TABLE OF CONTENTS FEATURES Introducing Dr. Ben Mudd—KPhA ED |6|
On the Cover Mission Statement: To advocate and advance the pharmacy profession to improve the health of Kentuckians.
Editorial Office: ©Copyright 2021 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association. Publisher: Ben Mudd Managing Editor: Sarah Franklin Editorial, advertising and executive offices at 96 C Michael Davenport Blvd., Frankfort, KY 40601. Phone: 502.227.2303 Fax: 502.227.2258. Email: info@kphanet.org. Website: www.kphanet.org.
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Save the Date: KPhA Annual Meeting & Convention— June 3-6, 20201—Downtown Louisville Marriott
IN EVERY ISSUE President’s Perspective |3| My Rx |6| January CE Article |10| February CE Article |20| February Quiz |24| February Answer Sheet |25| Pharmacy Law Update |28| New KPhA Members |30| Pharmacy Policy Issues |31| Campus Corner |34|
ADVERTISERS APSC |9| PTCB |26| CMP Pharma |27| APMS |27| EPIC |30| Pharmacists Mutual |36| Cardinal |37|
PRESIDENT’S PERSPECTIVE “WOW!” It is the one word that continues to escape my lips around every corner during this year as President. I know I seem to keep going down this road of saying this, but The Association is in a ton of areas within the practice, and there are a lot of things happening for us, against us, and by us. I am moved more to tears of happiness and feelings of professional warmth, realizing just how dynamic pharmacists and pharmacy technicians’ roles are in public health and overall patient wellbeing and care.
be paid for the services we provide within the usual practice of our profession. It is imperative you ask Just a few quick updates: your local representative to support you and all of us on this bill. Their co-sponsorship will cement We are still amid a once in a lifetime (hopefully) pandemic. Pharmacists are ROCKING it all over the with you that they do support you and us. Go get them! place, from our colleagues developing vaccines to those who help set policy on the roll-out and/or We are still working on defending our right to be providing #ShotsInArms, and all the while still the official dispensers within health care The opmanaging your daily jobs providing kickass patient tometrist seem to think that your mastering of outcomes. YOU ARE IT! The dedication you show these abilities can be done with a few hours of educannot be appreciated enough! cation. Engage your local optometrists and tell them you are willing to help them care for patients Organizationally, we have a ton of activities going jointly. Their purpose, in my opinion, will only lead through our committees. From JoAnne’s Public to patient jeopardy and increase health care cost. Health group producing our COVID-19 Toolkit to Clark’s Professional Affairs group staying abreast of Plans for the Annual meeting have begun and this pharmacy practice and further exploring the enviyear we will be back IN PERSON in the safest physironment in which many of us practice and the cally distanced way possible. June 3rd-6th we will staffing with which we surround ourselves. Also, meet at the Marriott downtown in Louisville. More Sam’s Organizational Affairs beginning the annual information will be forthcoming but please get exreview of the Association’s Policy and Procedures cited, feel safe knowing we are taking all precausto starting the development of the Board of Directions, and know we can’t wait to see everyone tors’ ballot. Finally, Trish’s Governmental Affairs again. The programing will again be broad and group has begun weekly meetings as The Session unique. kicks into full gear and with so much going on surChanging gears a little, I want to pose a question rounding the Profession itself. Things never stop, so stay tuned to our email blast and social meeting that often rumbles around in my head: posts.
If Pharmacy were a Superhero, which Superhero would we be?
KPhA member Representative Danny Bentley has prefilled House Bill 48 that would require the This question might sound a little crazy on the surrecognition and ability of the pharmacist to bill and face, but when you run as many miles as I do (as an |3| www.KPHANET.org
endurance runner) and try to ponder life’s professional and personal perspectives as much as me, then things and questions like this seem to present themselves front and center regularly. It might also help that I was a big comic book reader/collector as a kid and might still have some of the collection today. Over the past few weeks, I have pulled the old group of comics out to check on them, catalog them, and make sure they are well suited for storage. So, who have I identified as the Superhero that represents Pharmacy as a whole? Maybe Superman, the Man of Steel? His qualities speak for themselves. Not from this world, strongest of all the superheroes, but one simple rock of krptonite, and well, he is dead. Uggh! Iron-man?? The arrogant rich super intelligent man who created a suit powered by a device that was created to protect his life. Doubtful…I just can’t put the skills and practices we perform on a daily basis as being as self serving as Tony Stark. My personal favorite, The Green Lantern? A daredevil test pilot type of guy who is pure at heart. Loves the color green and has the coolest oath (just like ours). “In the brightest day, in the blackest night, No evil (illness) shall escape my sight Let those who worship evil’s might, Beware my power… Green Lantern’s (A Pharmacists’) light!” However, even though I can see us being Green Lantern, especially with that type of oath. I feel having our “powers” being generated by a ring just misses the point of what we all do. So, in my mind (and yes I have pondered this a few times) the profession of pharmacy and the work of pharmacists are more like THE HULK! Yes, The Incredible HULK! I mean, are we not genius scientists? Doesn’t green represent Pharmacy? Green brings with it the sense of hope, health, adventure, and renewal as well as self-control, compassion, and harmony. Do we not try to remain calm even in the face of chaos and stressful situations? Do we not step up and into a “monster” when it comes to protecting our patients and profession? I challenge you to find a better fit for the whole profession and would welcome your ideas of other Superheroes befitting the profession. How|4| Kentucky Pharmacists Association | January/February 2021
ever, admittedly, I will share that I tell myself to “Hulk-Up!” when times seem necessary for you all. I might not turn green on the outside but there are people who believe there is a monster inside when it comes to defending or supporting pharmacists and technicians. GRRRRR! In the end, I must do a few things to complete this article. First and foremost, tip my hat and bow my head to our President-elect, Cathy Hanna. She has really stepped up this year and immerse herself into the workings of The Association. She has been there attending meetings, providing input, invaluable research, and extraordinary perspective. I am excited to see what her year as leader of our association brings! Too many times, even though she has been covered up with life and professional things, she turns to me or sends me a note asking if there is anything she can do to help. This is the person she is…just wanted you to know. Now, with that all being said, I am saddened to report that her dear mother passed at the beginning of February. Julia Carolyn Bell Robertson passed peacefully surrounded by all of her children and her husband of 65 years, John. I know this hurts you as much as it does me because we are fortunate to have the fantastic Cathy helping us, and I’ve found the apple doesn’t fall far from the tree. Our hearts and prayers are with you and your family, Cathy. This Month’s article is dedicated to her! Peace and Blessings, my Friend! To all that celebrate Valentine’s Day, I raise a glass of champagne and open a big box of chocolate for you! May the day bring joy and happiness! My mother taught me life is better with LOVE in it and in your heart. So, know that all the beautiful things you are and do for the profession and your communities is a testament of your LOVE! I also want to wish my loving partner and wife of almost 28 years a Happy Valentine’s Day! YOU are the spark to life that allows me to do the crazy things I do. Without you as our ROCK, the girls and I would be lost. Sandy, I Love You! Finally, this Valentine’s Day marks the 5th anniversary of running my first FULL marathon. Not a day goes by that something in my life, whether a challenge, battle, success, or goal since that point has
not been affected by it. It opened a whole new world by reducing a barrier I never thought conquerable. It taught me that teamwork makes life sane. It taught me that “Never or Can’t” are only self-inflicted barriers and that if you want it…It can be done! It also showed me that patience and perseverance are two of the most remarkable traits in life and that we never master them, only learn to live with and by them. This patience and perserverence can even be applied to our current state with the pandemic still occurring. Remember we are just starting this marathon, and while it is not visible to us now, the end is still attainable!
to lead our beloved organization; it will be a good change having one of our own at the wheel. Stay Safe and Healthy! Joel GO KPHA!!!! GO PHARMACISTS!!!! TECHNICIANS!!! GO BEN!!!!
GO PHARAMCY
As I close this month’s article, please know we all understand that the battles of life, practicing pharmacy, and dealing with the pandemic are never easy. However, know that YOU ARE ROCKING THEM ALL! HULK-UP when you need that inner monster, or contain your inner monster when the calm, ultra intelligence needs to come out. Either way, be the best INCREDIBLE HEALTH CARE PROVIDER you can be! PS. As the word begins to hit that the government is beginning the release of the Federal vaccine storage, let’s take a moment to remember we are in this TOGETHER! Yes, rightfully so, there are pharmacists chomping at the bit to get vaccine to help their communities and Yes, there are pharmacists who have already been working and volunteering to vaccinate. Please keep in mind that we all are on the same team! Sooner than later we all will begin to get supply and help, equally. Until then, try to support where support is needed. This is an “all hands on deck” type of situation and success is garnered via unity not individuality. PPS. With this installation of my article, I want to welcome our new Executive Director, Dr. Ben Mudd, to the KPhA Family! Ben has been a member for years and recently was even our Speaker of the House of Delegates. Along with being a graduate of UK COP, Ben is an exciting and dynamic individual whose potential is boundless. He will bring great perspective to our organization and help move us forward. I am jazzed with his coming onboard and hope you will be too! As you get to know him better and see his work ethic, you will fully understand why I am so excited. Ben is the first executive director since the great Bob Barnett |5| www.KPHANET.org
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KPhA Board of Directors Nominations Deadline March 15, 2021 Visit www.kphanet.org for more information
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January CPE Article Guidance for Effectively & Safely Continuing Immunization Care in a Community Pharmacy During a Pandemic Authors: Gretchen Kreckel Garofoli, PharmD, BCACP, CTTS, Clinical Associate Professor, West Virginia University School of Pharmacy The authors declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest. During times of pandemic there are many tasks that community pharmacists must complete to continue to provide the best care possible for all their patients all while keeping themselves and their co-workers safe. Many pharmacists have questions regarding the provision of advanced patient care services such as immunizations during a pandemic. Through this monograph we will discuss the importance of adult immunizations and how to administer immunizations effectively and safely during a pandemic.
Learning Objectives: 1.
Recognize the potential impact of delaying routine adult immunizations.
2.
Identify ways to keep both patients and providers safe during immunization administration.
3.
Describe best practices for continuing immunization administration in the community-based pharmacy setting.
How to earn continuing education credit: NOTE: This activity is provided courtesy of FreeCE PharmCon. To claim credit, you should visit www.freeCE.com and create a free account by clicking the Sign In/Register Button in the top right. Once your account is created, click the program link and register for the program: https://www.freece.com/courses/guidance-for-effectively-safelycontinuing-immunization-care-in-a-community-pharmacy-during-a-pandemic/ Complete the pre-test, read the activity, and then proceed to the post-test. You will have unlimited attempts to achieve a passing grade of 70 or higher. Completion of the post-test and an online activity evaluation are required to earn credit.
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Credit Hours 1.0 Hour Activity Type |11| www.KPHANET.org
Immunizations are an important aspect of public health. Immunizations have been recognized as one of the top public health achievements, specifically with regards to their ability to decrease infectious diseases. Although disease eradication for the diseases that plague our country and world would be ideal, to date, only one disease, smallpox, has been eradicated. The eradication of smallpox worldwide has allowed routine smallpox immunizations to be discontinued. Polio has been targeted by the World Health Organization to be the next disease eradicated, but that has not yet occurred as there are countries throughout the world where polio remains.1
The Spanish Flu was the largest pandemic in recent history and lasted from 1918-1919. The Spanish Flu was responsible for 50 million deaths worldwide with 675,000 deaths in the United States of America. There was no vaccine available to prevent this disease and no antibiotics to treat the secondary infections, so control efforts included quarantine, isolation, good hygiene practices, the use of disinfectants, and limitations on public gatherings.3 All of these practices have been implemented during the COVID-19 pandemic since there is not currently a vaccine to prevent the disease. It is fascinating that with all the advances of modern medicine that a new virus can cause such upheaval and the most There are many diseases that are considered eliminated in the United protective measures in 2020 are the same as were implemented States due to successful immunizaover a century ago. The first inflution campaigns, but the diseases enza vaccine was introduced in still exist in other parts of the world, so immunizing continues to 1942, which was twenty-two years 4 provide protection and prevent dis- after the Spanish Flu pandemic. ease. In 2019, due to the large During pandemics recommendanumber of measles cases that octions can change quickly as more is curred as part of an outbreak in the learned about the pathogen and its United States where many of the respective communicability, so as cases were among an unvaccinated healthcare practitioners, it is adviscommunity in New York, the United able that we know where to find States was at risk for losing the sta- the most up-to-date information as tus of measles elimination that had general recommendations, and imbeen held for two decades. Fortu- munization recommendations may nately, the spread of the disease change as more and more decreased, and the United States knowledge is gained regarding the has maintained its status of meavirus. Our patients, family mem2 sles elimination. bers, and friends come to us as |12| Kentucky Pharmacists Association | January/February 2021
healthcare practitioners, thus we need to be equipped with the most up-to-date information to provide timely guidance. A repository of immunization related references to be utilized for vaccination recommendations during the COVID-19 pandemic can be found through the Immunization Action Coalition (https:// www.immunizationcoalitions.org/ resource-repository/). This resource is regularly updated, and I would recommend that you bookmark the site so that you can quickly reference it to review current recommendations. Amid the COVID-19 pandemic, many questions have arisen regarding the continuation of vaccinations. Shortly after the national emergency was declared in March of 2020, the Centers for Disease Control and Prevention (CDC) issued a recommendation that childhood vaccinations be continued during the pandemic. Although many recommendations from the CDC in other areas changed as the pandemic progressed their stance remained the same for childhood immunizations. The CDC additionally provided recommendations to continue childhood immunizations safely and effectively, especially for newborns through children who are less than 24 months of age when numerous vaccinations are given. They recommended that offices have well-child visits in the morning
and sick visits in the afternoon, that children be seen for well-child appointments in a different physical area of the clinic than those being seen for sick visits, and/or that providers collaborate with other providers in their community to have different physical building locations for sick visits versus well visits.5
diseases, especially if the percentages needed for herd immunity are not achieved. Additionally, with so many children falling behind schedule and not being up to date with the recommended vaccinations, procedures will need to be put in place to get these children back on schedule. This may require the use Even with the strong recommenda- of the catch-up schedule from the tion to continue childhood immun- CDC typically utilized for those who izations, the Morbidity and Mortali- start vaccination series late or for those who are more than one ty Weekly Reports (MMWR) pubmonth behind schedule for recomlished in May 2020 showed a demended vaccines, which would be cline in childhood immunization likely to be the case for many of rates. Two data sources were reof viewed to determine the impact of those studied given the length 8 the COVID-19 pandemic. the pandemic on non-influenza childhood vaccines. A decline in The CDC guidance for adult immunvaccines ordered was seen a week izations left many adult immunizaafter the national emergency decla- tion providers with questions as to ration. The decrease in number of whether adult immunizations non-influenza vaccines adminisshould continue during the pantered was not as great in the less demic. Immunizations fall under than 24 months of age group versus preventative services and the offithe over 24 months of age group.6 cial guidance from the CDC recomA study in Michigan looked at the mended that in areas with commuup-to-date vaccination status for nity transmission of COVID-19 imvarious age groups by comparing munizations should be postponed data from May 2016-2019 to May except when an in-person visit may 2020. A decrease was seen in vac- be scheduled for “some other purcination coverage in all age cohorts pose and the clinical preventive serexcept for the birth dose of the vice can be delivered during the Hepatitis B vaccine, which is typical- visit with no additional risk” or ly given to the newborn in the hos- when a “patient and their clinician pital prior to discharge.7 believe there is a compelling need With the declines in pediatric vac- to receive the service based on an cinations being administered, there assessment that the potential benis concern for the potential of a re- efit outweighs the risk of exposure 5 to the virus that causes COVID-19.” surgence of vaccine preventable
For physician offices, this guidance is clear in that patients should not come into the office for an appointment to only receive an immunization unless they fall into one of the categories previously mentioned. However, regarding pharmacy practice, in most community-based pharmacy practice locations, patients do not need appointments to see their pharmacist for immunization services. Additionally, even during the time of pandemic, patients need to visit the pharmacy, especially if their pharmacy does not offer delivery services to pick up their maintenance or acute medications. CDC guidance that was released for pharmacies in April 2020 specifically mentioned postponing immunizations for adult patients and following up with reminders later.9 Despite the guidance from the CDC, pharmacies and pharmacists across the United States approached the delivery of adult immunizations in a variety of ways - from continuing to provide immunizations as usual throughout the pandemic to deciding not to administer any immunizations. Many pharmacies were in this middle ground and confused about what was legal, illegal, or simply a recommendation regarding immunizations. Pharmacists voiced their confusion through online platforms as to whether immunizations should be continued or if they were even al|13| www.KPHANET.org
lowed to be continued during the COVID-19 pandemic. Pharmacists commented across the spectrum regarding what was being done in their practices from not providing any immunizations to continuing to provide vaccines as they did prepandemic. In the pharmacy where I practice, a couple in their 80’s who were not regular patients came into the pharmacy asking for an immunization to complete a vaccination series as the pharmacy where they usually filled prescriptions and received immunizations refused to complete the series. In this specific instance, these individuals who fell into the high-risk group during the pandemic had visited at least two community pharmacies to obtain an immunization. One of our pharmacists donned all the appropriate personal protective equipment (PPE) and administered the immunizations to the patients. This scenario was a risk versus benefit analysis as these patients were determined to receive the vaccine within the recommended timeframe for administration of the second dose and would have continued to put themselves at risk by visiting multiple additional healthcare facilities until they were able to obtain the immunization. With the pharmacist at my practice site efficiently administering the vaccines while following proper protocol with appropriate PPE, these patients were then protected
against the vaccine preventable disease that they sought protection from as well as having their respective risk of exposure to the Coronavirus decreased by not having to continue their search for a healthcare professional willing and able to administer the vaccine.
continue.10 Adults who have delayed immunizations, just as with children who have immunizations delayed, will be at risk for vaccine preventable diseases and we as healthcare practitioners need to work to get them caught up to ensure that they are protected.
Given the decrease that was seen in childhood immunizations during the first few months of the pandemic in the United States of America when this group had clear guidance to continue with routine immunizations, it should not be surprising that immunization rates for the adult population decreased as well since the guidance stated that clinical preventative services such as immunizations should be delayed unless the patient had an inperson visit for another reason or the patient and clinician felt that the service was needed after a riskbenefit analysis was completed.
Pharmacists who provide immunizations during a pandemic need to ensure that they and their staff take additional precautions to reduce the risk of exposure to disease. It is recommended that all patients, whether they are in the pharmacy to obtain a vaccination or for any other reason, wear a face mask. These masks can be cloth face masks that are homemade or purchased. All staff in the pharmacy should also be wearing masks, with medical or surgical face masks being preferred to cloth masks. If wearing cloth face masks, there is the option of having a mask made with a pocket where a filter can be inserted as another layer of protection and changed regularly. Face masks are recommended for source control as patients or pharmacy staff could be infected, but without noticeable symptoms.
A Medscape news article on adult immunizations reported that noninfluenza immunization rates decreased among all age groups during the studied timeframe in 2020 when compared with the same timeframe in 2019. During the week of April 6, 2020, the immunization rate in the over 65 years of age group decreased 83.1% when compared with the same week in 2019. This dramatic decrease is extremely concerning as this is the population that is at the greatest risk of complications from COVID19. The report does include the positive news that immunization rates have started to improve as of May 11, 2020, which will hopefully
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Social distancing should also be followed while in the pharmacy, but that is obviously not feasible when administering immunizations because the immunizer will need to be in close contact with the patient. Before an immunization is administered to a patient, the pharmacist (or student pharmacist or technician where legally allowed) should ensure that their face mask is appropriately positioned, wash their
hands for at least 20 seconds scrubbing all areas, and should also wear gloves as is standard practice for immunization administration. In areas where there is moderate or substantial disease transmission, it is also recommended to wear eye protection. Eye protection is considered optional in areas where the disease transmission in a community is low or nonexistent.9 In order to determine the transmission level in your community it would be recommended to contact your local or state health department, but this information should be used with caution as reporting requirements are not standardized at a federal level, so there may be variability in the reporting. Out of an abundance of caution, wearing goggles and face shield would be the safest approach during vaccine administration. Of note, neither eyeglasses, sunglasses, bifocals, nor contact lens protect eyeballs from transmission of a virus, as there needs to be a complete barrier around the eyes. At the pharmacy where I practice, one of our patients made us both cloth masks and face shields, which have been utilized while administering immunizations. As some of these items may be in short supply or highly priced during a pandemic it is important to utilize your resources as patients, colleagues, and friends may be able to assist with providing these items to you at little to no cost. During the COVID-19 pandemic, there were many people sewing cloth face masks and a colleague of mine even 3D printed
face shields to donate to local hos- before moving forward with impitals and clinics that were not able munizing patients. to obtain PPE through the normal An inventory should also be taken channels. of all the vaccinations in stock with Immediately following the adminspecial attention paid to the quantiistration of a vaccination, the imties and expiration dates of the vacmunizer should remove their gloves cinations in stock. If vaccinations and wash their hands once again were delayed due to the patient or for 20 seconds covering all areas. It pharmacy postponing during the is important to remember that pandemic those patients affected handwashing needs to be complet- should be contacted to be informed ed prior to and after administering that immunization services are reall immunizations and gloves need suming. For patients who are due to be changed between patients as for a subsequent dose in a vaccinawell. When taking off the first glove, tion series, priority should be given one should hold it with the 2nd to the patients whose due dates hand that still has a glove donned, occurred first, especially if there is a and then pull the 2nd glove off from short supply of the vaccine(s). the wrist to the fingers while encap- Pharmacy staff should review imsulating the previous glove. In addi- munization records to determine tion to the PPE that is worn by both how many doses of “post-due” vacthe immunizers and the patients, it cinations are needed and compare is recommended to clean the area that with the number of vaccines in where patients are being immuntheir inventory to determine how ized frequently. many additional doses need to be ordered. If the pharmacy preempAs vaccinating during a pandemic is tively offers vaccinations to patients new to many, there are some best when they are due, such as pneupractices that should be followed to mococcal vaccinations for patients ensure that patients are taken care who turn sixty-five, an analysis of of when immunization services are patients who are past due for those restarted or continued. If pharmavaccinations should be completed cies stopped giving vaccines, it and these patients should be notiwould be prudent to take time to fied as well. determine the best approach for restarting vaccination services. For It is also highly recommended for pharmacies that have continued to the pharmacy staff to determine if vaccinate during the pandemic, they will be offering immunizations they should review their policies on a walk-in basis or if patients and procedures to guarantee that need to schedule appointments. It they are meeting the best practice may be advisable during a pandemguidelines. The pharmacy should ic for pharmacies who typically proconfirm that they have the appro- vide immunizations on a walk-in priate PPE as discussed previously basis to temporarily move to
an appointment-based model |15| www.KPHANET.org
istration. Once the payment is complete, the patient should prothe pharmacy for a longer period than one would spend to pick up a ceed to the vaccination area (ideally prescription and also to ensure that a private patient counseling room) pharmacy staffing is optimal with a to wait for the immunizing pharmacist, immunizing student pharmadesignated person to provide imcist, or immunizing technician. munizations. This change would certainly be best communicated to patients in some manner more proThe patient should complete the active than a sign on the door or vaccination screening questionnaire once inside the pharmacy. as is standard practice if this is not Once the pharmacy is ready to re- able to be completed through elecsume immunization administration, tronic means prior to the patient patients can be called to notify arriving.11 Once the questionnaire them of the immunizations that is complete it should be reviewed, they are due for and to schedule an and any issues discussed. The imappointment if that model will be munizer should ask the patient adutilized. If scheduling appointditional screening questions regardments, it would be beneficial and ing the possibility of having the prudent to schedule the immuniza- pandemic causing disease. For extion when the patient is due to pick ample, for COVID-19 the disease up other medications to decrease can have a variety of symptoms the number of trips that the patient that typically develop 2 to14 days will need to make into the pharma- post exposure with patients develcy and thus reducing the potential oping a mild to severe illness. for exposure. Once the patient is Symptoms could include but were scheduled to receive their immun- not limited to the following: fever ization(s), it would be strategic for or chills, cough, shortness of breath the pharmacy to bill the immuniza- or difficulty breathing, fatigue, mustion to the patient’s insurance cov- cle or body aches, headache, new erage for the patient in advance of loss of taste or smell, sore throat, their arrival to decrease the wait congestion or runny nose, nausea time when the patient arrives. or vomiting, and diarrhea.12
to limit the number of patients in
If pharmacies are limiting the number of patients inside the building, the patient should call the pharmacy when they arrive and then enter the building if capacity allows. The patient can then be instructed to either provide payment information over the phone before entering the pharmacy, or they should proceed directly to the register to provide payment prior to vaccine admin-
should quickly be isolated, and referred for COVID-19 testing. Temperature checks are another method that could be employed during the screening process to determine if a patient may have the disease. If a patient knows that they are positive for COVID-19 they should not enter the pharmacy and should defer vaccinations until recovered as to not expose the pharmacy staff to the disease. After a non-remarkable screening is complete, the immunizer should prepare and don the appropriate PPE as discussed previously and then administer the vaccine. If possible, the patient should wait in the patient counseling room or another waiting area where the chairs are spaced at least 6 feet apart for fifteen minutes to ensure that they do not have an adverse reaction to the vaccine prior to exiting the pharmacy.
If the pharmacy has moved to a closed-door model during the pandemic it is still possible to administer immunizations but will require unique modifications to the process. Immunizations can be administered to patients by an immunizer leaving the pharmacy building to administer the vaccination to a paIt may be prudent that the screentient while they remain in their car. ing questions regarding the panIf this model is implemented, it demic causing disease are asked would be important for the pharprior to the patient entering the macy to ensure during the planning pharmacy to reduce the risk of exprocess that they have additional posure of the pharmacy staff by a pharmacists scheduled as in many patient who is exhibiting symptoms states it would be a legal issue to of disease. If after questioning, a leave the pharmacy open without a patient is found to exhibit the pharmacist physically in the buildsymptoms of the disease, they ing.
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For vaccinations that are administered to patients in their cars, the pharmacy should have a mobile device to transport all the necessary supplies to the patient’s car. The patient should be instructed prior to coming to the pharmacy that they will need to wear appropriate clothing, such as a short-sleeved shirt to ensure optimal access to the proper area for immunization, in addition to a face mask. When scheduling patients to have their immunizations administered in this manner the patients should also be instructed to call the pharmacy when they arrive and to be ready to answer screening questions and provide payment information over the phone. The immunizer can then prepare the vaccine in the pharmacy prior to going out to the patient’s car to administer the immunization.
visually check on the patient prior to the patient departing.
(those greater than 6 months of age), specifically those who are at high risk for complications from disFinally, another option for vaccinaease receive the influenza vaccination to reduce the risk of exposure tion by the end of October as is recfor your highest risk patients or for ommended by the CDC. Should those who are not able to travel to there be a surge of influenza cases, the pharmacy would be to offer particularly those resulting in hospihome-based immunizations. The talization, in addition to an increase pharmacy where I practice does of the pandemic causing disease vaccinations for our homebound society runs the risk of the patients during normal circumstanchealthcare systems becoming overes, so with some additional precauwhelmed due to the respiratory nations put into place regarding the ture of both diseases. use of the additional PPE mentioned previously, offering immun- Since there is a vaccine to prevent izations to these patients was seam- influenza we need to be recomlessly accomplished in our practice. mending and administering influenza vaccinations to all eligible paThings to consider if offering tients. Many pharmacies traditionimmunizations to patients in ally not only offer influenza immuntheir homes is ensuring that izations in their pharmacies, but alyou have the appropriate con- so offer off-site clinics for employer tainers to safely transport the groups or as part of a health fair. Post immunization, the patient vaccinations while maintaining the The World Health Organization should be instructed to wait in the cold chain and an ensuring that an (WHO) recommended that during parking lot for fifteen minutes to immunizing staff member is willing the COVID-19 pandemic mass vacconfirm that they do not have an and able to go into patients’ homes cination campaigns not be completadverse reaction. It may help to to administer immunizations. Many ed due to the increased risk of poprovide an exact time when the pa- factors need to be considered betential exposure when a large group tient could safely resume driving fore offering this option to patients of people gathers, especially if sothe vehicle, such as 2pm if the vac- such as staffing, equipment, and the cial distancing of at least 6 feet becine was administered at 1:45pm. If time commitment as the immunizer tween people is not possible.13 the patient has someone else will have to account for travel time If vaccination clinics continue to be waiting with them in the vehicle as well as time spent giving the im- held, the CDC does offer guidance that person should be advised to munization(s), plus waiting an addi- and recommends that appointment call the pharmacy immediately tional fifteen minutes with the pa- times are scheduled to avoid overshould the patient develop any life- tient to ensure that they do not crowding. It would be best to limit threatening symptoms such as diffi- have an adverse reaction. the number of people waiting especulty breathing. It is also recomcially if they fall into a high-risk A viral pandemic can of course mended to have the patient (or group, and potentially consider someone in their vehicle) to call the overlap with an influenza vaccinaoffering a dedicated time during the pharmacy prior to driving the vehi- tion season, which is typically the immunization clinic for only highbusiest immunization season in a cle. The pharmacist (or another risk patients to attend, like the qualified staff member) should then pharmacy. It will be imperative to strategy that grocery stores deensure that all eligible patients |17| www.KPHANET.org
ployed. There are physical barriers that one can set up to assist with ensuring social distancing such as having a unidirectional flow with signs, ropes, or other physical and visible measures to guarantee that the patients do not congregate close together.
When reviewing these recommendations, there is one facility where I have provided off-site influenza immunization clinics over the course of the last eight years that I know will take some additional planning to adhere to the CDC recommendations. It is a senior living facility, where many of the residents have During the planning process, it numerous health conditions. I can would also be advisable to confirm guarantee that for every event that that the site where off-site immunwe hold at this site the residents ization clinics will be held has a will not only arrive early, but also at large enough space to implement the same exact time. When we these safety precautions to ensure schedule vaccination clinics for a a minimum distance of 6 feet betwo-hour timeframe, we are typitween patients waiting, receiving cally done within the first 30 immunizations, and in the postminutes due to everyone arriving at vaccination monitoring areas where once, perhaps a subtle victory in they will sit for the fifteen minutes normal times, yet quite the chalpost immunization.11 lenge during the “new normal”. To adhere to these recommendaAnother challenge with this group tions, it will take a lot of additional is that many are also in wheelplanning for many immunizing chairs, which would make unidirecpharmacists to ensure that these tional flows, ropes to assist with the recommended measures are able flow, and barriers potentially hazto be implemented for their off-site ardous to their mobility. When influenza vaccination clinics. Once brainstorming options for the influa plan is drafted, have multiple enza vaccination season, I believe pharmacy team members read or that we will either have to schedule listen through it, to make sure that times for the individual patients to multiple viewpoints have been takcome to the facility’s activity room en into consideration, as what is to avoid the overcrowding, or we obvious to one, is quantum physics may need to visit the apartment of to another. It would be recomeach patient who is interested in mended that if you have not proreceiving the vaccine. In this invided a clinic for an organization in stance, visiting individual apartpast years that you visit the facility ments is probably not the best opto visualize the space where you tion as we do many vaccinations at will be administering the immunizathis clinic and it would take a lot of tions so that you can develop a manpower to be able to observe strategy for how to best set up the each patient to ensure that they space so that the recommended did not have an adverse reaction. safety precautions can be implemented. |18| Kentucky Pharmacists Association | January/February 2021
For all the off-site clinics that I participate in, I am fortunate to have enough staff to assist with crowd control as well as administer immunizations as I work with a community-based pharmacy resident and have one to two advanced pharmacy practice experience (APPE) students on rotation at my site that can be utilized for patient intake, immunization administration, and patient observation post vaccination. I have also observed that students from the local school of pharmacy are always willing to assist with immunization clinics to hone their immunization administration skills, which can be very beneficial for a pharmacy to take into consideration, if the process is strategically planned. I would recommend that if you choose to utilize any student pharmacists at your immunization clinics you first meet with the student pharmacists to review the site-specific screening procedures, collection of insurance information, immunization technique, and observe them administering an immunization prior to the scheduled clinic (when allowed by state law). I have observed that even well-trained students may make mistakes in the hustle and bustle of an on-site clinic. In addition to providing routine immunizations, it is also important for us to prepare to provide vaccines to prevent COVID-19. The available COVID-19 vaccines have been allocated based on risk and exposure, as allocations have been made in the past for certain vaccinations. Pharmacies should be prepared to
provide the demographics of the patient populations that they serve to their local or state health departments should that information be requested prior to the distribution of the vaccine. Additionally, pharmacies should ensure that they are able to track vaccine administration through statewide immunization information systems and should have recall systems in place since most currently available COVID-19 vaccines require 2 doses.14 I was a PGY-1 resident in a busy independent community pharmacy during the H1N1 pandemic and provided the H1N1 vaccines in addition to the seasonal influenza vaccine, which required our pharmacy to be extremely organized and have multiple processes in place to administer and appropriately document administration of the H1N1 vaccine in the statewide immunization registry. Conclusion
try, May 2016-May 2020. MMWR cination. As with so many facets of Morb Mortal Wkly Rep 2020;69:630life, planning and preparation go 631. DOI: http://dx.doi.org/10.15585/ together, especially in regard to a mmwr.mm6920e1external icon. vastly important public health effort such as immunizations. After- 8. Catch-up Immunization Schedule. (2020, February 3). Retrieved May 24, all, an ounce of prevention is worth 2020, from https://www.cdc.gov/ a pound of cure, and if there’s no vaccines/schedules/hcp/imz/ known cure, well we’re left solely catchup.html with our well-prepared plans for 9. Coronavirus Disease 2019 (COVID-19): prevention. Guidance for Pharmacies. (2020, May References 1.
2.
3.
4.
28). Retrieved June 7, 2020, from https://www.cdc.gov/ coronavirus/2019-ncov/hcp/ pharmacies.html
Andre, F., Booy, R., Bock, H., et al. (2008, February). Vaccination greatly reduces disease, disability, death and 10. Frellick, M. (2020, June 8). Vaccine inequity worldwide. Retrieved June Rates for All Ages Drop Dramatically 14, 2020, from https://www.who.int/ During COVID-19. Retrieved June 9, bulletin/volumes/86/2/07-040089/en/ 2020, from https:// Measles Cases and Outbreaks. (2020, www.medscape.com/ June 9). Retrieved June 14, 2020, from viewarticle/931913? https://www.cdc.gov/measles/casessrc=mkm_covid_update_200608_msc outbreaks.html pedit_&uac=215368HY&impID=24119 75&faf=1#vp_2 1918 Pandemic (H1N1 virus). (2019, March 20). Retrieved June 14, 2020, 11. Vaccination Guidance During a Panfrom https://www.cdc.gov/flu/ demic. (2020, June 9). Retrieved June pandemic-resources/1918-pandemic9, 2020, from https://www.cdc.gov/ h1n1.html vaccines/pandemic-guidance/ index.html Historic Dates and Events Related to Vaccines and Immunization. (2020, 12. Coronavirus Disease 2019 (COVID-19) April 6). Retrieved June 14, 2020, from – Symptoms. (2020, May 13). Rehttps://www.immunize.org/timeline/ trieved June 9, 2020, from https:// www.cdc.gov/coronavirus/2019-ncov/ Immunization Schedule Changes. symptoms-testing/symptoms.html (2020, May 26). Retrieved June 7, 2020, from https://www.cdc.gov/ 13. World Health Organization. (2020) vaccines/schedules/hcp/schedule. Guiding principles for immunization changes.html activities during the COVID-19 pandemic: interim guidance, 26 March Santoli JM, Lindley MC, DeSilba MB, et 2020. World Health Organizaal. Effects of the COVID-19 Pandemic tion. https://apps.who.int/iris/ on Routine Pediatric Vaccine Ordering handle/10665/331590. License: CC BY and Administration—United States, -NC-SA 3.0 IGO 2020. MMWR Morb Mortal Wkly Rep 2020;69:591-593. DOI: http:// 14. American Pharmacists Association. dx.doi.org/10.15585/ Immunizing Pharmacists News. May mmwr.mm6919e2external icon 18, 2020.
We have discussed many best practices throughout this document 5. that should be implemented prior to continuing or restarting immunization services in communitybased pharmacies. It is recom6. mended to implement the safeguards discussed and begin offering immunizations as soon as possible, and if possible, prior to the beginning of influenza vaccination season in order ensure a seamless process. It would be ideal to have as 7. Bramer CA, Kimmins LM, Swanson R, many of your patients up to date et al. Decline in Child Vaccination Covwith recommended immunizations erage During the COVID-19 Pandemic prior to influenza vaccination sea– Michigan Care Improvement Regisson and eventually COVID-19 vac-
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February CPE Article A Global Pandemic: Once a History Lesson Now a Modern-Day Reality – A Comparison Between the Spanish Flu and COVID-19 Pandemic Author: Jessica Mattingly, 2021 PharmD Candidate; Abigail Quinlin, 2021 PharmD Candidate; Amy Priest, 2022 PharmD Candidate; Emily Frederick, PharmD, BCPS The author declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity #0143-0000-21-001-H06-P &T 1.0 Contact Hours Expires 3/12/24 Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1. Compare and contrast influenza H1N1 with COVID-19. 2. Assess the severity of the viral infections. 3. Review “treatments” for each viral process. With the COVID-19 pandemic still causing global health and safety concerns and dominating news cycles, it may be difficult to recall a time the nation has ever previously been so strained by a healthcare crisis. However, this is not the first time such a large-scale pandemic has rocked the nation and likely not the last. One notable historical example of a large-scale pandemic is the 1918 influenza pandemic (also referred to as the Spanish Flu). Though over 100 years have passed since the onset of the 1918 influenza, many references and comparisons have been drawn between it and COVID-19. Though the two pandemics differ in their causative agents, they also share some parallels such as the global response to each.
the majority of infections and deaths attributable to the virus. The final wave of the pandemic struck the United States in early 1919. This final wave had a lower rate of infection than the second waved but still retained a similar mortality rate as compared to the second wave2. In total, it was estimated that the Spanish Flu lead to more than 500 million cases of infection and greater than 50 million individuals losing their lives due to the virus1.
It has been postulated that the impacts of Spanish Flu could have been exacerbated by several factors including uncleanliness and overcrowding. The symptoms of infection varied based on the severity of illness, but patients often presented with symptoms such as fever, headache, nosebleed, pneumoThe Spanish influenza spread globally between nia, encephalitis, blood-streaked urine, and coma. 1918-1920 and was caused by the orthomyxovirus, Those infected were also at risk of acquiring a secsubtype H1N1. This virus wreaked havoc initially in ondary bacterial pneumonia infection that further Europe before eventually spreading throughout the increased the possibility of complications and inUnited States in “waves”1. The initial wave in the creased the mortality rate1. United States resulted in mass illnesses, but relaAt the time when the 1918 influenza shocked the tively low mortality rates that are similar to annual world, science was less advanced compared to toinfluenza mortality rates. As the infection rates from day and there were not any known vaccines or the first wave decreased another wave was loommedications that were effective in mitigating it. ing. The next wave struck a few months later and Non-pharmacologic treatment options were conspread throughout Europe. The spread of this wave ceptualized and applied in certain cases, but sucwas thought to be partially due to shipping goods cess was limited. For example, in China, people and the subsequent contacts made upon carrier sprayed their houses with lime water or powder ships docking at shore. This wave contributed to |20| Kentucky Pharmacists Association | January/February 2021
and burned rhubarb and atracytoldes rhizome to disinfect the air. Additionally, for prevention some recommended drinking soup that was made from mung bean and rock sugar several times a day. Herbal remedies were also attempted to treat infected patients. Despite these efforts, it was not until the late 1930’s that a viable vaccination to treat influenza was finally in the developmental stages but even still, an empiric formulation did not become available to the masses until 19454.
immediately touching their face. This transmission pathway is referred to as aerosolized transmission and is the basis for the mask mandates and hand washing recommendations by the government and the CDC.
Once infected, it can take up to 14 days to exhibit symptoms, but there have been reports of symptoms appearing in as little as two days postexposure. Regardless of the length of the presymptomatic period, during the asymptomatic peSimilar to the impacts of the Spanish Flu, COVID-19 riod an infected person can still actively spread the has also rattled global society due to its high trans- virus. There are even individuals who have apmissibility and its lack of proven effective treatment peared asymptomatic but are still capable of transoption. Though similar in impact, COVID-19 differs mitting infection unknowingly. In addition to being from the Spanish Flu in its origin. COVID-19 is a res- highly transmissible, COVID-19 has also proven to piratory infection caused by the SARS-COV-2 virus. be particularly dangerous to patients considered to The virus is theorized to have begun its infectious be high-risk. These patient populations include oldpathway via animal source at a market in Wuhan, er adults and patient with certain disease states China. This market was involved in the trade of fish such as cancer, chronic kidney disease (CKD), and more “exotic” animals, such as bats – which is chronic obstructive pulmonary disorder (COPD), believed to be the original source of infection. The solid organ transplant recipients, obesity, heart failvirus mutated from the form which infected the bat ure (HF), coronary artery disease (CAD), cardiomyoand was able to successfully infect humans in a pathies, sickle cell disease, or type 2 diabetes mellimechanism that was previously never seen by the tus (T2DM)7. immune system. The first COVID-19 cases were reOnce a person begins to show signs of COVID-19 ported in December 2019 and eventually spread infection, they may still present with an array of throughout the world. Similar to the waves of Spansymptoms of varying severity. Some severe cases ish influenza infection, the COVID-19 pandemic has can often result in hospitalization. Such severe disbeen manifesting in peaks and troughs of infection ease complications may include trouble breathing, rates. In March of 2020, the World Health Organizapain or pressure in the chest, new onset confusion, tion (WHO) declared COVID-19 a global pandemic5. inability to wake or stay awake, and/or a bluish tint The initial symptoms of COVID-19 infection includto the lips or face. Upon admission to a hospital faed fever and dry cough which can progress to rescility, a patient will first be screened for symptoms piratory distress6. The CDC has published an exand then a COVID-19 test will be administered to panded symptom list that includes chills, difficulty confirm or rule out a diagnosis. There are two difbreathing, fatigue, body aches, headache, loss of ferent types of COVID-19 tests. One method of testtaste or smell, congestion, runny nose, nausea, ing screens for the presence of antibodies which vomiting, diarrhea7. Each of these symptoms is indicate a history of infection. Generally, the presused in health care facilities, inpatient and outpaence of antibodies provides protection from the tient a like, around the nation in order to screen pa- possibility of future infections from the same agent. tients coming in for COVID-19. However, it is currently uncertain as to whether a person previously infected with COVID-19 is proThe virus is primarily spread through respiratory tected from future exposures, and more research is droplets (usually from coughing or sneezing) that needed in this realm. The other type COVID-19 test either directly or indirectly infiltrate mucous memwhich is currently more commonly used is a viral branes in the eyes, nose, or mouth. With this mode test7. This test result indicates whether a patient of transmission, a person can become infected currently has an infection, but its accuracy levels simply from someone coughing in their face or run the risk of generating false negatives or false from touching a contaminated surface and then |21| www.KPHANET.org
positives. Newer tests have been approved with better results – 3% risk of false positives and 1.5% risk of false negatives8. Consequently, lab values and imaging tools are often utilized in inpatient settings when symptoms suggest the presence of COVID-19 of infection, but the test results do not.
ble patient safety concerns.
COVID-19 can affect people in varying severity and has a spectrum of complications. There is a surge in prothrombic molecules, and the effect typically presents in the lungs. Lung tissue becomes damaged due to the inflammation and allows fluids to infilDiagnostic imaging and laboratory values are used trate the lungs, making it difficult to breathe. The clinically to judge the diagnosis and resolution of body tries to repair the damage by synthesizing fithe infection but are not definite. Rather, these brotic tissue, which impairs the ability of the lungs tools are used with clinical judgement in order to to expand and contract. This tissue further inhibits provide the best possible treatment for patients. the ability to breathe and can cause chronic impairCertain images seen on chest x-rays include bilatment. Furthermore, the surge in prothrombic moleeral multi-focal opacities or peripheral ground glass cules increases the risk for thrombosis which can opacities which lead to areas of consolidation upon lead to a heart attack, stroke, pulmonary embolism, further resolution of the disease. Opacities are seen or deep vein thrombosis. These conditions can have with many disease states such as bacterial or viral a lifelong effect on the patient and impact their pneumonia. Though imaging studies may assist in quality of life. At the time of publication (11/09/2020) diagnosing COVID-19, diagnostic testing and best the US has seen 9,913,553 cases with 237,037 deaths. clinical judgement should be used for each patient The state with the highest death rate is New York presenting with a possible COVID-19 diagnosis. As with 33,439 deaths while Vermont has the least for laboratory values in possible COVID-19 cases, with 59 deaths. However, in terms of cases Califorleukopenia, lymphopenia, elevated aminotransfer- nia is has the most cases (964,639) and Vermont ase, C-reactive protein, D-dimer, ferritin, and lactate has the least (2,392).7 dehydrogenase are commonly seen9. Though each pandemic was caused by a different Currently, there are no definitive treatments or vac- virus and over 100 years separate the two public cinations for COVID-19 and no recommended prehealth crises, they share many parallels. Both panventative measures or post-exposure treatment, demics have disrupted normal functioning of sociewithout severe inpatient disease. However, many ty and have instilled fear due to lack of evidencepossible treatment options have been speculated based treatment or prevention options available. and treatment ideas for severe disease have exam- However, in each pandemic many still have atined medication mechanisms of action and clinical tempted to use either herbal or pharmacologic testing to determine validity and support further therapy in a novel way in hopes some agent will be use. Current possible therapy regimens include the found that may prove effective in curbing infecuse of anticoagulation with dexamethasone 6 milli- tions. Finally, it can be noted that over twenty years grams and use of remdesivir if the inclusion criteria passed before an effective vaccine for influenza are met. The NIH guidelines have recommendareached the market. In present time, society has far tions for remdesivir based on the severity of symp- advanced in medical science and technology which toms. With limited supplies, remdesivir was recom- likely will assist in developing a vaccine to curtail mended for hospitalized patients who require sup- the COVID-9 pandemic, but it is imperative that diliplemental oxygen but are not on high flow oxygen- gent research and clinical trials are conducted to ation, noninvasive ventilation, mechanical ventilaensure any vaccine that reaches the market is safe tion, or extracorporeal membrane oxygenation and effective. (ECMO). Typical therapy duration is 5 days for References: remdesivir and 10 days for dexamethasone. In addition to the aforementioned possible treatment op- 1. Martini M, Gazzaniga V, Bragazzi NL, Baberis I. The spanish influenza pandemic: a lesion from tions, Table 1 summarizes other theorized treathistory 100 years after 1918. J Prev Med Hyg. ment options along with their current known effi2019; 60(1):E64-E67. cacy levels for COVID-19 treatment and their possi|22| Kentucky Pharmacists Association | January/February 2021
Proposed Therapy
Mechanism of Action
Evidence
Concerns
No longer recommended
IL-1 and IL-6 inhibitors10
Prevents fusion to host cell membrane and blocks release of viral genome Inhibits cytokine storm
QTc prolongation Retinal toxicity Long half-lives (40 days) Infections
Mesenchymal Stem Cells9
Immunomodulary properties
Insufficient data
Infections Tumor growth Thrombus formation Administration site reactions
Vitamin C9
Antioxidant Free-radical scavenger Anti-inflammatory properties Receptor expressed on B and T cells and Antigen Presenting cells
Insufficient data
May affect point of care glucose readings
Insufficient data
Nephrocalcinosis
Zinc9
Increased concentrations efficiently impair replication in RNA viruses
Antithrombotic therapy9
Antagonize the prothrombic state
Anemia Leukopenia Ataxia Paresthesia Copper deficiency Bleeding HIT thrombocytopenia
Corticosteroids9
Inhibit cytokine storm
Remdesivir9
RNA chain termination
Insufficient data Recommend against doses above the recommended dietary allowance Recommended with no contraindications -on chronic therapy continue -prophylactic doses -treat thrombosis therapeutically Recommended on supplemental oxygen Recommended in COVID+ on supplemental Oxygen but not highflow, mechanical ventilation, or ECMO
Hydroxychloroquine Chloroquine10
10
Vitamin D9
2.
Nickol ME, Kindrachuk J. A year of terror and a century of reflection: perspectives on the great influenza pandemic of 1918-1919. BMC Infect Dis.2019; 19 (117).
3.
Cheng KF, Leung PC. What happened in china during the 1918 influenza pandemic? Int J Infect Dis. 2017; 11(4):360-364.
Not currently studied
hyperglycemia Increase in LFTs Increase in SCr Increase PTT GI symptoms
tential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Mar 11. [Epub ahead of print]. 7. United States COVID-19 Cases and Deaths by State. CDC. https://covid.cdc.gov/covid-datatracker/#cases_casesper100klast7days. 2020 Jan; 2020 Nov 5; 2020 Nov 5.
4. Wallace R. Medical innovations: from the 1918 pandemic to a flu vaccine. The National WWII Museum – New Orleans. 2020 Apr; 2020 Sept.
8. FDA – BinaxNOW COVID-19 Ag CARD. FDA. https://www.fda.gov/media/141570/download. 2020 Aug; 2020 Nov.
5.
9. 2020 NIH COVID-19 Treatment Guidelines. Published online 2020 Jul 17. Updated 2020 Jul 30. Accessed 2020 Aug 8.Kotwani A, Gandra S. Potential pharmacological agents for COVID-19.
Rico-Mesa JS, White A, Anderson AS. Outcomes in patients with COVID-19 infection taking ACEI/ARB. Curr Cardiol Rep. 2020; 22(5):31.
6. Li Y, Bai W, Hashikawa T. The neuroinvasive po-
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February 2021—A Global Pandemic: Once a History Lesson Now a Modern-Day Reality – A Comparison Between the Spanish Flu and COVID-19 Pandemic
A. B. C. D.
1. COVID-19 is occurring modern day (2020) but when did the H1H1 pandemic occur? 1875-1880 1918-1920 1957-1960 Current day alongside the coronavirus
A. B. C. D.
2. COVID-19 and the H1N1 influenza virus share similar infection pathways. Which pathway is correct? Fecal-oral Bloodborne Sexually transmitted Respiratory droplets
A. B. C. D.
3. What were some proposed nonpharmacological treatment options for the H1N1 pandemic? Drink plenty of fluids Get vaccinated for the disease Burning rhubarb and atracytoldes rhizome Eating feline spleens
A. B. C. D.
4. When was a vaccine available for the general population with regards to the H1N1 virus? 1850’s 1930’s 1940’s 2000’s
A. B. C. D.
5. What is one treatment that has been postulated for COVID-19, but no longer recommended? Remdesivir Hydroxychloroquine Acetaminophen Cyclosporine
A. B. C. D.
6. What state in the United States has the lowest infection rate for COVID-19, at the time of publication? Vermont California Kentucky Indiana
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A. B. C. D.
7. Name one key monitoring parameter for the therapies that are being used for COVID-19, remdesivir and dexamethasone. Electrolyte abnormalities Liver function EKG Lung biopsies
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Campus Corner Kappa Psi Epsilon Theta has not let the pandemic stop us. In the Spring Quarter of 2020, a new executive board was voted in by the chapter. The new board consists of John Wright (Regent), Maddie Sweeney (Vice-Regent), Katelyn Coomes (Chaplain, Cole Nunier (Sergeant-in-Arms), Amy Priest (Secretary), Courtney Henderson (Treasurer), Katie Ritchie (Pledge Educator), and Sierra Midkiff (Historian). We started the 2020-21 academic year in July with two of our brothers attending the virtual regional regent’s retreat where they learned more about leading a chapter of Kappa Psi. Shortly thereafter, the new executive board ran their first meeting and has managed to have a meeting every month since; some of which managed to be in person while taking all the proper precautions. The Epsilon Theta chapter also managed to complete a rush process, and recently added 13 new brothers into our fraternity in a virtual initiation session this month. In September, we had multiple brothers attend The Great Lakes Province Fall 2020 Virtual Assembly where brothers from all over the province came together to update by-laws and vote in the new executive council for the province. This was an extra special event because our brother Sierra Midkiff (P2; Historian) received one of two GLP 2020 scholarships given out at the assembly. One of our brothers (John Wright; P2; Regent) was also elected to serve on the Graduate Relations Committee for the GLP Province. In November, our Epsilon Theta chapter participated in the Suicide Awareness Out of the Darkness Walk as one of our service projects for the year. This event was held in downtown Louisville at the waterfront; we were able to walk and participate in activities to memorialize those who we have lost to suicide. Last fall, we were able to host a virtual brotherhood event with the Kappa Psi Chapter at Ohio Northern University where we got to meet with some of their brothers and play games together. This event was organized by our social chair, Brandon Van Zile (P2; Social Chair). This year we had the opportunity to send one of our brothers (John Wright; P2, Regent) to Kappa Psi’s Leadership Academy where he will meet monthly with brothers from all over the country to better his leadership skills. As part of the Leadership Academy, John is organizing a fundraiser where he will be selling tee shirts to honor and remember Brother Matthew Boyd. Matthew passed away in May of 2020, so we plan to have all of the proceeds to donated to The Matthew Boyd Memorial Scholarship at SUCOPHS. There were also many brothers along
Our brothers at the Suicide Awareness Out of the Darkness Walk. |34| Kentucky Pharmacists Association | January/February 2021
|35| www.KPHANET.org
|36| Kentucky Pharmacists Association | January/February 2021
|37| www.KPHANET.org
KPhA BOARD OF DIRECTORS
KPERF BOARD OF DIRECTORS
Don Kupper, Louisville donku.ulh@gmail.com
Chair
Clark Kebodeaux, Lexington clark.kebodeaux@uky.edu
Secretary
Joel Thornbury, Pikeville jthorn6@gmail.com
President
Treasurer
Cathy Hanna, Lexington channa@apscnet.com
President-Elect
Chris Killmeier, Louisville cdkillmeier@hotmail.com
President, KPhA
Brooke Hudspeth, Lexington brooke.hudspeth@uky.edu
Secretary
Joel Thornbury, Pikeville jthorn6@gmail.com
Chris Killmeier, Louisville cdkillmeier@hotmail.com
Treasurer
Kevin Lamping, Lexington kevin.lamping@twc.com
Lewis Wilkerson, Frankfort rphs2@aol.com
Past President Representative
Paul Easley, Louisville rpeasley@bellsouth.net Pat Mattingly, Lebanon pat@patspharmacy.com
Directors Ronnah Alexander, Providence ralexander@hfchc.net
Sam Willett, Mayfield willettsam@bellsouth.net
Jessika Chilton, Beaver Dam jessikachilton@ymail.com Kyle Harris, London kyleharrispharmd@yahoo.com Jacob Barnett, Lexington jacobbarnett15@gmail.com
KPhA Staff University of Kentucky Student Representative
Chad Corum, Manchester pharmdky21@gmail.com
Sarah Franklin Director of Communications & Continuing Education sarah@kphanet.org
Cassy Hobbs, Louisville cbeyerle01@gmail.com Thao Le Batovsky, Louisville tle3380@my.sullivan.edu
Ben Mudd Executive Director bmudd@kphanet.org
Sullivan University Student Representative
Jeff Mills, Louisville jeff.mills@nortonhealthcare.org Martika Martin, Owensboro Speaker of the House 12marmar@gmail.com Nathan Hughes, Louisville Vice Speaker of the House njhughes1980@gmail.com Trevor Ray, Caneyville trevor@midwaypharmacy.com Cory Smith, Barbourville corysmith6155@gmail.com Misty Stutz, Crestwood mstutz@sullivan.edu
|38| Kentucky Pharmacists Association | January/February 2021
Angela Gibson Director of Finance & Administrative Services agibson@kphanet.org Jody Jaggers, PharmD Director of Public Health jjaggers@kphanet.org Kristen Blankenbecler, PharmD Director of Clinical Outreach kristen@kphanet.org Michele Pinkston, PharmD, BCGP Director of Emergency Preparedness michele@kphanet.org Lisa Atha Office Assistant/Member Services Coordinator latha@kphanet.org
“I am intent on pharmacy as a profession being prepared for the revolution. While the pharmacist for years has been relegated to a minor position on the health team, the Neighborhood Health Center holds new promise for those pharmacists who care and ar willing to accept responsibilities that were unheard of not so many years ago.” -From The Kentucky Pharmacist, December 1970 Volume XXXIII, Number 12
Frequently Called and Contacted Kentucky Board of Pharmacy
Kentucky Society of Health-System Pharmacists
National Community Pharmacists Association (NCPA)
P.O. Box 4961
100 Daingerfield Road Alexandria, VA 22314
(502) 564-7910
Louisville, KY 40204 (502) 456-1851 x2 www.kshp.org info@kshp.org
www.pharmacy.ky.gov
Kentucky Regional Poison Center
Pharmacy Technician Certification Board (PTCB)
(800) 222-1222
State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601
2215 Constitution Avenue
American Pharmacists Association (APhA)
Washington, DC 20037-2985
2215 Constitution Avenue NW
(800) 363-8012
Washington, DC 20037-2985
www.ptcb.org
(800) 237-2742
(703) 683-8200 www.ncpanet.org info@ncpanet.org National Association of Chain Drug Stores (NACDS) 1776 Wilson Blvd., Suite 200 Arlington, VA 22209 www.nacds.org 703-549-3001
www.aphanet.org
KPhA/KPERF HEADQUARTERS 96 C Michael Davenport Blvd. Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) info@kphanet.org www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.youtube.com/KyPharmAssoc |39| www.KPHANET.org
THE
Kentucky PHARMACIST 96 C Michael Davenport Blvd. Frankfort, KY 40601
