Y K C U T N E K THE T S I C A M R A PH Vol. 9, No. 2 March 2014
United WE Stand! Get involved with YOUR KPhA!
More information at www.kphanet.org and inside!
News & Information for Members of the Kentucky Pharmacists Association
Table of Contents
March 2014
Table of Contents Table of Contents— Oath— Mission Statement President’s Perspective 136th KPhA Annual Meeting and Convention 2014 KPERF Golf Scramble From your Executive Director 2014 KPhA Board of Directors Election APSC 136th KPhA Annual Meeting and Convention 2014 KPhA Board of Directors Election Saving the Bowl of Hygeia March 2014 CE — Otitis Media and Antibiotics March Pharmacist/Pharmacy Tech Quiz AMA President visits UKCOP
2 3 4 5 6 7 8 9 10 12 13 18 19
Technician Review KPhA Pharmacy Emergency Preparedness April 2014 CE — Meet the New Kids on the Block April Pharmacist/Pharmacy Tech Quiz Kentucky Renaissance Pharmacy Museum KPhA New and Returning Members KPPAC KPhA Government Affairs Contribution Form Pharmacy Law Brief Meet the new KPhA staff member Pharmacy Policy Issues Pharmacists Mutual Cardinal Health KPhA Board of Directors 50 Years Ago/Frequently Called and Contacted
20 21 22 26 27 28 30 31 32 33 34 36 37 38 39
Oath of a Pharmacist At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy. I will consider the welfare of humanity and relief of human suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve. I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will embrace and advocate change in the profession of pharmacy that improves patient care. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.
Kentucky Pharmacists Association The mission of the Kentucky Pharmacists Association is to promote the profession of pharmacy, enhance the practice standards of the profession, and demonstrate the value of pharmacist services within the health care system.
Editorial Office: © Copyright 2014 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association. Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email ssisco@kphanet.org. Website http://www.kphanet.org.
The Kentucky Pharmacy Education and Research Foundation (KPERF), established in 1980 as a non-profit subsidiary corporation of the Kentucky Pharmacists Association (KPhA), fosters educational activities and research projects in the field of pharmacy including career counseling, student assistance, post-graduate education, continuing and professional development and public health education and assistance. It is the goal of KPERF to ensure that pharmacy in Kentucky and throughout the nation may sustain the continuing need for sufficient and adequately trained pharmacists. KPERF will provide a minimum of 15 continuing pharmacy education hours. In addition, KPERF will provide at least three educational interventions through other mediums — such as webinars — to continuously improve healthcare for all. Programming will be determined by assessing the gaps between actual practice and ideal practice, with activities designed to narrow those gaps using interaction, learning assessment, and evaluation. Additionally, feedback from learners will be used to improve the overall programming designed by KPERF. 2
THE KENTUCKY PHARMACIST
President’s Perspective
March 2014 Medicaid plan to prorate copayments to allow patients to synchronize multiple prescriptions of chronic diseases. Refills could then be synchronized according to a plan agreed upon by the patient, the pharmacist and the insurance allowing for better adherence and patient outcomes. KPhA worked with the bill sponsor, Rep. Addia Wuchner, on the language of the bill for provisions of the bill to apply to Medicaid and Medicaid managed care organizations in the same manner as those applied to private insurance plans. This bill has been approved by the House Banking and Insurance Committee.
PRESIDENT’S PERSPECTIVE Duane W. Parsons KPhA President 2013-2014 So far 2014 has been a very active year for our profession. Enhanced collaborative care agreements and recognition of pharmacists as providers within the health care team continue to gain momentum at the Commonwealth and national levels.
Several other bills have been recently filed. SB 201 filed by Sen. Denton would require managed care organizations to reimburse equally for all dosage forms of Suboxone. HB 543 filed by Rep. Will Coursey would allow for an income tax deduction for those providing services to the uninsured. SB 185 filed by Sen. Carroll Gibson would require health At the state level, the Collaborative Care Agreement bill, insurers and managed care organizations to establish poliSB76 sponsored by Senate Health and Welfare Committee cies to govern changes in existing provider agreements. Chair, Sen. Julie Denton, passed the House Health and YOUR KPhA has been a very active participant in repreWelfare Committee in mid-March. This important bill to give senting the interests of the profession for all of these propharmacists and physicians more flexibility in establishing posals. collaborative care agreements is the top priority of KPhA as well as other pharmacy groups in the Commonwealth. On a national level, KPhA has been very supportive of legKPhA has worked extensively with our lobbyists and the islation to increase patient access to pharmacist’s services. Kentucky Medical Association for the agreed upon lanOn Mar. 11, HR4190 sponsored by Representatives Brett guage within this provision. The proposal passed the Sen- Guthrie (R-KY), G.K. Butterfield (D-NC) and Todd Young (R ate in mid February. It has stalled a bit in the House since it -IN) was introduced in the US House of Representatives to has been attached to a revision for licensing requirements recognize pharmacists as providers under Medicare Part B. for out-of-state home medical equipment providers. The The bill would enable patient access to and reimbursement Board of Pharmacy has expressed some concern over the for Medicare Part B services in medically underserved comlanguage of this part of the proposal and worked with the munities. This is an important first step in the recognition of association representing home medical equipment provid- pharmacists as providers within the health care system. ers to attempt to reach a compromise. This, in all likelihood, will be an effort that could take time. SB 148, a bill mandating parity for oral chemotherapy treat- Provider status is a very active priority for YOUR KPhA. I established a very active work group to help advance this ment sponsored by Sen. Tom Buford, has been set for a hearing by the Senate Banking and Insurance Committee. effort. Grassroots efforts will be will be extremely important. We need to be contacting our legislators now to make them The bill seeks to provide the same coverage level for oral chemotherapy drugs as is provided for injected and intrave- aware of the importance of this initiative. nous treatments.
Again on a national level, CMS has proposed changes to the Medicare Part D program that would be extremely benSB 119, a bill seeking to establish a medical review panel to review potential medical malpractice claims before a law- eficial to community pharmacy. KPhA is in support of these changes. suit could be filed, passed the Senate and has been assigned to the House and Welfare Committee for hearing. Pharmacists need to get involved. NOW is our time. Inform This bill is sponsored by Sen. Denton. States where medi- your legislators of these issues, thank CMS for their efforts, cal review panels have been established are reporting resubmit our comments and those of our patients. Call on ductions in claims filed and reduction in insurance rates. YOUR KPhA if you need assistance. Help others see the The bill faces opposition from the association representing value pharmacists provide on a daily basis. Our comments trial attorneys. about personal experiences and issues along with those of HB 395 is a bill that would require insurers and the state
our patients greatly amplify our unified voice. 3
THE KENTUCKY PHARMACIST
136th KPhA Annual Meeting and Convention
March 2014
Registration Form Please print the following information and check the applicable boxes.
All meals are included for registrants except for Ray Wirth Banquet. Tickets will be provided for Ray Wirth Banquet at registration table. KPhA made this change to improve the accuracy of ordering meals for the event. If you require special assistance or special diet, please call us at (502) 227-2303 or email ssisco@kphanet.org.
First Name
Middle Initial
Last Name
PREFERRED BADGE NAME
Preferred Street Address
City
State
Daytime Telephone Number
Preferred Email Address
Zip Code
Business Affiliation
Pre-Conference Event Registration (NOT included in registration fees) If interested in preconference events on Thursday, June 5, 2014, check here: ______________ Possible programs include Immunization Training and MTM Certification. Additional charges will apply. Registration is open to all KPhA members. If you are not a current member, log in at www.kphanet.org, call 502-227-2303, or include membership with your registration. Membership rates: Pharmacists $225, Joint Members $335, Associate Members $225, Retired $120, Joint Retired $180 Technician $50, New Practitioner First year $70, New Practitioner Second Year $140. Single Day Registration Ray Wirth Full Registration Select Day: Banquet Friday – Saturday - Sunday Before May 16 After May 16 Before May 16 After May 16 Pharmacist Member Technician Member Resident Student Registration Total
$ 200.00 $ 85.00 $ 25.00 $ 5.00
$ $ $ $
250.00 110.00 35.00 10.00
$ 100.00 $ 50.00 $ 20.00
$ 125.00 $ 75.00 $ 30.00
$25.00 $25.00 $25.00 $5.00
Meal Events: Please indicate the total number that will be attending each meal event. Day
Meal Event th
Fri, June 6 Sat, June 7th Sat, June 7th
Self
KPhA Award Luncheon Preceptor Recognition Luncheon Ray Wirth Banquet
Credit Card Payment: Log onto www.kphanet.org and register online, or call 502-227-2303 to pay over the phone.
Guest(s) Name
@ $30 ea. @ $30 ea. @ $50 ea.
Total for Additional Guest(s) Meals Check Payment: Payable to KPERF and mail to KPhA, 1228 US 127 South, Frankfort KY 40601
# Guest(s)
$
Overnight Accommodations: Griffin Gate Marriott Resort rooms are available at a reduced rate of $129/night for single and double occupancy. Overnight accommodations can be made by visiting https://resweb.passkey.com/go/KYPHARMACIST2014ANNUALMEETING, or by calling 1-800-266-9432 before May 14, 2014 to receive the group rate. The group name is Ky Pharmacist Association Annual Meeting 2014. Lodging rate includes wireless internet access. 4
THE KENTUCKY PHARMACIST
2014 KPERF Golf Scramble
March 2014
To kick off the 136th KPhA Annual Meeting, join us for the KPERF GOLF SCRAMBLE Griffin Gate Marriott Resort Golf Course on June 5, 2014! Scramble begins at 10:00 AM SHOTGUN START Griffin Gate Marriott Resort Golf Club, 1800 Newtown Pike, Lexington, KY 40511 Don’t miss this opportunity to support the Kentucky Pharmacy Education & Research Foundation and KPhA and join friends, new and old, for an afternoon of fun and networking. Prizes will be awarded and beverages will be available on course. Two drink tickets per golfer are included in the registration fee.
The Kentucky Pharmacy Education & Research Foundation (KPERF) is the tax-exempt charitable foundation formed by the Kentucky Pharmacists Association. Entry Fee: Individual $100
Team $400
Hole Sponsor $150
REGISTRATION DEADLINE MAY 26, 2014!
ONE ENTRY FORM PER TEAM PLEASE
Team Name: _______________________________________ Player 1_________________________
$400 Team
Player 2__________________________
Player 3_________________________
Individual:_________________________
Player 4__________________________
OR
$100
Individual:_________________________ $100
Hole Sponsor:____________________________________________________ $150
(Text for Sign)
TOTAL $_____________ To pay by credit card, go to www.kphanet.org and register online, or call 502-227-2303 PLEASE MAKE CHECKS PAYABLE TO KPERF and SUBMIT PAYMENT TO: KPhA Annual Meeting, 1228 US 127 South, Frankfort, KY 40601
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THE KENTUCKY PHARMACIST
From Your Executive Director
March 2014
MESSAGE FROM YOUR
EXECUTIVE DIRECTOR Robert “Bob” McFalls This is YOUR KPhA! United WE Stand! I trust that you have noticed a change in how the Association now refers to itself and has been doing so for the last year. This is YOUR KPhA.
KPhA would not have resources to keep the lights on in the office or pay the salaries of our devoted staff. And to continue to further the mission of the Association, we will continue to need YOUR involvement—the collective YOU! And, there are many, many ways to engage with YOUR KPhA.
Let me tell you what that means to me. This Association is not just the Board of Directors or the House of Delegates. It is not simply the staff working at headquarters in Frankfort. KPhA is you. And You. And YOU. YOUR KPhA is the members in Pikeville, Covington, Paducah, Albany, Lexington, London and Louisville. It is the members who work for Kroger’s, Walgreens, Rite Aid, Walmart and CVS. It is members who work for Gibson’s Discount Pharmacy in Mayfield, Good Neighbor Pharmacy in Danville, Cayce’s Pharmacy in Hopkinsville, Ruwe Pharmacy in Covington and Donell's Pharmacy and Professional Compounding in Baxter. It is members who work for Baptist Health, Frankfort Regional Medical Center and Ephraim McDowell Regional Medical Center. And it is so many more—the Association is the collective YOU—YOUR KPhA.
Serve on the KPhA Board of Directors Participate in a KPhA Committee Testify on issues impacting the profession Call your legislators to urge them to support pharmacy issues Contribute to the Government Affairs Fund and the Kentucky Pharmacists Political Advisory Council Attend meetings of local pharmacy organizations; don’t have one? Work with YOUR KPhA to reignite a local affiliate where you live Attend the 136th KPhA Annual Meeting and Convention in Lexington June 5-8, 2014 Recruit your colleagues to be members of YOUR KPhA
Some of these require more time than others. Some would require monetary support. But YOUR KPhA needs YOUR involvement in all of these areas. To paraphrase the scholar Hillel, “If not me, then who? If not now, when?” We are all busy people with plates overflowing with plenty. But if YOUR KPhA is to continue to successfully advocate for the profession in Kentucky, we need YOU, and YOU and YOU to participate with and to represent the profession as YOUR Without YOU, there would not be a KPhA! If you are readKPhA. In the thoughts, words and reflections of Aked, ing this, chances are you are a member of KPhA, since this Burke and Kennedy, among others, it has been said that journal is one of the benefits of membership. Something for evil men to accomplish their purpose it is only necgrabbed your attention, and you realize that your memberessary that good men and women should do nothing. ship is beneficial—for you, for your profession and for your KPhA wants to hear from YOU. Do you have an idea to adpatients. vance YOUR KPhA’s mission? Call us. Email us. Come see Membership is a great first step. Without membership dues, us. YOUR KPhA: United WE Stand! YOUR KPhA staff is in Frankfort monitoring legislative issues on the state and national level. YOUR KPhA is developing a dynamic program for YOUR 136th KPhA Annual Meeting. We’re continuing to add features and resources to YOUR KPhA website to help you serve your patients more efficiently.
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THE KENTUCKY PHARMACIST
2014 KPhA Board of Directors Election
March 2014
Watch your inbox for the link to vote in the 2014 KPhA Board of Directors election! 2014 KPhA Board of Directors Election Paper Ballot Request Form The 2014 KPhA Board of Directors Election will be held online at www.kphanet.org. You will need to log in to the site to cast your vote. Paper ballots will be available, but ONLY upon request through this form.
Name:
Email:
Address: City, State Zip: Fax number: Preferred Method to Receive Ballot: (Circle one)
Fax
Return form to KPhA, 1228 US 127 South, Frankfort, KY 40601, Fax 502-227-2258, or email ssisco@kphanet.org. Call the KPhA Office at 502-227-2303 for more information.
2014 KPhA Professional Awards The Kentucky Pharmacists Association annually recognizes individuals from across the Commonwealth that exhibit exceptional service to patients and their community, continuously promote the profession of pharmacy, and demonstrate innovative pharmacy practice. The KPhA Organizational Affairs Committee is accepting nominations for the professional awards below: Bowl of Hygeia
Distinguished Service Award
Pharmacist of the Year
Professional Promotion Award
Young Pharmacist of the Year
Excellence in Innovation Award
Technician of the Year
Cardinal Health Generation Rx Champion
To nominate an individual, please submit a letter of nomination including the award information and the nominee’s accomplishments with regard to the award criteria. Multiple letters of support are accepted and highly encouraged. Individuals and recognized pharmacy organizations in Kentucky are encouraged to submit nominations. Individual nominators need not be a member of the Association; however, pharmacist and technician nominees must be a member of KPhA. Nominations: Letters of nomination may be submitted electronically to Scott Sisco at ssisco@kphanet.org or mailed to KPhA, Attn: Scott Sisco 1228 US 127 South, Frankfort, KY 40601 no later than March 31, 2014. The KPhA President, President-Elect, and the Chairman of the Board, participating in any voting for awards shall not be eligible for nomination or selection for any award. Conferral of any of the awards of the Association shall be at the discretion of the Organizational Affairs Committee and is not mandatory on an annual basis.
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THE KENTUCKY PHARMACIST
APSC
March 2014
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THE KENTUCKY PHARMACIST
136th KPhA Annual Meeting and Convention
March 2014
More information online! Full schedule will be posted soon. Accreditation is pending for continuing education programs.
Preconference events Thursday, June 5
MTM Certification with companion CE Programs KPERF Golf Scramble
Tentative Schedule Friday, June 6, 2013 7 a.m. 8 — 8:30 a.m. 9 — 10:30 a.m.
Sunday, June 8, 2014 Registration Opens 9 a.m. Continental Breakfast Opening Breakfast 10 a.m. Continuing Education KPhA Annual Membership Meeting The Kentucky Pharmacy Education & Research and Opening House of Delegates Foundation is accredited by The Accreditation Council 9 — 10:30 a.m. Continuing Education for Pharmacy Education as a provider of continuing 10:30 a.m. — Noon Board of Pharmacy Advisory Pharmacy education. Council 10:45 — 11:45 a.m. Continuing Education Potential CE Topics: Technician Track: 12 noon KPhA Awards Luncheon Medicare Star Ratings New Drugs 1:30 — 2:30 p.m. Continuing Education 2:40 — 3:40 p.m. Continuing Education Collaborative Care Law Update 3:50 — 5:20 p.m. Continuing Education Agreements Health Literacy 5:30 — 7:30 p.m. Opening of Hall of Exhibits HIPAA Changes 7:30 p.m. Dessert reception Calculations Student/New Practitioner event Opioid Abuse Inventory Management 8 — 9 p.m. Potential Continuing Education Self-Care Championships Saturday, June 7, 2014 7:30 a.m. Registration/Continental Breakfast *New Directors of the KPhA Board of Directors 7:30 a.m. Reference Committee will be installed at the end of the Closing House 8 — 10 a.m. Hall of Exhibits Open of Delegates meeting this year. 10 a.m. — noon CE Program (2 hr.) 12 noon Lunch (UK Preceptor Recognition) Overnight Accommodations: Technician Academy meeting 1:30 — 2:30 p.m. PRECEPTOR CE Griffin Gate Marriott Resort rooms are available at a reduced rate of $129/night for single 1:30 — 2:30 p.m. Calculations for Technicians and double occupancy. Overnight 2:40 — 3:40 p.m. CE Program (1 hr) accommodations can be made by visiting 3:45 — 5:15 p.m. House of Delegates https://resweb.passkey.com/go/ Closing Session* KYPHARMACIST2014ANNUALMEETING, 3:45 — 4:45 p.m. Health Literacy (Tech) or by calling 1-800-266-9432 before May 14, 2014 to receive the group rate. The 6 p.m. President’s Reception group name is Ky Pharmacist Association 7 p.m. Ray Wirth Banquet Annual Meeting 2014. Social event immediately following Lodging rate includes wireless internet access. Banquet 9
THE KENTUCKY PHARMACIST
2014 KPhA Board of Directors Election
March 2014
KPhA Board of Directors 2014-15 Candidates President-Elect Chris Clifton is a 2005 graduate of the University Of Kentucky College Of Pharmacy. He lives in Villa Hills with his wife Katy, also a 2005 UKCOP graduate, and three children: Brady, Finley, and Mallory. He currently practices pharmacy for the Kroger Co., where he manages the Ft. Mitchell store. For the past 3 years, he has served KPhA as on the Board of Directors and watched as KPhA has moved from a dark period to a time of more prominence and success.
working, organized and very task oriented. Her nominator believes she would be a good addition to the KPhA Board of Directors and serve KPhA well as Secretary.
Brooke Hudspeth is a clinical diabetes care pharmacist for Kroger Pharmacy and serves as the Program Coordinator for Kroger’s American Diabetes Association–recognized Diabetes Self-Management Education Program. She received her doctor of pharmacy degree from the University of Kentucky College of Pharmacy in 2007. Upon graduation, Dr. Hudspeth completed a postgraduate (PGY1) residency with an emphasis in community care with the Univer“I would like to continue as President-Elect to further our sity of Kentucky and Kroger Pharmacy. Dr. Hudspeth’s mission. As President-Elect, I would like to focus my tenure practice interests include medication therapy management on three main goals: and disease state management, particularly diabetes. 1. Strengthen the Association’s initiatives by continuing to In addition to her clinical practice activities, Dr. Hudspeth is recruit new practitioners and encourage their involveAssistant Professor at the University of Kentucky College of ment in KPhA. Over the past several years KPhA has experienced an alarming trend – our new practitioners Pharmacy. She serves as a preceptor for the University of are not joining OUR state association. This trend has to Kentucky College of Pharmacy/Kroger Community Pharmacy Residency Program. She also is on the faculty of the stop. We need the fresh ideas new practitioners can American Pharmacists Association’s certificate training probring to the table. Also, new practitioners need to become involved to develop mentoring relationships with gram, The Pharmacist and Patient-Centered Diabetes Care. seasoned practitioners across the state. 2. Focus KPhA members on the importance of becoming “I feel that I would be a valued addition to the KPhA Board. politically involved. As pharmacists we are the voice of My perspective on a number of issues related to our pharpharmacy, and it’s time to make our voice heard on the macy profession would be a positive asset to the board and state and national level! Our voice only becomes louder to KPhA’s desire to serve and protect our state’s pharmacists. The only way to progress our profession is to be an as we join together to promote our profession and our active change agent, and I feel one of the best ways I can profession’s important role as a healthcare provider. 3. Build bridges – we need to build those bridges between do this is by actively participating in my state’s pharmacy organization. I am involved in many avenues to showcase KPhA and other associations in the state. We also and enhance the impact of pharmacists on both the local need to build bridges between our new practitioners and practitioners who have so much wisdom to share. and national levels and am extremely passionate about my Finally, we need to build bridges between all pharmacy profession!” practitioners in our state – regardless of your practice Directors setting, years in practice or association affiliation. As Tony Esterly graduated from the University of Kentucky pharmacists we share a common goal: to provide exCollege of Pharmacy in 2006 where he served a year as cellent pharmaceutical care to our patients. By building Regent for the Upsilon chapter of Kappa Psi. He has bridges with one another, we can take our profession to worked in a broad range of pharmacy settings (some overnew heights we have only dreamed of before. lapping) which include retail at Kroger, compounding with I hope these three goals have highlighted to you why I Wickliffe Veterinary Compounding, managed care at Huwould like the opportunity to serve you as KPhA President- mana and his own consulting business. Today he is emElect, and I would appreciate your vote. Thank you for your ployed as a contracting consultant for Humana Trade Relatime and consideration.” tions. Secretary
“Throughout the past eight years of practicing pharmacy, my view of how organizations are able to impact the profesJulie Burris is an Assistant Professor at the Sullivan Unision has evolved. As a student and new practitioner, I was versity College of Pharmacy. She is dedicated to the profession which is demonstrated by her being a past recipient more introspective and focused more on measuring what the organization could do for me. Thanks to some experiof the KPhA Professional Promotion Award. Julie is hard 10
THE KENTUCKY PHARMACIST
2014 KPhA Board of Directors Election
March 2014
ence and a few mentoring pharmacists, my view on membership in organizations has fundamentally changed. Two common characteristics these mentors share are being ACTIVE members and STAYING involved. I would like the opportunity to emulate their dedication and give back to the profession. I hope to draw from my diverse background in pharmacy practice to make a difference for The Association. I'm not sure how much I can influence our practice of pharmacy and improve the lives of the patients we serve, but without being involved I will never know.”
graduating from the University of Kentucky's Pharmacy program in 2009, she went to work as a Staff Pharmacist and IV Manager at PharMerica in Louisville. In 2011, she became the Pharmacy Director of PharMerica's Glasgow pharmacy and remained in this role until January when she transitioned back to the Louisville pharmacy.
“I am interested in joining the board to work with other pharmacists around our state to protect our profession, educate the public about what we have to offer and help influence positive outcomes through regulation and legislation for our profession. I thank you for considering me with a vote to join your KPhA Board of Directors and look forward to serving our profession.”
“Based on my experience and willingness to serve, I believe that I would be a good choice for the Board of Directors position and would appreciate your vote!
Julie Owen is originally from Madisonville though she currently resides in Louisville with her husband and son. After
We must continue to strive to fight for adequate compensation for all of our services that we provide.”
She is a member of KPhA and ASCP, and also began precepting students from UK and Sullivan University. Last year, she was honored to receive the Preceptor of the Year award from Sullivan. She also became involved with the KPhA Long Term Care Academy, where she currently Matt Foltz is a 2003 graduate of University of Kentucky College of Pharmacy and has been the Director of Operaserves as the Director of Organizational Affairs. Also during tions for Med Care Pharmacy in Florence since 2007. Prior the past year, she has been involved with the Long Term to that, he was a pharmacy manager for Kroger in LouisCare working group and attended many meetings at the ville. In 2013, he joined the Board of Directors for the Board of Pharmacy Office providing input for the LTC reguNorthern Kentucky Pharmacists Association and has been lations that will go before the BOP for approval. In 2012 on the Government Affairs committee for KPhA the last two she was appointed to the PRN Committee of the BOP years. where she serves as a committee member.
Stacy Rowe is an assistant professor at Sullivan University College of Pharmacy. She is the faculty advisor of the SUCOP APhA-ASP chapter. Her professional involvement has been heavily focused through the student chapter nationalChris Killmeier would like to continue serving on the KPhA ly and she would like to increase involvement on a state Board of Directors. He enjoys being a part of solutions for level to be able to incorporate more in the ASP chapter acthe profession of pharmacy. He has been a pharmacist for tivities and learning. 24 years with Walgreens. Within Walgreens, he has held Stacy is reliable and dedicated to the profession. She curpositions from staff pharmacist up to district pharmacy surently works under a CCA agreement (although in the state pervisor. He is currently pharmacy manager at Walgreens of IN) but is very interested in that current legislative priority on Lime Kiln Lane in Louisville. He serves as chair of the of KPhA. Advisory Council to the Kentucky Board of Pharmacy. He Richard Slone has been a member of the Board of Direcalso serves on the Board of Pharmacy's PRN committee. tors for KPhA for the last nine years. He is currently chairChris has been married to his wife, Denise for 21 years this man of the Government Affairs Committee. He is a practicJuly. They have two wonderful children, Bayley Shea, 16 ing independent pharmacist in Hazard. His wife of 35 years and Olivia Blaire, 14.He was born and raised in Louisville, Zena is also a pharmacist. His son and daughter-in-law are where the Killmeiers reside today. both pharmacists. “Our profession has had enough apathy due to its fabulous “As you can see, I have a vested interest in our profession. diversity. This diversity needs a fresh start to be able to I have learned over the last few years that now more than deliver a unified message for our profession to legislators, ever all practices of our profession must be united under payers and other medical professionals (including other one flag or banner. We are all pharmacists of what path our pharmacists). There are many changes occurring in pharprofession has taken us. United we stand and well you macy today. Some of the changes may not be for the bet- know the rest. I believe that we must be progressive and ter. One needs to be involved, in order to be able to prochange and adapt to the current and future needs and opmote and stand up for our profession. We need to be inportunities of our profession, but we must never relinquish volved to make sure the changes in pharmacy are for the and always protect our historically and legal right to be betterment of pharmacy, not detrimental.” compounders and dispensers of pharmaceutical products.
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THE KENTUCKY PHARMACIST
Bowl of Hygeia
March 2014
Vote for Kentucky to be #1! Vote with your contribution for Kentucky to be #1 with the “Bowl of Hygeia State Association Challenge 2.0.” Every dollar you donate will double as a result of our 2013 Bowl of Hygeia recipient Leon Claywell’s pledge to match donations up to $5,000. You have earned $2,400 so far! You can help Kentucky earn the remainder of Leon’s Pledge! The APhA Foundation will award cash prizes to the state raising the most funds for the Bowl of Hygeia Endowment. The Endowment is at 75 percent of its National goal. To contribute, go to http://www.aphafoundation.org/kentucky-pharmacists-association-bowl-hygeia-team .
Kentucky Contributors as of March 27, 2014
$6,400 total contributions
For more information on the Bowl Of Hygeia, visit: http://www.aphafoundation.org/bowl-hygeiaaward.
Cassandra Beyerle
Chris Killmeier
Booneville Discount Drugs
Matthew & Aleshea Martin
Kenneth Calvert
Robert McFalls
Mike Cayce
Cayce's Pharmacy, Inc.
Medica Pharmacy and Wellness Center
Leon & Margaret Claywell
Bob Oakley
Brian Fingerson
Duane Parsons
Dwaine Green
Donald Riley
George Hammons
Patricia Thornbury
Tom Houchens
Simon Wolf
Donate online to the KPhA Government Affairs Fund! Funds contributed to KPhA Government Affairs are applied directly to our lobbying efforts in terms of staffing and contracted lobbying services. Company donations are acceptable for Government Affairs contributions, unlike contributions to Political Advocacy Funds, like KPPAC. Go to www.kphanet.org and click on the Advocacy tab for more information about the KPhA Government Affairs fund and the donation form or see Page 31 to send your check directly to KPhA. 12
THE KENTUCKY PHARMACIST
March 2014 CE — Otitis Media and Antibiotics
March 2014
Otitis Media and Antibiotics – Yes, No, or Maybe? By: Kristin McClung, Kayla Stover, and Debbie Minor, The University of Mississippi Medical Center, Departments of Pharmacy, Pharmacy Practice, and Medicine Reprinted with permission of the authors and the Mississippi Pharmacists Association where this article originally appeared. This activity may appear in other state pharmacy association journals. There are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-9999-14-003-H01-P&T 1.0 Contact Hour (0.1 CEU) Goal To describe and discuss the presentation, diagnosis, treatment and management of acute otitis media in children. Objectives At the conclusion of this article, the reader should be able to: 1. Describe the presentation and diagnosis of otitis media in children. 2. Review current recommendations for treatment and management of acute otitis media. 3. Discuss antibiotic options and appropriate selection for children with acute otitis media. INTRODUCTION
most common organism to cause AOM, followed by H. influenzae and M. catarrhalis (25-50 percent, 15-30 percent and 3-20 percent, respectively). By the early 2000s, rates of AOM caused by H. influenzae and S. pneumoniae were similar.4 The reduction in the incidence of S. pneumoniae is thought to be due to the heptavalent conjugate pneumococcal vaccine (PCV7), which includes protection against approximately 70 percent of the serotypes that cause AOM.2,4
KPERF offers all CE articles to members online at www.kphanet.org
Middle ear infection, or otitis media, is one of the most common types of infection among children in the United States and the primary reason for which antibacterial agents are prescribed. Fluid accumulation and inflammation in the middle ear occurs more often in children compared to adults because their Eustachian tubes are shorter and more horizontal, facilitating virus and bacteria entry.1-3 Otitis media is differentiated as otitis media with effusion (OME) and acute otitis media (AOM). OME may be caused by allergies, exposure to irritants (e.g., cigarette smoke) and viral infections. With OME, there are usually no signs or symptoms of acute infection, though there may be discomfort or problems with hearing. OME is more common than AOM. The buildup of middle ear fluid usually resolves on its own, but OME may be a prelude to or a sequela of AOM.1,4-5
While antibiotic use for AOM has been routine in the United States for many years, the standard of care in many countries is to treat the symptoms initially and only add antibacterial therapy if improvement fails to occur.4 Although antibiotics are often used to treat AOM, they are not appropriate or recommended for every earache.1 AOM and OME are frequently caused by viruses, for which antibiotics are ineffective. Earaches also are often self-limiting with high rates AOM is described as a painful ear infection that results of spontaneous improvement. Based on an analysis from from viral and bacterial causes. By the age of three, more the Agency for Healthcare Research and Quality, approxithan 67 percent of children have had at least one episode mately 80 percent of children with AOM are expected to of AOM and approximately 33 percent have had at least improve after 10 days without the use of antibiotics. With three episodes.1-2 Viruses including adenovirus, coronaimmediate antibiotic use, improvement rates were only 15 virus, enterovirus, parainfluenza virus, respiratory syncytial percent higher. Mastoiditis is the most concerning outcome virus and rhinovirus account for approximately 25 percent without antibiotic use, though the incidence is low (1.2 per 1-2,4 of cases. The most common bacteria causing AOM are 10,000 child-years).6 In contrast, adverse effects from antiStreptococcus pneumoniae, Haemophilus influenzae and biotics range from rash and diarrhea to hypersensitivity reMoraxella catarrhalis. In the 1990s, S. pneumoniae was the actions and Clostridium difficile infections. The rising rates 13
THE KENTUCKY PHARMACIST
March 2014 CE — Otitis Media and Antibiotics
March 2014
Table 1 – Antibiotics for AOM Generic
Brand
Age (months) <3 >3
Daily Dose
Amoxicillin
MoxatagTM
Amoxicillin/ clavulanate
Augmentin®
<3 >3
Cefdinir
Omnicef®
>6
20-30 mg/kg (divided into 2 doses) 80-90 mg/kg (divided into 2 doses) Based on < 40 kg, adult dosing if > 40 kg 30 mg/kg of amoxicillin component (divided into 2 doses) 90/6.4 mg/kg (divided into 2 doses) Based on < 40 kg, adult dosing if > 40 kg 14 mg/kg (divided into 1-2 doses, max: 600 mg/day)
Cefpodoxime
Vantin®
>2
10 mg/kg (divided into 2 doses, max: 200 mg/dose)
Cefuroxime
Ceftin®
>3
30 mg/kg (divided into 2 doses, max: 1 g/day)
Ceftriaxone
Rocephin®
50 mg/kg IM or IV (max: 1 g/day)
Clindamycin
Cleocin®
30-40 mg/kg (divided into 3 doses)
Compiled from references 5 and 7. of antibacterial use and the increasing prevalence of resistance in the United States, especially with the betalactam antibiotics (e.g., penicillins, cephalosporins), highlight the need for more judicious management of otitis media.1,2 Overall, the risk of poor outcomes without antibiotic treatment is fairly low, whereas the risks of adverse effects and other consequences of antibiotic use are high.6 Recently, the Centers for Disease Control and Prevention and other groups have attempted to focus the attention of the medical community and general public on the need for appropriate otitis media management.4 The goal of this review is to describe and discuss the presentation, diagnosis, treatment and management of acute otitis media in children.
ears) or intense erythema of the tympanic membrane. Clinicians should not diagnose AOM in children who do not have middle ear effusion.5 Other symptoms may include vertigo, nystagmus, tinnitus and hearing loss.2 At diagnosis, the severity of the child’s symptoms should be specified as non-severe, defined as mild ear pain lasting < 48 hours and fever < 102.2°F, or severe, defined as moderate to severe ear pain, ear pain lasting ≥ 48 hours, or fever > 102.2°F.5 The severity of symptoms is then considered when selecting the most appropriate treatment.
Ear pain is a major and common symptom of AOM and is an essential component in the initial management of AOM. Relief of ear pain is especially important during the first 24 hours of AOM onset. Analgesics (e.g., acetaminophen, ibuprofen) are the mainstay for treatment.4-5 For children < 12 TREATMENT AND MANAGEMENT OF AOM years old, the appropriate oral dose of acetaminophen is 10 The latest guidelines for the management of AOM in chilto 15 mg/kg/dose every 4 to 6 hours as needed (maximum dren, published in February 2013, outline specific diagnosis 2.6 g or 5 doses in 24 hours) and for ibuprofen, 4 to 10 mg/ and symptom severity criteria to determine treatment (i.e., kg/dose every 6 to 8 hours as needed (maximum 4 doses observation with/without an analgesic or immediate antibiin 24 hours).7 Topical agents, such as those containing otic). These recommendations focus on the management of benzocaine, may offer additional though brief benefit over uncomplicated AOM in otherwise healthy children between analgesics and may be considered in children > 5 years. the ages of 6 months to 12 years old without underlying There are no controlled studies that evaluate the effectivemedical conditions (e.g., anatomic abnormalities, cochlear ness of home remedies, including ear drops containing oil implants, genetic conditions, immunodeficiencies). The diand external application of heat or cold.4-5 agnosis and severity categorization of AOM are based on several factors. A diagnosis of AOM should be made in The decision to initiate antibacterial treatment immediately children with moderate to severe bulging of the tympanic or undergo a 48 to 72-hour observation prior to starting membrane or new onset of otorrhea not caused by acute treatment is based on the age of the child, illness severity otitis externa. A diagnosis also may be made in children and assurance of follow-up. Observation may be considwith mild bulging of the tympanic membrane and recent (< ered for children 6 to 23 months of age with unilateral AOM 48 hours) onset of ear pain (rubbing, holding and/or pulling and non-severe symptoms or those > 2 years of age with 14
THE KENTUCKY PHARMACIST
March 2014 CE — Otitis Media and Antibiotics
March 2014
either bilateral or unilateral AOM and non-severe symptoms.5 The caregivers of children who meet these criteria must ensure adequate follow-up if improvement is not seen after the observational period. Follow-up may include contacting or having the child re-evaluated by their health care provider and/or obtaining an antibiotic. During the observational period, symptomatic treatment may be provided, including analgesics (e.g., acetaminophen, ibuprofen) for pain management.4- 5
the initial treatment for children who have received amoxicillin in the previous 30 days, have concurrent purulent conjunctivitis or have a history of recurrent AOM unresponsive to amoxicillin (increased likelihood of high-level resistant S. pneumonia).4-5 The mechanism of resistance to betalactam antibiotics include alterations of the penicillinbinding proteins for S. pneumoniae resistance and the production of beta-lactamases for H. influenzae and M. catarrhalis.3 Risk factors for amoxicillin resistance include age < 2 years, daycare attendance and antibiotic use within the While observation is appropriate for some children, others last 30 days.4 If signs and symptoms do not improve after with AOM require immediate antibiotic treatment. An antibi48 to 72 hours of treatment with amoxicillin, the treatment otic should be prescribed for children ≥ 6 months with bilatshould be changed to amoxicillin-clavulanate (preferred), eral or unilateral AOM and severe signs or symptoms or ceftriaxone or clindamycin.2,5 In children who experience otorrhea. Children 6 to 23 months with bilateral AOM and treatment failure with amoxicillin-clavulanate, ceftriaxone is non-severe symptoms should receive an antibiotic.5 A 2006 preferred because of its superior efficacy against S. pneumeta-analysis suggests that children < 2 years of age with moniae.4-5 AOM regardless of symptoms and children with bilateral AOM or ear drainage benefit from antibiotic therapy.8 Antibiotic Selection – With Allergy to Penicillins Antibiotics used for the treatment of AOM include oral For children with an allergy to penicillins, the treatment of amoxicillin, amoxicillin-clavulanate, cefdinir, cefpodoxime, AOM may include cefdinir, cefpodoxime, cefuroxime, ceftricefuroxime, clindamycin or parenteral ceftriaxone (IM or axone or clindamycin. As recent evidence indicates that 5 IV). Selection of an the potential for allergy Table 2 - Duration of Therapy for AOM appropriate antibiotic cross-reactivity between is based on the child’s the penicillins and cephNumber of Days Treatment severity of symptoms, alosporins is lower than 1-3 Ceftriaxone - severe symptoms risk of antibiotic rehistorically reported, the 3 Ceftriaxone - severe symptoms with failure of sistance and history of 2013 guidelines recominitial antibiotic medication allergies mend use of a cephalo5-7 Oral therapy non-severe symptoms and and tolerances, as sporin in children with a 6-12 years of age well as prior treatment history of penicillin aller7 Oral therapy - non-severe symptoms and of AOM. The duration gy but without a severe 2-5 years of age of treatment depends or recent reaction. The 10 Oral therapy - severe symptoms or children on the selected antibioral cephalosporins (i.e., < 2 years of age otic, age of the child cefdinir, cefpodoxime, Compiled from reference 5. and severity of sympcefuroxime) are the pre5 toms. Antibiotic characteristics that increase patient compli- ferred choices. Of these, cefdinir is usually chosen due to ance (e.g., dosing interval, taste, formulation) should also its favorable taste.2 Ceftriaxone (IM, IV) is the drug of be considered. Recommendations for dosing and duration choice for children whose symptoms do not improve after of therapy are provided in Tables 1 and 2. 48 to 72 hours of oral treatment.4-5 A three-day course of ceftriaxone was shown to be more effective than a oneAntibiotic Selection – Without Penicillin Allergy time dose in treating children who failed to improve with For children without a history of penicillin allergy, the pretheir first antibiotic regimen. In children who are vomiting or ferred treatment of AOM is amoxicillin or amoxicillincannot tolerate oral antibiotics, ceftriaxone given as a sinclavulanate.5 Amoxicillin is the drug of choice for children gle dose or in three consecutive doses also may be used who have not received amoxicillin in the previous 30 days for treatment.4 Clindamycin may be used in those with a and do not have concurrent purulent conjunctivitis. Amoxi- severe or recent reaction to a penicillin or those with suscillin is preferred due to its narrow spectrum of activity, clin- pected penicillin-resistant S. pneumonia; however, efficacy ical success (S. pneumoniae - susceptible, intermediate, may be limited because of multi-drug resistant pathogens.5 some resistant strains), favorable safety profile, acceptable Of note, the macrolides (i.e., azithromycin, clarithromycin, taste and low cost. Amoxicillin-clavulanate is preferred as erythromycin) have limited efficacy and are no longer rec15
THE KENTUCKY PHARMACIST
March 2014 CE — Otitis Media and Antibiotics ommended as options for AOM treatment.
5
Alternative Therapies The utilization of alternative therapies (e.g., acupuncture, chiropractic therapy, herbal products, homeopathy and nutritional supplements) for the treatment of AOM is increasing. The use of these therapies is controversial due to the lack of supporting clinical data. Even though most of these therapies are harmless, others are toxic or could interfere with the effects of analgesics and antibiotics. Health care providers should question and educate caregivers about the use of alternative therapies and be able to discuss the possible risks and benefits of such therapies.4 Recurrent AOM For recurrent AOM (≥ 3 episodes in the previous 6 months or ≥ 4 episodes in the previous 12 months with ≥ 1 episode in the previous 6 months), tympanostomy tubes may be offered. The prophylactic use of antibiotics in children with recurrent AOM appears to offer only modest benefits in those with more frequent episodes. Use of such therapy requires considerations of costs, potential adverse effects and possible contributions to bacterial resistance. Longterm use of antibiotics is not appropriate for children with longstanding middle ear effusion or those with infrequent episodes of AOM. Instead, preventative measures should be the focus.5
March 2014 needs to be given three to five times a day throughout the respiratory illness season. The gum and lozenges appeared to offer greater benefits than the syrup; however, children < 2 years cannot safely use these formulations. 5 CONCLUSION AOM is a common condition among children with many opportunities for more effective management. As the most accessible health care provider, pharmacists should be well prepared to offer guidance and recommendations for the treatment and management of AOM. Most importantly, determining the appropriate treatment will maximize the benefits and minimize the associated risks. For selected children, based on diagnostic certainty, age, illness severity and assurance of follow-up, observation without use of an antibacterial agent is a viable option. This approach could reduce antibiotic prescriptions for ear infections in the United States by up to 3 million annually and would significantly reduce the prevalence of resistant bacteria.
References 1. Centers for Disease Control and Prevention. Ear Infections. 2012 May. Available at: http://www.cdc.gov/ getsmart/antibiotic-use/URI/ear-infection.html. Accessed 23 Oct 2013. 2. Chapter 57: Otitis externa, otitis media, and mastoiditis. Mandell: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed. Available PREVENTION through MD Consult. Accessed 23 Oct 2013. 3. Frei C, Frei B, Zhanel G. Chapter 117: Upper RespiraOne of the easiest and most effective ways to prevent reoctory Tract Infections. In DiPiro JT et al. Pharmacotheracurrence of and complications from AOM is prevention. Impy: A Pathophysiologic Approach. 8th Edition. 2011. munization has shown to dramatically reduce the incidence 2,4-5 Available via Access Pharmacy Website. Accessed 23 of influenza- and pneumococcal-associated AOM. Oct 2013. Health care providers should encourage parents to not only 4. Diagnosis and Management of Acute Otitis Media. Peimmunize their children, but to keep their own immunizadiatrics. 2004 May;113(5):1451-65. tions up to date to prevent transmission. Altering the pat5. Lieberthal AS, Carroll AE, Chonmaitree T, et al. Diagterns of daycare attendance and avoiding exposure to tonosis and Management of Acute Otitis Media. Pediatbacco smoke and air pollution may reduce the number of rics. 2013 Mar;131(3):e964-99. respiratory tract infections. Breastfeeding for at least the 6. Darby-Stewart A, Graber MA, Dachs R. Antibiotics for first 6 months, reducing or eliminating pacifier use in the acute otitis media in young children. AFP. 2011 Nov;84 second 6 months and bottle feeding in the upright position 4-5 (10):1095-97. also may provide some protective effect for infants. The 7. Lexi-Drugs. LexiComp [PDA program]. Huston: Lexi2013 guidelines mention the use of xylitol, a birch sugar Comp; 2012. available in chewing gum, lozenge and syrup formulations, 8. Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for prevention of recurrent AOM. Studies identified a 25 for acute otitis media: a meta-analysis with individual percent reduction in the risk of AOM occurrence among patient data. Lancet. 2006 Oct;368:1429-35. healthy children in a daycare setting with the routine use of xylitol, compared to a control. To be effective, the product
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THE KENTUCKY PHARMACIST
March 2014 CE — Otitis Media and Antibiotics
March 2014
March 2014 — Otitis Media and Antibiotics – Yes, No, or Maybe? 1. The most common bacteria to cause AOM include(s): A. Streptococcus pneumoniae. B. Haemophilus influenzae. C. Moraxella catarrhalis. D. all the above. 2. Diagnosis of AOM can include: A. mild to severe bulging of the tympanic membrane. B. middle ear effusion. C. recent onset of ear pain or intense erythema. D. all the above. 3. All children > 6 months of age with AOM and severe symptoms should be treated with an antibiotic. A. True B. False 4. All patients with a confirmed diagnosis of AOM should be treated with an antibiotic. A. True B. False 5. The duration of treatment with an antibiotic for AOM depends on the: A. class of antibiotic. B. gender of the child. C. severity of symptoms. D. history of medication intolerances.
7. Which antibiotic is preferred for children with AOM, severe symptoms, and no allergies who failed amoxicillin/ clavulanate? A. Amoxicillin B. Ceftriaxone C. Clindamycin 8. Of the oral cephalosporins, _______ is usually preferred, because of taste? A. Cefdinir B. Cefpodoxime C. Cefuroxime 9. Which antibiotic would be appropriate for a patient with a history of a severe penicillin allergy? A. Amoxicillin B. Ceftriaxone C. Clindamycin D. Cefpodoxime 10. Which of the following is not recommended for the treatment of severe AOM? A. Amoxicillin/clavulanate B. Azithromycin C. Ceftriaxone D. Clindamycin
6. The most appropriate treatment for a child with AOM and no allergies if Streptococcus pneumoniae resistance is suspected would be: A. amoxicillin. B. amoxicillin/clavulanate. C. erythromycin/sulfisoxazole. D. sulfamethoxazole/trimethoprim.
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Call Xcel Diagnostics today to schedule your screening day. (606) 218-5483 17
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March 2014 CE — Otitis Media and Antibiotics
March 2014
This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South, Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: March 1, 2017 Successful Completion: Score of 80% will result in 1.0 contact hour or 0.1 CEU. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. March 2014 — Otitis Media and Antibiotics – Yes, No, or Maybe? (1.0 contact hours) Universal Activity # 0143-9999-14-003-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B 5. A B C D 2. A B C D 4. A B 6. A B C D
7. A B C 8. A B C
9. A B C D 10. A B C D
Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________
NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD)
PHARMACISTS ANSWER SHEET March 2014 — Otitis Media and Antibiotics – Yes, No, or Maybe? (1.0 contact hours) Universal Activity # 0143-9999-14-003-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B 5. A B C D 2. A B C D 4. A B 6. A B C D
7. A B C 8. A B C
9. A B C D 10. A B C D
Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________
NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.
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Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.
THE KENTUCKY PHARMACIST
March 2014
AMA President visits UKCOP
AMA President Hoven visits UKCOP future of our profession,” said Beth Moore, Chair of the Board for KAPS, and a third-year PharmD student at the College. “Being able to bring a world-class presenter and The President of the American Medical Association (AMA) health care leader like Dr. Hoven allowed us to do that. I provided UK College of Pharmacy students, faculty, staff, am thankful that Dr. Hoven was so generous with her time alumni and friends with a special guest lecture as part of and was energized by the collaborative message she the Kentucky Alliance of Pharmacy Students (KAPS) Advoshared throughout the day.” cacy Day on February 5. “This discussion came at a critical time for policy developArdis Dee Hoven, who became the 168th president of the ment and legislative efforts for the advancement of collaboAMA in June 2013, provided her talk entitled “The AMA, rative pharmacy practice,” said Trish Freeman, Director of Pharmacists and the Future of Healthcare,” and helped the College’s Center for the Advancement of Pharmacy address the importance of pharmacists as a crucial memPractice (CAPP). “We were delighted to have Dr. Hoven ber of the physician-led healthcare team. join us for Advocacy Day. Providing our student pharma“Pharmacists fit in the big picture of healthcare in a major cists the opportunity to hear the perspective of one of the way,” said Dr. Hoven. “(All healthcare disciplines) have to nation’s top healthcare thought leaders was fantastic.” work together to improve health outcomes in this counBorn in Cincinnati, Dr. Hoven received her undergraduate try. Delivering team care is, in fact, the best care.” degree in microbiology and her medical degree from the Dr. Hoven, a past president of the Kentucky Medical Asso- University of Kentucky. She completed her internal mediciation, has a long history of promoting collaborative relacine and infectious disease training at the University of tionships between pharmacists and physicians through her North Carolina, Chapel Hill. work at the University of Kentucky as an internal medicine Board-certified in internal medicine and infectious disease, and infectious disease specialist. Dr. Hoven is a fellow of the American College of PhysiIn addition to her lecture, Dr. Hoven met with many pharcians and the Infectious Disease Society of America. She macy leaders as part of Advocacy Day. She conducted has been the recipient of many awards, including the Unismall group discussion with student leaders, engaged fac- versity of Kentucky College of Medicine Distinguished ulty in a dialogue and met with leaders from the Kentucky Alumnus Award and the Kentucky Medical Association DisPharmacists Association, Kentucky Society of Health Sys- tinguished Service Award. In 2013, Dr. Hoven was named tems Pharmacists, Kentucky Board of Pharmacy and one of Modern Healthcare Magazine’s Top 25 Women in American Pharmacy Services Corporation for a discussion Healthcare. about the future of healthcare. Dr. Hoven is married to Ron Sanders, PhD, an economist and college professor. They share a mutual enjoyment of “With this year’s Advocacy Day, KAPS wanted to really engage student pharmacists and current practitioners in a two grandchildren, sports, travel and philanthropic activimeaningful dialogue about why advocacy is so vital to the ties. American Medical Association President Provides KAPS Advocacy Day Lecture
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THE KENTUCKY PHARMACIST
Technician Review
March 2014
Technician Review From the KPhA Academy of Technicians The KPhA Pharmacy Technician Academy would like to invite any KPhA technician members to join the academy at no extra cost. By joining the Academy you are eligible to receive up to 10 hours of technician-specific CE per year provided by the Continuing Education Institute. The KPhA board members have shown strong support of the Technician Academy by approving the CE at no extra cost to the members. The Academy has submitted a set of proposals for the future of the pharmacy technicians in Kentucky to KPhA, KSHP and KY Board of Pharmacy Advisory Council. Its proposals are in accordance with the changes that are coming from the national level, and the goal is to make Kentucky one step ahead of the rest of the nation. The Advisory Council is reviewing its proposals so they can present a final set of recommendations to the Board of Pharmacy.
In the next couple of months the Academy will be holding an election for a KPhA Pharmacy Technician delegate position as one of the three directors. The current chair will step down and each delegate will move upward in the leadership of the academy. If you are interested in becoming a delegate for the KPhA Pharmacy Technician Academy, please send a brief autobiography to Don Carpenter. To be a delegate you must be a member of KPhA and of the Technician Academy. Each candidate will be presented to the entire Academy where members will vote for their choice. If you have any questions about the KPhA Pharmacy Technician Academy, please contact Don Carpenter at dacarpenter@st-claire.org. Thank you, Don Carpenter, CPhT KPhA Pharmacy Technician Academy Chair
KPhA Member Pharmacy Technicians
FREE CE
KPhA Technician members are eligible for Free CE modeled on PTCB standards by becoming a member of the KPhA Pharmacy Technician Academy. All KPhA Technician Members are eligible for Academy Membership at no additional cost. The mission of the KPhA Academy of Pharmacy Technicians is: To unite the pharmacy technicians throughout the Commonwealth to have one voice toward the advancement of our profession. To follow what is currently happening with your profession please read our newsletter articles and become involved.
For more information contact Don Carpenter via email at dacarpenter@st-claire.org 20
THE KENTUCKY PHARMACIST
KPhA Pharmacy Emergency Preparedness
March 2014
Emergency Supply Kits: Be Prepared Be Responsible and Be Prepared! By being prepared and staying informed, you can prevent or reduce harm to yourself, your family members and loved ones, or persons for whom you advocate. Survival Supplies Kit: You need a survival supply kit that will provide for your needs — for at least three days and up to 10 days. Consider two kits: In one kit put everything you will need to stay where you are and survive on your own for a period of time. The other kit should be a lightweight smaller version that you can take with you if evacuation from your place of residence is necessary. Be sure to bring this kit with you. The kit should be stored in a sturdy, easy-to-use container and include the following recommended items: Basic Supply Kit Items
Flashlight, extra batteries
Food (label and date, use compact lightweight food that does not require refrigeration, cooking or preparation; store in plastic bags)
Blankets, towels, inflatable pillows, air mattresses, sleeping bags
Water (1 gallon per person for each day; include enough for pets and sanitation, label and date, or purchase bottled water)
Extra clothing (depending on weather, include waterproof coats, ponchos, boots, warm coats, gloves, sturdy shoes, heavy socks, hat, mittens, scarf)
First aid kit (keep one kit in your home and one in your car) Medications and medical supplies for at least 5 - 7 days (glasses or contact lens, eye wash, hearing aid batteries, etc., as well as over-the-counter supplies, e.g., aspirin, fever/pain relievers, anti-diarrhea medication, emetic, [to induce vomiting], antacids, sterile gauze pads 2-3 inches, sterile roller bandages, adhesive bandages, antiseptic spray, hydrogen peroxide, rubbing alcohol, petroleum jelly, latex gloves, scissors, tweezers, safety pins, etc.).
Whistle, air horn, or other noisemaker to signal for help
Other Recommended Supply Kit Items
Important documents in a waterproof container (photocopies of birth certificate, marriage certificate, medical condition, allergies, and prescription needs, including glasses, serial number for pace maker, immunization records, stocks, bonds, bank accounts, deeds, title, mortgage papers, will)
Extra copies of prescriptions (ask your doctors, and let them know they are for your emergency kit)
Wear a medical emblem (bracelet or necklace noting diagnosis, such as “Diabetes,” “Dialysis,” “Hemophilia,” etc.)
Manual can opener, utility knife
Cell phones, phone chargers
Emergency contact names and numbers
Identification (photocopies of identification, driver’s license, Social Security card, Medicare card, other health insurance information, credit cards)
Cash and coins
Sanitation-related items (soap and water, or alcoholbased hand sanitizer, basic personal hygiene items such as toothbrush, toothpaste, denture needs, soap, shampoo, feminine products, wipes, etc., bathroom tissue, facial tissue, paper towels, dust mask, garbage bags, bleach, etc.)
Portable, battery-powered radio or weather radio, plus extra batteries
Special equipment you will need, such as a transfer board and/or other assistive device
Plastic measuring cups, paper or plastic plates, plastic spoons, forks, knives
Maps (state & local), compass
Paper, pencils, pens
Tape (duct / masking)
Tool kit (hammer, screw driver, pliers, wrench, utility knife, rope)
Ice chest if your medications need to be cold (keep your ice trays filled in your refrigerator in case you need ice)
Candles and matches in a waterproof container (Note: do not use matches if there is a gas leak, chemical exposure, oxygen tank or any other condition or substance that would make a flame dangerous)
Fire extinguisher
For more Emergency Preparedness Resources, visit www.kphanet.org, click on Resources and Emergency Preparedness. 21
THE KENTUCKY PHARMACIST
April 2014 CE â&#x20AC;&#x201D; Meet the New Kids on the Block
March 2014
Meet the New Kids on the Block: Ospemifene, Canagliflozin, Levomilnacipran and Dolutegravir By: Amanda N. Jett, Pharm.D. and Holly L. Byrnes, Pharm.D., BCPS, Sullivan University College of Pharmacy There are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-14-004-H04-P&T 1.5 Contact Hours (0.15 CEUs) Goal: To review new medications which gained approval by the Food and Drug Administration (FDA) in 2013, and to discuss their mechanisms of action, place in therapy and other important clinical aspects relevant to pharmacy practice. Objectives: At the conclusion of this lesson, the reader should be able to: 1. Recognize newly approved medications and their indications. 2. Identify the place in therapy for newly approved medications. 3. Discuss key aspects of newly approved medications, including mechanism of action (MOA) and important counseling points.
KPERF offers all CE articles to members online at www.kphanet.org
(SERM) that mimics estrogen on the vaginal tissues and The FDA approved more than 20 new molecular entities in induces changes to increase thickness and decrease fragil2 2013.1 The novelty of each of these new drugs varies from ity. innovative mechanisms of action, well-established mecha- Similar to conjugated estrogens and other SERMs, ospemnisms of action in the form of new molecular formulas and ifene has a black box warning for cardiovascular events new biologic agents that are approved for the treatment of such as deep vein thrombosis (DVT) and stroke. In addicertain cancers.2-6 New medications discussed in this re- tion, this medication also carries a black box warning for view focus on the treatment of painful symptoms related to endometrial cancer for women with an intact uterus not menopause, as well as treatment for chronic disease states concurrently taking a supplemental progestin, although no such as diabetes, depression and Human Immunodeficien- reports of endomentrial cancer were found in ospemifene cy Virus (HIV).2-5 The purpose of this review is to explore clinical studies. Other adverse reactions found in clinical these new medications in more detail, explaining the mech- studies include hot flashes (7.5 percent), vaginal discharge anisms of action, place in therapy and key aspects that dif- (3.8 percent), muscle spasms (3.2 percent), hyperhidrosis fer from previously used therapies. (1.6 percent) and genital discharge (1.3 percent).2 Introduction
Ospemifene (Osphenaâ&#x201E;˘) 1
Nonhormonal lubricants and moisturizers are recommended initially to relieve painful intercourse. When these fail to provide relief, vaginal estrogens are preferred.8 Ospemifene can be considered for use following treatment failure with vaginal estrogens, or in cases where patients prefer an oral option.8 Table 19 provides a cost comparison of vaginal estrogens and ospemifene.
Ospemifene was approved by the FDA in February 2013. It is the first orally administered agent indicated for moderate to severe dyspareunia (painful intercourse) in postmenopausal females.2 During menopause, a womanâ&#x20AC;&#x2122;s estrogen levels will decrease, causing vaginal tissues to become thinner, drier and more fragile. These natural changes are symptoms of vaginal and vulvar atrophy, and often lead to The recommended dose of ospemifene is 60 mg daily takpain during intercourse.7 en with food, for the shortest duration necessary. PostmenPrior to the approval of ospemifene, a number of over-the- opausal women taking this medication should be evaluated counter (OTC) lubricants and moisturizers, as well as estro- periodically to determine if therapy is still necessary. gen-containing prescription products were available for Ospemifene is contraindicated in women with undiagnosed treating the symptoms of vaginal atrophy, including painful abnormal vaginal bleeding, a history or active DVT or pulintercourse.7 Ospemifene provides a new mechanism of monary embolism (PE), a history of arterial thromboembolic action to treat the underlying issues associated with vaginal disease, an estrogen-dependent tumor or those who are atrophy. It is a selective estrogen receptor modulator pregnant or may become pregnant.2 22
THE KENTUCKY PHARMACIST
April 2014 CE — Meet the New Kids on the Block
March 2014
9
Table 1
Product
Brand Name
Dose
Cost
Estradiol Cream (topical)
Estrace®
2-4 g/day for 1-2 weeks
$169.96
Estradiol Ring (vaginal)
Estrace®
2 mg, lasts 90 days
$268.12
Estradiol Tablets (vaginal)
Vagifem®
1 tab/day for 2 weeks, then 1 tab twice a week
$103.10 (for 8 tabs)
Conjugated Estrogen Cream
Premarin®
1 g/day
$241.25
Ospemifene Tablets (oral)
Osphena™
60 mg daily
$189.60
fourth SNRI to be approved for major depressive disorder (MDD) in the United States.12 While this medication does Canagliflozin, approved in March 2013 for the treatment of not offer a new mechanism of action, it does offer other Type 2 diabetes mellitus in adults,1,3 brings a new mechapotential benefits to patients suffering from MDD. nism of action to the treatment of diabetes. This medication acts on the sodium-glucose cotransporter-2 (SGLT-2), During clinical trials, levomilnacipran was found to have which is located in the kidneys and is responsible for reab- twice the potency for norepinephrine reuptake inhibiton relsorbing glucose that is filtered by the kidneys. SGLT-2 in- ative to serotonin reuptake inhibition, and 17 and 27 times hibitors block reabsorption, increasing the amount of glu- higher selectivity for norepinephrine reuptake inhibition cose excreted, and lowering blood glucose concentra- compared with venlafaxine and duloxetine (both SNRIs), tions.10 respectively. Since there are not currently selective norepinephrine reuptake inhibitors approved for the treatment of In one clinical trial, canagilflozin 100 mg and canagliflozin depression in the US, this may be an important characteris300 mg were compared with glimepiride in combination tic for this drug. Levomilnacipran potentially could be used with metformin. The canagliflozin 100 mg, canagliflozin 300 as a first or second line option following failure with SSRIs mg and glimepiride groups all showed a similar reduction in or SNRIs, or as an add on to other antidepressants.12 hemoglobin A1c from baseline; however, the canagliflozin groups showed a greater than 4 percent reduction in body In addition to the benefit of providing more selective norepiweight compared to a 1 percent increase in body weight in nephrine reuptake, levomilnacipran is an extended-release the glimepiride group. Additionally, the canagliflozin groups capsule, and is only taken once daily. All other SNRIs used experienced a much lower incidence of hypoglycemia com- for MDD are dosed twice daily.4,9 This medication comes in pared to the glimepiride group (6 percent vs. 34 percent). 11 a titration pack, as the starting dose is 20 mg daily for two The recommended dose of canagliflozin is 100 mg before days followed by 40 mg daily, with a maximum dose of 120 the first meal of the day, as this medication can reduce mg daily.4 postprandial hyperglycemia.3 Because levomilnacipran is an extended-release capsule, it Due to the mechanism of action of canagliflozin, one of the is important to note that it should be taken whole, and not most commonly experienced side effects is genitourinary crushed or chewed. Side effects related to levomilnacipran infections. Approximately 11 percent of females experi- are similar to other SNRIs, and include gastrointestinal disenced genital mycotic infections (i.e., vulvovaginal candidi- turbances such as nausea, vomiting and constipation. Paasis) and 6 percent experienced urinary tract infections tients may also experience tachycardia and palpitations. (UTIs). Male genital mycotic infections occurred in about 4 Also, like other SNRIs, levomilnacipran has a black box percent of subjects. Hypotension and hyperkalemia were warning for suicidal thoughts and behaviors upon initiation also reported due to osmotic diuresis.3 in young adults, and in fact, is not indicated for children.4,9 Canagliflozin (Invokana®)
Levomilnacipran (Fetzima™)
Dolutegravir (Tivicay®)
Levomilnacipran, an active enantiomer of the serotoninnorepinephrine reuptake inhibitor (SNRI) milnacipran (Savella®), gained FDA approval in July 2013 and became available to patients in December 2013. 1,4,9 This is the
Dolutegravir was approved for the treatment of Human Immunodeficiency Virus (HIV) in adults and children ages 12 and older in August 2013.1,5 This is the third integrase inhibitor to be approved in the United States, blocking the
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THE KENTUCKY PHARMACIST
April 2014 CE — Meet the New Kids on the Block strand transfer step of DNA integration, which is necessary for HIV replication. 9,13
March 2014
Table 214-17 Study
n*
SPRING-2 (Dual-NRTI +)
822
Drug
Suppression** (% of pts)
Dolutegravir
88
Raltegravir
86
new drugs, approved in 2013, appear to have received a great deal of recognition in the pharmaceutical world. We should all be on the lookout for the increased use of the medications and how to best educate our patients on their use.
This medication Dolutegravir + 88 showed a great Epzicom SINGLE 833 deal of promise in Atripla 81 clinical trials when Dolutegravir 79 SAILING compared to other 719 (≥1 active agent +) Raltegravir 70 drugs used to treat 14-17 HIV. When Dolutegravir 63 VIKING-3 183 References: compared to ralte(Resistant HIV) Placebo N/A gravir (the first 1. U.S. Food and *Number of study subjects integrase inhibitor **Suppression refers to the HIV suppression rates demonstrated in each study arm Drug Administration. to be approved for Drug Approval Reports the treatment of HIV) in treatment naïve patients in the [Data file]. Retrieved from http:// SPRING-2 trial, dolutegravir proved to be noninferior with www.accessdata.fda.gov/scripts/cder/drugsatfda/ similar tolerability to raltegravir.14 In the SINGLE trial, doindex.cfm? lutegravir, when used in combination with abacavir/ fuseaction=Reports.NewOriginalNDA#navigation. lamivudine combination drug showed superiority to efaviAccessed December 30, 2013. renz/emtricitabine/tenofovir combination drug.15 Dolute2. Osphena™ [package insert]. Penn Pharmaceutical gravir was again compared to raltegravir, this time in anServices Ltd. Tredegar, Gwent, South Wales, Unittiretroviral-experienced patients, in the SAILING trial, and 16 ed Kingdon. February 2013. again showed non-inferiority. The last clinical trial that helped dolutegravir to gain approval was the VIKING-3 trial, 3. Invokana® [package insert]. Janssen Pharmaceutiwhere dolutegravir was compared to placebo in patients cals, Inc. Titusville, NJ. March 2013. with resistant HIV. Sixty-three percent of patients in the 4. Fetzima™ [package insert]. Forest Pharmaceutidolutegravir trial were virologically suppressed at the concals, Inc. St. Louis, MO. July 2013 clusion of this study.17 Table 214-17 shows a comparison of these trials and the results. 5. Tivicay® [package insert]. GlaxoSmithKline. Research Triangle Park, NC. August 2013. In most patients, dolutegravir is dosed 50 mg daily. Ralte6. Kalantaridou SN, Dang DK, Davis SR, Calis KA. gravir is dosed twice daily, which could lead to adherence Chapter 91. Hormone Therapy in Women. In: Wells issues. Like raltegravir the most commonly reported adBG, ed. Pharmacotherapy: A Pathophysiologic Apverse effects during clinical trials were insomnia, headache 9,13 proach. 8th ed. New York: McGraw-Hill; 2011. and fatigue. Unlike raltegravir, however, dolutegravir is http://www.accesspharmacy.com/content.aspx? stable against known resistance mutations associated with aID=7994084. Accessed December 30, 2013. raltegavir, which provides the rationale as to why this drug showed promise in treatment of resistant patients.9 Summary Two of the medications discussed in this review, ospemifene and canagliflozin, are novel agents with novel mechanisms of action. While neither medication is considered first line therapy for their respective disease states at this time, there seems to be promise in the future of these drugs. The other two medications, levomilnacipran and dolutegravir, have well-known mechanisms of action, but can both provide the benefit of having once-daily dosing when compared to older medications in their drug class. All of these 24
7. Kingsberg SA, Kellogg S, and Krychman M. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy. Int J Women’s Health. 2009;1:105-111. 8. Seal A, Kerac M. Ospemifene (Osphena) for Dyspareunia. The Medical Letter on Drugs and Therapeutics. 2013;1420:55. Retrieved from http:// secure.medicalletter.org/TML-article-1420c. Accessed December 30, 2013. 9. Lexi-Comp Online®, Lexi-Drugs Online®, Hudson, Ohio: Lexi-Comp, Inc; August 14, 2013.
THE KENTUCKY PHARMACIST
April 2014 CE — Meet the New Kids on the Block
March 2014
10. Valentine, V. The role of the kidney and sodiumglucose cotransporter-2 inhibition in diabetes management. Clinical Diabetes. 2012;30(4):151-155. 11. Cefalu W, Leiter L, Yoon K, et al. Efficacy and safety of canagliflozin versus glimepiride in patients with type 2 diabetes inadequately controlled with metformin (CNTATA-SU): 52 week results from a randomized, double-blind, phase 3 non-inferiority trial. The Lancet . July 12, 2013. 12. American Psychaitric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd. Ed. Arlington (VA): American Psychiatric Association (APA); Oct 2010: (52).
agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/ lvguidelines/AdultandAdolescentGL.pdf. Accessed August 23, 2013. 14. Raffi F, Rachlis A, Stellbrink. Et al. SPRING-2 Study. Lancet . 2013:381(9868);735-743. 15. Fantauzzi A, Turriziana O, Mezzaroma I. Potential benefit of dolutegravir once daily: efficacy and safety. HIV AIDS (Auckl) 2013:5;29-40 16. Cahn P, Pozniak A, Mingrone et al. SAILING Study. Lancet 2013:382(9893):700-708 17. Eron J, Clotet B, Durant J, et al. VIKING Study. J Infect Dis 2013:207(5);740-748
13. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral
April 2014 — Meet the New Kids on the Block: Ospemifene, Canagliflozin, Levomilnacipran and Dolutegravir 1. Choose the statement that makes ospemifene unique from previously marketed drugs for moderate to severe dyspareunia. A. It is an orally administered medication. B. It is a SERM. C. It should not be used in pregnant women. D. A & B. E. All of the above. 2. One of the most common side effects of ospemifene is: A. Itching. B. Hot flashes. C. Discharge. D. Blurry vision. E. Excessive thirst.
6. What is a potential benefit of levomilnacipran? A. Once daily dosing B. Greater selectivity for norepinephrine reuptake inhibition C. Fewer adverse effects D. A & B E. All of the above 7. Levomilnacipran carries a Black Box Warning for: A. Suicidal thoughts and behavior. B. Cardiovascular death. C. Development of diabetes. D. Neutropenia. E. Pancreatitis. 8. Dolutegravir is in which drug class? A. Protease inhibitors B. Integrase inhibitors C. Nucleoside reverse transcriptase inhibitors D. Non-nucleoside reverse transcriptase inhibitors E. Combination integrase inhibitor/nucleoside reverse transcriptase inhibitor
3. Canagliflozin works by: A. Increasing glucose reabsorption. B. Decreasing glucose reabsorption. C. Inhibiting SGLT-2. D. A & C. E. B & C.
9. Clinical studies on dolutegravir have shown: A. Non-inferiority to raltegravir in treatment-naïve patients. B. Non-inferiority to raltegravir in treatment-experienced patients. C. Benefit in treatment resistant patients. D. A & C. E. All of the above.
4. Adverse effects seen in canagliflozin clinical trials include: A. Hypokalemia. B. Hypertension. C. Genital mycotic infections. D. A & B. E. B & C. 5. Canagliflozin may offer a benefit over glimepiride in which area? A. Improved weight loss B. Fewer adverse effects C. Decreased HbA1c D. Improved adherence E. Utility in type 1 diabetes
10. Which is true regarding dolutegravir and raltegravir? A. Dolutegravir is dosed twice daily and raltegravir is dosed once daily B. Dolutegravir has less side effects than raltegravir C. Dolutegravir is resistant to mutations affecting raltegravir D. Dolutegravir cannot be used in ages 12 and up while raltegravir can E. All of the above 25
THE KENTUCKY PHARMACIST
April 2014 CE — Meet the New Kids on the Block
March 2014
This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South, Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: March 21, 2017 Successful Completion: Score of 80% will result in 1.5 contact hour or 0.15 CEU. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. April 2014 — Meet the New Kids on the Block: Ospemifene, Canagliflozin, Levomilnacipran and Dolutegravir (1.5 contact hours) Universal Activity # 0143-0000-14-004-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 3. A B C D E 5. A B C D E 2. A B C D E 4. A B C D E 6. A B C D E
7. A B C D E 8. A B C D E
9. A B C D E 10. A B C D E
Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________
NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) PHARMACISTS ANSWER SHEET April 2014 — Meet the New Kids on the Block: Ospemifene, Canagliflozin, Levomilnacipran and Dolutegravir (1.5 contact hours) Universal Activity # 0143-0000-14-004-H04-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 3. A B C D E 5. A B C D E 2. A B C D E 4. A B C D E 6. A B C D E
7. A B C D E 8. A B C D E
9. A B C D E 10. A B C D E
Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________
NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.
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Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.
THE KENTUCKY PHARMACIST
Kentucky Renaissance Pharmacy Museum
March 2014
The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's leading preservation organization for pharmacy. While contributions of any size are greatly appreciated, the following levels of annual giving have been established for your consideration.
Friend of the Museum $100 Proctor Society $250 Damien Society $500 Galen Society $1,000 Name______________________________________ Specify gift amount________________________ Address ____________________________________ City____________________Zip______________ Phone H____________________W________________ Email___________________________________ Employer name_____________________________________________________for possible matching gift. Tributes in honor or memory of_____________________________________________________ Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax deductible contributions will be mailed to you annually.
Questions: Contact Lynn Harrelson @ 502-425-8642 or Lharrelsonky@aol.com
For more information on the museum, see www.pharmacymuseumky.org or contact Gloria Doughty at g.doughty@twc.com or Lynn Harrelson at lharrelsonky@aol.com.
27
THE KENTUCKY PHARMACIST
KPhA New and Returning Members
March 2014
KPhA Welcomes New and Renewing Members January-February 2014 Crystal Akridge Shepherdsville
Clyde Brown Mayfield
Elizabeth Coomes Bardstown
Kevin Fosso Carlisle
Doug Antle Louisville
Amy Brown Greenup
Karen Cornelius Middlesboro
Clarence Francis Maysville
Michael Arnold Wilder
Aeron Burns North Canton, Ohio
Freddie Cox Corbin
John Fuller Versailles
Maryann Awosika Cold Spring
Amanda Burton Danville
Terry Coyle Campbellsville
Lynn Fuller Versailles
Karen Baisch Louisville
Donell Busroe Harlan
Autumn Cravens Crestwood
Patty Gayheart Hindman
Stephanie Bargo Lexington
Misty Camp Horse Branch
Kristin Daniels Ashland
Lisa Goodlett Springfield
Cathy Barker Flatwoods
Mark Capps Burkesville
Helen Danser Tyner
Stephen Goodlett Lexington
Mary Beimesch Hebron
Shelia Carrico Lawrenceburg
Joey Darling Wheelersburg, Ohio
Charles Gore Russell Springs
Michelle Bell Burkesville
Daniel Carver Alexandria
Amy Delcourt Greenup
Cynthia Gray La Grange
Danny Bentley Russell
Alan Cash Albany
Jane Dunbar-Suwalski Longmont, Colo.
Darrell Greenwalt Livermore
Marguerite Bertram Albany
Timothy Castagno Louisville
Catherine Elmes Sarasota, Fl.
Michael Gruber Carrollton
Gregory Blank Covington
Brian Cheek Louisville
Paul Elmes Louisville
Elizabeth Haegele Erlanger
Benjamin Bloemer Fort Mitchell
Jane Cheek Louisville
Kay Embrey Brandenburg
Brandon Hale Murray
Deirdre Bloemer Fort Mitchell
Carolyn Chou Louisville
Tony Esterly La Grange
Jessica Hall Flatwoods
Charles Boggs Dandridge, Tenn.
Carrie Christofield Ft Mitchell
Jina Estridge Tyner
Deborah Harden Campbellsville
Kenneth Boggs Hazard
Leanne Clark Richmond
Edward Feeney Louisville
David Harris Mayfield
Virginia Bohmer Cincinnati, Ohio
David Clarke Lexington
Lindsay Ferrell Owingsville
Clara Hartgrove Martin
Michael Bordes Williamsburg
David Conyer Paducah
David Figg Beaver Dam
Greg Hayse Shelbyville
Emily Brooks Berea
William Conyers Glasgow
Matthew Foltz Villa Hills
Dale Heise Harrodsburg
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THE KENTUCKY PHARMACIST
KPhA New and Returning Members
March 2014
Jolinda Henry Lexington
Jerry Morris Louisville
Mike Robinson Newport
Gisela Torres Louisville
Larry Hill Williamsburg
Shelley Nall Lexington
Scott Ross Hopkinsville
Emily Tschop Grayson
Kristina Hinkle Heidrick
Burnice Napier Hazard
Jennifer Roth Lexington
John Turpin Pineville
James Hinkle Heidrick
LeAnne Nieters Louisville
Lauren Routt Owingsville
Terry Vest Russell
Susan Hogsten Flatwoods
Carolyn Northcutt Union
Thomas Russell Independence
Sarah Vickey Wilmore
Barry Horne Danville
Karl O'Dell Flatwoods
Larry Schaefer Madisonville
Susan Victor Morehead
Tawnya Hunt Greenup
Tara Olash Louisville
Jim Scott Earlington
Phillip Vowels Taylorsville
H. Dale Johnson Corbin
Peter Orzali Cold Spring
Barry Siegel Evansville, Ind.
Joseph Wagner Louisville
Jennifer Keller Harrodsburg
Beth Parks Coralville, Iowa
Roberta Sloan Lexington
Kathy Wagner Louisville
Rene Kendrick Taylorsville
Duane Parsons Richmond
Richard Slone Lexington
Nancy Walker Cynthiana
Christopher Killmeier Louisville
Mike Patrick Booneville
Sheel Slone Lexington
Sara Wells Gilbertsville
David Kramp Louisville
George Patterson Gilbertsville
Justin Smith Williamsburg
Sandy Wethington Liberty
Mark Kupper Louisville
Charles Peterson Rineyville
Vance Smith Harrodsburg
Beverly White Williamsburg
Kay Lloyd Louisville
Lance Piecoro Louisville
Billy Smith Shepherdsville
Cary White Lexington
Morris Lloyd Louisville
Vicky Pulliam Bardstown
Kristen Soden Union
Paul Williams Hardinsburg
Katherine Martin Metropolis, Ill.
Sarah Raake Palmyra, Ind.
Cheryl Stevens Louisville
Christine Windham London
Tom Mattingly Olive Hill
Nancy Rath Louisville
Robert Stone Glasgow
Dan Yeager Lexington
Okey Mbadike Louisville
Teressa Reavis Graham, N.C.
Kelley Stout Crestview Hills
Jane Yeager Lexington
Charles McQuillan Union
J. Clay Rhodes Louisville
Stephanie Taylor Corbin
Charles Moore Wentzville, Mo.
Jill Rhodes Louisville
Nicole Thacker Flatwoods
Ronald Moreland Falmouth
Stacey Rider Harrodsburg
Mykel Tidwell Mayfield
Know someone who should be on this list? Ask them to join YOU in supporting YOUR KPhA!
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THE KENTUCKY PHARMACIST
KPPAC
March 2014
Kentucky Pharmacists Political Advocacy Contribution Form Name: _________________________________ Pharmacy: ___________________________ Address: _______________________ City: ________________ State: _____ Zip: ________ Phone: ________________ Fax: __--_______________ E-Mail: __________________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)
Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601
CONTRIBUTION LIMITS The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election.
Cash Contributions: $50 per contributor, per election. Contributions by cashier’s check or money order are limited to $50 per election unless the instrument identifies the payor and payee. KRS 121.150(4)
Individuals may contribute no more than $1,500 per year to all PACs in the aggregate.
Anonymous Contributions: $50 per contributor, per election, maximum total of $1,000 per election.
In-kind contributions are subject to the same limits as monetary contributions.
(This information is in accordance with KRS 121. 150)
Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines The following broad guidelines should guide an author to completing a continuing education article for publication in The Kentucky Pharmacist.
Include a quiz over the material. Usually between 10 to 12 multiple choice questions.
Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers.
Average length is 4-10 typed pages in a word processing document (Microsoft Word is preferred).
When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article.
Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not pertinent to technicians, that needs to be stated clearly Articles should address topics designed to narrow at the beginning of the article. gaps between actual practice and ideal practice in Article should begin with the goal or goals of the pharmacy. Please see the KPhA website overall program – usually a few sentences. (www.kphanet.org) under the Education link to see Include 3 to 5 objectives using SMART and meas- previously published articles. urable verbs.
Articles must be submitted electronically to the KPhA director of communications and continuing education Feel free to include graphs or charts, but please submit them separately, not embedded in the text (ssisco@kphanet.org) by the 15th of the month preceding publication. of the article.
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THE KENTUCKY PHARMACIST
NKY Pharmacist/physician passes
March 2014
Northern Kentucky Pharmacist/Physician passes away Philip B. Schworer passed away Dec. 24, 2013. Schworer, 80, of Lakeside Park, Ky., practiced in northern Kentucky, beginning in 1960 with an office in Ft. Mitchell. During his career, he served as Chairman of the Pulmonary and Pharmacy Departments at St. Elizabeth Medical Center. KPhA extends our collective condolences to the family.
KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________
Email: ______________________________________________________________ Address: _____________________________________________________________ City: ___________________________________________ State: _________ Zip: ____________ Phone: ________________ Fax: __--_______________ E-Mail: ______________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs) Credit Card (AMEX; Discover; MasterCard; VISA) Account #: _______________________________________ Expiration date: _______ CVV: ______________ Billing address (if different from above) ___________________________________________________________________________________
Mail to: Kentucky Pharmacists Association, 1228 US Highway 127 South, Frankfort, KY 40601
Pharmacists Mutual Insurance offers Medicare Surety Bond In 2009 the Centers for Medicare and Medicaid Services (CMS) implemented Surety Bond Requirements for suppliers of Durable Medical Equipment, Prosthetics and Supplies (CMS-6006 -F). This ruling requires that each existing supplier must have a $50,000 surety bond to CMS.
To see if you qualify for a $250 Medicare Surety Bond, or would like information regarding our other products, please contact us:
Pharmacists Mutual Insurance Company, through its subsidiary Pro Advantage Services, Inc. d/b/a Pharmacists Insurance Agency (in California), led the way to meet this requirement by negotiating the price of the bond from $1,500 down to $250 for qualifying risks.
31
Call 800.247.5930 Extension 4260 E-mail medbond@phmic.com Contact a Pharmacists Mutual Field Representative or Sales Associate http:// www.phmic.com/phmc/services/ibs/Pages/ Home.aspx In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815 or Tracy Curtis at 800.247.5930 ext. 7103 or 270.799.8756.
THE KENTUCKY PHARMACIST
Pharmacy Law Brief
March 2014
Pharmacy Law Brief: Medications and Lawful Executions Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: I’ve read some items recently in the newspaper about a state court case challenging use of medications to carry out court-ordered executions of violent criminals. What is the controversy surrounding use of these pharmaceuticals? I thought that approach had been used for years.
Submit Questions: jfink@uky.edu Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief discussion of an issue or topic for educational or discussion purposes can adequately and fully address the multifaceted and often complex issues that arise in the course of professional practice. It is always the best advice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intricacies of a specific situation, and render advice in accordance with the full information.
Response: There were several developments late in 2013 related to this topic. In early December, the Circuit Court judge conducting the case for a number of years declined to lift an injunction he had put in place during 2010 that prevented state officials from using lethal injections to carry out the court ordered executions. Then later in the same month officials at the Kentucky Justice Cabinet announced that they would not appeal that ruling, directing their efforts to another approach to the matter.
case for a number of years. The judge ruled that matters related to the medications used “have been adjudicated to One of the issues that led to the 2010 injunction barring finality.” Now the jurist is focusing his current review on how executions using medications was whether the use of the the state will determine whether an inmate is mentally disatraditional three drug mixture caused an amount of pain and bled, whether members of the public and defense attorneys suffering to be unconstitutional. The Eighth Amendment to can view a sufficient portion of the preparations for the exethe U.S. Constitution prohibits “cruel and unusual punishcution and whether the inmate has sufficient access to his ments” with that prohibition being extended to state-level or her attorney in the hours leading up to the event. activities by the Fourteenth Amendment and a decision of It should be noted that a case challenging the three drug the U.S. Supreme Court. approach to executions in Kentucky made it all the way to Lethal injection was first used in Oklahoma during 1977 and the U.S. Supreme Court during 2008 where use of that lewas touted as being a more humane approach to carrying thal injection protocol was upheld. Another case of note out the court order than the traditional methods of hanging, related to this topic that was addressed by the nation’s firing squad, electric chair or gas chamber. The use of phar- highest court arose in 1985 when a group of death row inmaceuticals has traditionally involved sodium thiopental, mates in Oklahoma and Texas challenged the FDA’s repancuronium bromide and potassium chloride, in that order. fusal to bar use of the three drug protocol as rendering the In Kentucky the relevant provision in K.R.S. directs that drugs misbranded because these were “unapproved, off“every death sentence shall be executed by continuous label” uses. The agency had refused to take action on the intravenous injection of a substance or combination of sub- matter and the U.S. Supreme Court decreed that the agenstances sufficient to cause death.” cy decision not to act was not reviewable because whether to take action was committed to agency discretion under Earlier in 2013, the Commonwealth put in place procedures the Administrative Procedure Act. dictating use of either one medication or two. Neither the method nor the specific medications to be used met with As of this writing the Commonwealth has 33 inmates on objections by the judge who has been presiding over this death row. The last execution in the state was during 2008.
136th KPhA Annual Meeting and Convention June 5-8, 2014 Griffin Gate Marriott, Lexington, KY 32
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136th KPhA Annual Meeting and Convention
March 2014
Ramey joins KPhA Elizabeth Ramey joined KPhA as its Receptionist/Office Assistant in February 2014. She has worked in administrative support for about 10 years for state government, church organizations and other communitybased services. She attended the University of Kentucky majoring in Family and Consumer Science and Bluegrass Community and Technical College, majoring in Medical Information Technology. She has a passion for reading and loves volunteering at L.I.F.E. House for Animals. Elizabeth resides in Frankfort with her high school love and husband, Greg.
Registration and schedule information will be at www.kphanet.org! Mark your calendar now!
Are you connected to KPhA? Join us online!
Facebook.com/KyPharmAssoc
@KyPharmAssoc @KPhAGrassroots
KPhA Company Page
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Pharmacy Policy Issues
March 2014
PHARMACY POLICY ISSUES: Implications of Plan B One-Step® Being Available OTC Author: Lauren Broderick Belt is a third professional year Pharm.D. student at the UK College of Pharmacy. Lauren hails from Muncie, Ind., and completed her pre-professional education with a B.S. in biology from Saint Mary-of-theWoods College in Terre Haute, Ind. Issue: The availability of Plan B One-Step® in pharmacies without a prescription has created a number of issues for pharmacists to consider. This discussion is designed to highlight for practitioners some of the issues to consider and perhaps discuss with colleagues. Discussion: According to the Centers for Disease Control and Prevention and the National Center for Health Statistics, approximately 10 percent of women in the United States have used a product for emergency contraception. This approach is not intended to be used regularly and, as its name implies, it is only to be used in an “emergency.” Emergency contraceptives are essentially a higher dose of ordinary oral contraceptive tablet and they work in a similar fashion. They may prevent ovulation from occurring, they may prevent fertilization of the egg and they may prevent implantation by altering the lining of the uterus. They are considered effective with pregnancy prevention rates of about 75-90 percent.
regarding distribution of Plan B took place in June 2013, when the Department of Justice dropped their initial plan to appeal a court ruling granting broader access to the medication. As of Aug. 1, 2013, Plan B One-Step is available for purchase over-the-counter by anyone, regardless of age. It also does not have to be obtained from behind the pharmacy counter, and thus may be purchased from the aisle with other sexual health items.
Previously, there were several states that had statutes in place regarding the accessibility and purchase of Plan B from pharmacies; however, Kentucky was not one of them. More specifically, there were 21 states that have laws describing access to Plan B or emergency contraception, 16 Plan B is currently the only over-the-counter (OTC) emerstates that require hospitals and health care facilities to gency contraceptive. It is a high dose progesterone tablet either discuss emergency contraception or administer it to that must be taken within 72 hours of unprotected intervictims of sexual assault upon request, and nine states that course to be effective. Therefore, if a woman took Plan B specified that a pharmacist can only dispense and initiate after the 72 hour time-frame then the medication would be emergency contraception drug therapy if they undergo speconsidered ineffective. This medication is not to be concific training or work in collaboration with a physician. Since fused with RU-486 or mifepristone, which is used to termi- Kentucky did not have any statutes that imposed limits on nate pregnancies and is not available without a prescripdispensing Plan B, pharmacies were allowed to draft their tion. own policies and procedures. These might include statements that the medication must be sold from behind the Originally, Plan B was only available via a prescription after pharmacy counter and that if a pharmacist or other memFood and Drug Administration (FDA) approval in 1999, but ber of the pharmacy staff has an ethical or religious objecin 2006 the FDA changed the status of Plan B to an OTC tion to selling Plan B then they can refuse to sell the medimedication. It had to be obtained in a pharmacy and specifcation as long as the customer is given the option to puric criteria needed to be met. The individual, male or female, chase from another staff member or be referred to another had to show a photo ID and be at least 18 years of age. pharmacy. The regulations were changed again in 2009 so that individuals as young as age 17 could purchase the medication The right for a pharmacist or other health care personnel to without a prescription. Anyone younger than 17 would need refuse to sell Plan B originates from the conscience clause a prescription to purchase Plan B. The most current update which is a piece of many states’ laws. In general, con-
Have an Idea?: This column is designed to address timely and practical issues of interest to pharmacists, pharmacy interns and pharmacy technicians with the goal being to encourage thought, reflection and exchange among practitioners. Suggestions regarding topics for consideration are welcome. Please send them to jfink@uky.edu. 34
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March 2014
The Kentucky Pharmacist online science clauses state that pharmacists can refuse to dispense or sell a medication based upon moral, ethical or religious beliefs. Kentucky does not have a conscience clause or refusal clause statute; however, there are several professional organization policies that make the statement. For example, APhA’s position, first adopted in 1998 and affirmed in 2010, is that it “recognizes the individual pharmacist’s right to exercise conscientious refusal and supports the establishment of systems to assure patients’ access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal.” The selling of Plan B has largely been taken out of the hands of the pharmacists as many customers will most likely ring up their purchase with the cashier at the front of stores such as CVS, Kroger, Rite Aid or Walgreens; how-
ever, some new questions arise, such as whether cashiers will be allowed the right to refuse to sell the product based on religious grounds and also whether the medication is truly safe to be sold in this manner. For example, Plan B is not meant to be used regularly because this is the purpose of other contraceptives, but it could be used in an improper manner if patients are not educated. If a patient can come in to purchase the product without it being sold by a pharmacist then there is a decreased opportunity for counseling. This is especially a consideration because girls of any age can obtain and use the product even though there is little research about Plan B in the adolescent population. It will be just as important, if not more important, now for pharmacists to be accessible to patients that have questions regarding this product.
The Kentucky Pharmacist is online! Go to www.kphanet.org, click on Communications and then on The Kentucky Pharmacist link.
Would you rather receive the journal electronically? Email ssisco@kphanet.org to be placed on the Green list for electronic delivery. Once the journal is published, you will receive an email with a link to the online version.
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March 2014
Pharmacists Mutual
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Cardinal Health
March 2014
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KPhA Board of Directors/Staff
March 2014
KPhA BOARD OF DIRECTORS
HOUSE OF DELEGATES
Kimberly Croley, Corbin kscroley@yahoo.com
Chair 606.304.1029
Cassandra Beyerle, Louisville cbeyerle01@gmail.com
Duane Parsons, Richmond dandlparsons@roadrunner.com
President 502.553.0312
Ethan Klein, Louisville kleinethan@gmail.com
Bob Oakley, Louisville Boakley@BHSI.com
President-Elect 502.897.8192
KPERF ADVISORY COUNCIL
Frankie Hammons Abner, Barbourville frankiehammons@gmail.com
Secretary 606.627.7575
Glenn Stark, Frankfort glennwstark@aol.com
Treasurer
Ann Amerson, Lexington amerson@insightbb.com
Ron Poole, Central City ron@poolespharmacycare.com
Past President
KPhA/KPERF HEADQUARTERS
Directors Heather Bryan, Mt. Washington Sullivan University hcarby8529@my.sullivan.edu Student Representative Matt Carrico, Louisville matt@boonevilledrugs.com Chris Clifton, Villa Hills chrisclifton@hotmail.com
Vice Speaker of the House
Kim Croley, Corbin kscroley@yahoo.com
1228 US 127 South, Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.twitter.com/KPhAGrassroots www.youtube.com/KyPharmAssoc Robert McFalls, M.Div. Executive Director rmcfalls@kphanet.org
Trish Freeman, Lexington trish.freeman@uky.edu Brooke Herndon, Louisville brhe226@uky.edu
Speaker of the House
University of Kentucky Student Representative
Chris Killmeir, Louisville cdkillmeier@hotmail.com Jeff Mills, Louisville* jeff.mills@nortonhealthcare.org Chris Palutis, Lexington chris@candcrx.com Richard Slone, Hindman richardkslone@msn.com Mary Thacker, Louisville mary.thacker@att.net Sam Willett, Mayfield duncancenter@bellsouth.net * At-Large Member to Executive Committee
Scott Sisco, MA Director of Communications & Continuing Education ssisco@kphanet.org Kelli Sheets Office Manager ksheets@kphanet.org Leah Tolliver, PharmD Director of Pharmacy Emergency Preparedness ltolliver@kphanet.org Elizabeth Ramey Receptionist/Office Assistant eramey@kphanet.org
KPhA sends email announcements weekly. If you arenâ&#x20AC;&#x2122;t receiving: eNews, Legislative Updates, Grassroots Alerts and other important announcements, send your email address to ssisco@kphanet.org to get on the list. 38
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50 Years Ago/Frequently Called and Contacted
March 2014
50 Years Ago at KPhA MCDOWELL LIBRARY FOUND After a long search the Ephraim McDowell Library was located in the East and reached Kentucky on January 18th. The books, 27 in number, are, for the most part, in splendid condition. The viewing of the collection was held by the McDowell House Committee in the Hunt-Morgan House in Lexington. One of the books was a “medical common-place book” written by hand and containing over 400 pages. Two American incunabula were included, both by Benjamin Rush and published in Philadelphia in 1793 and 1794. Others include books by Cheselden, Pringle, Keill, Cullen, Smellie and the famous Bowrhaave. The collection is now at the library of Transylvania College, but will eventually be housed at Centre College in Danville. - From The Kentucky Pharmacist, March 1964, Volume XXVII, Number 3.
Frequently Called and Contacted Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org
Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org info@kshp.org American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org
National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 info@ncpanet.org Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu Kentucky Regional Poison Center (800) 222-1222
KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA informed by sending this information to ksheets@kphanet.org. Deceased members for each year will be honored permanently at the KPhA office. 39
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Kentucky PHARMACIST 1228 US 127 South Frankfort, KY 40601
Save the Date 137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY For more upcoming events, visit www.kphanet.org. 40
THE KENTUCKY PHARMACIST