanding pharmacist-legislators like Bobby Parham, R.Ph., Butch Parrish, R.Ph., Ralph Twiggs, R.Ph., Eddie Madden, R.Ph., Jim Martin, R.Ph., David Graves, R.Ph., Ron Stephens, R.Ph., and Buddy Carter, R.Ph. As an independent pharmacist, I have had first hand experience in the issues that concern the pharmacy profession and that too will be valuable to me in the House.” As for his service to pharmacy, in addition to his time at GPhA, he served on the Georgia Board of Pharmacy, the University Of Georgia College Of Pharmacy Alumni Advisory Council, the Georgia Statewide Healthcare Coordinating Council, and as a member of the Executive Committee of the National Alliance of State Pharmacy Associations. “When I retired from the GPhA and Linda and I settled in Cordele, I had no thoughts of running for public office, but when my good friend Johnny Floyd retired from the Georgia House of Representatives, I decided to run. I feel that I have had opportunities in life to gain some knowledge of the political system and having owned my own business also gained a working knowledge of business management. In addition, my
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January 2009
companies, care management organizations, pharmacy benefit managers and a host of others who don’t have a clue as to the needs of the patient.” GPhA will be working closely with Representative Harden and the other pharmacist-legislators when the legislature convenes in January.
years at GPhA presented me with opportunities to understand the healthcare needs of the people of Georgia and to manage a corporate structure.” “The name of the job is Representative. I have expressed to the people of my district that the one thing I want to accomplish is to be a good listener and to represent their wishes,” said Harden. “Insofar as the issues are concerned, my district, which includes all of Crisp County and parts of Dooly, Houston, Pulaski and Worth, has an economy whose economic base is 80% agricultural. Agricultural products will account for approximately $300,000,000 of sales this year. We have an abundance of natural resources and with the expansion in usage of biofuels, I believe we are positioned to expand our economy and create much needed job opportunities for our young people.” When asked about what issues he hopes to achieve on behalf of pharmacy during his time in the House of Representatives, Harden responded, “I would hope to be able to help in passage of legislation that would return control of a patient’s healthcare to the patient and the patient’s providers. I believe that the quality of healthcare can be improved while simultaneously reducing the cost. In working with the Georgia Pharmacy Foundation, the American Pharmacy Foundation, the Georgia Medical Care Foundation and the Centers for Medicare and Medicaid, I have seen the dramatic improvement in patient care and outcomes and the cost savings produced when healthcare providers are given the opportunity to care for a patient instead of insurance
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Oren H. Harden, Jr., R.Ph.
458 Lakeshore Way, Cordele, GA 31015 email: ohhjr@sowega.net Professional Experience: July 2006 – Present President Harden Pharmacy Consultants (HPC)
January 1997 – July 2006 Executive Vice President & CEO Georgia Pharmacy Association
1970 – 1996 President & CEO Deriso Drugs, Sylvester and Albany, GA
Independent Pharmacy Practice: Rainer’s Pharmacy - Tifton, GA, 1964-1968 Chain Pharmacy Practice: Jacobs Pharmacy, Tifton, GA, 1968-1970 Dunaway Drugs, Marietta, GA, 1962-1963 Liggett Rexall Drugs, Atlanta, GA , 1962 Hospital Pharmacy Practice: Worth County Hospital, Sylvester, GA 1970-1971 Womack Army Hospital, Ft. Bragg, NC 1963-1964
January 2009
GEORGIA
PHARMACY
SCHOOLSʼ
NEWS
Pharmacy Schools’ News Capomacchia Receives Faculty Mentor Award University of Georgia News:
Pharmaceutical and Biomedical Sciences as a Bridges to the Doctorate student.
The Institute is funded annually by Dr. Ted Greenwood of the Alfred P. Sloan Foundation and is organized by Dr. Ansley Abraham of the Southern Regional Education Board. Members of the Compact include the Southern Regional Education Board, Western Interstate Commission for Higher Education, Alfred P. Sloan Foundation, National Science Foundation Alliances for Graduate Education and the Professorate, National Institute of Health Bridges for the Professoriate NIGMS-MARC, and Ronald E. McNair Post-baccalaureate Achievement Program.
Dr. Ken Pepion, director of Bridges to the Professoriate Western Interstate Com¬mission for Higher Education, left; Bridg’ette Johnson Israel, College of Pharmacy gradu¬ate student; and Dr. Tony Capomacchia, associate professor of pharmaceutical and biomedical sciences.
Tony Capomacchia, Ph.D., associate professor at the University of Georgia College of Pharmacy, was one of four recipients of a 2008 Faculty Mentor of the Year award at the 15th annual Institute on Teaching and Mentoring.
The Institute, which was sponsored by the Compact for Faculty Diversity, had more than 1,000 participants, making it the largest gathering of minority Ph.D. scholars in the nation. The Compact for Faculty Diversity represents a partnership of regional, federal and foundation programs that focus on mentoring graduate education and faculty diversity.
Capomacchia has directed the College’s Sloan Foundation Minority Ph.D. program since 1999 and has coordinated UGA’s participation in the Bridges to the Doctorate program with North Carolina AT&T. He was nominated for the award by Brig’ette Johnson Israel, who began her graduate study with Capomacchia in 2004 in the College’s Department of
The Georgia Pharmacy Journal
Other UGA Items:
Brad Phillips, Pharm.D., Professor and Head of Clinical and Administrative Pharmacy, was appointed as Abstract Chair for the 2009 American College of Clinical Pharmacy/European Society of Clinical Pharmacy International Congress on Clinical Pharmacy. Phillips also presented “Why Residency Programs are Important to the Future of Pharmacy” to the Phoebe Putney Memorial Hospital Pharmacy Department in Albany. Sally Huston, Assistant Professor received a Junior Faculty Grant for $9,310 for “Personal Models of Diabetes among Youth” project.
Kalen Porter, Clinical Assistant Professor, Presented Pharmacy Grand Rounds at Medical College of Georgia in Augusta, entitled “To Dose or Not to Dose: Aminoglycosides Once Daily in CF Patients.” The office of continuing Education and Outreach held the final live CE program of the year at the UGA Conference Center in Tifton, Georgia on November 22, 2008. The South Georgia Pharmacy Finale included the following presentations by GPhA members: “Fibromyalgia Update,” by Melody Clay Sheffield and “HIV/AIDS and Cultural Issues,” by Deborah L. Strong.
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January 2009
GEORGIA
PHARMACY
Mercer University News: by Megan Spencer
SCHOOLSʼ
The Mercer University COPHS APhA-ASP Immunization Committee assisted with flu immunizations at the Medicine Shoppe Pharmacy in Dunwoody on Saturdays in October and November. Pharmacy students helped with the additional administrative paperwork this flu season has brought forth as well as administering flu shots. This project was approved with the school’s Pharmacy Practice department as a service learning opportunity as well which helped encourage retention on the project. We are fortunate to have 4 dedicated students who participated almost every Saturday since October 4. Additionally, we are fortunate to have such a great practice site so near to our campus that offers many immunizations including Zostavax, the flu shot, travel vaccines, and others and is happily willing to work
PHARMACIST
IN
THE
NEWS
NEWS
with and educate students. This practice site has worked through the challenges that pharmacies and pharmacists have faced this season with flu shots by calling doctors in advance for prescriptions, setting up appointments for shots, as well as handling walkin patients through the in-house collaborative practice agreement. All flu shots given by the pharmacist and the student pharmacist are in 100% accordance with all laws surrounding immunizations. The students made immunization services available to patients who might otherwise not have received a flu shot. Patients on Medicare who have not signed over their benefits to an HMO are able to receive flu shots at no charge. In addition to helping vaccinate patients, the students were also able to fully counsel patients to help them decide whether the flu shot or the inhaled spray was the best immunization method for that patient. This has truly been a rewarding and educational project for the students.
Statesboro artist and Stone family to present Georgia’s 12th District with White House Christmass tree ornament design Congressman John Barrow (GA-12) has chosen Statesboro resident and Master Photographer Lori Grice to create the Christmas ornament to represent the 12th District of Georgia on the 2008 official White House Christmas tree. The tree is decorated with 369 ornaments which were hand-decorated by artists from around the country. The ornaments were selected by their respective Members of Congress. Grice chose as one of her images a photo of Dean and Krista Stone and their family. The Stones are long standing members of GPhA, and Dean served as President of the GPhA in 2006-2007 The theme for this year's Christmas tree is "Red,
The Georgia Pharmacy Journal
White, and Blue." Grice's ornament perfectly captures this theme and features photographic images reflecting the spirit of Georgia. Among the images Grice included are Dr. Michael and Audrey Guido, representing the importance of faith; the Georgia Southern Bald Eagle, representing freedom; and several Georgia families, representing the power of love and commitment. The ornament is featured prominently on the front of the tree in the White House's Blue Room. Lori Grice is the founder of Lori Grice Fine Art and Photography. In 2004, she earned the prestigious Master of Photography degree from the Professional Photographers of America (PPA), and was only the ninth woman in Georgia to receive this honor. She lives in Statesboro with her husband, DeWayne, and daughter, Edie Grace.
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January 2009
Financial Planning for Georgia’s Pharmacists
ScriptPro S/P 200 – Central Server and 1 S/P Station
Michael T. Tarrant Independent Strategies and Customized Solutions for Building Wealth & Security
Installed July 2006 – currently not in use. Owner financing options available.
Financial Network Associates 1117 Perimeter Center West, Suite N-307 Atlanta, GA 30338 • 770.350.2455 mike@fnaplanners.com www.fnaplanners.com
E-mail inquiries: andyjask@dhsinc.us
Securities, certain advisory services and insurance products are offered through INVEST Fi nanci al Co rpo rati o n (INVEST), member FINRA/SIPC, a federally registered Investment Adviser, and affiliated insurance agencies. INVEST is not affiliated with Financial Network Associates, Inc. Other advisory services may be offered through Financial Network Associates, Inc., a registered investment adviser.
50 Lenox Pointe, NE Atlanta, GA 30324
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January 2009
Call for awards nominations... The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA 134th Annual Convention in 2009. A brief description and criteria of each award is included. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 9, 2009. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at GPhA’s 134th Annual Convention at the Marriott Sawgrass in Ponte Vedra Beach, FL. Bowl of Hygeia Award (sponsored by Wyeth-Ayerst)
Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has an outstanding record of service to the community which reflects will on the profession.
Distinguished Young Pharmacist Award (sponsored by Pharmacist Mutual)
Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of GPhAʼs most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate in association and community activities, and 2) To annually recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programs or activities and community service projects.
Call for nominations GPhA 134th Annual Convention 2009
Innovative Pharmacy Practice Award (sponsored by NASPA/GPhA)
This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.
2009 Awards 2009 Bowl of Hygeia
Distinguished Young Pharmacist
Innovative Pharmacy Practice Award
Nomineeʼs Full Name _______________________________________________ Nickname ___________________
Home Address _________________________________________ City _______________ State _____ Zip ______
Practice Site __________________________________________________________________________________
Work Address __________________________________________ City _______________ State _____ Zip ______
College/School of Pharmacy _____________________________________________________________________ List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities: _____________________________________________________________________________________________
_____________________________________________________________________________________________
Supporting information: _________________________________________________________________________ _____________________________________________________________________________________________
Submitted by (optional): _________________________________________________________________________ Submit this form completed by March 9, 2009 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324. Complete this form online at www.gpha.org.
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January 2009
GA S PV hE A T UH PE D ADTAET E
Become a part of GPhA’s grassroots team and support your profession!
February 18, 2009
Very Involved Pharmacist Day Georgia State Capital
– – May 12, 2009
Eggs and Issues Breakfast Washington, D.C.
Register for this event at www.gpha.org (https://m360.gpha.org/ViewEvent.aspx?id=4668&instance=0 and http://m360.gpha.org/ViewEvent.aspx?id=4689&instance=0)
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January 2009
UP
COMING
EVENT
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January 2009
Lawyer and Pharmacist Leroy Toliver, Pharm.D., R.Ph., J.D. • Professional Licensure Disciplinary Proceedings • Medicaid Recoupment Defense • Challenges in Medicaid Audits • OIG List Problems • SCX or Other Audits
Leroy Toliver has been a Georgia Registered Pharmacist for 34 years. He has been a practicing attorney for 25 years and has represented numerous pharmacists and pharmacies in all types of cases. Collectively, he has saved his clients millions of dollars.
Toliver and Gainer, LLP 942 Green Street, SW Conyers, GA 30012-5310 altoliver@aol.com 770.929.3100
The Georgia Pharmacy Journal
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January 2009
Gossel
Thomas A. Gossel, R.Ph., Ph.D. Professor Emeritus Ohio Northern University Ada, Ohio
J. Richard Wuest, R.Ph., PharmD Professor Emeritus University of Cincinnati Cincinnati, Ohio
Wuest
ADHD and Its Treatment in Adults Goal. The goal of this lesson is to
explain attention-deficit/hyperactivity disorder (ADHD) in adults with focus on its clinical characteristics and confirmation, and its treatment.
Objectives. At the conclusion of
this lesson, successful participants should be able to: 1. recognize epidemiologic information and characteristics relevant to ADHD; 2. identify symptomatology that characterizes ADHD and the principles that govern its clinical confirmation and management in adults; and 3. select from a list specific nonpharmacologic and pharmacologic measures that are reported to modify signs and symptoms of ADHD in adults. Attention-deficit/hyperactivity disorder (ADHD), which affects up to 12 percent of children and adolescents, persists into adulthood in up to 60 percent of cases. Four to 5 percent of adults worldwide are affected, making ADHD one of the most common psychiatric conditions in adulthood for which treatment is available.
Only recently has the persistence of untreated ADHD in adults been recognized in primary care. Marked by inattention, distractibility and impulsivity, clinical features of adult ADHD are reminiscent of the symptoms of childhood ADHD; however, the condition evolves and changes as the individual matures. Work productivity loss in adults with ADHD is estimated at 35 days each year. Annual health care costs for adults with ADHD, compared with an age-matched cohort of unaffected adults, are three times higher, and annual health care expenditures for their family members are approximately 1.9 times higher compared with a matched cohort (group consisting of shared characteristics) of family members of non-ADHD patients.
Background
In adults, ADHD can lead to substantial social and occupational impairment and is associated with increased familial stress. Fewer adults with ADHD are employed full time, indicating that those with ADHD have a lower average income than control subjects, regardless of academic achievement or personal
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characteristics. Adults with ADHD have been shown to be more careless drivers, and more likely to receive multiple citations for speeding and have their driver’s license revoked. Adults with ADHD are twice as likely to have been arrested and convicted of a crime. Only 47 percent of adults with ADHD report being satisfied with their family life, compared with 68 percent of those without the condition. Adults with ADHD are twice as likely to be divorced. Only half of affected adults report contentment with their professional life. Adolescents with and without ADHD have the same rate of substance abuse; such is not the case for adults with ADHD. Between adolescence and adulthood, the rate of substance abuse increases substantially for individuals with ADHD. Although parents may worry that treating ADHD with psychostimulants will predispose their children to substance abuse later in life, treatment may actually protect against the development of substance abuse. If ADHD is consistently and effectively treated during the childhood and adolescent years, the risk of substance abuse
January 2009
Table 1 Top ten symptoms of adults with ADHD that lead to self-referral to a physician
1. Poor concentration 2. General disorganization 3. Tendency to leave projects incomplete 4. Inattention 5. Poor school performance 6. Problems with time management 7. Difficulty controlling temper 8. Impulsive 9. Anxiety 10. Difficulty functioning at work
Adapted in part from Faraone SV, Spencer TJ, Montano B, Biederman J. Arch Intern Med. 2004;164:1221-1226.
later in life is no greater than in the general population. ADHD may affect sexual behavior. The Milwaukee Young Adult Outcome Study showed that sexually transmitted disease was four times more prevalent among persons with ADHD than their non-affected peers. Affected persons also had far more children by age 20, but only half of the ADHD parents retained custody of their children. Executive functioning (the ability to maintain appropriate problem solving activity for attainment of a future goal) is an area of intense research in the study of ADHD. Problems present clinically as deficits in time management, organization, and sequential and hierarchical thinking. Exceptionally intelligent adults are often able to compensate for their inabilities through adolescence and even young adulthood, but the cumulative challenges may eventually overwhelm their compensatory mechanisms. Data describing the likelihood that a child with ADHD will also have the disorder as an adult are conflicting. As definitions of ADHD subtypes improve, some subtypes will likely be found that cause more adult dysfunction than others.
Pathogenesis
As in childhood and adolescent ADHD, the most critical neurotransmitters in adults with ADHD are the catecholamines dopamine and norepinephrine, both of which appear to regulate inhibitory influences in the frontalcortical processing of information. Specific neurobehavioral roles for these neurotransmitters remain unclear. Both dopamine and norepinephrine act upon relatively specific pathways that regulate attention, concentration and other cognitive functions. It is theorized that dopamine enhances signals and improves attention, acquisition, focus, on-task behavior and cognition, perception and vigilance. Norepinephrine may diminish “noise;” decrease distractibility and shifting; improve executive operations; and increase behavioral, cognitive, and motor inhibition. In terms of pathophysiology, it is postulated that neurotransmitter dysfunction causes dysregulation of the inhibitory influences of frontalcortical activity, which is predominantly regulated by norepinephrine, and of lower striatal structures, which are predominantly dopaminergic. These striatal structures are driven by dopaminergic agonists controlled or modulated by higher inhibitory structures sensitive to adrenergic agents.
Clinical Confirmation in Adults
There are no efficient standardized assessment tools to specifically identify adult ADHD, which makes diagnosis confirmation challenging. Extensively studied in children, its persistence into adulthood was not recognized until the mid-1970s. These symptomatic adults were diagnosed retrospectively with ADHD following interviews with their parents and determination that symptoms of illness characteristic of the disorder had indeed been noticed during the affected adults’ early years.
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Current guidelines for both children and adults are that patients must meet the criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSMIV). Symptoms are categorized as follows: inattention (difficulty sustaining attention), forgetfulness and distractibility; hyperactivity (fidgeting, excessive talking and restlessness) and impulsivity (difficulty waiting one’s turn and frequent interruption of others). The DSM-IV criteria also include onset by age seven (confirmed, possibly, by retrospective analysis), impaired functioning in at least two settings (home, work, school), and persistence beyond six months. Symptoms. Symptoms in adults are similar to those in childhood except they are usually less disruptive and more along the lines of a sense of inner restlessness. Typically, adults with ADHD are unaware that they have the disorder. They may feel it is difficult to get organized, to stick with a job or keep an appointment. Everyday tasks of arising in the morning, getting dressed and ready for the day’s work, arriving at work on time and being productive on the job can be major challenges for the ADHD adult. Problems may intensify in adulthood when they begin an independent life with increasing challenges for organization associated with marriage, parenting, occupational planning and administration. Adults almost always self-refer for treatment rather than having a physician suggest its presence initially. This may occur when their children are diagnosed with the disorder and they begin to understand that some of the traits that have troubled them for years might point to ADHD as the root cause of their problems. Other adults seek professional help for anxiety or other symptom(s) listed in Table 1. They may have a history of social inadequacy or problems at work, or
January 2009
they have been involved in frequent automobile accidents and they seek answers for the root cause of their “problem.” Gender distribution of self-referring adults is nearly equal. A presenting comorbidity (concomitant, but unrelated illness) may be the first clue to the presence of adult ADHD. The majority of adults with ADHD have at least one additional psychiatric disorder such as anxiety, bipolar disorder or major depressive disorder; some adults may have more than one. Because there is considerable symptom overlap, this creates the potential for diagnostic confusion with consequent tendency to disguise a diagnosis of ADHD. It is also possible that many adult patients with ADHD have clinically significant but subthreshold symptoms. Hyperactivity symptoms may decrease with age because of developmental trends toward selfcontrol. Adults with ADHD are generally less hyperactive than children. Whereas young children can often be seen in purposeless climbing, jumping and running about, adult variants of these characteristics include such traits as being a workaholic, feeling uncomfortable sitting through meetings or a movie, being unwilling to wait in line, and speeding while driving. Affected adults often work overtime and/or hold more than one job. Symptoms of hyperactivity in adults may also be based not so much on motor behavior but on other aspects of functioning, such as talking. Adults may feel they need to talk excessively or they regularly talk out of turn, blurt out inappropriate comments, or feel compelled to talk endlessly on their cell phone during meetings or while driving. Such behaviors can lead to both personal and professional harm. Inattentive symptoms do not appear to have a similar developmental advantage and they tend to remain constant throughout adulthood. Adults with ADHD may be unable to understand which of their actions provoke irritation in others, but
advancing age does have an advantage in that they may have better insight into monitoring the reactions of others and so they adjust their behavior accordingly. Traits that were problematic in childhood may be adaptive to selective jobs by an adult. This does not imply that these adults no longer suffer impairment in quality of life, social relationships, personal planning, underemployment, motor vehicle safety and other dimensions of functioning. As one adult wisely said, “You don’t grow out of ADHD; you just get better at coping with it!” It stands to reason that adults with ADHD experience life differently from persons without ADHD.
Treatment
Pharmacotherapy of adult ADHD is an effective means to manage symptoms of the disorder, with approximately two-thirds of adult patients experiencing moderatetomarked improvement with drugs when combined with psychoeducational management. Clinical trials have confirmed that medications positively improve core ADHD symptoms by enhancing levels of dopamine and/or norepinephrine. Stimulants. The two major stimulant categories used to treat ADHD are the amphetamines and methylphenidates, compounds with a similar clinical effect. Stimulants comprise the majority of treatment protocols for both children and adolescents, and for adults. Seventyfive to 80 percent of adults with ADHD responded positively to stimulants in short-term trials. It is reported that 1.5 million adults in the United States now take stimulants on a daily basis to treat their ADHD, with 10 percent of users older than 50 years of age. Amphetamines include dextroamphetamine (damphetamine; Dexedrine, etc.) and mixed amphetamine salts (Adderall, etc.). Recent advances have occurred with delivery systems rather than new and novel drugs. Long-acting formulations allow for
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more convenient and confidential administration of medication and eliminate the possibility of forgetting to take midday doses. They also reduce peak and trough adverse effects such as headache and moodiness, and eliminate afternoon wear-off and rebound. An extendedrelease form of mixed amphetamine salts (Adderall XR) provides 10 to 12 hours of activity. Lisdexamfetamine (Vyvanse ), approved in 2007 for use in children, may become another alternative therapy for adults. Lisdexamfetamine is composed of damphetamine combined with the amino acid lysine that renders the molecule inert. Gastric enzymes cleave the lysine, which activates the molecule. Since gastric enzyme exposure is necessary for activation, this ensures that the medication cannot be misused if snorted or injected intravenously. Lisdexamfetamine is also long-acting and has consistent pharmacodynamic properties. Methylphenidate is available in immediate-release (four-hour duration of action), longer acting (six- to eight-hour duration), and extended-release (10- to 12-hour duration) formulations. Osmoticrelease oral system (OROS) methylphenidate (Concerta ) releases the active ingredient slowly over 12 hours. Dexmethylphenidate (Focalin ) is comprised solely of the dextro(active) portion of the methylphenidate molecule. Products are available in immediateand extended-release formulations. The methylphenidate transdermal system (Daytrana) is an alternative to orallyadministered drugs that delivers the active ingredient via skin patch. With optimal wear time of nine hours each day, its duration of action persists up to three hours after the patch is removed. Adverse effects of stimulants are generally mild and can be managed by adjusting the medication timing and dosage. The most common shortterm effects are diminished appetite, GI disturbance, headache, insomnia and motor disturbance.
January 2009
Table 2 Helpful websites for adult ADHD*
www.cdc.gov Centers for Disease Control and Prevention www.chadd.org Children and Adults with Attention-Deficit/Hyperactivity Disorder www.nami.org National Alliance on Mental Illness www.nimh.nih.gov National Institute of Mental Health *Enter Adult ADHD and search. Non-stimulants. Atomoxetine (Strattera) is a highly selective norepinephrine reuptake inhibitor in presynaptic neurons; it reduces reuptake of dopamine in prefrontal lobes to a lesser extent. It is of interest that development of atomoxetine was initially piloted in adults rather than children, although confirmation of benefit in children followed. At present, it is the only non-stimulant with FDA approval for treatment in adults. It often takes longer than the stimulants to achieve clinical effect, but has a powerful anxiolytic effect and minimal abuse potential. Atomoxetine is generally well tolerated with few mild side effects including appetite suppression and insomnia. Antidepressants are considered a second choice for treatment of adults with ADHD following a trial with the stimulants and atomoxetine. The older antidepressants (tricyclics) are sometimes used because they modify norepinephrine and/or dopamine. Venlafaxine (Effexor), a non-tricyclic antidepressant, is also used for its enhancement effect on norepinephrine. Bupropion (Wellbutrin, etc.), an antidepressant with an indirect effect to increase central dopamine, has been useful in treatment of ADHD in both children and adults. It has the added benefit of aiding reduction of nicotine dependence. Education and Psychotherapy. Although pharmacotherapy provides needed support, the individual must succeed on his own. To assist in this struggle, both education and individual psychotherapy can be helpful. Adults can learn how to organize their life by posting a large
calendar where it will be seen each morning that lists important tasks for the day. A special place can be set aside for keys, bills and the paperwork of everyday life. Tasks can be organized into segments such that completion of each part can give a sense of accomplishment. Above all, adults with ADHD should learn as much as they can about their disorder so they understand what is going on in their body and, thus, be better equipped to manage it. Psychotherapy can be a useful adjunct to medication and education, Therapy can help patients improve their poor self-image by examining experiences that produced it. The therapist can encourage patients to adjust to changes in their life by treatment – the loss of impulsivity and desire for risk-taking, and the new feeling of thinking before acting. As patients begin to understand their new ability to organize the complexities of life, they can often begin to appreciate characteristics of ADHD that are positive, such as new-found energy, warmth, and enthusiasm. Focused therapies that incorporate cognitive-behavioral features have reportedly been effective in children, adolescents and adults with ADHD. The benefit of these treatments without concurrent pharmacotherapy has yet to be determined. Drug Holidays. Drug holidays, common in treatment of childhood ADHD, may also become part of the pharmacotherapy of adult ADHD. However, there is growing consensus that this practice of withholding medication one or more days each week in adults is inappropriate and
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that medication is most effective when taken consistently without interruption. Adherence. Poor adherence with treatment is common in the care of adult patients initiating stimulant therapy. In one study, adults initiating pharmacological treatment for ADHD continued their medications for an average of only 50 days. Although early discontinuation of treatment commonly occurs in the care of adult ADHD, the factors that promote continuity of stimulant treatment remain largely unknown. Optimal management of ADHD includes pharmacologic and nonpharmacologic interventions. Support groups help persons of all ages with ADHD and their family members understand the disorder and available resources. Support groups can be located by calling an ADHD hotline (800.233.4050) or by contacting Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) (Table 2). Other helpful websites on ADHD are also listed in Table 2.
Summary and Conclusions
Adult ADHD is one of the most common psychiatric disorders. It differs from ADHD in children and adolescents in that adults can often modify their daily routines to better match their temperament. It has been shown in most clinical trials that pharmacologic treatments effective in children and adolescents are also effective in adults. Although adults with ADHD are at higher risk for substance abuse than adults without the disorder, recent studies have shown that pharmacotherapy may reduce the risk of substance abuse in adults with ADHD. The content of this lesson was developed by the Ohio Pharmacists Foundation, UPN: 129-000-08-009-H01-P. Participants should not seek credit for duplicate content.
January 2009
Quiz
ADHD and Its Treatment in Adults
1. Work production loss in adults with ADHD is estimated at: c. 55 days each year. a. 15 days each year. b. 35 days each year. d. 75 days each year.
b. They are not able to adjust their behavior to the reaction of others. c. They do not suffer impairment to quality of life or social relationships. d. Traits that were problematic in childhood may be adaptive to selective jobs.
2. Between adolescence and adulthood, the rate of substance abuse for individuals with ADHD: a. increases. b. decreases.
7. The percentage of adults with ADHD who responded positively to stimulants in short-term trials has been: a. 55 to 60 percent. c. 75 to 80 percent. b. 65 to 70 percent. d. 85 to 90 percent.
3. The most critical neurotransmitters in adults with ADHD are dopamine and: a. acetylcholine. c. norepinephrine. b. gamma-aminobutyric acid. d. serotonin.
8. Which of the following products is comprised solely of the dextro- (active) portion of the methylphenidate molecule? a. Strattera c. Dexedrine b. Focalin d. Concerta
4. Which of the following in NOT listed as a function regulated by dopamine and/or the neurotransmitter referred to in question # 3? a. Concentration c. Perception b. Attention d. Memory
9. Which of the following products is a non-stimulant drug? a. Strattera c. Dexedrine b. Focalin d. Concerta
5. Which of the following statements is true? a. Adults almost always self-refer for treatment of ADHD. b. Physicians almost always suggest the presence of ADHD in adults initially.
10. There is growing consensus that the practice of withholding ADHD medication one or more days each week in adults is: a. appropriate. b. inappropriate.
6. Which of the following statements is most likely to be true about adults with ADHD? a. They understand which of their actions provoke irritation in others.
The Georgia Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ADHD and Its Treatment in Adults
Volume XXVI, No. 9 GPhA Code J09-01 Program Number: 142-999-09-001-H01-P CE Hours: 1.5 (0.15 CEUs) Release Date: 1/5/2009 Expiration: 09/15/2011
1. Select one correct answer per question and circle the appropriate letter below using blue or black ink (no red ink or pencil). 2. Members submit $4, Non-members must include $10 to cover the cost of grading and issuing statements of credit. Please send check or money order only. Note: GPhA Members will receive priority in processing CE. Statements of credit for GPhA members will be mailed within four weeks of receipt of the course quiz.
1. 2. 3. 4. 5.
A A A A A
B C D B B C D B C D B
6. A 7. A 8 A 9. A 10. A
B B B B B
C C C C
D D D D
Mail completed quiz to: GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324 A passing grade of 70% is required for each examination. A person who fails the exam may resubmit the quiz only once at no additional charge. Please check here if you are indicating a change of address ______
Phone # __________________
Name ________________________________________ License Number(s) and State(s) ____________
Address _____________________________________________________________________________
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January 2009
2008 - 2009 GPhA BOARD OF DIRECTORS
The Georgia Pharmacy Journal Editor: Jim Bracewell
Name
jbracewell@gpha.org
Sharon Sherrer Robert C. Bowles Eddie Madden Dale Coker Jack Dunn Jim Bracewell Burnis Breland Hugh Chancy Judy Gardner Keith Herist John McKinnon Andy Rogers Tommy Whitworth Alex Tucker Tony Singletary Renee Adamson Bill McLeer Shobhna Butler Bobby Moody Pam Marquess Larry Batten Alissa Rich Chris Thurmond Marshall Frost Ken Eiland Rusty Lee Liza Chapman Debbie Nowlin Tim Short Michelle Bishop Hillary Volsteadt John T. Sherrer Michael Farmer Pat McPherson
Managing Editor: Kelly McLendon
kmclendon@gpha.org
The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2009, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor. All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, officers or members of the Georgia Pharmacy Association.
ARTICLES AND ARTWORK
Those who are interested in writing for this publication are encouraged to request the official GPJ Guidelines for Writers. Artists or photographers wishing to submit artwork for use on the cover should call, write or e-mail the editorial offices as listed above.
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The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for nonmembers is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.
The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offices. POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.
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Position
Chairman of the Board President President Elect First Vice President Second Vice President Executive Vice President/CEO State at Large State at Large State at Large State at Large State at Large State at Large State at Large Region One President Region Two President Region Three President Region Four President Region Five President Region Six President Region Seven President Region Eight President Region Nine President Region Ten President Region Eleven President Region Twelve President ACP Chairman AEP Chairman AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Ex Officio - President, GA Board of Pharmacy Ex Officio - Chairman, GSHP EX Officio Mercer Ex Officio Mercer ASP Ex Officio South Ex Officio South ASP Ex Officio UGA Ex Officio UGA ASP
January 2009
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Sid Anderson sanderson@GPhA.org Toll Free 1.888.871.5590
January 2009