The Georgia Pharmacy Journal: November 2011

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15

Departments

Smyrna Interstate Bridge Named for William A. “Bill” Atkins, Sr., R.Ph. FEATURE ARTICLES

7 10 11 18 23 24

BlueCross BlueShield Insurance Information NCPA Elects New Officers and Board Members Including Chancy and Sherrer VIP Day at the Capitol Save-the-Date Memo to Pharmacists: Security Paper for CII Hard Copy Required

5 12 14 16 16 22 30 30

NPLC Nomination Form Pharm PAC Contributors Pharm PAC Contribution Card GPhA New Members Hit Us with Your Best Shot 2012 Award Nomination Form GPhA Board of Directors Masthead

Advertisers 2 10 13 13 16 17 21 23 23 32

Pharmacists Mutual Companies Financial Network Associates Logix, Inc. Melvin Goldstein, P.C. Barbara Cole, Attorney at Law AIP GPhA Workers’ Compensation Frances Cullen, PC Winter CPE Ski Trip UBS

Leadership Georgia 2012 Class includes 2 GPhA Members CPE Opportunity: Dietary Supplementation of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty Acids

COLUMNS

4 6

President’s Message

For an up-to-date calendar of events, log onto

Editorial

The Georgia Pharmacy Journal

www.gpha.org.

3

November 2011

PRESIDENT’S MESSAGE L. Jack Dunn, Jr., R.Ph. GPhA President

November: A Time to be Thankful

am so blessed to have the involvement of the GPhA board of directors, the staff, and the executive committee to help govern this professional association. This past week the members of the executive committee attended the last region meetings, speaking about the association updates and the legislative agenda. I would like to thank the members of the executive committee for their help in making the region meetings a success.

Thanksgiving and spend some time with family, friends, neighbors, and your colleagues. Be thankful for your profession and the friendships that your profession has made possible. Remember the theme of GPhA, “There are many practices but one profession.” God bless each and every one of you. Have a great Thanksgiving.

I

Last year, as you recall, GPhA was instrumental in the passing of 3 bills in the legislature that promoted our profession and assisted all pharmacists in their ability to care for their patients. These bills were vaccinations, PBM audits and the drug monitoring bill. As a result of the passage of these three bills, GPhA is eager for this year’s legislative session to begin.

We are ready to further advance our profession by promoting the passage of legislation to increase the number of immunizations allowed by pharmacists, the ability to bill all insurance companies for immunizations (any willing provider), mail order and increased PBM legislation. Your involvement in this process, along with the GPhA executive committee, is imperative to ensure that we are successful in this endeavor. As an executive committee member, I want to thank you for your involvement in your professional association and, with your help we will push this profession to greater heights.

On a personal note, with the holidays upon us I would ask that everyone take some time during this month of The Georgia Pharmacy Journal

4

November 2011

Would You Like to Help Jump Start the Future of a Pharmacy Leader?

The Georgia Pharmacy Foundation New Practitioner Leadership Conference will expose the attendee to the development of personal and professional leadership skills.

This could be a decisive step in the leadership career of a young pharmacy professional.

Three Top Desired Qualities of Nominees 1.

Leadership potential 2.

Active Involvement in Student Activities and or Professional Organizations 3.

Activity in Community Organizations Nominees may not have practiced more than 10 years in pharmacy.

The 2012 class will not exceed 20 in total.

Conference Location: Legacy Lodge & Conference Center Lake Lanier Islands, GA Conference Dates: April 13-15, 2012 If there is a person you would like to nominate, please complete the form below and return it by January 23, 2012.

Nominee’s Name: _________________________________________ Address: _______________________________________________ ______________________________________________________ Phone: ________________________________________________ Email: _________________________________________________ Nominator Name: _________________________________________ Address:________________________________________________ ______________________________________________________ Phone: ________________________________________________ Email: _________________________________________________ Return to : Georgia Pharmacy Foundation 50 Lenox Pointe Atlanta, GA 30324 Or Fax 404-237-8435 If you need additional information contact Regena Banks at 404-237-8435 or email rbanks@gpha.org.

The Georgia Pharmacy Journal

5

November 2011

EXECUTIVE VICE PRESIDENT’S EDITORIAL Jim Bracewell Executive Vice President / CEO

How is my Contribution to the Georgia Pharmacy Foundation Used? hat is not a rhetorical question, but a very good question as we approach the end of 2011 and many of you consider gifts to various charitable organizations. Most of these organizations have a greater need this year than ever before.

someone who has had to deal with this issue then you know the value of this annual conference.

T

Each spring, the foundation hosts the New Practitioners Leadership Conference, bringing together up to 20 of the brightest young pharmacy professionals for training in leadership skills that will advance our profession. Over a third of the board of directors of GPhA are graduates of this conference. Perhaps you know someone deserving of this opportunity. If so go to the www.gpha.org and make a nomination.

All gifts to the Georgia Pharmacy Foundation are fully tax deductible just like a gift to your church, synagogue or your college foundation.

As a pharmacist you know the value of a scholarship or some financial help at a crucial time in your education and what it meant. Or perhaps you were fortunate enough to have resources from family, work and loans, nonetheless you knew others who struggled and without some help at the right time may not have made it to graduation.

I hope you will make a year-end charitable contribution to the Georgia Pharmacy Foundation. You can go to the GPhA website at www.gpha.org or call the GPhA office and we can take your gift by phone or you can always drop a check in the mail to Georgia Pharmacy Foundation Annual Fund at 50 Lenox Pointe, Atlanta, Georgia 30324. Whatever the amount, you will know your gift is well invested in your our profession and its future.

The Georgia Pharmacy Foundation annually provides twelve scholarships: four to the University of Georgia, four to Mercer University and four to South University.

In just a couple of years the foundation will add four to the Philadelphia College of Osteopathic Medicine School of Pharmacy as they graduate their first class of pharmacists.

The number and values of these scholarships are directly dependent on the generosity of our membership and friends of the Georgia Pharmacy Association.

The Foundation also annually hosts the Southeastern Professional Recovery Network Conference in Atlanta.

The Foundation brings in participants from many states to help address this need in our profession. If you lost your license to practice pharmacy and were faced with huge bills for treatment I am sure life would seem insurmountable. Your foundation helps examine the latest treatments and causes of impairment. Countless families and lives have been saved by these efforts. If you know of The Georgia Pharmacy Journal

6

November 2011

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Blue Cross and Blue Shield of Georgia Medical Plans

You will have the option to enroll in one of the following four (4) medical plans:  Open Access Point of Service (OA POS) – The plan provides benefits both in and out of network. The plan does not require a referral to see a specialist who participates in the BCBS Open Access network.  Health Savings Account (HSA) – This plan provides you with the flexibility to use a health care provider either in or out of the network without a referral.

Medical Plan Highlights

OA POS

OA POS

OA POS

HSA

Medical deductible – In network

$500

$1,500

$1,000

$3,000

$1,500

$4,500

$2,500

$5,000

Medical deductible – Out of network

$1,000

$3,000

$1,000

$3,000

$1,500

$4,500

$5,000

$10,000

Out-of-pocket maximum – In network

$1,000

$3,000

$1,000

$3,000

$1,000

$3,000

$5,000

$10,000

Out-of-pocket maximum – Out of network

$4,000

$12,000

$4,000

$12,000

$4,000

$12,000

$10,000

$20,000

Primary care physician visit

$25 copay Ded. waived

$40 copay Ded. waived

$40 copay Ded. waived

40% Ded. waived

$0 Ded. waived

40% after ded.

Specialist visits

$35 copay Ded. waived

$50 copay Ded. waived

$50 copay Ded. waived

40% Ded. waived

20% Ded. waived

40% after ded.

Coinsurance

20% after deductible

20% after deductible

20% after deductible

40% Ded. waived

20% Ded. waived

40% after ded.

Emergency room

$100 copay Ded. waived

$100 copay Ded. waived

$100 copay Ded. waived

$100 copay Ded. waived

20% Ded. waived

40% after ded.

Generic

$15 copay

$15 copay

Ded. then 40%

Ded. then 20%

Ded. then 40%

Ded. then 40%

$15 copay

Ded. then 40%

Blue Cross and Blue Shield of Georgia Dental Plans

Dental coverage Calendar year deductible Single

$50

Family

$150

Deductible applies to

Type II and III

Coinsurance

GAD\1-hda\ebpg\Clients\GA Pharmacy Association\GA Pharm Assoc NL attachment 2011_2

Preventive services (Type I)

100%

Basic Services (Type II)

80%

Major Services (Type III)

50%

Periodontics and Endodontics

80%

Annual maximum

$1,000

Out of network usual and customary

90%

Do you want more information on the Blue Cross Blue Shield GPhA Plans?

Blue Cross and Blue Shield of Georgia Medical Plans

You will have the option to enroll in one of the following four (4) medical plans: Open Access Point of Service (OA POS) – The plan provides benefits both in and out of network. The plan does not require a referral to see a specialist who participates in the BCBS Open Access network.

Health Savings Account (HSA) – This plan provides you with the flexibility to use a health care provider eitherdo in or out of thefor network without a referral.

Who I contact information?

Medical Email Plan Ruth Highlights

Ann McGeheeOAatPOS rmcgehee@gpha.org orOA callPOS on her direct line at 404-419-8104 OA POS

HSA

Medical deductible $500 $1,500 $1,000 $1,500 $2,500 “The responses from our currently insured groups have been$3,000 overwhelmingly positive.$4,500 This plan in many respects$5,000 mirrors – In network

the plan of the Georgia Dental Association that has long been a successful plan for dentists across Georgia. I am proud the $1,000 $3,000 $1,000 $3,000 $1,500 $4,500 $5,000 $10,000 GPhA was able to put together such a quality offering for the pharmacists and pharmacies of our association,” said$1,000 GPhA Executive Vice President the president$5,000 of Blue Cross Blue $3,000 $1,000 Jim Bracewell. $3,000 “Morgan $1,000Kendrick, $3,000 $10,000 Out-of-pocket maximum Shield and I serve on the board of the Georgia Healthcare Information Exchange. Morgan is a leader in healthcare and its – In network future in our state.”

Medical deductible of – leadership Out of network

$4,000 Out-of-pocket maximum – Who Out of will network administer the

$12,000

$4,000

$12,000

$4,000

$12,000

$10,000

$20,000

plan for us?

Primary care physician visit

$25 copay Ded. waived

$40 copay Ded. waived

$40 copay Ded. waived

40% Ded. waived

$0 Ded. waived

40% after ded.

Specialist visits

$35 copay Ded. waived

$50 copay Ded. waived

$50 copay Ded. waived

40% Ded. waived

20% Ded. waived

40% after ded.

20% after

40%

20% Ded.

40% after

$15 copay

Ded. then 40%

Ded. then 20%

Ded. then 40%

Georgia Pharmaceutical Services, GPhA wholly owned subsidiary and insurance agency will provide the administration for the plan as they have in the past for The Insurance Trust.

Who are the board members of Georgia Pharmaceutical Services, Inc.?

Coinsurance

20% after

Generic

$15 copay

20% after

deductible deductible waived ded.

The board of directors of the GPhS are electeddeductible by the GPhA board of directors and theDed. current boardwaived is made up of Robert Bowles, room Dale Coker, Eddie Madden, Pam$100 Marquess, Bobby Moody, 20% and Ded. Sharon40% Sherrer.

Emergency $100 Jack copayDunn, Robert Hatton, $100 copay copay $100 copay after Ded. waived waived Ded. waived Ded. waived ded.

Executive Vice President Jim Bracewell servesDed. as the secretary in an ex-officio non-voting position. waived Ded. then 40%

$15 copay

Ded. then 40%

New Health Insurance Benefit From GPhA Plan Facts BlueEffective CrossOctober and Blue Shield ofCross Georgia Dental 1, 2011, Blue & Blue ShieldPlans of Georgia will be GPhA’s Plan Administrator.

Dental coverage

Calendar Members of the GPhA health care plan will have four plans to choose from. year deductible

Dental will be included.

Guaranteed rates through December 31, 2012.

The Georgia Pharmacy Journal

GAD\1-hda\ebpg\Clients\GA Pharmacy Association\GA Pharm Assoc NL attachment 2011_2

Single

$50

Family

$150

Deductible applies to

Type II and III

Coinsurance

9

Preventive services (Type I)

100%

Basic Services (Type II)

80%

Major Services (Type III)

50%

Periodontics and Endodontics

80%

Annual maximum

$1,000

Out of network usual and customary

90%

November 2011

Member News

NCPA Elects New Officers and Board Members Including Chancy and Sherrer Alexandria, Va. - October 25, 2011 -- The National Community Pharmacists Association (NCPA) installed new Officers and its Board of Directors for 2011-2012 at its 113th Annual Convention and Trade Exposition, held Oct. 8-12, in Nashville, Tenn. They are the association's governing body, which represents the voice of the members and direct the association's objectives. All are practicing pharmacists.

John Sherrer, Marietta, Ga. Bradley Arthur, Buffalo, N.Y. Keith Hodges, Gloucester, Va. DeAnn Mullins, Lynn Haven, Fla. David Smith, Indiana, Pa. Immediate Past President - Robert J. Greenwood, Waterloo, Iowa Officers First Vice President - Bill Osborn, Miami, Okla.

Second Vice President - Brian Caswell, Baxter Springs, Kan. Third Vice President - Michele Belcher, Grants Pass, Ore. Fourth Vice President - Hugh Chancy, Hahira, Ga. Fifth Vice President - Jeff Carson, San Antonio, Tex.

The convention marked the beginning of the one-year term for new NCPA president, Lonny Wilson, DPh, of Oklahoma City, Okla. Wilson has long been a fixture of Oklahoma health care and pharmacy circles. He is currently CEO of Pharmacy Providers of Oklahoma (PPOk).

"We congratulate Lonny Wilson on becoming NCPA president," said NCPA CEO, B. Douglas Hoey, R.Ph., MBA. "He has been a tireless advocate for helping better position independent community pharmacies, with their focus on providing numerous patient care services, for the future. Part of those efforts also requires pushing state and federal officials to implement common-sense policies that level the playing field."

I can answer your

QUESTIONS ABOUT TAXES & FINANCIAL PLANNING Join us for THIRD THURSDAY CONFERENCE CALLS

"Community pharmacists play a vital role in improving health outcomes while reducing costs," Wilson said. "First, local pharmacists help maximize the appropriate use of lower-cost generic drugs by dispensing 20 percent more generic drugs than out-of-state mail order facilities.

Second, pharmacists provide critical, face-to-face patient counseling on the proper use of medications, and on combating diabetes and other common conditions.

Dial our complimentary conference line on the third Thursday of Sept., Oct. & Nov. from 4:00 to 4:30pm: (800) 391-1709 PIN 582280 Compliments of

MICHAEL T. TARRANT Financial Network Associates

In addition, the following independent community pharmacy owners were designated to the following positions:

1117 Perimeter Center West, Suite N-307 "UMBOUB (" t '/"QMBOOFST DPN t NJLF!'/"QMBOOFST DPN

An Independent Financial Planner since 1992 Focusing on Pharmacy since 2002

Board of Directors President - Lonny Wilson, Oklahoma City, Okla.

President-Elect - Donnie Calhoun, Anniston, Ala. Chairman - Mark Riley, Little Rock, Ark. The Georgia Pharmacy Journal

Securities, certain advisory services and insurance products are offered UISPVHI */7&45 'JOBODJBM $PSQPSBUJPO */7&45 t .FNCFS FINRA/SIPC, a federally registered Investment Advisor, and affiliated JOTVSBODF BHFODJFT */7&45 JT OPU BĂŻMJBUFE XJUI 'JOBODJBM /FUXPSL Associates, Inc. INVEST does not provide tax or legal advice. Other BEWJTPSZ TFSWJDFT NBZ CF PĂŞFSFE UISPVHI 'JOBODJBM /FUXPSL "TTPDJBUFT *OD B SFHJTUFSFE JOWFTUNFOU BEWJTPS J BE

10

November 2011

2012 VIP Day at the Capitol Save-the-Date

Notice to all Pharmacists and Pharmacy Technicians: All members and potential members are welcome to attend.

Register online today at www.gpha.org or by calling 404-231-5074.

When: Thursday, February 09, 2012 Where: The Georgia Railroad Freight Depot - Freight Room 65 Martin Luther King, Jr., Drive, S.E. Atlanta, GA 30334 Schedule of Events *NOTE: This schedule is tentative. We will continue to update you as it becomes more permanent.

6:00 a.m.: Registration & Exhibit Hall Opens with Coffee 6:30 a.m.: GPhA Attendee Orientation 7:00 a.m.: Breakfast with Your Legislator(s) 8:00 a.m.: Presentation of GPhA Legislator of the Year Award & Closing Remarks 9:15 a.m.: Group Photo on the Capitol Steps 10:00 a.m.: Tour the Georgia Capitol Building Special GPhA Recognitions to be made by GA House and Senate Members Wear your white coat to make our presence more effective!

Parking directions available online.

If you have any questions please contact Sarah Bigorowski at sbigorowski@gpha.org or 404-418-8126.

The Georgia Pharmacy Journal

11

November 2011

Current Pharm PAC Members Titanium Level ($2400 minimum pledge) T.M. Bridges, R.Ph. Michael E. Farmer, R.Ph. David B. Graves, R.Ph. Raymond G Hickman, R.Ph. Robert A. Ledbetter, R.Ph. Jeffrey L. Lurey, R.Ph. Marvin O. McCord, R.Ph. Scott Meeks, R.Ph. Judson Mullican, R.Ph. William A Murray, R.Ph. Mark Parris, Pharm.D. Fred F. Sharpe, R.Ph. Jeff Sikes, R.Ph. Dean Stone, R.Ph., CDM Platinum Level ($1200 minimum pledge) Barry M. Bilbro, R.Ph. Robert Bowles, Jr., R.Ph., CDM, Cfts Jim R. Bracewell Larry L. Braden, R.Ph. William G. Cagle, R.Ph. Hugh M. Chancy, R.Ph. Keith E. Chapman, R.Ph. Dale M. Coker, R.Ph., FIACP Patrick Dunham Jack Dunn, Jr. R.Ph. Neal Florence, R.Ph. Andy Freeman Martin T. Grizzard, R.Ph. John Hansford, R.Ph. Robert M. Hatton, Pharm.D. Ted Hunt, R.Ph. Alan M. Jones, R.Ph. Ira Katz, R.Ph. Hal M. Kemp, Pharm.D. J. Thomas Lindsey, R.Ph. Brandall S. Lovvorn, Pharm.D. Eddie M. Madden, R.Ph.

Jonathan Marquess, Pharm.D., CDE, CPT Pam Marquess, Pharm.D. Kenneth A. McCarthey, R.Ph. Drew Miller, R.Ph., CDM Laird Miller, R.Ph. Cynthia K. Moon Jay Mosley, R.Ph. Allen Partridge, R.Ph. Houston Lee Rogers, Pharm.D., CDM Tim Short, R.Ph. Danny Toth, R.Ph. Tommy Whitworth, R.Ph., CDM

William J. McLeer, R.Ph. Albert B. Nichols, R.Ph. Richard Noell, R.Ph. William Lee Prather, R.Ph. Sara W. Reece, Pharm.D., BC-ADM, CDE Edward Franklin Reynolds, R.Ph. Sukhmani Kaur Sarao, Pharm.D. David J. Simpson, R.Ph. James N. Thomas, R.Ph. Alex S, Tucker, Pharm.D. Flynn W. Warren, M.S., R.Ph. William T. Wolfe, R.Ph.

Gold Level ($600 minimum pledge) James Bartling, Pharm.D., ADC, CACII Larry Batten, R.Ph. Liza G. Chapman, Pharm.D. Mahlon Davidson, R.Ph., CDM James Gordon Elrod, R.Ph. Kevin M. Florence, Pharm.D. Robert B. Moody, R.Ph. Sherri S. Moody, Pharm.D. Jeffrey Grady Richardson, R.Ph. Andy Rogers, R.Ph. Daniel C. Royal, Jr., R.Ph. Michael T. Tarrant

Bronze Level ($150 minimum pledge) Monica M. Ali-Warren, R.Ph. Fred W. Barber, R.Ph. John R. Bowen, R.Ph. Ben Cravey, R.Ph. Michael A. Crooks, Pharm.D. William Crowley, R.Ph. Charles Alan Earnest, R.Ph. Randall W. Ellison, R.Ph. Mary Ashley Faulk, Pharm.D. Amanda R. Gaddy, R.Ph. Ed Kalvelage John D. Kalvelage Steve D. Kalvelage Marsha C. Kapiloff, R.Ph. Joshua D. Kinsey, Pharm.D. Brenton Lake, R.Ph. William E. Lee, R.Ph. Michael Lewis, Pharm.D. Ashley Sherwood London Charles Robert Lott, R.Ph. Max A. Mason, R.Ph. Amanda McCall, Pharm.D. Susan W. McLeer, R.Ph. Mary P. Meredith, R.Ph. Rose Pinkstaff, R.Ph. Leslie Ernest Ponder, R.Ph.

Silver Level ($300 minimum pledge) Renee D. Adamson, Pharm.D. Chandler M. Conner, Pharm.D. Terry Dunn, R.Ph. Marshall L. Frost, Pharm.D. Johnathan Wyndell Hamrick, Pharm.D. Michael O. Iteogu, Pharm.D. - NEW James E. Jordan, Pharm.D. Willie O. Latch, R.Ph. W. Lon Lewis, R.Ph. Kalen Porter Manasco, Pharm.D. Michael L. McGee, R.Ph.

If you made a gift or pledge to Pharm PAC in the last 12 months and your name does not appear above, please contact Andy Freeman at afreeman@gpha.org or 404-419-8118. Donations made to Pharm PAC are not considered charitable donations and are not tax deductible.

The Georgia Pharmacy Journal

12

November 2011

Pharm PAC Contributors’ List Continued Kristy Lanford Pucylowski, Pharm.D. Leonard Franklin Reynolds, R.Ph. Laurence Neil Ryan, Pharm.D. Richard Brian Smith, R.Ph. Charles Storey, III, R.Ph. Archie Thompson, Jr., R.Ph. Marion J. Wainright, R.Ph. Jackie White Carrie-Anne Wilson Steve Wilson, Pharm.D. Sharon B. Zerillo, R.Ph.

GPhA would like to welcome the following new PharmPac members as of November 1, 2011: Michael O. Iteogu, Pharm.D.

Members (no minimum pledge) John J. Anderson, Sr., R.Ph. Mark T. Barnes, R.Ph. Henry Cobb, III, R.Ph., CDM Carleton C. Crabill, R.Ph. Wendy A. Dorminey, Pharm.D., CDM David M. Eldridge, Pharm.D. James Fetterman, Jr., Pharm.D. Charles C. Gass, R.Ph. Christina Gonzalez Christopher Gurley, Pharm.D. Ann R. Hansford, R.Ph. Joel Andrew Hill, R.Ph. Carey B. Jones, R.Ph. Susan M Kane, R.Ph. Emily Kraus Carroll Mack Lowrey, R.Ph. Tracie Lunde, Pharm.D. Roy W. McClendon, R.Ph.

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Tom E. Menighan, R.Ph., MBA, ScD, FAPhA

William Moye, R.Ph. Darby R. Norman, R.Ph. Christopher Brown Painter, R.Ph. Steve Gordon Perry, R.Ph. Whitney B. Pickett, R.Ph. Michael Roland Reagan, R.Ph. James L. Riggs, R.Ph. Victor Serafy, R.Ph. James E. Stowe, R.Ph. James R. Strickland, R.Ph. Celia M. Taylor, Pharm.D. Leonard E. Templeton, R.Ph. Heatwole C. Thomas, R.Ph. Erica Lynn Veasley, R.Ph. William D. Whitaker, R.Ph. Elizabeth Williams, R.Ph. Jonathon Williams, Pharm.D.

The Georgia Pharmacy Journal

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November 2011

Join Pharm PAC Today!

Pharm PAC is GPhA's Political Action Committee, providing the resources for the association to lobby and advocate on behalf pharmacy. GPhA leads the way in influencing pharmacy-related legislation in Georgia. There are two ways in which to become a member.

Once you have completed this form please mail it to Pharm PAC, 50 Lenox Pointe, NE, Atlanta, GA 30324.

Name: __________________________________________________ Address: _________________________________________________ Phone#: _________________________________________________ Email Address: ____________________________________________ Circle the Level in which you would like to participate with a monthly contribution: Titanium ($200/month) Platinum ($100/month) Silver ($25/month)

Gold ($50/month)

Bronze ($12.50/month)

Or If you wish to make a one time contribution write the amount you wish to contribute here: _____________________________________________ If you are making a monthly contribution you will be contacted for additional information to set up your monthly contribution. If you are making a one time payment please mail your check in with your form.

The Georgia Pharmacy Journal

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November 2011

Windy Hill Road Bridge Over I-75 Named for Bill Atkins, R.Ph. he state of Georgia honored retired state Rep. William A. “Bill” Atkins, Sr., R.Ph., of Smyrna by naming the Windy Hill Road bridge over I-75 named after him during an Oct. 17 ceremony. For safety considerations (it is a rather busy stretch of road), the noon ceremony took place at Howard’s Deli at 652 Concord Road in Smyrna. Many of Bill’s friends, family and colleagues joined him to celebrate this happy occasion.

T

Bill graduated from Mercer University Southern School of Pharmacy in 1954, and served patients in the Smyrna area in his practice. He represented Smyrna for several decades in the legislature, and served as the Director of Georgia Drugs and Narcotics for a number of years until his retirement. The resolution to name the bridge after him was sponsored by Democratic state Sens. Doug Stoner of Smyrna and Steve Thompson of Powder Springs.

Former state representative Bill Atkins is presented with a copy of the sign from long time friend Senator Steve Thompson.

(Left) Staff/Todd Hull

Former state representative Bill Atkins thanks all of his family and supporters for thier hard work during his time in office.

(Below) Staff/Todd Hull

Cake provided by friends and family honoring the long-time director of the Georgia Drugs and Narcotics Agency during which time he earned the nickname “Drug Czar.” (Left)

The Georgia Pharmacy Journal

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November 2011

GPhA MEMBER NEWS

Welcome to GPhA! The following is a list of new members who have joined Georgia’s premier professional pharmacy association! If you or someone you know would like to join GPhA go to www.gpha.org and click “Join” under the GPhA logo.

Nathan Greenfield, Suwanee Elizabeth Ashley Hickman, Augusta Marybeth T. Isley, Athens Oluwatobi Oluwaseyi John, Cumming Jis K. Joseph, Norcross

Individual Pharmacist Members Shirmil Clark, Pharm.D., Norcross Susan Lynn Sinclair, Sharpsburg

New Graduate Pharmacist Members Fasika T. Yigezu, Pharm.D., Austell

Pharmacy Technician Members Janet Denise Jackson, C.Ph.T, Athens Shlonda Merriweather, C.Ph.T., Thomson Latonya Tuwan Sheppard, C.Ph.T., Augusta

Pharmacy School Student Members Sonali Barkat Dinani, Villa Rica

Hit us With Your Best Shot!

Summit a photo of a GPhA member doing a great job in their practice along with a sentence telling us what is special about this pharmacist and their practice. We will publish the photo and the sentence in a future issue of the Journal.

Please send the high resolution (300 dpi or higher) photo and the sentence (100 words or less) to kmclendon@gpha.org.

If you have questions about this please contact Kelly McLendon at kmclendon@gpha.org or 404-419-8116.

BARBARA COLE ATTORNEY AT LAW, LLC 539 Green Street, NW Gainesville, GA 30501 678-971-9088 email bcoleattorney@gmail.com www.barbaracoleattorney.com All Aspects of Representation of Health Care Professionals Licensure Medicare Administrative Medicaid Criminal Bankruptcy Compliance State Bar Health Law Section Former Chief Magistrate Judge

We look forward to seeing what you are doing!

The Georgia Pharmacy Journal

16

November 2011

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The Office of Secretary of State

MEMORANDUM TO:

Georgia Pharmacists

FROM:

Georgia Board of Pharmacy

DATE:

September 22, 2011

RE:

Use of Security Paper for Hard Copy Prescription Drug Orders

Effective July 1, 2011, O.C.G.A.§ 26-4-80.1 was signed into law requiring that certain Schedule II prescriptions must be written on Board of Pharmacy approved security paper.

O.C.G.A. § 26-4-80.1. Use of security paper for hard copy prescription drug orders. (a) Effective October 1, 2011, every hard copy prescription drug order for any Schedule II controlled substance written in this state by a practitioner must be written on security paper. (b) A pharmacist shall not fill a hard copy prescription drug order for any Schedule II controlled substance from a practitioner unless it is written on security paper, except that a pharmacist may provide emergency supplies in accordance with the board and other insurance contract requirements. (c) If a hard copy of an electronic data prescription drug order for any Schedule II controlled substance is given directly to the patient, the manually signed hard copy prescription drug order must be on approved security paper that meets the requirements of paragraph (38.5) of Code Section 26-4-5. (d) Practitioners shall employ reasonable safeguards to assure against theft or unauthorized use of security paper and shall promptly report to appropriate authorities any theft or unauthorized use. (e) All vendors shall have their security paper approved by the board prior to marketing or sale in this state. (f) The board shall create a seal of approval that confirms that security paper contains all three industry recognized characteristics required by paragraph (38.5) of Code Section 26-4-5. The seal shall be affixed to all security paper used in this state. (g) The board may adopt rules necessary for the administration of this Code section. (h) The security paper requirements in this Code section shall not apply to: (1) Prescriptions that are transmitted to the pharmacy by telephone, facsimile, or electronic means; or (2) Prescriptions written for inpatients of a hospital, outpatients of a hospital, residents of a

237 Coliseum Drive ● Macon, Georgia 31217 ● (478) 207-2440 www.sos.ga.gov

nursing home, inpatients or residents of a mental health facility, or individuals incarcerated in a local, state, or federal correctional facility when the health care practitioner authorized to write prescriptions writes the order into the patient's medical or clinical record, the order is given directly to the pharmacy, and the patient never has the opportunity to handle the written order.

HISTORY: Code 1981, § 26-4-80.1, enacted by Ga. L. 2011, p. 659, § 5/SB 36.

On September 22, 2011, the Georgia Board of Pharmacy revised its policy regarding the Board’s seal for tamper resistant prescription paper:

Georgia State Board of Pharmacy Policy on Approval of Security Paper for Prescription Pads or Paper Adopted on 9-22-2011 All vendors, which produce security paper used in the printing or creation of pads of prescriptions to be used in this state, and which security paper contains all of the following criteria will be deemed to be an approved vendor by the Georgia State Board of Pharmacy: (1) One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form; (2) One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription form by the practitioner; and (3) One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

By meeting all of the criteria identified above, a vendor may market and sell security paper for use in the production of prescriptions and prescription pads in this state provided the vendor notifies the Board in writing and provides the Board a copy of the product. If the Board determines that the paper submitted does not meet the requirements listed above, the Board will notify the vendor in writing. The Board will maintain a list of approved vendors.

All approved security paper shall have the Board’s seal of approval affixed to the paper. The Board’s seal of approval, as shown below, will be ½ inch in diameter, with the text in the seal being Georgia font, with the Rx within the circle being a size of 9 pt, with the text “GEORGIA STATE BOARD OF PHARMACY” within the circle capitalized with a size of 4 pt, and the text “SEAL OF APPROVAL” underneath the Rx with a size of 3 pt and capitalized.

The seal as shown below is the official seal:

237 Coliseum Drive ● Macon, Georgia 31217 ● (478) 207-2440 www.sos.ga.gov

All approved security paper used to print or create a prescription shall bear an identifying lot number, and each individual prescription shall be numbered sequentially beginning with the number one.

The security paper requirements shall not apply to: (1) Prescriptions that are transmitted to the pharmacy by telephone, facsimile, or electronic means; or (2) Prescriptions written for inpatients of a hospital, outpatients of a hospital, residents of a nursing home, inpatients or residents of a mental health facility, or individuals incarcerated in a local, state, or federal correctional facility when the health care practitioner authorized to write prescriptions writes the order into the patient's medical or clinical record, the order is given directly to the pharmacy, and the patient never has the opportunity to handle the written order.

In the event a prescription pad or paper containing the Board seal, sequential numbering, and lot number is not available for the prescription and a medical health emergency exists, a prescription may be issued on paper meeting the requirements for approval for an amount of medication to cover not more than 30 days. The prescription must contain a statement that an emergency exists. All providers must have the board-approved security paper by December 31, 2011. This exception for emergencies only applies to prescriptions written before December 31, 2011.

237 Coliseum Drive â—? Macon, Georgia 31217 â—? (478) 207-2440 www.sos.ga.gov

Call for awards nominations...

The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA 137th Annual Convention in 2012. A brief description and criteria of each award is included below. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 1, 2012. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at GPhA’s 137th Annual Convention at the Hilton Head Marriott Resort & Spa on Hilton Head Island

Bowl of Hygeia Award Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has an outstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist Award Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of GPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate in association and community activities, and 2) To annually recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programs or activities and community service projects.

Innovative Pharmacy Practice Award This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.

2012 Awards Nomination Form Bowl of Hygeia

Distinguished Young Pharmacist

Innovative Pharmacy Practice Award

Nominee’s Full Name _______________________________________________ Nickname ___________________ Home Address _________________________________________ City _______________ State _____ Zip ______ Practice Site __________________________________________________________________________________ Work Address __________________________________________ City _______________ State _____ Zip ______ College/School of Pharmacy _____________________________________________________________________ List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Supporting information: _________________________________________________________________________ ____________________________________________________________________________________________ Submitted by (optional): _________________________________________________________________________ Submit this form completed by March 1, 2012 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

The Georgia Pharmacy Journal

22

November 2011

Member News

Leadership Georgia Class of 2012 Includes GPhA Members Chapman and Knight

Your license is your livelihood.

Protect it!

eadership Georgia is delighted to announce its 2012 Class. This group of 60 leaders selected from nominations and individual applications were impressive and the process yielded a high caliber group of representatives from our growing state. This group of leaders includes the Georgia Pharmacy Association members Liza Chapman of Dawsonville and Kasey Knight of Quitman.

L

Frances Cullen PC Professional Licensing Attorney (404) 806-6771 6771 phone (404) 806-7319 fax www.francullen.com

Liza has served in many leadership positions within GPhA and is an employee pharmacist with the Kroger Company, Atlanta Division.

Practice devoted solely to the representation of licensed professionals Over 20 years of experience with licensed professionals, Georgia Boards, GDNA & DEA Former Assista tant nt District Attorney Former Assistant Attorney General Criminal & License Defense

Kasey is a member of the staff of Lee & Pickels Drugstore and has been a member of GPhA since 2009.

We congratulate these two leaders and look forward to their future role in GPhA.

20th Annual Winter CE Seminar

Westin Riverfront Resort & Spa at Beaver Creek Mtn. in the Vail Valley-Avon, CO

January 8-11, 2012

15 hours of CE 7-9 am & 4:30-6:30 pm Full, "First Tracks" and other CE registration options Gondola at Ski Valet door Social dinner & reception; Lodging, rental & lift discounts.

Visit www.copharm.org to JOIN US!

admin@copharm.org

303-756-3069

"As a first time attendee, this program FAR exceeded my expectations. Its no wonder you’re celebrating the 20th one next year.� ....2011 guest

The Georgia Pharmacy Journal

23

November 2011

continuing education for pharmacists Dietary Supplementation of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty Acids Mona T. Thompson, R.Ph., PharmD 'U 7KRPSVRQ KDV QR UHOHYDQW ÀQDQFLDO UHODWLRQVKLSV WR GLVFORVH

Goal. The goal of this lesson is to provide information on select vitamins and supplements, with emphasis on the current consumption recommendations in adults.

Objectives. At the conclusion of

this lesson, successful participants should be able to: 1. list the recommended daily allowance, adequate intake, and tolerable upper intake level for each supplement discussed; UHFRJQL]H WKH KHDOWK EHQHĂ€WV that each supplement provides, as well as the risk of excessive use; 3. identify the current indications for which supplementation is supported, based on recent evidence-based literature; and 4. demonstrate an understanding of pertinent patient counseling advice regarding selection and use of over-the-counter (OTC) supplements, including drug-drug interactions, and regulatory information.

a survey conducted by the Centers IRU 'LVHDVH &RQWURO DQG 3UHYHQWLRQ &'& IRXQG WKDW ELOOLRQ out-of-pocket dollars were spent

by Americans on complementary and alternative medicine self-care products. In the midst of a media LQĂ XHQFHG LQIRUPDWLRQ RYHUORDGHG and self-care, health-seeking population, it is important that health care professionals assist the lay public in deciphering the data in order to make sound and healthy decisions about OTC supplementation.

In order to assess and guide nutrient intake, the Food and Nutrition Board (FNB) has developed reference intake values. These 'LHWDU\ 5HIHUHQFH ,QWDNHV '5,V

DUH GHĂ€QHG LQ 7DEOH It is important to note that while dietary supplements are UHJXODWHG E\ WKH )RRG DQG 'UXJ $GPLQLVWUDWLRQ )'$ WKH\ DUH QRW regulated in the same manner that medications are. In fact, dietary supplements do not require premarket review or approval. Manufacturers do have a responsibility to ensure that their products are safe and that the labeling is clear and truthful. However, they do

Background and General Information Regarding Supplementation

7KH 2IĂ€FH RI 'LHWDU\ 6XSSOHPHQWV 2'6 ZKLFK RSHUDWHV ZLWKLQ WKH National Institute of Health (NIH), reported that in 2004, Americans spent 20.3 billion dollars on dietary supplements. Among Americans 20 years of age and older, 52 percent reportedly are taking at least one supplement with the greatest percentage found in adults greater than 60 years. In addition, in 2007,

The Georgia Pharmacy Journal

not need to provide this informaWLRQ WR WKH )'$ SULRU WR PDUNHWLQJ 6XSSOHPHQW PDQXIDFWXUHUV are also permitted to print health EHQHĂ€W FODLPV RQ WKH ODEHO DV ORQJ as it is followed by the words, “This statement has not been evaluated E\ WKH )RRG DQG 'UXJ $GPLQLVWUDtion. This product is not intended to diagnose, treat, cure, or prevent any disease.â€? Consumers should be advised that not all supplements may be manufactured to the same standard. A list of independent organizations that offer “seals of approvalâ€? can be found in Table 2.

These organizations only test the product to verify that it is free of contaminants and contains the ingredients listed on the label. They do not test the product for safety or HIĂ€FDF\

Vitamin D

9LWDPLQ ' LV D IDW VROXEOH YLWDPLQ that is obtained endogenously when ultraviolet radiation strikes the skin initiating synthesis, or when it is consumed through food and supplements. In supplements DQG IRRG YLWDPLQ ' LV DYDLODEOH DV ergocalciferol and cholecalciferol.

The forms are considered equiva-

Table 1 Dietary reference intakes 5HFRPPHQGHG 'LHWDU\ $OORZDQFH 5'$

$YHUDJH GDLO\ OHYHO RI LQWDNH VXIĂ€FLHQW WR PHHW WKH QXWULHQW UHTXLUHPHQWV RI nearly all healthy people

$GHTXDWH ,QWDNH $,

(VWDEOLVKHG ZKHQ HYLGHQFH LV LQVXIĂ€FLHQW WR GHYHORS DQ 5'$ DQG LV VHW DW D OHYHO assumed to ensure nutritional adequacy

Tolerable Upper Intake Level (UL)

24

Maximum daily intake unlikely to cause adverse health effects

November 2011

Table 2 Organizations that verify dietary supplement manufacturing Organization Consumer Lab

Website www.consumerlab.com

8 6 3KDUPDFRSHLD 'LHWDU\ 6XSSOHPHQW ZZZ XVS RUJ 8639HULĂ€HG GLHWDU\ 9HULĂ€FDWLRQ 3URJUDP 6XSSOHPHQWV 1DWXUDO 3URGXFWV $VVRFLDWLRQ 7UX/DEHO 3URJUDP

lent and effectively raise [25(OH) '@ OHYHOV WKH SK\VLRORJLFDOO\ DFWLYH IRUP RI YLWDPLQ ' DOVR NQRZQ DV calcitriol. It is the result of two hyGUR[\ODWLRQ VWHSV WKDW RFFXU ÀUVW LQ the liver and second in the kidney.

9LWDPLQ ' LV PRVW FRPPRQO\ known for its role in allowing the absorption of calcium from the gut, and for enabling normal bone growth and bone remodeling by osteoclasts and osteoblasts. It has an accepted role in the prevention and treatment of osteoporosis, and FOLQLFDO WULDOV KDYH FRQĂ€UPHG LWV role in decreasing bone fractures.

2WKHU IXQFWLRQV RI YLWDPLQ ' LQclude adjusting cell growth, neuromuscular and immune function, DQG UHGXFWLRQ RI LQĂ DPPDWLRQ While some foods naturally FRQWDLQ YLWDPLQ ' VNLQ RI VDOPRQ tuna, and mackerel; cheese; and HJJ \RONV IRUWLĂ€HG IRRGV VXFK as milk, orange juice, yogurt and breakfast cereals provide most of WKH YLWDPLQ ' LQ WKH $PHULFDQ diet. An eight-ounce glass of milk FRQWDLQV ,8 RI YLWDPLQ ' Also, sun exposure initiates YLWDPLQ ' V\QWKHVLV LQ WKH ERG\ DOWKRXJK LW LV GLIĂ€FXOW WR SUHGLFW WKH DPRXQW 6XQVFUHHQ ZKLFK LV recommended by the American $FDGHP\ RI 'HUPDWRORJ\ WR UHGXFH the risk of skin cancer, can reduce WKH DPRXQW RI YLWDPLQ ' SURGXFHG from sun exposure. *URXSV DW ULVN RI YLWDPLQ ' GHĂ€FLHQF\ LQFOXGH ROGHU DGXOWV DQG persons with limited skin exposure, dark skin, or malabsorption of viWDPLQ ' REHVH LQGLYLGXDOV RU WKRVH who have undergone gastric bypass

The Georgia Pharmacy Journal

ZZZ QSDLQIR RUJ

surgery, as well as those who are taking medications that accelerate WKH PHWDEROLVP RI YLWDPLQ ' 9LWDPLQ ' KDV UHFHQWO\ JDLQHG the attention of the medical, public health, and lay communities for its SRWHQWLDO DQWL FDQFHU EHQHĂ€WV DV well as in the prevention and treatment of other conditions including diabetes, glucose intolerance, hypertension, multiple sclerosis, and cardiovascular disease.

The Institute of Medicine (IOM) assembled a committee to essentially determine which health RXWFRPHV DUH LQĂ XHQFHG E\ YLWDPLQ ' DQG RU FDOFLXP KRZ PXFK YLWDPLQ ' DQG FDOFLXP LV QHHGHG DQG KRZ PXFK YLWDPLQ ' LV WRR PXFK In November of 2010, the IOM released a report concluding that bone health was the only outcome that was supported by research and established a cause and effect,

dose-response relationship with YLWDPLQ ' DQG FDOFLXP LQWDNH For cancer, cardiovascular disease, diabetes, falls, autoimmune disorders, and other extraskeletal disease outcomes, the evidence was inconsistent and inconclusive.

Therefore, despite the eagerness WR WUHDW VXESDU YLWDPLQ ' OHYHOV WKH DGGLWLRQDO SURFODLPHG EHQHĂ€WV must still be viewed as hypothesis.

Large scale randomized clinical trials, designed with these primary outcomes mentioned, have not yet been conducted and are desired.

The IOM report also suggested a U-shaped risk analysis curve for several outcomes related to vitamin ' SURSRVLQJ WKDW PRGHUDWH VHUXP OHYHOV RI YLWDPLQ ' PD\ EH RSWLmal, and that the risk of disease increased at both low and high OHYHOV RI YLWDPLQ ' 0RVW H[SHUWV agree that serum concentration of > 2+ '@ VKRXOG EH PDLQWDLQHG EHWZHHQ QJ PO OHYHO JUHDWHU than 20 supports healthy bones), and new data suggest that there may be health risks associated ZLWK OHYHOV DERYH QJ PO The committee also updated WKH '5,V IRU ERWK FDOFLXP DQG YLWDPLQ ' ZKLFK KDG EHHQ ODVW examined in 1997. The adult values DUH OLVWHG LQ 7DEOH DQG UHĂ HFW the total amount that should be consumed through diet and supplementation.

Various repletion regimens

Table 3 Calcium and vitamin D dietary reference intakes by life stage Life stage and gender

Calcium Vitamin D 5'$ PJ GD\ 8/ ,8 GD\ 5'$ PJ GD\

8/ PJ GD\

19-30 yr (M+F) 31-50 yr (M+F) 51-70 yr (M) 51-70 (F) 71+ (M+F) 19-50 yr pregnant or lactating

1000 1000 1000 1200 1200 1000

4000 4000 4000 4000 4000 4000

2500 2500 2000 2000 2000 2500

600 600 600 600 800 600

&KDUW DGDSWHG IURP ,20 5HSRUW RQ &DOFLXP DQG 9LWDPLQ ' 5HTXLUHPHQWV 0 PDOH ) IHPDOH 5'$ UHSUHVHQWV LQWDNH WKDW FRYHUV ! RU SHUFHQW RI SRSXODWLRQ IRU WKDW OLIH VWDJH

25

November 2011

have been found to be effective for YLWDPLQ ' GHĂ€FLHQW DGXOWV $GXOWV ZLWK > 2+ '@ VHUXP OHYHOV QJ PO DUH RIWHQ UHSOHWHG ZLWK 50,000 units (calciferol or ergocalciferol) weekly for six to eight weeks, followed by 600 to 800 units GDLO\ 3DWLHQWV VSHFLĂ€FDOO\ WUHDWHG IRU YLWDPLQ ' GHĂ€FLHQF\ GR UHTXLUH IROORZ XS > 2+ '@ VHUXP WHVWLQJ and the dose may require further adjustment. However, healthy DGXOWV FRQVXPLQJ WR XQLWV day for supplementation do not require lab monitoring. ([FHVVLYH YLWDPLQ ' VXSSOHmentation is associated with negative consequences. It can cause anorexia, weight loss, polyuria, and heart arrhythmias. It can also raise blood levels of calcium leading to YDVFXODU DQG WLVVXH FDOFLĂ€FDWLRQ damaging the heart, blood vessels, and kidneys.

Calcium

Calcium is an essential dietary mineral that is commonly found in milk, yogurt, cheese, and dark green vegetables. Many foods are DOVR IRUWLÀHG ZLWK FDOFLXP VXFK DV orange juice, cereal and bread. An eight ounce glass of milk or fortiÀHG RUDQJH MXLFH FRQWDLQV PJ RI elemental calcium. It is not produced by the body and, therefore, must be consumed through food and supplements. Calcium is a major component of bones and teeth and is needed for proper function of the heart, muscle, and nerves.

In recent years, calcium has been studied for its potential role LQ FDQFHU SUHYHQWLRQ VSHFLĂ€FDOO\ colorectal cancer. Numerous large scale randomized studies have been conducted to determine if an association between calcium supplementation ranging from 500 PJ GD\ DQG FRORUHFWDO FDQFHU existed. Although the studies did not consistently result in a statistical difference in colorectal cancer risk reduction, the World Cancer 5HVHDUFK )XQG $PHULFDQ ,QVWLWXWH IRU &DQFHU 5HVHDUFK SXEOLVKHG a report in 2007 concluding that calcium probably has a protective effect against colorectal cancer.

The Georgia Pharmacy Journal

Other studies suggest that high calcium intake may increase the risk of prostate cancer while the available information regarding a relationship between calcium and breast cancer is inconsistent.

3UHVHQWO\ WKH 1DWLRQDO &DQFHU Institute does not recommend calcium supplements to reduce the incidence of colorectal or any other type of cancer due to inconsistent data.

In patients requiring calcium supplementation for the prevention or treatment of osteoporosis, calcium carbonate and calcium citrate are most often used. Calcium carbonate is generally more affordable. It is absorbed better when taken with a meal, and requires the presence of chloride.

Calcium citrate is well absorbed in both the fasting and fed state. Its absorption is not affected in patients taking proton pump inhibitors or H2 blockers where chloride is decreased.

5HFRPPHQGHG GLHWDU\ DOORZances for calcium are based on elemental calcium and are listed on Table 3. Calcium carbonate contains only 40 percent elemental calcium which means that a 1250mg tablet actually delivers 500mg of FDOFLXP 'RVHV JUHDWHU WKDQ PJ of elemental calcium should be divided.

While calcium supplementation is generally considered safe when the UL (tolerable upper intake level) is not exceeded, those consuming calcium supplements in addition to substantial amounts through the diet, or even multivitamin products, may be at risk of developing kidney stones. Other risks of excessive calcium consumption, especially in the presence of kidney disease, include hypercalcemia and kidney failure. Excessive intake of milk and some types of antacids (which contain calcium carbonate or sodium bicarbonate) over an extended period of time can result in milk-alkali syndrome, an acquired condition in which there are high levels of calcium and a shift in the ERG\¡V DFLG EDVH EDODQFH WRZDUGV alkaline (metabolic alkalosis). This

26

Table 4 Potential indicators of adverse outcomes associated with excess intake of calcium and vitamin D Calcium Hypercalcemia Hypercalciuria 9DVFXODU DQG VRIW WLVVXH FDOFLĂ€FDWLRQ Nephrolithiasis (kidney stones) 3URVWDWH FDQFHU Interactions with iron and zinc Constipation Vitamin D Intoxication and related hypercalcemia and hypercalciuria Elevated serum calcium Emerging evidence for all cause mortality, cancer, cardiovascular risk, falls, and fractures JAMA, February 2, 2011 Vol 305, No. 5

condition can also lead to calcium deposits in the kidneys and other tissues, as well as kidney failure.

Table 4 includes adverse outcomes associated with excessive intake of FDOFLXP DQG YLWDPLQ '

Vitamin E

Vitamin E is a fat-soluble antioxidant that is found naturally in some foods, added to others, and available as a dietary supplement.

It occurs in eight different forms, while only the alpha-tocopherol form is recognized to meet human requirements. Nuts, seeds, vegetable oils, green leafy vegetables, DQG IRUWLĂ€HG FHUHDOV DUH WKH EHVW sources of alpha-tocopherol. VitaPLQ ( GHĂ€FLHQF\ LV UDUH DQG REYLRXV GHĂ€FLHQF\ V\PSWRPV KDYH QRW been found in healthy individuals who obtain little vitamin E from their diets.

Vitamin E’s potential to prevent and treat disease is based on its function as an antioxidant, as well as its role in the antiLQà DPPDWRU\ SURFHVVHV LQKLELWLRQ of platelet aggregation, and immune enhancement. Antioxidants protect cells from the damaging effects of free radicals, which are molecules that contain an un-

November 2011

only for those with LQWHUPHGLDWH $0' LQ one or both eyes, or DGYDQFHG $0' LQ RQH Male Female Pregnant Lactating H\H $0' GLDJQRVLV 5'$ \UV

PJ ,8

PJ ,8

PJ ,8

PJ ,8

PXVW EH FRQĂ€UPHG E\ an eye care profesUL (14-18 yrs) 800mg (1200 IU) 800mg (1200 IU) 800mg (1200 IU) 800mg (1200 IU) sional.

UL (19 yrs+) 1000mg (1500 IU) 1000mg (1500 IU) 1000mg (1500 IU) 1000mg (1500 IU) Most vitamin E supplements provide UL refers to all forms of supplemental alpha-tocopherol at least 100 IU of the nutrient, which is substantially greater than the DYHUDJH RI ÀYH DQG RQH KDOI \HDUV shared electron. Free radicals 5'$V ([FHVVLYH LQWDNH RI DOSKD of data, they found that the vitadamage cells and may contribute tocopherol supplementation may min E or selenium taken alone, or to the development of cardiovascucause hemorrhagic effects. Table in combination with each other, did lar disease and cancer. Unshared 5 lists the established adequate not prevent prostate cancer. Thereelectrons are highly energetic and intake and upper tolerable limit for fore, study participants were told react rapidly with oxygen to form vitamin E. to discontinue their supplements.

UHDFWLYH R[\JHQ VSHFLHV 526

Table 5 Adult dietary reference intake for vitamin E

7KH ERG\ IRUPV 526 HQGRJHQRXVO\ when it converts food to energy, and antioxidants might protect cells from the damaging effects of 526 $V DQ DQWLR[LGDQW YLWDPLQ ( VWRSV WKH SURGXFWLRQ RI 526 IRUPHG when fat undergoes oxidation. In addition, vitamin E increases the expression of two enzymes that suppress arachidonic acid metabolism, which increases the release of prostacyclin from the endothelium, leading to dilated blood vessels and inhibition of platelet aggregation.

In 2003, the Agency for HealthFDUH 5HVHDUFK DQG 4XDOLW\ $+54

published two evidence reports resulting from extensive literature searches examining the effects of vitamin E (as well as vitamin & DQG FRHQ]\PH 4 7KH ÀUVW report was focused on the prevention and treatment of cancer, and the second looked at the prevention and treatment of cardiovascular GLVHDVH &9' RU PRGLÀFDWLRQV RI NQRZQ ULVN IDFWRUV IRU &9' Neither evaluation concluded with support for vitamin E supplementation.

0RUH UHFHQWO\ WKH 6(/(&7 6HOHQLXP DQG 9LWDPLQ ( &DQFHU 3UHYHQWLRQ 7ULDO WULDO ZDV SUHmaturely halted in 2008. The trial was designed to show a 25 percent reduction in prostate cancer with each supplement alone or in combination. When the Independent 'DWD DQG 6DIHW\ 0RQLWRULQJ &RPmittee met in 2008 to review an

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:KLOH QR VWDWLVWLFDOO\ VLJQLĂ€FDQW differences were found between the groups, there was a larger number of cases of prostate cancer in men taking vitamin E alone. This difference could have occurred by chance.

Another published clinical trial in 2008 that examined the use of vitamin E (400 IU every other day) DQG RU YLWDPLQ & PJ GDLO\ LQ men’s cardiovascular health found no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, or cardiovascular mortality. In addition, the use of vitamin E was associated with a VLJQLÀFDQWO\ LQFUHDVHG ULVN RI KHPorrhagic stroke.

However, a formulation consisting of vitamin E (400 IU), vitamin C (500mg), beta-carotene (15mg), zinc (80mg), and copper (2mg) was clinically proven to slow the progression of age-related macular GHJHQHUDWLRQ $0' ZKLFK LV WKH PRVW FRPPRQ FDXVH RI VLJQLĂ€FDQW vision loss in older adults. The $JH 5HODWHG (\H 'LVHDVH 6WXG\ $5('6 ZDV D ODUJH UDQGRPL]HG trial that concluded that particiSDQWV ZLWK HDUO\ VWDJH $0' FRXOG slow the progression of their disease by taking this combination for an average of 6.3 years, compared to participants taking a placebo.

7KH VSHFLĂ€F FRPELQDWLRQ LV QRZ marketed by Bausch and Lomb XQGHU WKH WUDGHPDUN 3UHVHU9LVLRQÂŽ eye vitamin and is recommended

27

Omega-3 Fatty Acids (Fish Oil)

The supplement omega-3 fatty acids is known in most households as WKH WHUP ´ÀVK RLOV ¾ $OSKD OLQROHLF acid (ALA) is a polyunsaturated fatty acid structurally recognized as an omega-3 fatty acid. It is converted in the body to eicosaSHQWDHQRLF DFLG (3$ DQG GRFRVDKH[DHQRLF DFLG '+$ (3$ DQG '+$ DUH IRXQG LQ IDWW\ FROG ZDWHU ÀVK VXFK DV VDOPRQ PDFNHUHO DQG herring; hence the term ÀVK RLOV. In addition, ALA is also present in leafy green vegetables, nuts, vegetable oils such as canola and soy, DQG à D[VHHG DQG à D[VHHG RLO /LQROHLF DFLG /$ LV FODVVLÀHG as an omega-6 fatty acid with a slightly different structure and is converted to arachidonic acid (AA).

AA is further converted to leukotrienes and prostaglandins which SOD\ D UROH LQ LQĂ DPPDWLRQ DQG will be discussed later in this lesson. Omega-6 fatty acids are more convenient to eat as LA is found in meat as well as soybean, safĂ RZHU VXQĂ RZHU DQG FRUQ RLOV DQG processed foods.

Neither form can be synthesized by the body and both are an important part of our diet. Most Americans consume far more omega-6 fatty acids than is required and not enough omega-3. The IOM has established the adult adequate LQWDNH IRU $/$ DQG /$ DV J

November 2011

GD\ DQG J GD\ UHVSHFWLYHO\ 2IĂ€FLDO '5,V DUH QRW DYDLODEOH IRU '+$ DQG (3$ ,W LV QRW NQRZQ whether a desirable ratio of omega-3 to omega-6 fatty acids exist, or to what extent excessive intakes of omega-6 fatty acids interfere with WKH EHQHĂ€WV RI RPHJD FRQVXPStion since their byproducts are metabolized by the same pathways and competition may exist.

The role of omega-3 fatty acids, VSHFLÀFDOO\ WKH ÀVK RLOV '+$ DQG (3$ LQ WKH UHGXFWLRQ RI FDUGLRvascular disease has been well accepted. In the 1970s, it was noted WKDW SRSXODWLRQV ZLWK KLJK ÀVK FRQsumption, such as Eskimos, experienced relatively low cardiovascular mortality.

A systematic review of studies examining the dietary and supplemental omega-3 fatty acids affect on primary and secondary cardiovascular outcomes was conducted E\ WKH 7XIWV (YLGHQFH 3UDFWLFH &HQWHU DQG IXQGHG E\ WKH $+54 The evidence supported the hypothesis that the consumption of omega-3 fatty acid supplements, ÀVK DQG ÀVK RLO UHGXFHV DOO FDXVH mortality and outcomes such as sudden death, cardiac death, and myocardial infarction, with the strongest evidence in support of ÀVK DQG ÀVK RLO 7KHVH SK\VLRORJLF HIIHFWV RI ÀVK RLO FRQVXPSWLRQ DUH thought to occur within weeks of routine consumption and are likely a result of altered cell membrane à XLGLW\ DQG UHFHSWRU UHVSRQVHV following the incorporation of polyunsaturated fatty acids into cell membranes. At typical dietary intakes, antiarrhythmic effects predominate, which is presumed to be responsible for the decreased incidence of sudden cardiac death DQG &9' $W KLJKHU GRVHV VXFK DV PJ WR PJ GD\ VHUXP triglyceride levels may be reduced by as much as 25 to 30 percent in a dose dependent fashion. Also, HYLGHQFH KDV VKRZQ WKDW ÀVK RLO FRQVXPSWLRQ ORZHUV V\VWROLF %3 E\ approximately 3 to 5mm Hg, and GLDVWROLF %3 E\ DSSUR[LPDWHO\ WR 3mm Hg. This is due to reductions in systemic vascular resistance,

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with a dose-response that appears more linear at lower (dietary) doses, and plateaus at higher (supplement) doses. Although not found WR EH VWDWLVWLFDOO\ VLJQLĂ€FDQW KHDUW rate may also be reduced by 1.6 beats per minute. The clinical risk decrease associated with reduced triglycerides is a result of a higher dose and longer duration of supplementation than what is required to reduce coronary mortality.

0RUH UHFHQWO\ ÀVK RLO VXSSOHPHQWDWLRQ VSHFLÀFDOO\ '+$ KDV gained the attention of pregnant ZRPHQ '+$ LV D QHFHVVDU\ VWUXFtural component of the brain and eye. While data are limited, they VXJJHVW WKDW ÀVK RLO VXSSOHPHQWV DQG GLHWDU\ ÀVK FRQVXPSWLRQ GXUing the pre- and post-natal periods SRVVHVV EHQHÀWV RQ QHXURGHYHORSment and cognitive outcome of RIIVSULQJ +RZHYHU SUHQDWDO ÀVK intake remains controversial as PRVW ÀVK DUH FRQWDPLQDWHG ZLWK organic methyl mercury. Exposure to mercury in fetal life causes widespread neurological damage, such as delayed developmental milestones, blindness, deafness, and cerebral palsy. Methyl mercury is well absorbed following ingestion and readily crosses the blood brain barrier and placenta. It cannot be FRRNHG RXW RI ÀVK 7DEOH VXPPDUL]HV WKH (3$ (QYLURQPHQWDO 3URWHFWLRQ $JHQF\

DQG )'$ MRLQW FRQVXPHU DGYLVRU\ to assist pregnant and lactating PRWKHUV DFKLHYH WKH EHQHÀW RI '+$ ZKLOH PLQLPL]LQJ WKH KHDOWK risks caused by methyl mercury DQG RWKHU FRQWDPLQDQWV 3UHVently, worldwide expert panels have recommended that pregnant and lactating women should aim WR DFKLHYH DQ DYHUDJH GLHWDU\ '+$ LQWDNH RI DW OHDVW PJ WR PJ GD\ IURP D ÀVK WKDW LV NQRZQ WR contain low levels of mercury.

6XSSOHPHQWV FRQWDLQLQJ HLWKHU ÀVK RLO RU '+$ V\QWKHVL]HG E\ algae are also available in a variety of doses and special formulations for pregnant women. Because these supplements are low in mercury and contaminants, they provide DQ DWWUDFWLYH DOWHUQDWLYH WR ÀVK

28

Table 6 Joint EPA and FDA dietary fish intake advisory The following advisory has been issued for women who might become pregnant, women who are pregnant, and nursing mothers.

'R QRW HDW VKDUN VZRUGĂ€VK RU king mackerel. They contain high levels of mercury.

2. Eat up to 12 ounces (2 meals) per ZHHN RI D YDULHW\ RI Ă€VK DQG VKHOOĂ€VK that are low in mercury. Five of the PRVW FRPPRQO\ HDWHQ Ă€VK WKDW DUH low in mercury are shrimp, canned light tuna, salmon, pollock, and FDWĂ€VK NOTE. Albacore “whiteâ€? tuna has more mercury than canned light tuna – limit albacore consumption to 6 ounces (1 meal) per week.

3. Check with local advisories about WKH VDIHW\ RI ÀVK FDXJKW E\ IDPLO\ and friends in local lakes, rivers, and coastal areas. If no advice is available, limit weekly consumption to 6 ounces (1 meal) for that week.

Adapted from “What you need to know DERXW PHUFXU\ LQ Ă€VK DQG VKHOOĂ€VKÂľ IURP WKH (3$ DQG )'$

consumption even though some GLHWDU\ FRQVXPSWLRQ RI ÀVK LV VWLOO recommended by experts.

(3$ DQG '+$ DUH K\SRWKesized to reduce the synthesis of WKH SURLQà DPPDWRU\ VXEVWDQFHV prostaglandins and leukotrienes, by competitive inhibition. These lipid compounds are otherwise a product of the oxidation of arachiGRQLF DFLG 7KHUHIRUH ÀVK RLOV have been postulated to play a role LQ VHYHUDO LQà DPPDWRU\ GLVHDVHV such as asthma, rheumatoid arthriWLV LQà DPPDWRU\ ERZHO GLVHDVH and systemic lupus erythematosus.

Currently, no conclusions have EHHQ GUDZQ EDVHG RQ VFLHQWLÀF evidence that support supplementation for these diseases with the exception that these fatty acids can reduce joint tenderness and the need for corticosteroids in rheumatoid arthritis. $V SUHYLRXVO\ PHQWLRQHG ÀVK oil supplements are available in various doses and formulations.

Currently, one prescription formu-

November 2011

Table 7 Select drug interactions with vitamins D and E, calcium, and fish oil Supplement 9LWDPLQ '

Second agent &KROHVW\UDPLQH 2UOLVWDW 3KHQREDUELWDO

Interaction 5HGXFHG YLWDPLQ ' DEVRUSWLRQ 5HGXFHG YLWDPLQ ' DEVRUSWLRQ $OWHUHG YLWDPLQ ' DEVRUSWLRQ

&DOFLXP

3KHQREDUELWDO 3KHQ\WRLQ 3UHGQLVRQH 4XLQRORQH DQWLELRWLFV

,URQ 7K\URLG KRUPRQHV

5HGXFHG FDOFLXP DEVRUSWLRQ 5HGXFHG FDOFLXP DEVRUSWLRQ ,QWHUIHUHV ZLWK FDOFLXP DEVRUSWLRQ 'HFUHDVHG DEVRUSWLRQ RI TXLQRORQH antibiotic 5HGXFHG LURQ DEVRUSWLRQ 5HGXFHG OHYHOV DQG HIIHFW RI WK\URLG hormone

Vitamin E

Vitamin K antagonists (warfarin) &KHPRWKHUDS\

Tipranavir oral solution

)LVK 2LO

$QWLSODWHOHWV $QWLFRDJXODQWV

lation is available. LOVAZAŽ (omega-3-acid ethyl esters) is indicated as an adjunct to diet to reduce triglyceride (TG) levels in adult SDWLHQWV ZLWK VHYHUH • PJ G/

hypertriglyceridemia. It is available in a 1gm soft gelatin capsule; the daily recommended dose is 4gm which can be divided in two doses if desired. LOVAZAŽ contains ethyl esters of omega-3 fatty acids REWDLQHG IURP VHYHUDO ÀVK VRXUFHV 7KHUHIRUH DV ZLWK RWKHU ÀVK RLO supplements, patients with allerJLHV WR ÀVK DQG RU VKHOOÀVK DUH DW an increased risk of allergic reactions and should use the product with caution. &RQVXPSWLRQ RI ÀVK RLO LV JHQHUDOO\ VDIH 6LGH HIIHFWV DUH JHQHUally mild and include eructation (belching), dyspepsia, vomiting, GLDUUKHD DQG WDVWH SHUYDVLRQ ÀVK\ WDVWH +LJK GRVH ÀVK RLO PJ day) does increase bleeding time; however, it has not been associated with higher rates of clinical bleeding. Consumers taking other medications that alter coagulation should be monitored and take

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May increase the effect of warfarin

cardiovascular disease and cancer.

Yet, a combination product containing vitamin E has been shown to slow the progression of age-related macular degeneration. Finally, ÀVK RLOV DUH ZLGHO\ DFFHSWHG IRU their contribution to cardiovascular health and reduction of sudden death, cardiac death, and myocarGLDO LQIDUFWLRQ '+$ FRQVXPSWLRQ SUHIHUDEO\ IURP GLHWDU\ ÀVK LV generally recommended for pregnant and lactating mothers for its EHQHÀFLDO UROH LQ WKH H\H QHXURGHvelopment, and cognitive outcome of the offspring.

6HOHFW NQRZQ GUXJ LQWHUDFWLRQV with the agents listed in the lesson are listed in Table 7.

0D\ UHGXFH HIĂ€FDF\ RI FKHPRWKHUDS\ by inhibiting oxidative damage to cancerous cells Oral solution contains vitamin E; therefore additional vitamin E should be avoided )LVK RLO PD\ SURORQJ EOHHGLQJ WLPH DQG PD\ HQKDQFH DQWLSODWHOHW anticoagulant effect

Ă€VK RLOV XQGHU WKH VXSHUYLVLRQ RI D healthcare provider.

Summary

In summary, dietary supplementation has dramatically increased over the last decade and consumers are taking a more active role in self care and preventing disease.

3KDUPDFLVWV FDQ SOD\ DQ LPSRUWDQW role in assisting the lay public in understanding not only the safety SURĂ€OHV RI WKHVH VXSSOHPHQWV EXW also the indications for which supplementation is supported. All supplements are not alike and pharmacists should aid consumers in selecting products from reliable manufacturers. &DOFLXP DQG YLWDPLQ ' DUH FXUrently indicated for skeletal disease only and play a critical role in bone health. Large scale randomized trials are underway to determine WKH UROH WKDW YLWDPLQ ' PD\ SOD\ LQ cardiovascular disease. While antioxidant therapy seemed promising at one time, vitamin E studies have failed to provide consistent data in their role in the prevention of

29

7KH DXWKRU WKH 2KLR 3KDUPDFLVWV )RXQGDWLRQ DQG WKH 2KLR 3KDUPDFLVWV $VVRFLDWLRQ GLVFODLP DQ\ OLDELOLW\ WR \RX RU \RXU SDWLHQWV UHVXOWLQJ IURP UHOLDQFH VROHO\ XSRQ WKH LQIRUPDWLRQ FRQWDLQHG KHUHLQ %LEOLRJUDSK\ IRU DGGLWLRQDO UHDGLQJ DQG LQTXLU\ LV DYDLODEOH XSRQ UHTXHVW

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

To receive CE credit, your quiz must be postmarked no later than August 15, 2014. A passing grade of 80% must be attained.

Program 0129-0000-11-052-H01-P 5HOHDVH GDWH Expiration date: 8-15-14

CE Hours: 1.5 (0.15 CEU) 7KH 2KLR 3KDUPDFLVWV )RXQGDWLRQ ,QF is accredited by the Accreditation CounFLO IRU 3KDUPDF\ (GXFDWLRQ DV D SURYLGHU of continuing pharmacy education.

November 2011

2011 - 2012 GPhA BOARD OF DIRECTORS

The Georgia Pharmacy Journal Editor:

Jim Bracewell jbracewell@gpha.org

Managing Editor & Designer:

Kelly McLendon kmclendon@gpha.org

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2011, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, officers or members of the Georgia Pharmacy Association.

ARTICLES AND ARTWORK Those who are interested in writing for this publication are encouraged to request the official GPJ Guidelines for Writers. Artists or photographers wishing to submit artwork for use on the cover should call, write or e-mail the editorial offices as listed above.

SUBSCRIPTIONS AND CHANGE OF ADDRESS The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324.

Periodicals postage paid at Atlanta, GA and additional offices.

POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

ADVERTISING Advertising copy deadline and rates are available at www.gpha.org upon request. All advertising and production orders should be sent to the GPhA headquarters as listed above.

Name

Position

Dale Coker Jack Dunn Robert Hatton Pam Marquess Bobby Moody Robert Bowles Hugh Chancy Keith Herist Eddie Madden Jonathan Marquess Tim Short Richard Smith Christine Somers Fred Sharpe Renee Adamson Amanda Gaddy Julie Bierster Ashley Faulk Amanda McCall Larry Batten Kristy Pucylowski Christopher Thurmond Ashley London Ken Eiland Thomas Jeter Josh Kinsey Sonny Rader Ira Katz Gail Lowney Christina Gonzalez John T. Sherrer Michael Farmer Steve Wilson

Chairman of the Board President President-Elect First Vice President Second Vice President State At Large State At Large State At Large State At Large State At Large State At Large State At Large 1st Region President 2nd Region President 3rd Region President 4th Region President 5th Region President 6th Region President 7th Region President 8th Region President 9th Region President 10th Region President 11th Region President 12th Region President ACP Chairman AEP Representative AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Georgia State Board of Pharmacy Representative Georgia Society of Health Systems Pharmacists Mercer Faculty Representative South Faculty Representative UGA Faculty Rep. ASP Mercer University Rep. ASP South University Rep. ASP UGA Rep. Executive Vice President

Patricia Knowles

GPHA HEADQUARTERS 50 Lenox Pointe, NE Atlanta, Georgia 30324 Office: 404.231.5074 Fax: 404.237.8435

Amy Grimsley Rusty Fetterman Sukh Sarao Negin Sovaidi Annie Tran David Bray Jim Bracewell

www.gpha.org

Print: Star Printing - 770.974.6195

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30

November 2011

Program 0129-0000-11-052-H01-P 0.15 CEU

continuing education quiz

Please print.

Dietary Supplementation of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty Acids

Address_____________________________________________

Name________________________________________________

City, State, Zip______________________________________

1. According to the Food and Nutrition Board, the recommended dietary allowance (RDA) for a supplement is: D WKH PD[LPXP GDLO\ LQWDNH XQOLNHO\ WR FDXVH DGYHUVH health effects.

E WKH DYHUDJH GDLO\ OHYHO RI LQWDNH VXIĂ€FLHQW WR PHHW WKH nutrient requirements of nearly all healthy people. c. the daily intake amount recommended by the manufacturer.

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

7. Although the National Cancer Institute does not recommend calcium supplementation for the prevention of any type of cancer, there is evidence suggesting it may have a protective effect against: a. breast cancer. c. colorectal cancer. b. prostate cancer. d. ovarian cancer.

2. An important counseling point for pharmacists to convey to patients regarding supplements is that: a. they are regulated by FDA in the same manner as prescription medications.

E LQGHSHQGHQW RUJDQL]DWLRQV WHVW IRU VDIHW\ DQG HIĂ€FDF\ and offer “seals of approval.â€? c. they are regulated by FDA, but safety information need not be provided prior to marketing.

8. Calcium citrate: a. is generally more affordable than calcium carbonate. b. does not require the presence of chloride in order to be absorbed. c. is not well absorbed in the fasting state.

3. All of the following individuals are at risk of vitamin D GHĂ€FLHQF\ (;&(37 D WKRVH ZLWK OLPLWHG VNLQ H[SRVXUH b. those who have undergone gastric bypass surgery. c. those who are obese. d. those with light skin color.

([FHVVLYH FDOFLXP FRQVXPSWLRQ PD\ OHDG WR D DQRUH[LD F NLGQH\ VWRQHV b. bruising. d. drowsiness.

4. In a recent IOM report, the only outcome establishing a cause and effect relationship with vitamin D and calcium intake was: a. cancer. c. cardiovascular disease. b. bone health. d. AMD.

10. Vitamin E’s potential to prevent and treat disease is based on its function as an: D DQWLR[LGDQW F DQWLK\SHUWHQVLYH b. antiarrhythmic. d. antilipidemic. ,Q D UHFHQW FOLQLFDO WULDO H[DPLQLQJ WKH XVH RI YLWDPLQ ( DQG RU YLWDPLQ & WKHUH ZDV D VLJQLÀFDQW LQFUHDVH LQ WKH risk of: a. renal disease. c. hemorrhagic stroke. b. colorectal cancer. d. rheumatoid arthritis.

%DVHG RQ FXUUHQW DYDLODEOH OLWHUDWXUH PRVW H[SHUWV DJUHH that serum concentration of vitamin D, [25(OH)D], should be maintained between: a. 50-100ng/ml. c. 100-150ng/ml. b. 10-20ng/ml. d. 20-40ng/ml.

7KH $JH 5HODWHG (\H 'LVHDVH 6WXG\ $5('6 FRQFOXGHG that participants with early-stage AMD could slow the progression of their disease by taking a combination product containing which of the following? a. Vitamin E c. Vitamin D b. Calcium d. Omega-3 Fatty Acids

7KH FXUUHQW 5'$ IRU FDOFLXP YLWDPLQ ' UHVSHFWLYHO\ IRU a 51-year-old female is: a. 1200mg/600 IU. b. 1000mg/400 IU.

&RPSOHWHO\ ÀOO LQ WKH OHWWHUHG ER[ FRUUHVSRQGLQJ WR your answer.

1.

2.

3.

4.

5.

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

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

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

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

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

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

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

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

13. Fish oils have been postulated to play a role in: a. multiple sclerosis. c. osteoarthritis. b. rheumatoid arthritis. d. Alzheimer’s disease.

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

14. LOVAZAÂŽ (omega-3-acid ethyl esters) is indicated for: a. hypertension, 1gram once daily. b. angina, 2grams twice daily. c. hypertension, 4grams once daily. d. hypertriglyceridemia, 4grams once daily or 2grams twice daily.

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

5DWH WKLV OHVVRQ ([FHOOHQW 3RRU

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.

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3DWLHQWV FRQVXPLQJ ÀVK RLO VXSSOHPHQWV VKRXOG EH counseled on which of the following potential side effects? a. Kidney stones, hypercalcemia, milk-alkali syndrome E $QRUH[LD ZHLJKW ORVV SRO\XULD F %HOFKLQJ YRPLWLQJ GLDUUKHD ÀVK\ WDVWH

31

Dietary Supp CE November 2011

Georgia Pharmacy Association 50 Lenox Pointe, NE Atlanta, GA 30324

Introducing the GPhA/UBS Wealth Management Program UBS has agreed to provide all members of the Georgia Pharmacy Association with exclusive access UP ÏOBODJBM TFSWJDFT SFTPVSDFT UISPVHI UIF 8JMF $POTVMUJOH (SPVQ 5IJT OFX HSPVQ SFMBUJPOTIJQ UP ÏOBODJBM TFSWJDFT SFTPVSDFT UISPVHI UIF 8JMF $POTVMUJOH (SPVQ 5IJT OFX HSPVQ SFMBUJPOTIJQ FOBCMFT NFNCFST UP MFWFSBHF UIF WBTU TDBMF PG QSPEVDUT BOE TFSWJDFT BU 6#4 FOBCMFT NFNCFST UP MFWFSBHF UIF WBTU TDBMF PG QSPEVDUT BOE TFSWJDFT BU 6#4 8JUI NPSF UIBO ZFBST PG ÏOBODJBM TFSWJDFT FYQFSJFODF 5IF 8JMF $POTVMUJOH (SPVQ BU 6#4 IBT 8JUI NPSF UIBO ZFBST PG ÏOBODJBM TFSWJDFT FYQFSJFODF 5IF 8JMF $POTVMUJOH (SPVQ BU 6#4 IBT been recognized as one of Barron’s 5PQ 'JOBODJBM "EWJTPST JO UIF DPVOUSZ 5IF 8JMF $POTVMUJOH Barron’ss 5PQ 'JOBODJBM "EWJTPST JO UIF DPVOUSZ 5IF 8JMF $POTVMUJOH Barron’ Group is the endorsed wealth management provider for the Georgia Dental Association and also 1SJDF8BUFSIPVTF$PPQFST 4PVUIFSO %JWJTJPO 5IFZ XJMM SFQMJDBUF UIFTF TBNF PťFSJOHT UP UIF (1I" 1SJDF8BUFSIPVTF$PPQFST 4PVUIFSO %JWJTJPO 5IFZ XJMM SFQMJDBUF UIFTF TBNF PťFSJOHT UP UIF (1I" .FNCFS CFOFlUT JODMVEF .FNCFS CFOFlUT JODMVEF $PNQMJNFOUBSZ ¾ $ ÏOBODJBM QMBOOJOH B L¾ L WBMVF

¾ PNQMJNFOUBSZ ÏOBODJBM QMBOOJOH B L¾ L WBMVF

¾ # OFX L SFUJSFNFOU TBWJOHT QMBO EFTJHOFE #SBOE ¾ SBOE OFX L SFUJSFNFOU TBWJOHT QMBO EFTJHOFE exclusively for GPhA members at a group discount rate "EWJTPSZ ¾ EWJTPSZ BOE JOWFTUNFOU QSPHSBN PťFSFE BU HSPVQ ¾ " BOE JOWFTUNFOU QSPHSBN PťFSFE BU HSPVQ discount rate ¾ 3 QMBOOJOH HVJEBODF JODMVEJOH B SFUJSFNFOU 3FUJSFNFOU ¾ FUJSFNFOU QMBOOJOH HVJEBODF JODMVEJOH B SFUJSFNFOU income replacement system – Lending capabilities with competitive interest rates ¾ ' 'SFF BDDFTT UP 6#4 HMPCBM JOWFTUNFOU SFTFBSDI ¾ SFF BDDFTT UP 6#4 HMPCBM JOWFTUNFOU SFTFBSDI

Harris Gignilliat, CRPS® Vice V ice President–Investments 1FBDIUSFF 3PBE /& 4VJUF

1FBDIUSFF 3PBE /& 4VJUF "UMBOUB (" "UMBOUB ("

IBSSJT HJHOJMMJBU!VCT DPN ubs.com/team/wile

Chartered Retir Chartered Retirement ement Plans SpecialistSM and CRPS® ar are e rregistered egistered service marks of the College for Financial Planning®. /FJUIFS 6#4`'JOBODJBM 4FSWJDFT`*OD OPS BOZ PG JUT FNQMPZFFT QSPWJEFT MFHBM PS UBY BEWJDF :PV TIPVME DPOTVMU /FJUIFS 6#4`'JOBODJBM 4FSWJDFT`*OD OPS BOZ PG JUT FNQMPZFFT QSPWJEFT MFHBM PS UBY BEWJDF : PWJEFT MFHBM PS UBY BEWJDF :PV TIPVME DPOTVMU PV TIPVME DPOTVMU XJUI ZPVS QFSTPOBM MFHBM PS UBY BEWJTPS SFHBSEJOH ZPVS QFSTPOBM DJSDVNTUBODFT "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CSPLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE XJUI ZPVS QFSTPOBM MFHBM PS UBY BEWJTPS SFHBSEJOH ZPVS QFSTPOBM DJSDVNTUBODFT "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CSPLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BS F HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT 'PS NPSF JOGPSNBUJPO PO UIF EJTUJODUJPOT CFUXFFO PVS CSPLFSBHF BOE JOWFTUNFOU BEWJTPSZ TFSWJDFT QMFBTF TQFBL XJUI ZPVS 'JOBODJBM "EWJTPS S 'JOBODJBM "EWJTPS EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BSF HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT 'PS NPSF JOGPSNBUJPO PO UIF EJTUJODUJPOT CFUXFFO PVS CSPLFSBHF BOE JOWFTUNFOU BEWJTPSZ TFSWJDFT QMFBTF TQFBL XJUI ZPVS 'JOBODJBM "EWJTPS UIF 8 JMF $POTVMUJOH (SPVQ PS WJTJU PVS XFCTJUF BU VCT DPN XPSLJOHXJUIVT 'JOBODJBM 1MBOOJOH TFSWJDFT BSF QSPWJEFE JO PVS DBQBDJUZ BT B SFHJTUFSFE JOWFTUNFOU BEWJTFS "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT UIF 8JMF $POTVMUJOH (SPVQ PS WJTJU PVS XFCTJUF BU VCT DPN XPSLJOHXJUIVT 'JOBODJBM 1MBOOJOH TFSWJDFT BSF QSPWJEFE JO PVS DBQBDJUZ BT B SFHJTUFSFE JOWFTUNFOU BEWJTFS "T B ŖSN QSPWJEJOH XFBMUI NBOBHFNFOU TFSWJDFT UP DMJFOUT JO UIF 6 4 XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CS PLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BSF HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT /PUF UP UIF 6TFS '*/3" /"4%

JO UIF 6 4 XF PšFS CPUI JOWFTUNFOU BEWJTPSZ BOE CSPLFSBHF TFSWJDFT 5IFTF TFSWJDFT BSF TFQBSBUF BOE EJTUJODU EJšFS JO NBUFSJBM XBZT BOE BSF HPWFSOFE CZ EJšFSFOU MBXT BOE TFQBSBUF DPOUSBDUT /PUF UP UIF 6TFS '*/3" /"4%

SSFRVJSFT UIBU UIF QSPTQFDUVT PšFS MFHFOE UIF ŖSTU QBSBHSBQI CFMPX CF JO B GPOU TJ[F UIBU JT BU MFBTU UIF TBNF TJ[F BT UIBU VTFE JO UIF NBJO UFYU PG UIF NBSLFUJOH QJFDF BOE JO B EJšFSFOU QSJOU TUZMF TVDI BT CPME PS JUBMJD UZQF 0ODF FRVJSFT UIBU UIF QSPTQFDUVT PšFS MFHFOE UIF ŖSTU QBSBHSBQI CFMPX CF JO B GPOU TJ[F UIBU JT BU MFBTU UIF TBNF TJ[F BT UIBU VTFE JO UIF NBJO UFYU PG UIF NBSLFUJOH QJFDF BOE JO B EJšFSFOU QSJOU TUZMF TVDI BT CPME PS JUBMJD UZQF 0ODF UIJT EJTDMPTVS F UIF QSPTQFDUVT PšFS MFHFOE JT VTFE JO BOZ QVCMJD GBDJOH NBUFSJBMT UIF NBUFSJBMT BSF TVCKFDU UP ŖMJOH XJUI '*/3" /"4% CZ B 4FSJFT 1SJODJQBM UBS Financial Services Inc. is a subsidiary of UBS AG. h 6#4 UIJT EJTDMPTVSF UIF QSPTQFDUVT PšFS MFHFOE JT VTFE JO BOZ QVCMJD GBDJOH NBUFSJBMT UIF NBUFSJBMT BSF TVCKFDU UP ŖMJOH XJUI '*/3" /"4% CZ B 4FSJFT 1SJODJQBM UBS h 6#4 Financial Services Inc. All rights rreserved. eserved. Member SIPC. @ Y @"9 @(JH)