Y K C U T N E K E H T T S I C A PHARM Vol. 7, No. 3
Gov. Beshear signs Pharmacy Audit Bill
May 2012
2012 Legislative Session Recap, Pg. 12
Registration form and schedule inside!
Also inside: CPE Monitor: What does it mean for you?
News & Information for Members of the Kentucky Pharmacists Association
CE: Compounding for Scalp Disorders
Table of Contents
May 2012 Agency for Healthcare Research and Quality Pharmacy Time Capsules KPhA at NASPA Leadership Conference KPhA Government Affairs June CE— Reducing the Burden of ADEs June Pharmacist/Pharmacy Tech Quiz APhA Annual Conference—the Student Perspective Why Do I Need To Be Certified? McWhorter College of Pharmacy Pharmacy Policy Issues Long Term Care CE Event Pharmacists Mutual Companies KPhA Board of Directors Frequently Called and Contacted/Classifieds
Table of Contents Table of Contents— Oath— Mission Statement President’s Perspective ASCP/HD Smith KPhA Annual Meeting 2012 KPhA Invitation for Membership Kentucky Legislative Session Summary May CE—Compounding for Scalp Disorders May Pharmacist/Pharmacy Tech Quiz KPPAC Contribution Form Pharmacy Law Brief CPE Monitor: Change is coming Pharmacy Technician Certification Board
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30 31 32 33 34 38 39 40 41 42 44 45 46 47
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.
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.
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.
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.
Editorial Office: © Copyright 2012 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bimonthly. 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.
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THE KENTUCKY PHARMACIST
President’s Perspective
May 2012
President’s Perspective
Lewis Wilkerson PharmD, CGP KPhA President 2011-2012
As I sit down to write this last article, it’s hard for me to believe that a year has nearly passed, and what a tremendous year it has been……A year full of opportunities, challenges, advancements, set-backs, colleagues, students, mentors, old friends and new friends. I can’t tell you how rewarding it has been to be President of your Association, and I thank you for the opportunity. Over the year, I have harped on the fact that I believe apathy has been one of the single largest problems impacting our profession. My goal has been to challenge individuals to say, “Yes I Will,” and be involved. As I’ve stated, leadership has to come from a willingness to first be engaged. I’m happy to report that I believe our association and profession have made great strides in being more engaged, yet there is still a tremendous amount to accomplish.
tice settings with different pharmacy experience to discuss and plan the path forward for pharmacy. By all accounts, the meeting was a success and proved that a coalition of pharmacists is possible, necessary and meaningful in order to advance our profession. I am not going to attempt to recap the meeting in this article, as the coalition will be developing a report with the proceedings of the summit. However, four broad categories were identified as important in advancing the profession. They include Communication, Redefining the Pharmacist’s Role, Education & Credentialing and Practice Model. Go visit Gloria and Lynn’s Kentucky Pharmacy History Museum, and you’ll certainly see that our profession has not been a stagnant one. I don’t know a lot, but I know that change in our profession is destined to continue and it will continue to change at a pace unlike we have seen before. With the changing landscape of healthcare and the continued introduction of technology, the practice of pharmacy, as it stands today, will not be the same tomorrow. Will we internally chart the course for our future, or will we allow outside sources to continue to shape our profession? I hope you will join the coalition in saying, “Yes We Will”, and get engaged. Your next opportunity to get involved with the discussion will occur June 14 at the KPhA annual meeting. Although being held during the KPhA meeting, it will be a continuation of the coalition discussion. Even if you haven’t registered for the meeting, we welcome your attendance and input during this discussion from 8 to 10 pm. Having said that, I hope you have made plans to attend part – if not all – of the 134th KPhA Annual Meeting. It will be held at the Marriott Griffin Gate in Lexington, Ky., on June 13 – 16. If you have never attended, or if you haven’t attended in more than five years or maybe since you were a student, please consider attending. Our association moves forward only through your engagement!
I continue to want to hear from you. If you have a desire to In my many years of involvement with the association, I’ve be or questions about how to be involved, please email me at rphs2@aol.com. never experienced a more engaged and active Board of Directors. We have seen an increased activity with our local associations, as local leaders have stepped up to lead. Individuals not previously engaged with the association have stepped up to serve on or even chair committees. In addition to our standing committees (Organizational, Professional and Public Affairs), we have very involved and active special called committees, including Government Affairs, Budget and Audit, Contract Review, Policy Review, Past-Presidents, Health Information Technology, and Emergency Preparedness committees. The work these committees are doing is important and is strengthening our association and our profession.
KPhA Social Media Links
I was inspired by the number of pharmacists and student pharmacists that attended the April 13 and 14 Advancing Pharmacy Practice Summit that KPhA helped sponsor. The event was hosted by UK COP’s Center for Advancement of Pharmacy Practice (CAPP), and in addition to KPhA, APSC, KY BOP, KSHP and SUCOP also sponsored the event. On a weekend in April with many competing happenings, almost 100 individuals came from different prac-
www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc
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THE KENTUCKY PHARMACIST
APSC—HD Smith
May 2012
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THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
Tentative Program Description The Kentucky Pharmacists Association supports the pharmacists and pharmacy technicians of Kentucky by providing programming on up-to-date topics faced in pharmacy practice. Pharmacists and pharmacy technicians that practice in hospital/health systems, community, retail, consultant, long term care and insurance industries are the targeted audience for this meeting. Since patient centered care is paramount, this convention targets topics such as diabetes, probiotics and new drugs, as well as topics related to improving patient medication use and safety and more! Attendees will get an update on pharmacy law; fraud, waste and abuse; and drug shortages. As an ACPE accredited provider, the Kentucky Pharmacy Research and Education Foundation (KPERF) must ensure balance, independence, objectivity and scientific rigor in all its educational activities. Any person who is in a position to control the content or direction of a CPE activity must disclose any financial interest or other relationship with a commercial interest producing healthcare goods or services that have a direct bearing on the subject matter of the programming. Full Disclosure will be given verbally prior to the activity. For successful completion of the Knowledge Based CPE activities and subsequent awarding of credit, each participant (Pharmacists and Technicians) must COMPLETE and TURN IN an activity evaluation form TO THE MODERATOR at the end of each activity. You will receive your certificates no later than six to eight weeks after the meeting. Meal functions are open to all registered attendees; name tags required. Registration is required to attend all continuing education programs. Meeting attire is casual; President’s Reception and Ray Wirth Banquet are semi-formal. 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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THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
134th Kentucky Pharmacists Association Annual Meeting Registration Form June 13-16, 2012 Marriott Griffin Gate, Lexington, KY
Please Type or Print the following: __________________________________ ________ __________________________ First Name
MI
Last Name
____________________________________________________ PharmD RPh CPhT Other Business Affiliation
_____________________________________________ _________________________ ______ _____ Street Address
City
State
Zip
__________________________ _______________________________________________________________ Daytime Phone
Student- Free Full Registration: By June 1 After June 1 Single Day Registration: By June 1 After June 1
Email Address
Registration Fees: Please circle applicable Fee Member Non-Member Technician/Resident $200 $250
$375 $425
$105 $195 $130 $220 Circle Day: Thursday
Friday
$85 $110
$25 $35
$55 $80
$20 $30 Saturday
Meal Events: Please indicate the total number that will be attending each meal event. Welcome Luncheon: Thursday ____ yes ____ no _____ additional guest $30 Kroger Luncheon: Friday ____ yes ____ no _____ additional guest $30 Ray Wirth Awards Banquet: Friday ____ yes ____ no _____ additional guest $45 Luncheon: Saturday ____ yes ____ no _____ additional guest $30 Guest Name(s): ______________________________________________________________________________ Please include your guests’ name(s) if you have purchased additional event tickets Registration $ _______ Additional Meal Tickets $ _______ Credit Card Information: AMEX Discover MasterCard
Total Enclosed $_________ Visa
Number: ___________________________________________ Expiration Date:______________ NOTE: If billing address is different than above, please include on back of sheet, or separate sheet. Please make checks payable to KPhA Annual Meeting. Mail to: KPhA Annual Meeting 1228 US 127 South Frankfort, KY 40601. For overnight accommodations: Contact Marriott Griffin Gate via the KPhA custom web reservation site at https:// resweb.passkey.com/go/KYPharmacistAssoc, or call1-800-266-9432 and reference Group Code KY Pharmacists Associa tion for the special rate of $129/night. Cut-off for this rate is May 22, 2012. Lodging rate includes parking on site and wireless internet access. Special Assistance. If you require special assistance or diet to attend, please indicate need on back of this sheet, call 502.227.2303 or email ssisco@kphanet.org. 6
THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
Thursday, June 14, 2012
Tentative Schedule
7:30 AM
Registration
7:30 AM to 9:00 AM
Welcome Breakfast (Open to All) Sponsored By Kentucky Health Information Exchange
8:30 AM to 10:30 AM
Quality Medication in the Elderly Demetra Antimisiaris, Pharm.D., CGP, FASCP, Assistant Professor, Director of Geriatric Pharmacotherapy, University of Louisville.
10:30 AM to 10:45 AM
Refreshment Break
10:45 AM to 11:45 AM
Medication Therapy Management Update
Option 1
Matt Worthy, Pharm.D., Director of Professional and Clinical Services, Rx Therapy Management. Christine Richardson, PharmD., Clinical Pharmacist, Rx Therapy Management
10:45 AM to 11:45 AM
Lawsuit Protection
Option 2
Luke Morgan, J.D., McBrayer, McGinnis, Leslie and Kirkland, PLLC
11:45 AM to 1:00 PM
Lunch Sponsored By University of Kentucky College of Pharmacy
1:00 PM to 2:00 PM
CHEST Guidelines Update Sarah F. White, Pharm.D., Assistant Professor, Clinical and Administrative Sciences, Sullivan University College of Pharmacy
2:00 PM to 4:00 PM Option 1
Overview of eHealth in KY: The Impact of HITECH and the Kentucky Health Information Exchange Polly Mullins-Bentley, Acting Director, Kentucky Health Information Exchange
2:00 PM to 4:00 PM
Clinical Pearls (Specific topics to be determined)
Option 2 4:00 PM to 5:00 PM
Situation Critical: Managing Drug Shortages Rola Kaakeh, PharmD, CFPH, Assistant Professor and Founding Director, International Center for Health Outcomes Policy, Sullivan University College of Pharmacy
4:00 PM to 5:30 PM
House of Delegates Opening Session
5:30 PM to 7:30 PM
Grand Opening of Hall of Exhibitors
8 PM to 10 PM
Follow-Up for Advancing Pharmacy Practice in Kentucky Summit
10 PM
Hospitality Suite 7
THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
Friday, June 15, 2012 7:30 AM to 9:00 AM 8:00 AM to 9:00 AM
Breakfast/Registration Clinical Services in Community Pharmacy Amy Thompson, PharmD,.Kroger Pharmacy, D5 Patient Care Specialist
9:00 AM to 9:30 AM
Reference Committee
9:00 AM to 11:30 AM
Hall of Exhibitors Open
10:15 AM to 10:30 AM
Refreshment Break in Hall of Exhibitors
11:00 AM to Noon
Fraud, Waste and Abuse Molly Nicole Lewis, McBrayer, McGinnis, Leslie and Kirkland, PLLC
Noon to 1:45 PM
KPhA Awards Lunch Sponsored By Kroger
1:45 PM to 3:45 PM
NASPA-NMA Student Pharmacist Self-Care Championship Endowed by Procter & Gamble
3:45 PM to 4:00 PM
Refreshment Break
4:00 PM to 5:00 PM
Avoiding Liability Landmines for the Kentucky Pharmacist
Option 1
Bruce A. Lafferre, Field Representative, Pharmacists Mutual Companies
4:00 PM to 5:00 PM
Mythbusters Diabetes Management
Option 2
Sarah Lawrence, PharmD, MA, Community Pharmacy PGY1 Resident, Clinical Assistant Professor, College of Pharmacy, Sullivan University
6:00 PM to 7:00 PM
President’s Reception Sponsored By Rx Therapy Management
7:00 PM to 9:00 PM
Ray Wirth Banquet
9 PM
Hospitality Suite
Saturday, June 16, 2012 7:30 AM to 9:00 AM
Continental Breakfast Sponsored By American Pharmacy Services Corporation
8:00 AM to 10:00 AM
New Drugs Update Trish Rippetoe Freeman, R.Ph., Ph.D., Clinical Associate Professor and Director of Professional Practice Programs, University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science.
8:00 AM to 10:00 AM
Closing House of Delegates
10:00 AM to 10:15 AM
Refreshment Break
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THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
Saturday, June 16, 2012 Continued 10:30 AM to 11:30 AM
Demystifying Probiotics: Role in Health and Disease
Option 1
Michel Farhat, PhD, Director of Global Professional and Techincal Affairs at Procter and Gamble Healthcare
10:30 AM to 11:30 AM
Preceptor update
Option 2
Anne Policastri, Pharm.D., MBA, Assistant Director of Experiential Education, UK College of Pharmacy.
11:45 AM to 1:00 PM
Lunch Sponsored by Sullivan University College of Pharmacy
1:00 PM to 2:00 PM
Kentucky Legislative and Pharmacy Law Update Ralph Bouvette, B.Sc.Pharm, Ph.D., J.D., Executive Vice-President, American Pharmacy Services Corporation.
2:00 PM to 3:00 PM
Business Meetings for Academies
Check the KPhA website for registration forms and more information updates on the 134th KPhA Annual Meeting
www.kphanet.org/2012annualmeeting 9
THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
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THE KENTUCKY PHARMACIST
134th KPhA Annual Meeting
May 2012
The Kentucky Pharmacists Association Invitation to Membership Name Home Address City/State/Zip College & Year of Graduation Home Phone Home Fax E-Mail License Number Business Name Business Address City/State/Zip Business Phone Business Fax Preferred Mailing Address Charge to my:
Home
Office
American Express
Discover
_MasterCard
VISA
Card# Card Expiration Date Signature Membership Investment:
$210 Active Member (licensed in KY)
$315 Joint Member (both spouses licensed in KY)
$210 Associate Member (Licensed only in other state or non-pharmacist) $120 Retired Member
$180 Joint Retired
$50 Certified Technician
$70 1st Year Tiered
$140 2nd Year Tiered
$25 Academy for Consultant Pharmacist Member
$15 Academy for Compounding Pharmacist Member
CONTACT ME—I want to be involved with KPhA!
Send to: Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601
For more information: www.kphanet.org Phone: 502-227-2303 Fax: 502-227-2258
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THE KENTUCKY PHARMACIST
Kentucky General Assembly Summary
May 2012
SUMMARY OF PHARMACY ISSUES 2012 Kentucky General Assembly Prepared by Jan Gould, Gay Dwyer, Bob McFalls and Laura Leigh Goins Overview: KPhA gratefully acknowledges the engagement of pharmacist members throughout the Commonwealth who made legislative advocacy a personal priority during the 2012 regular and special sessions. Pharmacists were united in your resolve to make a difference by conducting regular telephone calls and engaging in one-on-one conversations with your state senators and representatives. From the Government Affairs Committee, Chair Richard Slone, and the entire Board of Directors: Give yourself and your colleagues a well-deserved “pat on the back” for your due diligence and commitment. Your advocacy continues to make a difference!
will continue during the interim and into the next session. The following summary provides a narrative regarding the activity on some of the major issues affecting pharmacists that were considered during this year’s legislative session. Visit www.lrc.ky.gov to access complete summaries of the bills prepared by legislative staff on all action taken on the measures, as well as to review the full text of individual bills and resolutions. Bills enacted during the 2012 Regular Session will take effect on July 12 unless a specific effective date was included in the legislation or the legislation contained an emergency clause making it effective as soon as it was signed by the Governor. The comprehensive anti-prescription drug abuse bill enacted in the 2012 Extraordinary Session takes effect July 20.
KPhA acknowledges and thanks our advocacy partners for this session: American Pharmacy Cooperative, Inc., American Pharmacy Services Cooperative, EPIC Pharmacies, Inc., Kentucky Independent PharPrescription Drug Abuse/Pain Clinics: Despite macy Alliance, Kentucky Retail Federation National Association of Chain Drug Stores, National Communi- spending considerable time this session discussing ty Pharmacists Association and HD Smith. the issue of prescription drug abuse, lawmakers failed to reach a compromise on legislation to address the Lawmakers adjourned the 2012 General Assembly issue before adjourning the 2012 Kentucky General without resolving two key issues that caused GoverAssembly. The issue, however, was on the agenda of nor Steve Beshear to immediately call legislators into the Special Session called by Governor Beshear Special Session on April 16. The legislature adwhich began on April 16 where a much-revised verjourned on April 12 without enacting a budget to imsion of HB 1 passed on April 20. plement the state road plan and without acting on Background: While many proposals were filed adcomprehensive anti-prescription drug abuse legislation. Both issues were on the call and addressed dur- dressing the prescription drug abuse issue, including ing the Special Session. the regulation of pain clinics, the major focus was on HB 4 sponsored by House Speaker Greg Stumbo (DKPhA’s “watch list” for the 2012 Session included Prestonsburg). As the bill passed the House, it remore than 30 bills and resolutions. Working with its quired pain clinics to be owned by physicians or adpartners and through a concerted effort by engaged vanced practice registered nurses and placed repharmacists, KPhA was successful in making signifi- strictions on the dispensing of controlled substances cant changes to the state’s pharmacy audit law, by prescribers. The bill also made significant changes stopped efforts by physicians’ assistants to obtain the to the state’s electronic prescription reporting system ability to dispense drugs and had significant input into (KASPER). Among the changes was a provision that the deliberations on the pain clinic/prescription drug moved the administration of KASPER from the Cabiabuse issue. While the legislature failed to pass legis- net for Health and Family Services to the Office of lation addressing the problems with Medicaid manAttorney General. It also called for an assessment on aged care, the session provided KPhA with many op- prescribers and pharmacists to fund the program and portunities to educate legislators about issues with the required pharmacists to report data to the KASPER managed care organizations that now serve the ma- system daily rather than weekly. jority of the Medicaid population. These opportunities
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THE KENTUCKY PHARMACIST
Kentucky General Assembly Summary
May 2012
The Senate passed an amended version of the bill retaining many of the original provisions but also making some significant changes. The Senate stripped the language in the original bill that established a fee on prescribers and pharmacists to fund KASPER. It also delayed the effective date for the accelerated reporting of KASPER data until July 1, 2013. Additionally, the Senate added several provisions taken from SB 2 that further regulated the activities of pain clinics. The Senate passed the revised version of the bill on March 28 but the House failed to concur with the Senate changes. Ultimately the bill wound up in a free conference committee where legislators tried to work out the differences between the House and Senate versions.
along with the fact that legislators were responsive to hearing and addressing concerns from the pharmacist community as well as those from other provider groups. We remain committed to continuing our work with legislators and other healthcare providers to combat prescription drug abuse, and pharmacists will continue to assure appropriate medication use for our patients." Highlights of the legislation include: The KASPER program is retained in the Cabinet for Health and Family Services rather than being moved to the Office of Attorney General as originally proposed. The fee on pharmacists and prescribers was eliminated. Language clarifying who must register for In the waning days of the session, several draft comKASPER was added in the Senate. promise proposals were put forward. The initial com- Language was removed from the original bill tying promise included a fee on prescribers and pharmaregistration to DEA permits. cists to fund KASPER. The fee, however, was set at Language was removed from the original bill that $50 annually with allowances for annual adjustments would have allowed significantly broader access based on inflation. It retained most of the provisions to KASPER reports by law enforcement personthat the Senate added to regulate pain clinics and nel. also retained the requirement that pharmacists enter Pain clinics operating today will be grandfathered data into the KASPER system daily rather than on the from the requirement that pain clinics be owned by current weekly schedule with the delayed effective physicians. date. The draft added a new provision that placed restrictions on the dispensing of certain controlled sub- HB 1 establishes new rules for the operation of pain stances by prescribers. Additionally, it prohibited clinics and, in the future, requires that they be owned pharmacies from dispensing more than a 30-day sup- by physicians. It requires physicians to obtain ply of Schedule II drugs, Schedule III drugs containing KASPER reports before prescribing controlled subhydrocodone and drugs containing alprazolam, stances under certain circumstances and limits disclonazepam or diazepam. This version was never offi- pensing by prescribers. It requires that pharmacists cially acted upon by either chamber. who are authorized to dispense controlled substances register for a KASPER account but does not mandate On the last day of the session, another draft compro- that pharmacists obtain KASPER reports. The provimise was put forth that removed the fee language and sion requiring daily rather than weekly reporting of made other slight modifications to the bill. The legisla- KASPER data by pharmacies is included in the bill, ture adjourned without considering the proposal. but the effective date for this provision is delayed until July 1, 2013. Also, the penalties for failure to report to During the course of the discussion on prescription KASPER were reduced. drug abuse, KPhA was instrumental in seeking changes to various proposals that surfaced. An early Pharmacy Audits: HB 349, a KPhA-backed proposal proposal would have required pharmacists to obtain to revise Kentucky’s pharmacy audit law, was signed KASPER reports before dispensing any controlled into law by Governor Beshear after passing both substance. Another proposal would have required chambers unanimously. The bill, sponsored by Representative Tommy Thompson (D-Owensboro), amends pharmacists to obtain photo identification from persons picking up controlled substance prescriptions. Kentucky’s current audit law to address continuing KPhA effectively worked with lawmakers and its part- problems faced by pharmacists with audits conducted by insurers and pharmacy benefit managers. HB 349 ners to get these proposals off the table. specifies that an auditing entity may not recoup payOutcome: HB 1 passed the Kentucky legislature as ments because of clerical errors or omissions, unless its last act during the Special Session that ended on there is evidence of fraud or an actual overpayment has been made. Under the provisions of HB 349, reApril 20. In noting its passage, President Lewis D. Wilkerson noted, “KPhA is gratified to see the imcoupment of overpayments is limited to the actual portant issue of prescription drug abuse addressed, amount of the overpayment and would not include the 13
THE KENTUCKY PHARMACIST
Kentucky General Assembly Summary
May 2012
dispensing fee. The bill also limits the length of time lowable cost” pricing was filed in the House but failed an auditing entity can require a pharmacy to keep rec- to receive a hearing. ords. The bill limits record retention to two years or the period of time required by state or federal law. Significant problems remain for both health care providers and patients in the new Medicaid managed Another significant provision of HB 349 is the removal care environment. The issue will no doubt be a major of the exemption for managed care organizations topic of discussion during the interim and KPhA will (MCOs) serving the Medicaid population. The current continue to keep legislators informed about the problaw exempted these entities from the audit relems pharmacists are experiencing with the managed strictions. With the expansion of managed care in the care organizations. Medicaid program late last year, private companies are now responsible for providing benefits to the ma- Therapeutic Shoes: HB 403, a bill that clarified that jority of the Medicaid population. pharmacy technicians and pharmacist interns can continue to assist pharmacists in the fitting of theraImplementing improvements to Kentucky’s pharmacy peutic shoes for diabetics died in the Senate Licensaudit law was a legislative priority established by the ing, Occupations and Administrative Regulations 2011 KPhA House of Delegates and pharmacists’ ma- Committee. The measure was introduced by Reprejor achievement in this legislative session. sentative Leslie Combs (D-Pikeville) to address a problem that surfaced with the existing orthotics, peMedicaid Managed Care: Despite multiple hearings dorthics and prosthetics licensing law that is schedon the problems with the implementation of managed uled to go into effect in 2013. Although the law allows care for Medicaid recipients, the legislature did not act pharmacists to fit therapeutic shoes for diabetics, it on any significant legislation addressing Medicaid restricts the ability of pharmacy personnel to assist managed care. Lawmakers were reluctant to interpharmacists in the process. Despite unanimously vene, citing concerns over the potential budget impact passing the House, the bill never received a commitif the Medicaid managed care program was revised. A tee hearing after a member of Senate leadership excomprehensive proposal to require the Medicaid man- pressed concerns about the proposal. aged care organizations (MCOs) to comply with proMedicaid Fraud: A bill sponsored by House Speaker vider and patient protections in the insurance code (HB 566) was introduced. Despite being supported by Greg Stumbo (D-Prestonsburg) proposing to establish a broad range of patient and provider groups, includ- the “Kentucky False Claims Act” cleared the House but died in the Senate Judiciary Committee. HB 401 ing KPhA, the proposal never received a vote in the House. allowed a third party (“whistleblower”) to bring an action for fraud against anyone doing business with the Several bills relating to the pharmacy portion of the state. If fraud was found, the whistleblower was entimanaged care program were filed, but all of them ulti- tled to a portion of the money recovered. Representamately stalled. Two bills requiring the MCOs to charge tive Jimmy Glenn (D- Owensboro) filed a similar prouniform copayments (HB 262 and SB 137) received posal (HB 51) early in the Session. Glenn’s bill was considerable discussion during the session but both limited to Medicaid providers and did not receive a died in the Senate after the MCOs testified that the hearing in the House committee to which it was asmeasures would cause them to open their contracts signed. KPhA was part of a health care provider coaliwith the state which would result in additional Medition that mounted an aggressive campaign opposed caid expenditures. The bills would have increased to these bills. pharmacy reimbursement by allowing pharmacies to keep the copayments in addition to the contractual Physicians’ Assistants: Senator Tom Buford (Rreimbursement. A proposal that established guideNicholasville) introduced a bill to permit physicians’ lines for the establishment of “maximum allowable assistants to prescribe controlled substances as descost” pricing mechanisms for not only the MCOs but ignated by a supervising physician. SB 96 also would for all PBMs (SB 125) was introduced. The bill was have allowed PAs to dispense all legend drugs. After strongly opposed by PBMs, health insurers, the KPhA objected to allowing PAs to dispense drugs, the MCOs and payor groups. SB 125 received a hearing sponsor agreed to remove the dispensing language in the Senate Health and Welfare Committee and was from the bill before it received further consideration. approved by the committee. It was later recommitted SB 96 received a hearing in the Senate Judiciary to the Senate Appropriations and Revenue CommitCommittee but no vote was taken, ending consideratee where it died. Another bill affecting “maximum al- tion of the proposal for the session. 14
THE KENTUCKY PHARMACIST
Kentucky General Assembly Summary
May 2012
PSE Regulation: A compromise proposal restricting the sale of products containing pseudoephedrine (PSE) passed the legislature this year and was signed into law by the Governor. SB 3 allows an individual to purchase up to 7.2 grams of PSE per month with a maximum annual limit of 24 grams without a prescription. Sales limits would be monitored by the current MethCheck (NPLEX) system. Once that amount is exceeded, a prescription would be required. Gel caps and liquid preparations are exempted. The bill also incorporates provisions of other bills introduced this session that would block sales of PSE to persons convicted of meth-related offenses. The regulation of PSE has been a much-debated issue for several years as legislators grappled with the growing problem of illegal methamphetamine production. SB 3 was one of many bills introduced this session that dealt with the issue. DME Licensing: Another new licensing requirement was passed in HB 282 that calls for the Board of Pharmacy to license providers of home medical equipment and services. Unless the equipment and related services are provided through a separate legal entity, licensed pharmacies that sell, rent or lease durable medical equipment (DME) are not required to obtain the new license. Neither are equipment manufacturers or wholesale distributors that do not deal directly with the patient. The bill authorizes licensees to provide home medical equipment and services that require a prescription or order from a practitioner. Prescription Drug Disposal: Representative Joni Jenkins (D-Shively) filed legislation (HB 238) establishing a disposal program for unused prescription drugs. The bill easily passed the House but died in the Senate Veterans, Military Affairs and Public Protection Committee. The bill called for the Energy and Environment Cabinet to work with local governments to set up collection points for unused prescription drugs in unopened containers. APRN Prescribing: The APRN association sought legislation this session to eliminate the requirement
that APRNs have a collaborative practice agreement with a physician in order to prescribe non-controlled drugs. While the bill (SB 187) never received a hearing in the Senate Judiciary Committee, its provisions were added to HB 512 in the House. HB 512 passed the House but died in the Senate Judiciary Committee as well. A competing proposal backed by the Kentucky Medical Association was also introduced but likewise failed to pass. SB 190 sought to place additional requirements on APRNs wishing to prescribe drugs. It outlined specific elements required to be in collaborative practice agreements and gave the Board of Medical Licensure more oversight of these agreements, Mail Order Pharmacy: The House unanimously adopted HR 198 urging the Personnel Cabinet, the Kentucky Retirement System and the Kentucky Teachers’ Retirement System to evaluate the policies of the mail order pharmacy benefit programs they provide to make sure the policies are compliant with state laws requiring that local pharmacies have the opportunity to participate. As a simple resolution, it required no action by the Senate. Other Pharmacy Issues: Legislation to place restrictions on e-prescribing systems has been signed by the Governor (SB 144). The bill prohibits eprescribing systems from being designed to limit a physician’s choice of drug and calls for the state to incorporate national standards once they have been developed. The Governor also signed SB 114, a bill placing restrictions on the use of step therapies for drugs by insurance companies. The legislature failed to pass HB 377, a bill essentially prohibiting generic substitution for tamper-resistant opioids. It was approved by the House Health and Welfare Committee but was later recommitted to the House Appropriations and Revenue Committee. A measure to prohibit the sale of products containing dextromethorphan as the only active ingredient to anyone under age 18 was introduced in the House but HB 106 was not considered in the House Judiciary Committee.
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THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
Compounding for Scalp Disorders KPERF offers all and Conditions CE articles to members online at By: Y. Pramar, Ph.D., Professor of Pharmaceutics www.kphanet.org Xavier University of Louisiana, College of Pharmacy, New Orleans, Louisiana. Reprinted with permission of the author and the Louisiana 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 # 0143-9999-12-005-H04-P 1.5 Credit Hours (0.15 CEUs) Goals: The goals of this article are to provide information on the physiology and disorders of the scalp, and typical drug therapy used to treat these disorders. Objectives: At the conclusion of this lesson, the reader should be able to: 1. 2. 3. 4.
Discuss the physiology of the scalp and the function of the sebum, sweat glands and pores. List at least five disorders/conditions of the scalp. Describe different treatment approaches used in scalp disorders. Become familiar with various formulations used in the treatment of seborrheic dermatitis, dandruff, psoriasis, hair loss, lice and ringworm.
Skin: Each layer of the skin (epidermis, dermis, subcutaneous) has a specific function. Included in the Scalp disorders may be painful, annoying, unsightly and embarrassing. Scalp problems may require short- skin are the sebaceous glands that produce sebum and secrete it through the sebaceous ducts into hair term treatment, but many of them need long-term follicles where it migrates to the surface of the skin. therapy over months, and sometimes years. ComThis flow of sebum removes dead skin cells that flake pounding pharmacists have a significant role in off from inside the hair follicle. Sebum consists of fatty achieving successful therapeutic outcomes in this acids and other substances and protects the skin by emerging field. reducing the evaporation of water from the skin and Anatomy and Physiology blocks the penetration of excess water into the skin. The scalp consists primarily of the skin, sweat glands, This sebum is one of two constituents making up the sebaceous glands, hair shafts and hair. When these lipid film present on the skin surface, the other being appendages are not functioning properly in harmony the lipids of the epidermal cells. with one another, various scalp disorders can occur. Pores: The pores in the skin are where the hair folliIntroduction
Scalp: The scalp is the portion of the body consisting of skin and subcutaneous tissue normally containing hair that covers the neuro-cranium. It is especially rich in blood vessels; therefore, profuse bleeding may occur with scalp injuries. The functions of the scalp (skin) include protection and excretion. It secretes metabolic waste materials and toxins in order to rid the body of them. It also secretes sweat to cool the body, and sebum to protect the skin.
cles reside. The pore size is related to sebaceous gland size. Pores enlarge to accommodate a greater oil flow. Acne caused by blocked pores often clears up when the pores enlarge allowing unimpeded movement of sebum through the pore. Sweat Glands: Sweat glands consist of a single tube, the lower portion of which is coiled into a ball and the upper part (the duct) opens onto the surface of the skin. There are two types of sweat glands, the eccrine
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THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp and the apocrine. The eccrine sweat glands, distributed all over the body, primarily regulate body temperature and eliminate toxic substances and waste products; the perspiration is clear and consists of traces of salt, carbohydrates, protein and oil. The sweat they produce is primarily odorless. The apocrine sweat glands are primarily in the underarm area, around the nipples and in the genital area. They are stimulated by the same hormones that stimulate hair growth in the underarms and genital area. The fluid they secrete is milky and rich in organic material that is subject to bacterial decay, causing body odor. The hair entraps both sweat and bacteria.
May 2012 SCALP DISORDERS AND THEIR TREATMENT Seborrheic Dermatitis and Dandruff
Description: Seborrheic dermatitis is an acute or chronic papulosquamous dermatitis presenting with dry scales and underlying erythema. In some cases pruritis is present. Dandruff occurs when there is a mild scaling without any erythema, and can occur if the scalp is dry or oily. It may be the result of several factors, including hormonal imbalance, impaired metabolic nutrition, diet, tension, increased bacterial and fungal activity, biochemical changes in the scalp, the use of topical medications and cosmetics. Seborrheic dermatitis occurs when there is general erythema Sebum: When the sebum gets stuck in the pores, without tight, thick, silvery scales. Psoriasis is eviwhiteheads, blackheads, papules, pimples and cysts denced by the presence of well-demarcated red can ultimately occur. It is a result of the sebum getting plaques. blocked during its transport and clumping with dead skin cells, being acted upon by bacteria and ultimately Treatment: Routine treatment for seborrhea of the scalp involves a shampoo that may contain tar, zinc blocking the opening to the skin surface. If pressure pyrithione or selenium, used daily if necessary. A kebuilds up, pustules and cysts result. toconazole 1 percent or 2 percent shampoo can be Hair: Hair grows on the scalp and each hair filament used twice weekly. If needed, solutions or lotions of originates in a deep hair follicle which penetrates into topical corticosteroids can be used twice daily. the dermis. At the base of the follicle is the papilla which is the center of hair growth containing the capil- Psoriasis laries and nerves that supply the hair. As new cells Description: Psoriasis is an inflammatory skin disease are formed and older cells are pushed upward, they that may be based upon a genetic predisposition. gradually die and harden into a hair shaft, consisting When the skin is injured or irritated, it tends to induce of two layers, the cuticle and cortex. The outer layer, lesions of psoriasis at the site. There are several varithe cuticle, consists of flat, colorless, overlapping ants of psoriasis, with the most common being the cells. The cortex contains pigment and a tough proplaque type. Psoriasis presents as silvery scales on tein called keratin, forming the bulk of the hair shaft. bright red, well-demarcated plaques that may be acCoarse hair, as on the scalp, contains an additional companied by itching. inner core called the medulla. The hair is lubricated by Treatment: The treatment selected for psoriasis of the sebaceous glands that are located in the hair follicle. scalp is based on its extent and severity. Therapy can In general, human scalp hair is shed every two to four be initiated using a corticosteroid preparation. Other years; body hairs are shed more frequently. measures include tar preparations, such as coal tar Hair growth: Hair growth is cyclical, consisting of three solution (LCD, Liquor Carbonis Detergens), anthralin, phases. The growing phase is the “Anagen” phase; calcipotriene and tazarotene. Treatment can be initiatabout 90 percent of scalp hairs are in the anagen ed with a tar shampoo used daily. For thick scales on phase at any point in time. On a daily basis, about 50 the scalp, a 6 percent salicylic acid gel, or a phenol : to 100 scalp follicles go into the resting phase, or the mineral oil : glycerin mixture can be used. Alternative“Catagen” phase, which involves 1 percent of the ly, fluocinolone acetonide 0.01 percent in oil can be hairs daily. The shedding phase is the “Telogen” applied under a shower cap at night followed by tar phase and approximately 10-20 percent of scalp hairs shampoo in the morning. Corticosteroids such as trimay be in the telogen phase at any point in time. amcinolone, fluocinolone, betamethasone dipropio17
THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
nate, fluocinonide, amcinonide, or clobetasol in solution form can be used twice daily. Hair Loss I. Description: Pattern, or androgenetic baldness, is the most common form of alopecia. It is of genetic predetermination with the earliest changes occurring on the front sides of the scalp and at the crown of the skull. The extent of hair loss is variable and unpredictable, but may be experienced by approximately 80 percent of all men. Treatment: A 5 percent solution of minoxidil alone or in combination with other active ingredients can be used in both male and female patients, generally twice daily. Those that respond are usually less than five years into their hair loss. II. Description: Alopecia areata is believed to be the result of an imuunologic process. Typically, there are patches that are smooth, without scarring. Tiny hairs, generally 2-3 mm in length, may be seen. In some cases, all the scalp hair may eventually be involved. Alopecia areata is a self-limiting disease where there may be complete re-growth of hair in about 80 percent of cases. In some cases, mild alopecia areata is resistant to therapy.
lol, indomethacin, amphetamines, salicylates, gentamicin and levodopa. Drug-induced alopecia is very disconcerting to the patient, but it is reversible when the causative agent is discontinued. Treatment: No real treatment is indicated in such cases, other than discontinuation of the causative agent. Lice Description: Pediculus humanus var capitis (the head louse, approximately 3-4 mm long) is the causative agent for pediculosis of the skin of the scalp. It is presented as pruritis with excoriation and the presence of nits on hair shafts; they are easiest to see above the ears and at the nape of the neck. Head lice can be spread by individuals sharing hats or combs and it is epidemic among children of all socioeconomic classes, especially in elementary schools. Adults in close contact with children may also get the infestation.
Treatment: Options for treating head lice include ivermectin 0.8 percent lotion, malathion 0.5 percent or 1 percent lotion, permethrin 1 percent cream rinse and pyrethrins 0/17 percent to 0.33 percent. The ivermectin lotion is left on for 8 to 12 hours prior to rinsing off. The malathion is applied to the scalp and left on for about 12 hours. The permethrin cream rinse is left on from 30 minutes to 8 hours prior to rinsing off and Treatment: Severe forms may be treated by systemic treatment is repeated in one week. Following applicacorticosteroids; however, recurrences generally occur tion of these preparations, it is important to meticuwhen therapy is discontinued. Corticosteroids can lously remove the nits with a fine-tooth comb. also be administered intralesionally; for example, triamcinolone acetonide 2.5 to 10 mg/mL can be inject- Ringworm ed in aliquots of 0.1 mL every 1 to 2 cm in the inDescription: Ringworm presents as a ring-shaped levolved areas. The total dose should not exceed 30 sion with an advancing scaly border and central mg per month for adults. Another treatment includes cleared area, or as scaly patches with a distinct bordaily use of anthralin 0.5 percent ointment. der on the skin or scalp. The affected areas may also Other therapeutic approaches involve the use of topi- itch. Trichophyton rubrum is the most common causacal diphenylcyclopropenone and squaric acid dibutyl tive agent. ester. These agents serve to sensitize the skin; this is Treatment: Many of the topical antifungal agents can followed by application of progressively weaker conbe used, including miconazole, clotrimazole, ketoconcentrations designed to produce a slight dermatitis. azole, econazole, sulconazole, oxiconazole, ciclopirThis results in hair re-growth in 3 to 6 months in some ox, butenafine and terbinafine. Topical dosage forms patients. commonly used include creams, solutions and gels. III. Description: Drug-induced alopecia may result If the product is expected to be exposed to a wet enfrom thallium, excessive vitamin A, retinoids, antimi- vironment, an ointment would be more appropriate. totic agents, anticoagulants, antithyroid drugs, oral Treatment should be continued up to two weeks after contraceptives, trimethadione, allopurinol, proprano- symptoms have resolved. 18
THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012 Systems’ by Howard C. Ansel, Nicholas G. Popovich, and Loyd V. Allen, Jr. Ninth Edition. Lippincott, Williams & Wilkins. 2011.
References
1. ‘A practical guide to contemporary pharmacy practice’ by Judith E. Thompson, Third Edition. Lippincott, Williams & Wilkins. 2009 3. ‘The Art, Science, and Technology of Pharmaceutical Compounding’ by Loyd V. Allen, Jr. Third Edi2. ‘Pharmaceutical Dosage Forms and Drug Delivery tion. American Pharmacists Association. 2008.
Formulations For Treating Scalp Disorders and Conditions General Applications for Pruritus of the Scalp
Propylene glycol
25 mL
Rx Hydrocortisone 1 percent Antipruritic Scalp Lotion
Ethanol 95 percent
25 ml
Purified Water, qs
100 mL
Hydrocortisone
1g
Menthol
250 mg
Polysorbate 80
0.25 mL
Ethanol 95 percent
25 mL
Propylene glycol
25 mL
Purified water, qs
100 mL
Mix the triamcinolone with the propylene glycol and ethanol. Add sufficient purified water to volume and mix well. Package and label. Rx Anti-Seborrhea Clear Lotion Progesterone Ethanol 95 percent mL
Mix the hydrocortisone and menthol with the Polysorbate 80. Add the propylene glycol and ethanol and mix well. Add sufficient purified water to volume and mix well. Package and label. Formulations for Seborrheic Dermatitis and Dandruff Rx Selenium Sulfide 1 percent Shampoo Selenium Sulfide
1g
Propylene glycol
5 mL
Shampoo vehicle (commercial), qs
100 mL
500 mg 10
Ethoxy diglycol
50 mL
Methylparaben
50 mg
Propylparaben
20 mg
Propylene glycol
1 mL
Purified water, qs
100 mL
Dissolve the progesterone in the ethanol. Add the ethoxy diglycol. Dissolve the methylparaben and propylparaben in the propylene glycol and add to the progesterone solution. Add sufficient purified water to volume and mix well. Package and label.
Levigate the selenium sulfide with the propylene glycol. Rx Sulfur Shampoo Add the shampoo vehicle to volume and mix well. PackSulfur (colloidal) 1g age and label. Magnesium aluminum silicate 1g Rx Zinc Pyrithione 1 percent Shampoo. Ammonium lauryl sulfate 40 g Zinc pyrithione 1g Lauramide DEA 4.5 g (equivalent) Sodium chloride 200 mg Propylene glycol 10 mL. Methylparaben 50 mg Shampoo vehicle (Commercial), qs 100 mL Propylparaben 20 mg Levigate the zinc pyrithione with the propylene glycol. Add the shampoo vehicle to volume and mix well. PackPurified water, qs 100 mL age and label. Slowly add the magnesium aluminum silicate to about Rx Triamcinolone 0.1 percent Scalp Lotion 50 mL of purified water while agitating and mix until smooth and uniform. Add the colloidal sulfur, ammoniTriamcinolone 100 mg um lauryl sulfate, lauramide DEA, sodium chloride, 19
THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
methylparaben and propylparaben and mix well. Add Mix the coal tar with the polysorbate 80 and incorposufficient purified water to volume and mix well. Pack- rate the anthralin. Incorporate into the Aquaphor and age and label. mix until uniform. Package and label. Rx Phenol, Glycerin and Mineral Oil Shake Lotion Phenol
1g
Glycerin
10 mL
Purified water
20 mL
Methylparaben
50 mg
Propylparaben
20 mg
Mineral Oil, Light, qs
100 mL
Dissolve the phenol, methylparaben and propylparaben in the glycerin. Add the purified water and mix well. Add the mineral oil and agitate. This is not an emulsion, but is an immiscible shake-type lotion.
Rx Anthralin 1 percent Medication Stick Anthralin
200 mg
Polyethylene glycol 3350
6.5 g
Polyethylene glycol 300
15 mL
Mix the polyethylene glycols together by heating to a temperature of about 550C. Incorporate the anthralin and mix well. Pour into medication stick molds and allow to cool. Package and label. Rx Calcipotriene 0.003 percent Lotion Calcipotriene 0.005 percent Cream 60 g Propylene glycol, qs
100 mL
Formulations for Psoriasis
Mix the commercial calcipotriene 0.005 percent cream with sufficient propylene glycol to make 100 mL. Package and label.
Rx Coal Tar Shampoo
Rx Fluocinolone Acetonide 0.01 percent in Oil
Coal tar solution
2.8 g
Fluocinolone acetonide
10 mg
Polysorbate 80
5 mL
Vegetable oil, qs
100 mL
Shampoo vehicle (commercial), qs
100 mL
Mix the coal tar solution with the polysorbate 80. Incorporate the shampoo vehicle and mix well. Package and label. Rx Coal Tar and Salicylic Acid Scalp Lotion Coal tar solution
10 mL
Salicylic acid
6g
Polysorbate 80
1 mL
Ethanol 95 percent
20 mL
Propylene glycol, qs
100 mL
Mix the polysorbate 80 with the coal tar solution. Mix the salicylic acid with the alcohol and about 60 mL of the propylene glycol. Add the coal tar solution mixture slowly with mixing to the propylene glycol mixture. Add sufficient propylene glycol to volume and mix well. Package and label.
Incorporate the fluocinolone acetonide into a vegetable oil, such as sesame oil, or almond oil, and mix well. Package and label. Formulations for Hair Loss Rx Minoxidil 5 percent and Retinoic Acid 0.01 percent Scalp Lotion
1g
Coal tar
1g
Polysorbate 80
2g
Aquaphor, qs
100 g
5g
Retinoic acid
10 mg
Propylene glycol
20 mL
Ethanol 95 percent, qs
100 mL
Mix the minoxidil and retinoic acid with the propylene glycol. Add sufficient ethanol to volume and mix well. Package and label. Rx Minoxidil 2 percent and Finasteride 0.1 percent Scalp Lotion
Rx Anthralin 1 percent and Coal Tar 1 percent Ointment Anthralin
Minoxidil
Minoxidil
2g
Finasteride
100 mg
Propylene glycol
20 mL
Ethanol 95 percent, qs
100 mL
Pulverize the required number of finasteride tablets and mix with about 75 mL of ethanol in a covered con20
THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
tainer and let sit for a couple of hours. Filter through a paper filter to remove the excipients. Add the minoxidil and propylene glycol to the filtrate and mix well. Add sufficient ethanol to volume and mix well. Package and label.
sal passages. Wear disposable gloves to prevent retention of odor on the hands. Disperse the malathion in the isopropyl alcohol. Add the fragrances and mix well. Add sufficient ethanol to volume and mix well. Package and label.
Rx Spironolactone Scalp Lotion
Rx Ivermectin 1 percent Creme Rinse
Spironolactone
1g
Methylcellulose
0.25 g
Ethanol 95 percent
40 mL
Propylene glycol
20 mL
Purified water, qs
100 mL
Acetone, qs
100 mL
Dissolve the diphenylcyclopropenone in sufficient acetone to volume. Package and label. Caution: Diphenylcyclopropenone is a strong sensitizing agent. Exercise care when preparing these solutions; wear appropriate masks, garb and gloves. Rx Squaric Acid Dibutyl Ester 0.1 percent to 1 percent Solutions Squaric acid dibutyl ester
Polyethylene glycol 300
17 mL
Creme Rinse (Commercial), qs
100 mL
Rx Ivermectin 1 percent Lotion
Rx Diphenylcyclopropenone 0.1 percent to 2 percent Solutions 100 mg to 2 g
1g
Mix the ivermectin with the polyethylene glycol 300 to form a smooth paste. Incorporate the creme rinse and mix well. It may be necessary to work the product in a mortar with a pestle to ensure uniform and small particle size of the ivermectin. Package and label.
Mix the spironolactone and methylcellulose with the propylene glycol. Add the ethanol and mix well. Add sufficient purified water to volume and mix well. Package and label.
Diphenylcyclopropenone
Ivermectin
Ivermectin
1g
Propylene glycol
15 mL
Dermabase
30 g
Purified water, qs
100 mL
Mix the ivermectin with the propylene glycol to form a smooth paste using a mortar and pestle. Incorporate the Dermabase and mix well. Slowly add sufficient purified water to volume and mix well. Package and label. Formulations for Ringworm
100m g to 1g
Rx Clotrimazole 1 percent Scalp Lotion
Acetone or Ethanol 95 percent, qs 100 mL Dissolve the squaric acid dibutyl ester in sufficient acetone OR ethanol to volume. Package and label.
Clotrimazole
1g
Propylene glycol
50 mL
Polyethylene glycol 300, qs
100 mL
Dissolve the clotrimazole in the propylene glycol and add sufficient polyethylene glycol 300 to volume and mix well. Package and label.
Formulations for Lice Infestation Rx Malathion 0.5 percent Topical Lotion
Rx Miconazole 1 percent and Tolnaftate 1 percent Scalp Lotion
Malathion
500 mg
Isopropyl alcohol 70 percent
70 mL
Lavender oil
30 drops
Bay oil
3 drops
Ethanol 95 percent, qs
100 mL
Miconazole
1g
Tolnaftate
1g
Propylene glycol
50 mL
Polyethylene glycol 300, qs
100 mL
Note: Compound this preparation in a well-ventilated Dissolve the miconazole and tolnaftate in the propylarea or use an exhaust hood, since malathion fumes ene glycol and add sufficient polyethylene glycol 300 can be irritating to the mucous membranes of the nato volume and mix well. Package and label. 21
THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
Rx Ketoconazole 2 percent Solution
label.
Ketoconazole 2g Polyethylene glycol 300 80 mL Propylene glycol 20 mL Dissolve the ketoconazole in the polyethylene glycol 300 and propylene glycol and mix well. Package and
Note: With the exception of a few formulations containing drugs such as triamcinolone, fluocinolone acetonide, spironolactone, finasteride, and squaric acid dibutyl ester, the remaining preparations can be dispensed over-the-counter.
Attention all Pharmacists and Pharmacy Technicians!!!! You MUST sign up for a NABP e-Profile ID to receive CE credit from KPERF or any other ACPE Provider as of this year. Visit www.kphanet.org/CPEMonitor for more.
CPE Monitor: Information for Pharmacists and Pharmacy Technicians What is CPE Monitor? CPE MonitorTM is a national, collaborative effort by the Accreditation Council for Pharmacy Education (ACPE) and the National Association of Boards of Pharmacy (NABP) to provide an electronic system for pharmacists and pharmacy technicians to track their completed continuing pharmacy education (CPE) credits. It will also offer boards of pharmacy the opportunity to electronically authenticate the CPE units completed by their licensees, rather than requiring pharmacists and pharmacy technicians to submit their proof of completion statements (i.e. statements of credit) upon request or for random audits. How CPE Monitor Works Pharmacists and pharmacy technicians will receive a unique identification number (ID), known as the NABP e-Profile ID, after setting up their e-Profile with NABP (see How to Register for CPE Monitor). Many ACPE-accredited CPE providers are now requiring pharmacist and pharmacy technician participants to provide their NABP e-Profile ID and date of birth (DOB in MMDD format) to the ACPE-accredited provider when they register for a CPE activity or submit a request for credit. It will be the responsibility of the pharmacist or pharmacy technician to provide the correct information [i.e. ID and DOB (in MMDD format)] in order to receive credit for participating in a CPE activity. The CPE Monitor system will direct electronic data from ACPE-accredited providers to ACPE and then to NABP, ensuring that CPE credit is officially verified by the providers. Once information is received by NABP, pharmacists and pharmacy technicians will be able to log in to access information about their completed CPE activities. How to Register for CPE Monitor Pharmacists and pharmacy technicians are asked to obtain their NABP e-Profile ID now at www.MyCPEmonitor.net to ensure their e-Profile is properly setup prior to implementation of CPE Monitor. As ACPE-accredited providers begin transitioning their systems to CPE Monitor throughout 2012, the eProfile ID and DOB in MMDD format will be required by those providers to receive credit for any ACPEaccredited CPE activities. By the end of 2012, all ACPE-accredited CPE providers will require the e-Profile ID and the DOB in MMDD format to receive CPE credit. NABP Customer Service custserv@nabp.net Tel: 847-391-4406 Fax: 847-391-4502 Hours: M-F, 9 AM to 5 PM central
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THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
May 2012 — Compounding for Scalp Disorders and Conditions
1. Components of the scalp include: A. Skin B. Sebaceous glands C. Hair shafts D. Sweat glands E. All of the above 2. Common disorders of the scalp include all of the following, EXCEPT: A. Hyperhidrosis B. Dandruff C. Seborrheic dermatitis D. Lice infestation E. Ringworm 3. All of the following may be used to treat psoriasis, EXCEPT: A. Coal tar solution B. Anthralin C. Minoxidil D. Fluocinolone acetonide E. Clobetasol 4. Individuals may have a genetic predisposition to: A. Ringworm B. Lice C. Dandruff D. Psoriasis E. Seborrheic dermatitis 5. Which of the following should be used to treat ringworm? A. Coal tar solution B. Miconazole C. Hydrocortisone D. Anthralin E. Malathion
6. All of the following may be used to treat a lice infestation, EXCEPT: A. Terbinafine B. Malathion C. Ivermectin D. Permethrin E. Pyrethrins 7. Squaric acid dibutyl ester can be used in the treatment of: A. Seborrheic dermatitis B. Dandruff C. Psoriasis D. Alopecia E. Lice 8. Seborrhea of the scalp may be treated with: A. Zinc pyrithione B. Selenium C. Ketoconazole shampoo D. Topical corticosteroids E. All of the above 9. Select the FALSE statement about lice infestations from the following: A. It is epidemic among children of all socioeconomic classes. B. It presents with dry scale and underlying erythema. C. It is spread by sharing hats or combs. D. The nits on hair shafts are easiest to see above the ears and at the nape of the neck. E. Adults in close contact with children may also get the infestation. 10. Special precautions are required when dealing with the following drugs: I. Malathion II. Diphenylcyclopropenone III. Coal tar A. I only B. III only C. I and II only D. II and III only E. I, II and III
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THE KENTUCKY PHARMACIST
May 2012 CE-Compounding for Scalp
May 2012
This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. The fee for duplicate certificates is $5. Please send a self addressed, stamped envelope to KPERF, 1228 US 127 South, Frankfort, KY 40601. Expiration Date: May 15, 2015 Successful Completion: Score of 80 percent will result in 1.5 contact hours or 0.15 CEUs. Participants who score less than 80 percent will be notified and permitted one re-examination. May 2012 — Compounding for Scalp Disorders and Conditions TECHNICIANS ANSWER SHEET. Universal Activity # 0143-9999-12-005-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 2. A B C D E
3. A B C D E 4. A B C D E
5. 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 #_________________________________ Birthdate _______________________(MM/DD)_ May 2012 — Compounding for Scalp Disorders and Conditions Universal Activity # 0143-9999-12-005-H04-P PHARMACISTS ANSWER SHEET Name ________________________________________________ KY Lic. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 2. A B C D E
3. A B C D E 4. A B C D E
5. 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 #_________________________________ 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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THE KENTUCKY PHARMACIST
KPPAC Contribution Form
May 2012
Support the Candidates who Support YOU! Make your Donation Today! KPPAC Contribution
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Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601
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THE KENTUCKY PHARMACIST
Pharmacy Law Brief
May 2012
Pharmacy Law Brief: Importation of Prescription Drugs Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: What is the current status of the law with regard to prescription medications entering the country, both when brought in by a patient and when shipped from outside the country to a patient? I seem to recall that there even were some programs sponsored by a number of states to facilitate their citizens getting medications from sources in Canada. Response: The federal law in this area is unchanged and has been the same for quite some time. Succinctly stated, it prohibits anyone, including an individual private citizen or a business organization, from bringing into the country an unapproved new drug product that violates the Federal Food, Drug and Cosmetic Act. It does not matter whether the products are for personal use or for resale. The legal position is that the category of unapproved new drugs includes “any drugs, including foreign-made versions of U.S. approved drugs that have not been manufactured in accordance with and pursuant to an FDA approved process.” A number of studies have documented that pharmaceuticals coming into the US and purporting to have been made in one country really come from manufacturers based in other lands. Products labeled to appear to have been manufactured in Canada have been found to originate in Brazil or any number of African nations. It is important to bear in mind that the highly controlled system of drug product approval, manufacturing and distribution was put in place over the past century with the goal of having only approved drug products available for use by those in the U.S. Some measure of validity attached to the notion of importing medications for personal use from Canada arose when several states launched initiatives to encourage their citizens to take advantage of potential savings claimed to exist. Probably the highest profile initiative of this type was “I-Save Rx” promoted by the nowdiscredited Gov. Rod Blagojevich of Illinois. This program used both Canadian sources as well as ones in Europe. At least four other states joined the effort but the program died when the Canadian supplier withdrew, claiming that the states had not adequately promoted the program to their citizens. All this being said, the U.S. Food and Drug Administration has the same enforcement discretion as does any law enforcement agency. Just like the state trooper who pulls over a speeding motorist and then decides to issue a warning rather than a ticket, the FDA has some latitude in how it approaches enforcement of the statutes and regulations under its jurisdiction. As a general rule, FDA does not bring its enforcement might to bear on individual patients who are importing medications for personal use. The agency has bigger fish to fry,
Resources for further information: APhA, Drug importation: The realities of safety and security. http://www.pharmacist.com/AM/Template.cfm?Section=Home2&CONTENTID=17842&TEMPLATE=/CM/ ContentDisplay.cfm FDA, Information on importation of drugs. http://www.fda.gov/ForIndustry/ImportProgram/ImportPolicyandInformationbyProduct/default.htm FDA, FDA operation reveals many drugs promoted as “Canadian” products really originate from other countries. http://www.fda.gov/NewsEvents/ Newsroom/ Press Announcements/2005/ucm108534.htm. FDA, Importing prescription drugs: Letters to state and local officials. http://www.fda.gov/Drugs/DrugSafety/ucm170594.htm.
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Pharmacy Law Brief
May 2012
e.g., tracking down the source of the counterfeit Avastin® that recently made its way into the nation’s drug supply. Some of the factors the FDA will weight when deciding whether to pursue enforcement in a given case have been laid out by the agency this way:
The intended use of the imported product is unapproved, and it is for a serious condition which has no approved treatment in the U.S. There is no known commercialization or promotion of the product to U.S. citizens by those distributing the product. The product is not deemed to pose an unreasonable risk. The individual affirms in writing that it is for personal use, supplies the name and address of the U.S.based physician responsible for supervising use of the product, or provides evidence the product being imported is for continuation of a treatment regimen begun abroad.
For the pharmacist an important consideration is that when patients procure medications from a foreign source they may be reluctant to report that to their local pharmacist or physician. Hence, those health professionals may have an incomplete picture of the medications actually being used by the patient. Given the reluctance of patients to volunteer such information and their hesitance to inquire about the desirability of drug importation from their trusted pharmacist who may be their traditional source for drug products and information about them, the local pharmacy practitioner may be unaware of the extent of such activities in his or her area. 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. Submit Questions: jfink@uky.edu 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
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CPE Monitor
May 2012
CPE MONITOR: Change is coming By: Scott Sisco, Director of Communications and Continuing Education
Change can be good. Change can be easy. Change can be challenging. Change can be scary, but it doesn’t have to be. CPE Monitor is a change. For some pharmacists and certified pharmacy technicians (yes techs, this includes you), this is a welcome change that will simplify one aspect of your professional life. For those who are not as technology friendly, this change will require some assistance from your techsavvy associates. CPE Monitor was developed through collaboration between the Accreditation Council for Pharmacy Education (ACPE) and the National Association of Boards of Pharmacy (NABP) to create an electronic system for pharmacists and certified pharmacy technicians to track completed continuing education credits. Since the initial launch of the CPE Monitor service in March 2011, more than 93,100 pharmacists and 36,500 pharmacy technicians set up NABP e-Profiles to prepare for the shift to electronic tracking of all ACPE-accredited CPE units. The continuing education programs you attend and journal articles you
read WILL NOT change. The Ken- audits your license, your CPE units tucky Pharmacy Education and Re- will be authenticated electronically search Foundation (KPERF), and by the investigator. all other ACPE CE Providers, will You may have noticed the new lines on the answer sheets for the CE articles in The Kentucky Pharmacist in 2012 requesting NABP # and Birthdate. These lines were added in anticipation of KPERF’s changeover to CPE Monitor later this year. And ladies, you only have to provide month and day on the birthdate. continue to offer quality, educationWe don’t have to know how old you al programs. The way you earn are, just the month and day you your CE will not change. were born. ALL ACPE Providers CPE Monitor only changes how the will completely implement CPE certification of your CE is delivered. Monitor by the end of 2012 and will No longer will you have to snail be requiring this information. mail a self-addressed stamped enYour first step in this process is to velope with your journal answer sign up for your NABP eProfile ID sheets. For those over-worked at www.nabp.net. Click on the CPE pharmacists and technicians who Monitor logo, and it will take you to send in that last CE at the end of the sign up page. NABP Customer the year, this eliminates the wait Service is available to answer your time to receive the certificate in the questions at custserv@nabp.net or mail. on the telephone Monday through Instead, you will be able to go to Friday 9 a.m. to 5 p.m. Central your computer and print out either Time at 847-391-4406. a list of the CE activities you comWatch this journal and email mespleted or certificates for those activ- sages from KPhA for updates on ities. You won’t have to keep your CPE Monitor. Updates will also be binder of certificates in your pharposted at www.kphanet.org/ macy. If the Board of Pharmacy CPEMonitor. 28
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Pharmacy Technician Certification Board
May 2012
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Agency for Healthcare Research and Quality
May 2012
KPhA partners with AHRQ to offer free resources for members, patients The Federal Agency for Healthcare Research and Quality (AHRQ) launched a nationwide initiative to raise awareness of patient-centered outcomes research and to encourage its use. AHRQ provides pharmacists, other clinicians and patients free resources and tools that objectively summarize current clinical evidence on various treatment methods to inform health care decision making. KPhA is partnering with AHRQ to provide our members quick access to these materials and to announce new products as they become available.
port shared decision making between clinicians and patients, with a goal of better care and increased patient satisfaction. Clinician materials provide clinical bottom line information, citing research gaps, when applicable. Patient materials are written in plain language and contain an overview of the condition in addition to the comparative effectiveness information. These unbiased resources can help pharmacists:
Patient-centered outcomes research informs health care decision making by comparing the evidence on the effectiveness, benefits and harms of different treatment options for common health conditions. Many of the research studies compare medication therapies used to treat a wide range of conditions, including cancers, cardiovascular diseases and related conditions, diabetes, arthritis and mental health disorders.
Examples of currently available titles include:
In conducting systematic reviews, researchers synthesize the available evidence on drugs, medical devices, tests, surgeries or ways to deliver health care. The research findings are translated into practical resources, including:
Clinician research summaries (most are two pages) Plain language patient research summary brochures (in English and Spanish) Accredited CME/CE modules (including several accredited for pharmacists) Faculty slide presentations
Identify issues to discuss with patients. Talk about side effects. Analyze treatments and assess benefits and harms for patient outcomes.
Treating Cholesterol With Combination Therapy Comparing Medications for Adults With Type 2 Diabetes ACEIs, ARBs or DRI for Adults With Hypertension Analgesics for Osteoarthritis
To view or download AHRQ resources, visit www.EffectiveHealthCare.ahrq.gov. To order free printed copies of the clinician or patient research summaries, including bulk quantities, call the AHRQ Publications Clearinghouse at 1-800-358-9295 and provide the code C-02. For more information about this initiative, contact Victoria McGhee in AHRQ’s Atlanta Regional Office at 404-836-2303 or victoria.mcghee@ahrq.hhs.gov.
Watch your email box for updates on new information in eNews!
All of these tools are designed to encourage and sup-
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Pharmacy Time Capsules
May 2012
Pharmacy Time Capsules 1987—Twenty-five years ago: Petition requesting recognition of Nutrition Support Pharmacy Practice as a specialty was submitted to the Board of Pharmaceutical Specialties. 1962—Fifty Years Ago: New England College of Pharmacy affiliated with Northeastern University. The Indian Hospital at Crow Agency, Montana began filling outpatient prescriptions directly from the patient’s medical record. This was eventually adopted throughout the Indian Health Service. 1937—Seventy-five Years Ago: National Cancer Institute was established to conduct and support research relating to the cause, diagnosis, and treatment of cancer. 1912—One hundred Years Ago: Public Health and Marine Hospital Service was renamed the Public Health Service (PHS) and the mission was expanded to include communicable diseases field investigations, navigable stream pollution, and information dissemination. APhA House of Delegates was established as a forum for all branches of the profession to have a voice. By: Dennis B. Worthen Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America's history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org
You MUST sign up for a NABP e-Profile ID to receive CE credit from KPERF or any other ACPE Provider. Visit www.kphanet.org/CPEMonitor for more.
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NASPA Leadership Conference
May 2012
KPhA at NASPA Leadership Conference sponsored by Pharmacists Mutual Companies President-Elect Kimberly Croley and Executive Director Robert McFalls attended the National Alliance of State Pharmacy Association Leadership Conference sponsored by Pharmacists Mutual Companies April 29-May 1 at U.S. Pharmacopeia in Rockville, Md. Association directors and president-elects learned leadership skills and shared ideas to solve problems faced by many of the state pharmacy associations. Pictured are leaders from Georgia, Executive Jim Bracewell and PresidentElect Robert Hatton; Alabama Executive Louise Jones; NCPA PresidentElect Donnie Calhoun; and McFalls and Croley.
UKCOP student shares study-abroad experience Katy Monson, a fourth-year pharmacy and MPA student in the Martin School of Public Policy & Administration at the University of Kentucky, is studying on
a six week experiential education rotation in Ecuador. She is blogging about her experiences there http://pharmdstudentinecuador.blogspot.com/.
KPhA sends email announcements weekly. If you aren’t receiving: eNews, Legislative Updates, Grassroots Alerts and other important announcements, send your email address to ssisco@kphanet.org to get on the distribution list. 32
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May 2012
KPhA Government Affairs Contribution
Support the Candidates who Support YOU! Make your Donation Today!
KPhA Government Affairs Contribution
Name: _________________________________ Pharmacy: ___________________________________ 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: _______ Address to which credit card statement is mailed (if different from above) ___________________________________________________________________________________
Mail to: Kentucky Pharmacists Association 1228 US Highway 127 South Frankfort, KY 40601
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June 2012 CE—Reducing the Burden of Adverse Drug Events
May 2012
Reducing the Burden of Adverse Drug Events
KPERF offers all CE articles to members online at www.kphanet.org
By: Lewis Wilkerson, PharmD, CGP M. Trent Blacketer, MBA, PharmD candidate at University of Kentucky College of Pharmacy There are no financial relationships that could be perceived as real or apparent conflicts of interest.
Universal Activity # 0143-9999-12-005-H04-P 1.0 Credit Hours (0.1 CEUs) Objectives - Discuss the scope of Adverse Drug Events in practice and the importance of prevention - Identify the drug classes most at risk for Adverse Drug Events - Assess patient characteristics that may increase the risk for Adverse Drug Events - Recognize the need for complete patient analysis Background Adverse Drug Events (ADEs) are one of the leading causes of preventable morbidity in our healthcare practices. A review of studies assessing the incidence of ADEs in inpatient and outpatient settings reveals disturbing results for providers. The median ADE prevalence rate was 9.5 percent within analysis of prospective studies. ADEs have the potential to elevate costs within the healthcare system as well, most notably when leading to unnecessary hospitalizations. Studies have shown that nearly 5 percent of ADEs will lead to an additional hospitalization for our patients.1, 2
Opioids and NSAIDS are the obvious offenders in the analgesic class. Many cardiovascular agents have a high potential to cause ADEs ranging from diuretics to anticoagulants. Some diabetic agents merit concern due to their potential for hypoglycemia. Hypoglycemic agents do not result in a large majority of the ADEs that we come across, but a higher percentage of the events are of serious nature and therefore lead to more hospitalizations. This explains why they are included on most high-risk drug lists. Table 1 lists drug groups that most commonly led to ADEs in a recent prospective study.5
As illustrated in the table, NSAIDs should be of utmost concern for pharmacists when verifying and monitoring patient therapies. Past histories of bleeding or ulceration, as well as potential for renal impairment, are important factors to be proactive about when providing care for patients. The other drug group of high concern with nearly 30 percent of ADE cases is diuretics. Over- or under-diuresing a patient can lead to a number of avoidable effects, such as hypotension or electrolyte imbalances. Stressing the importance of accuCommon Drug Class Offenders rate dosing and frequency of diuretics are necessary 5 A substantial portion of the ADEs encountered by pro- steps in preventing negative outcomes. viders are caused by a limited number of drug classes. The potential ADE risk drops significantly for anticoagAnalgesic, cardiovascular, and hypoglycemic agents ulants when compared to the NSAIDs and diuretics. combine to account for more than 85 percent of ADEs. This is most likely due to the attitude that clinicians It has also been exposed that more than 20 percent of all ADEs could have been prevented if medications were prescribed and monitored correctly. Prevention and timely recognition of potential ADEs will help to improve patient and medication safety within our practices.3,4 This article will discuss drug classes commonly leading to ADEs, as well as patient characteristics to make ourselves more aware of, in hopes of decreasing the troubling ADE rates encountered today.
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June 2012 CE—Reducing the Burden of Adverse Drug Events
May 2012
Table 1: Drug Groups Commonly Leading to Adverse Drug Events percent of ADE cases
Individual drugs
Adverse reactions
NSAIDs
29.6
Aspirin, diclofenac, ibuprofen, rofecoxib, celecoxib, ketoprofen, naproxen
GI bleeding, peptic ulceration, haemorrhagic cerebrovascular accident, renal impairment, wheezing, rash
Diuretics
27.3
Furosemide, bumetanide, spironolactone, amiloride, metolazone, indapamide
Renal impairment, hypotension, electrolyte disturbances, gout
Anticoagulants
10.5
Warfarin
GI bleeding, haematuria, high INR, haematoma
ACE inhibitors/ARB
7.7
Ramipril, enalaparil, captopril, lisinopril, irbesartan, losartan
Renal impairment, hypotension, electrolyte disturbance, angioedema
Antidepressants
7.1
Fluoxetine, paroxetine, amitriptyline, citalopram, lithium, venlafaxine
Confusion, hypotension, constipation, GI bleed, hyponataemia
β blockers
6.8
Atenolol, propranolol, sotalol, bisoprolol, metoprolol, carvedilol
Bradycardia, heart block, hypotension, wheezing
Opiates
6.0
Morphine, dihydrocodeine, tramadol, fentanyl
Constipation, vomiting, confusion, urinary retention
Drug group
have adopted regarding warfarin monitoring. The medication itself is just as dangerous, if not more so compared to the aforementioned drug groups, but comprehensive anticoagulant follow-up has become standard practice today. This likely decreases the amount of ADEs that warfarin causes and is a testament to the effect that pharmacists contributions can have.
Patient Characteristics Predicting Risk
The remainder of the drug classes noted in the study caused less than 10 percent of the total reported ADEs.5 The data in Table 1 clearly demonstrates that a small subset of the total number of drug groups lead to an overwhelming majority of the ADEs that we encounter within our healthcare practices. By digesting this evidence based knowledge and using it to direct our efforts toward these concerning classes, the total number and impact of ADEs could be significantly reduced. Assessing the appropriateness of medications within these drug classes is a great place to start. Always be alert and consider if the benefits outweigh the risks before exposing patients to the potential harmful effects of medications.
ADEs vary widely in prevalence between different age groups. A review of multiple studies, looking at different age brackets, found that the median prevalence rates ranged from 2.45 percent for children, to 5.27 percent for adults, and up to 16.1 percent for the elderly population. Pediatric patients normally have a lower patient/healthcare provider ratio and are always under close supervision, which explains their lower rate of ADEs. Additionally, the trend shows that as a patient becomes older they seem to be more susceptible to ADEs.6 As providers, we need to recognize this and prioritize our elderly patients in order to prevent their higher ADE rates. The Beers’ criteria are a great resource for clinicians to use for uncovering po-
Now that we have discussed which drug classes are most likely to lead to ADEs, we next must determine which patients have the highest potential for developing ADEs. Focusing on statistics regarding patient demographics helps signify what a high-risk patient may appear like to us as healthcare providers.
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June 2012 CE—Reducing the Burden of Adverse Drug Events tential medication threats in elderly patients. The recently updated criteria can be found on The American Geriatrics Society website, which is linked in the references section .10 Patient demographics other than age do not tend to reveal such dramatic statistical variances with respect to ADE rates, but there are some others worth noting. With respect to gender, females tend to present with more ADEs in comparison to males. One specific study focusing on ADEs leading to emergency room visits found that 60 percent of all ADEs are from the female population.7 This could be attributed to differing severity tolerance levels of the events. Race is also a demographic that has shown to present with differing ADE rates. Non-Hispanic whites tend to have the lowest ADE rates, with Hispanics and Blacks having a higher adjusted risk ratio.8
May 2012
events is to do a thorough medication review. This includes medications that they might obtain via another pharmacy, samples, and OTC’s or supplements. Pharmacists should also be on the alert when patients have multiple prescribers as this increases the risk of potential drug-drug or drug-disease interactions and potential adverse events.
Health literacy is not often a topic associated with reducing ADEs, but many health safety experts believe it should be. Recent studies have shown that around 20 percent of Americans read at or below a fifth grade level, yet package inserts and other health information data are often written at or above the 10th grade level.9 It is reasonable to assume that many ADEs could be prevented if patients simply understood what their medications are for and exactly how and when they are supposed to use them. Understanding the health Past medical history is a characteristic of patient health literacy gap between providers and patients, and taking that can further inform providers of possible ADE risks. steps to assure patients are well informed about their regimens may result in reductions in ADEs. Comorbid disease states are too often overlooked when dispensing and monitoring a patient’s therapy. Conclusion Medications that are beneficial in treating one condition can be extremely dangerous when exposed to a patient Improving health safety and decreasing the burden of ADEs for patients requires constantly addressing mediwith secondary conditions. Secondary disease states cation risks versus benefits. We must not only detersuch as cancer or even an acute infection can signifimine the appropriateness of physicians prescribing decantly alter the pharmacokinetics of drug therapies.11 cisions, but also focus on recognizing and preventing Analyzing how comorbid disease states may affect unseen ADEs before they occur. Simply glancing over medications in our patients will undoubtedly reduce the a patient’s profile for drug interactions needs to beoccurrence of ADEs in our practices. come a routine of the past. Instead, we need to imAnother section of patient health that is frequently prove quality and outcomes by actively monitoring, skipped over when reviewing for potential ADEs is so- managing, and reassessing all aspects of our patients cial history. Diet and exercise routines, as well as tohealth. Diminishing the prevalence of ADEs will elimibacco and recreational drug use, are important aspects nate the excess costs from our healthcare system and, to be informed about for proper medication evaluation. most importantly, improve our patients’ lives. It is well known that certain food and supplements have the potential to cause drug interactions, yet practition- References 1. Miller GC, Britth HC, Valenti L. Adverse drug events ers monitoring regimens often have no knowledge regarding their patients diets. Vigorous exercise has the in general practice patients in Australia. Med J Aust. 2006 Apr 3;184(7):321-4. potential to alter metabolism and excretion of medica2. Thomsen LA, Winterstein AG, et al. Systematic retions. Additionally, knowing about a patients tobacco view of the incidence and characteristics of preventable and recreational drug use is extremely valuable when adverse drug events in ambulatory care. Ann Pharmaassessing therapies, especially concerning cardiovas- cother. 2007 Sep;41(9):1411-26. Epub 2007 Jul 31. cular agents. Social history can sometimes seem like 3. Kanjanarat P, Winterstein AG, et al. Nature of preinsignificant information, but the risk for ADEs can defiventable adverse drug events in hospitals: a literature nitely be affected by our patients daily habits. review. Am J Health Syst Pharm. 2003 Sep 1;60 Another key to assessing patient’s for adverse drug
(17):1750-9. 36
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June 2012 CE—Reducing the Burden of Adverse Drug Events 4. Von Laue NC, Schwappach DL, et al. The epidemiology of preventable adverse drug events: a review of the literature. Wien Klin Wochenschr. 2003 Jul 15;115 (12):407-15. 5. Pirmohamed M, James S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ. 2004 July 3; 329 (7456): 15–19. 6. Tache SV, Sonnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systemic review. Ann Pharmacother. 2011 Jul;45(7-8):977-89. Epub 2011 Jun 21. 7. Sikdar KC, Alaghehbandan R, et al. Adverse drug events in adult patients leading to emergency department visits. Ann Pharmacother. 2010 Apr;44(4):641-9.
May 2012
Epub 2010 Mar 16. 8. Metersky ML, Hunt DR, et al. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring Program. Med Care. 2011 May;49(5):504-10. 9. Safeer RS, Keenen J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005 Aug 1;72(3):463-8. 10. The American Geriatrics Society. AGS Beers Criteria pocket card. http://www.americangeriatrics.org/ files/documents/beers/PrintableBeersPocketCard.pdf. 11. GR Robertson, C Liddle, SJ Clarke. Inflammation and Altered Drug Clearance in Cancer: Transcriptional Repression of a Human CYP3A4 Transgene. Clinical Pharmacology & Therapeutics (2008); 83, 6, 894– 897.
June 2012 — Reducing the Burden of Adverse Drug Events
1. What was the median ADE prevalence rate within the analysis of prospective studies discussed in the article? A. 5.4 percent B. 9.5 percent C. 14.0 percent D. 25.5 percent 2. What percent of ADEs are found to lead to additional hospitalizations? A. 1 percent B. 3 percent C. 5 percent D. 12 percent 3. What percent of ADEs have the potential to be prevented if monitored correctly? A. 5 percent B. 10 percent C. 15 percent D. 20 percent
6. What should every healthcare provider conclude before exposing patients to the potential harmful side effects of medications? A. Side effects are mild in nature B. Benefits will outweigh risks C. Patient is a non-smoker D. Patient has no other common disease states 7. Which age group tends to encounter ADEs at the highest rate? A. Infants B. Pediatrics C. Adults D. Elderly 8. True or False: Males present with more ADEs than females. A. True B. False
9. Which race demographic has the lowest ADEs rates? 4. Which three drug classes account for over 85 percent A. Asians B. Blacks of all ADEs? A. oncologic, antipsychotic, cardiovascular C. Hispanics B. hypoglycemic, immunosuppressant, oncologic D. Non-Hispanic Whites C. analgesic, cardiovascular, and hypoglycemic 10. Health information data is often written at or above D. analgesic, antipsychotic, cardiovascular which grade level? A. 3rd grade 5. Which two drug groups each account for more than B. 6th grade 25 percent of the total ADEs respectively? A. NSAIDs and diuretics C. 10th grade B. antidepressants and anticoagulants D. 12th grade C. opiates and diuretics D. β blockers and NSAIDs 37
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June 2012 CE—Reducing the Burden of Adverse Drug Events
May 2012
This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. The fee for duplicate certificates is $5. Please send a self addressed, stamped envelope to KPERF, 1228 US 127 South, Frankfort, KY 40601. Expiration Date: May 15, 2015 Successful Completion: Score of 80 percent will result in 1.0 contact hours or 0.1 CEUs. Participants who score less than 80 percent will be notified and permitted one re-examination. June 2012 — Reducing the Burden of Adverse Drug Events TECHNICIANS ANSWER SHEET. Universal Activity # 0143-0000-12-006-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 2. A B C D
3. A B C D 4. A B C D
5. A B C D 6. A B C D
7. A B C D 8. A B
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 #_________________________________ Birthdate _______________________(MM/DD)_ June 2012 — Reducing the Burden of Adverse Drug Events Universal Activity # 0143-0000-12-006-H04-P PHARMACISTS ANSWER SHEET Name ________________________________________________ KY Lic. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 2. A B C D
3. A B C D 4. A B C D
5. A B C D 6. A B C D
7. A B C D 8. A B
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 #_________________________________ 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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May 2012
Student Perspective at APhA
APHA ANNUAL CONFERENCE—THE STUDENT PERSPECTIVE
APhA Annual Meeting and Exposition Not Just for Practicing Pharmacists By: Amanda Jett, Sullivan University College of Pharmacy PharmD Candidate 2013 This was not my first APhA Annual Meeting. With that being said, my expectations of what I would learn were not as high as when I attended last year’s meeting in Seattle. Having served as the President of the Sullivan University College of Pharmacy’s chapter of APhA-ASP for almost a year, I thought I was pretty well set in my knowledge of how to run a chapter, ideas for member recruitment, how to get members interested and involved in advocacy, as well as all of the other responsiEditor’s Note: Amanda bilities that come with being a chapter president. However, when I arrived in New is a recipient of the Dr. Orleans and attended the first ASP workshop, I immediately knew it was going to Ralph Bouvette KPhA be a long and exhausting, yet extremely rewarding weekend. Student Leadership Institute Scholarship to Despite the meeting occurring during finals week, SUCOP was able to send four members of our current Executive Committee to New Orleans. The first event we attend the APhA Annual attended was the Executive Committee Leadership Workshop, sponsored by TarConference. get. At this workshop national leaders from Target spoke on ways of effective communication within an organization and addressed the issue of smart decision-making. Questions based on hypothetical business scenarios were posed to the chapter committees, and groups had to work together to come up with acceptable answers. While it seemed as though this workshop was geared more toward leading a business, it still challenged our group to communicate with each other and make decisions that would affect our “business.” The four of us then went our separate ways to attend our respective positions’ workshops. Although I attended the President-Elect workshop last year, I went again with my current President-Elect to share examples of what our chapter has accomplished over the past year. I was sure that I would receive the same information and ideas that were discussed previously, and that this would be a waste of an hour and fifteen minutes. While our chapter has been very successful in recruiting and maintaining members this year – due in part to the ideas I received at the last APhA Annual Meeting – we took pages and pages of notes on ways that other chapters recognize outstanding members and boost morale. We were even able to share some of our ways to make sure that committee leaders can be held accountable for responsibilities and deadlines of which other chapters had not thought. The other members of our group came back from their workshops with some great ideas as well to implement next year. My favorite portion of the meeting was the House of Delegate sessions and the meetings on proposed resolutions. These events gave our chapter members an opportunity to hear several of the current issues surrounding our profession, our education and the way in which pharmacists interact with other healthcare providers. Again, we were challenged to sit down together and discuss what we as a chapter felt were the best decisions to make to lead the future of our profession. Even though most groaned when they were told to attend a three-hour session, I could tell by the end of the weekend that the House of Delegates sessions were others’ favorites as well, as it was exciting to watch our chapter’s opinion of an issue be supported or opposed. Although I will not be leading our chapter next year, I am still excited to see the progress our new executive committee will make having had an opportunity to attend the APhA Annual Meeting. After returning from this trip, I believe that you cannot attend too many of these types of events, as they all have something unique and new to offer.
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THE KENTUCKY PHARMACIST
May 2012
Pharmacy Technicians
Why Do I Need To Be Certified? What’s In It For Me? Article written by Mark Prifogle, 2011 President of the Indiana Academy of Pharmacy Technicians (IAPT), an academy of the Indiana Pharmacists Alliance (IPA). Reprinted with permission. Original article appeared in the Indiana Pharmacist (Vol. 92, No. 3), third quarter, 2011.
I teach an annual 5-month pharmacy technician certification class for GrandView Pharmacy, which is currently in session. One of the questions I receive from prospective students, employees or from the public, is, “Why do I need to be certified?” “What’s in it for me?” While many answers have come to mind, over the years, I have gleaned down my responses to those below. Certification is a quality indicator. Indiana currently does not require a pharmacy technician to become certified, only licensed*. Many states, 17 in total (34 percent of the US), require certification by one of the certifying bodies. However, whether or not you need to be certified to work in your state is immaterial, because certification is about so much more than entrance into your profession—it’s a very clear way to demonstrate to employers, customers and peers that your professional knowledge and skills meet nationally recognized standards. In discussions with hundreds of pharmacists in the last five years, all have commented on how much they rely on their certified technicians because of the level of knowledge and credibility they bring into the clinical practice. Dr. Lisa O’Hara, Director of Pharmacy Services at GrandView Pharmacy, states, “Any technician that is willing to learn to the level of national certification exemplifies a commitment to personal growth. Individuals that are committed to personal growth do better work. I need to know that the pharmacy technicians that I trust with my license are willing to go to that level”. Certification leads to increased job prospects. The employment rate for pharmacy technicians is expected to increase 31 percent by 2018.** What’s also interesting about this promising number is that, as the Bureau of Labor Statistics notes, “job prospects are expected to be good, especially for those who are certified.” Essentially, adding a CPhT designation to your resume can mean having an advantage in the job market when it comes to finding a job, commanding a higher salary and being considered for promotions. Certification increases patient care. Another important reason to consider certifying is because of the effect it can have on the quality of patient care you provide. As a pharmacy technician, one of
your main duties is to prepare prescription medications under the supervision of a licensed pharmacist. These medications are critical to the management of a vast array of conditions, and staying on top of the latest technological advances in pharmaceuticals can prove critical to how well you serve your customers. Once you become a certified pharmacy technician, you will re-certify every two years. The continuing education requirement requires you to keep up with the changes in our industry that occur every day. You must complete a minimum of 20 hours of continuing education with at least one hour in pharmacy law. This continued learning can facilitate the extended pharmaceutical knowledge that will prove valuable to your patients. Certification is attainable. You can choose to prepare for the certification examination in one of three ways—on your own with study material you’ve purchased from an organization, at work in an employer-sponsored training program or through a pharmacy technician program at an accredited school. Pharmacy technician programs typically range from six months to two years, depending on which level of education you pursue (certificate, diploma, or associate’s degree). Through classroom instruction and hands-on laboratory experience, you can learn everything from pharmaceutical calculations, terminology, and recordkeeping to the laws and ethics related to the pharmacy technology field. Many of these programs also include internships in professional pharmacies, which provide you with a valuable opportunity to practice your skills and network with potential employers. Certified pharmacy technicians collaborate as coprofessionals with pharmacists to ensure that the medications dispensed in a variety of practice settings are of the highest quality in the most efficient ways possible. Pharmacists depend on CPhTs to help them serve their patients. CPhTs increase quality while earning more money than their uncertified counterparts. The decision is easy and the path clear, now go get certified! * Kentucky requires technicians to register with the Kentucky Board of Pharmacy. ** Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, web site accessed on Nov. 12, 2010.
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THE KENTUCKY PHARMACIST
McWhorter School of Pharmacy
May 2012
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THE KENTUCKY PHARMACIST
Pharmacy Policy Issues
May 2012
PHARMACY POLICY ISSUES: Behind-the-Counter (BTC) Medication A New Third Class By: Tam N. Ho Author:
Tam N. Ho is a 2012 Pharm.D. graduate of the UK College of Pharmacy who is now practicing pharmacy with RiteAid. A native of Ho Chi Minh City, Viet Nam, she earned a B.S. in Biology at the University of Kentucky prior to beginning pharmacy school.
Issue:
Should a new category of medications be established based on an intermediate level of consumer access?
Discussion: The nomenclature “Behind-the-Counter” (BTC) signifies an intermediate class of medications that falls between the relatively more widely established classes of prescription medications and over-thecounter (OTC) medications. Consumers can purchase BTC medications without the need to visit a physician; however, a pharmacist’s intervention is required prior to dispensing of any BTC products. The concept of an intermediate drug class was established in an effort to mitigate controversial issues surrounding the potential for improper use of medications such as pseudoephedrine, Plan B, and dextromethorphan by patients, where such products were previously available OTC or by prescription.
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.
This third class of medications (BTC) has found widespread use internationally in Europe, and in countries such as Australia, Canada and New Zealand. International implementations of BTC programs highlight the potential need to establish an official third class of medications in the United States. Specific drug products that have been suggested for inclusion in BTC programs in the United States are medications that treat chronic conditions such as asthma, diabetes, hypercholesterolemia, hypertension, osteoporosis and urinary incontinence.
Arguments for and against the relatively new concept of a category of BTC medications are numerous. Proponents for a third class of medication (i.e., proponents for BTC programs) assert that such implementations could increase drug availably to patients, especially those patients from underserved populations, e.g., those who are uninsured, underinsured and those with limited access to primary care providers. Further, within the context of administering BTC products, it is argued that pharmacists are well qualified to do so, given that pharmacists generally possess thorough knowledge of drug information. Additionally, pharmacists have typically undergone patient-focused training. With increased interaction between pharmacists and patients through BTC programs, increases in patient adherence rates and ultimately improved health outcomes are anticipated. Opponents argue that the adoption of the BTC classification for administering selected medications could potentially decrease drug availability to consumers, especially if there is a lack of adequate communication regarding which medications are available through the BTC program. Also, there are concerns that since community pharmacists are generally fully occupied while managing the activities in the pharmacy, fulfillment of such duties may not leave sufficient time to provide high quality intervention services to patients. Lastly, it is argued that BTC programs may lead to patients not being treated properly, i.e., treated for symptoms while undue attention is not provided to treating the underlying illness.
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THE KENTUCKY PHARMACIST
May 2012
Pharmacy Policy Issues
Prior to the implementation of BTC classifications, some issues pertaining to costs, pharmacists and infrastructure must be addressed. Pharmacist-related issues include defining the role, responsibility, liability and additional training that may be required. Potential cost-related issues include insurance coverage for such products, reimbursement for pharmacists’ services, and possible out-of-pocket cost for consumers. Last, infrastructure-related issues include providing sufficient lab data regarding patient health status with due regard for patient privacy.
Check the KPhA website for registration forms and more information updates on the 134th KPhA Annual Meeting www.kphanet.org/2012annualmeeting
Do you have a story to tell?
WANTED: Blood Glucose Test Strips
Coming in future editions of The Kentucky Pharmacist
I buy unopened, unexpired diabetic test strips.
My Story: A Profile of a KPhA Member
The following brands are what I look for
The Kentucky Pharmacists Association is looking for members with a story to tell. Have a patient success story to share? Find a new way to provide a service to the community? What makes you stand out in a crowd? Why did you become a pharmacist?
Accu Chek Aviva Accu Chek Compact Accu Chek Active plus Bayer Contour Bayer Breeze2 Freestyle lite One Touch Ultra Blue
If you would like to be featured in The Kentucky Pharmacist, email Scott Sisco at ssisco@kphanet.org with a brief description of your story.
Please contact Tim at Green Horseshoe Healthcare at 502 287 2763.
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KPhA Academy of Consultant Pharmacists -KY ASCP CE Event
May 2012
Long Term Care Continuing Education KPhA's Academy of Consultant Pharmacists and the Kentucky Chapter of ASCP held a joint continuing education program, April 29, 2012 at the Kentucky Renaissance Pharmacy Museum. Several new members were added to both the KY-ASCP Chapter and KPhA's Academy. The group raised several hundred dollars for the Museum. The meeting organizers, Leah Tolliver, Jason Baker, Rob Godwin and Kim Croley, hope that this meeting will spark a Renaissance in opportunities to educate and learn how the practice of consultant pharmacy can positively influence the health of all Kentuckians!
Photos by Jason and Jennifer Baker
For more information For KY-ASCP Chapter: http://www.kyascp.com Or contact: Leah Tolliver at leahtolliver@tollivergroup.net or (859) 333-4748 For KPhA Academy: Go to http://www.kphanet.org
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Pharmacists Mutual Companies
May 2012
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KPhA Board of Directors
May 2012
KPhA BOARD OF DIRECTORS
HOUSE OF DELEGATES
Clay Rhodes, Louisville jclayrhodes@gmail.com
Chairman 502.476.1796
Tyler Whisman, Florence tyler.whisman@gmail.com
Lewis Wilkerson, Frankfort rphs2@aol.com
President 502.695.6920
Matt Martin, Louisville Vice Speaker of the House matt67martin@gmail.com
Frankie Hammons, Barbourville frankiehammons@gmail.com
Secretary 606.627.7575
KPERF ADVISORY COUNCIL
Duane Parsons, Richmond dandlparson@roadrunner.com
Treasurer 502.553.0312
Kimberly Croley, Corbin kscroley@yahoo.com
President-Elect 606.304.1029
Leon Claywell claywell24@gmail.com
Past President
Kelley Ratermann klrater200@uky.edu
Student Representative
Amanda Jett ajett1706@my.sullivan.edu
Student Representative
Amanda Burton, Lexington amandastarkburton@gmail.com Chris Clifton, Erlanger chrisclifton@hotmail.com Trish Freeman, Lexington trish.freeman@uky.edu Joey Mattingly, Prospect joeymattingly@gmail.com Matt Martin, Louisville matt67martin@gmail.com Jeff Mills, Louisville jeff.mills@nortonhealthcare.org Glenn Stark, Frankfort glennwstark@aol.com Sam Willett, Mayfield duncancenter@bellsouth.net Leah Tolliver, Lexington leahtolliver@tollivergroup.net Richard Slone, Hindman richardkslone@msn.com
Speaker of the House
Ann Amerson, Lexington amerson@insightbb.com Kim Croley, Corbin kscroley@yahoo.com
KPhA/KPERF HEADQUARTERS 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 Robert McFalls Executive Director rmcfalls@kphanet.org Matt Worthy, PharmD Director of Professional & Clinical Services mworthy@kphanet.org Scott Sisco Director of Communications and Continuing Education ssisco@kphanet.org Kelli Sheets Office Manager ksheets@kphanet.org Christine Richardson, PharmD Clinical Pharmacist crichardson@kphanet.org Darcie Nixon Administrative Coordinator & Billing Specialist dnixon@kphanet.org Nancy Baldwin Receptionist/Office Assistant nbaldwin@kphanet.org
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THE KENTUCKY PHARMACIST
Frequently Called and Contacted
May 2012
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 Systems Pharmacists 1501 Twilight Trail Frankfort, KY 40601 (502) 223-5322 www.kshp.org
Kentucky Regional Poison Center (800) 222-1222 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
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 with a White Coat.
KPhA Classifieds Western Kentucky Pharmacist available for relief/part-time work. Experienced in retail, long-term care, home IVs, hospital and consulting. Willing to drive. Respond to The Kentucky Pharmacist (ssisco@kphanet.org) or cell (270-6252434.)
Director of Pharmacy 75-bed hospital in South-central KY seeking pharmacist director. Doctorate of Pharmacy or 10 years experience as Registered Pharmacist. KY license. Hospital experience, preferred. Ability to develop/implement policies/processes consistent with hospital, state and federal regulatory guidelines and maintain continuous compliance. Email Michelle.Mitchell@lpnt.net resume and salary requirements.
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THE KENTUCKY PHARMACIST
May 2012
THE
Kentucky PHARMACIST 1228 US 127 South Frankfort, KY 40601
134th KPhA Annual Meeting June 13-16, 2012 Griffin Gate Marriott Resort and Spa Lexington, KY Visit www.kphanet.org for updates. Look inside for a tentative schedule!
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