The Kentucky Pharmacist July/August 2019 by Kentucky Pharmacists Association

Vol. 14 No. 4 July/August 2019

THE KENTUCKY

PHARMACIST Official Journal of the Kentucky Pharmacists Association

INSIDE: Welcome to President Don Kupper 2019 Annual Meeting & Convention Wrap Up

TABLE OF CONTENTS FEATURES Professional Awards |4 & 5| KPERF Golf Scramble |10| Annual Meeting & Convention Sponsors |11| Sip & Mingle Networking |12| Dean Stowe Honorary Membership |18| KPPAC Reception |17| House of Delegates Summary |13-16| Board of Directors Recognition |35| Annual Meeting & Convention Exhibitors |41|

Mission Statement: The mission of KPhA is to advocate for and advance the profession through an engaged membership.

Editorial Office: ©Copyright 2019 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: Mark Glasper 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.

On the Cover Pictured left to right: KPhA President-Elect Joel Thornbury, KPhA President Don Kupper and KPhA Chair Chris Palutis

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IN EVERY ISSUE President’s Perspective |8| My KPhA Rx |9| Continuing Pharmacy Education |19 –32| Campus Corner |34| New KPhA Members | 36| Member Spotlight |36| Academy of Pharmacy Technicians |39| Pharmacy Policy Issues |40| Pharmacy Law Brief |44|

ADVERTISERS APSC|3| APMS |8| PTCB |25| Pharmacists Mutual |42| Cardinal |43| EPIC |45|

|2| Kentucky Pharmacists Association | July/August 2019

|3| www.KPHANET.org

Annual Meeting & Convention Professional Awards

Bowl of Hygeia

KPhA Pharmacist of the Year

Cathy Hanna Pictured with 2018 – 19 KPhA President Chris Palutis and 2018 – 19 Chair Chris Harlow

Paula Ruwe Miller Pictured with 2018 – 19 Chair Chris Harlow and 2018 – 19 KPhA President Chris Palutis

Pharmacists Mutual Distinguished Young Pharmacist of the Year Kyle Harris Pictured with Bruce Laffere, Pharmacists Mutual 2018 – 19 Chair Chris Harlow and 2018 – 19 KPhA President Chris Palutis

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KPhA Excellence in Innovation Award Trish Freeman Pictured with 2018 – 19 Chair Chris Harlow and 2018 – 19 KPhA President Chris Palutis

KPhA Distinguished Service Award

KPhA Professional Promotion Award

Sam Willett Pictured with 2018 – 19 Chair Chris Harlow and 2018 – 19 KPhA President Chris Palutis

Kim Croley Pictured with 2018 – 19 Chair Chris Harlow and 2018 – 19 KPhA President Chris Palutis

KPhA Technician of the Year Award

Jan Gould KPhA Meritorious Service Award

Luke Shockley Pictured with 2018 – 19 Chair Chris Harlow and 2018 – 19 KPhA President Chris Palutis

Sen. Jimmy Higdon Dr. Connie White

|5| www.KPHANET.org

PRESIDENT’S PERSPECTIVE Adapted from the President’s address delivered at the Ray Wirth Awards Banquet during the 141st KPhA Annual Meeting and Convention. KPhA Board Members, past and present, former and current office holders of KPhA, KPhA staff, and distinguished guests, I am honored to stand before you as the 139th President of your Kentucky Pharmacists Association which has been in existence for 142 years. I also had the pleasure of serving as the President of the Kentucky Society of Health System Pharmacists. KSHP has been in existence for 58 years and I was their 41st president. As for KPhA, I will be the fourth pharmacist to serve as president of both organizations. And no better time than the present.

“Our Pharmacist Association should be for all pharmacists no matter the practice environment.”

all three titles into this talk which I hope will encourage each of you about our profession and this association. The key storyline in A Don Kupper Star is Born was the adPresident, KPhA diction issue of the character that Bradley Cooper portrayed and the character’s eventual demise. His leading lady was played by Lady Gaga. Prior to the movie, I was not a Gaga fan. But, she played a great part; together with Cooper they created Oscar nominated roles about the subject of addiction which, as we know, has been around a long time, but has escalated in recent years!

At this time, I want to recognize KPhA staff members Jody Jaggers, Michele Pinkston and Jessica Johnson for their work with the issue of our opioid For those of you who don’t know much about my crisis. They are currently managing work duties pharmacy life, I am a third-generation pharmacist – around the five grants associated with the Kentucky not many of us in that category anymore. My career Department of Public Health; one of which I bestarted in community pharmacy with my Father. lieve was Unplanned. From there I started in hospital pharmacy at HuI also want to recognize KPhA Board Chair Chris mana Audubon Hospital, when Humana owned hospitals. My first leadership role was with the Sis- Harlow and his work with representatives from KSHP, Colleges of Pharmacy and the Kentucky ters of Charity at Our Lady of Peace Hospital. Eventually, they added to my responsibilities when Board of Pharmacy who developed our first Kenthey put me in charge of pharmacy services for their tucky Opioid Summit that occurred March 30. It community hospital, SS Mary and Elizabeth, now was very well attended, and I appreciate all those called Caritas. I left the Sisters of Charity of Naza- who participated. reth facilities to become the pharmacy leader at The It is my desire to continue KPhA’s focus on this criUniversity of Louisville Hospital and James Grasis, Opioid addiction, or addiction in general as we ham Brown Cancer Center, where I stayed for 15 know it, which affects all socioeconomic classes years and eventually became a Vice President of and can destroy a family if left unattended. When I Pharmacy and Materials Services. I am now back in was working at Our Lady of Peace or Peace as I retail working in compounding. I do some night called it, I had the opportunity to lead a group of work in long-term care at PharMerica, I consult addicted patients who were in recovery. I had very with surgery centers, and work with a mail order personal and sometimes emotional conversations. group in Florence to construct a compounding facil- The group I led was comprised of those who were ity in their operation. on the cusp of being discharged, back to their lives This past year, I have seen three movies: A Star is outside of Peace. It was very rewarding work during those years. Born, Breakthrough, and Unplanned. I will work |6| Kentucky Pharmacists Association | July/August 2019

Additionally, I want to mention Executive Director Mark Glasper has been coordinating with our Board to hold a Strategic Planning Retreat facilitated by consultant Tim Burcham this summer, for the development of our operational and business plans to support all of our initiatives. This is a very important time in our history from a legislative perspective; Having a Breakthrough when Senate Bill 5 was passed in the 2018 legislative session, which highlighted the issues concerning pharmacy benefit managers and the money they were essentially NOT paying the pharmacies in our state. Reforming PBMs in our state will benefit the state and pharmacy providers who care for patients. Also, I wish to announce another initiative for KPhA and my year as President. One that is long overdue. The time is right now! Past President Chris Clifton, in his address to members in 2015, outlined a vision to unite the profession and rally around provider status, to broaden our practice and enable us to be providers of primary care. We should embrace primary care as our own. Primary CARE needs Pharmacy and we should embrace the opportunity. I learned a new acronym, while attending the Na-

KPhA Chair Chris Palutis (R) and KPhA Executive Director Mark Glasper (L) present KPhA President Don Kupper with the Presidential Journal and the NCPA Leadership award at the Ray Wirth Awards Banquet.

had a program. Pharmacists in Indiana, Tennessee and Ohio have academies or societies but have one statewide pharmacy organization. One voice for our profession. The time is now. Organizational Affairs and Membership Engagement committees will be charged with establishing the academies or societies for the various membership groups. I look forward to our discussions and to our strategic planning retreat. In the interim, I expect to meet with our strategic partners to start the dialogue. As KPhA, we have a great deal to offer our health system, compounding, community, long-term care and consulting pharmacists. With the recent addition of our VoterVoice advocacy software, allowing for easy access to the legislative process and our legislative officials, it is a state-of-the art system for all pharmacy! Additionally, we have Lecture Panda software which will compliment and expand our ability to provide state-of-the-art professional education with CEUs automatically reporting directly into CPE Monitor.

Our Pharmacist Association has a fully staffed professional office building in Frankfort that can be home for all academies and/or societies of pharmacy. We are working on a “Center of Excellence”, a tional Alliance of State Pharmacy Associations program that can engage all pharmacists from any leadership meeting in May. It is C.A.V.U. which stands for Ceiling And Visibility Unlimited. In oth- practice area. Soon you will get to know the Center of Excellence and how it can help all pharmacists. er words, “The Sky is the Limit”! KPhA President Don Kupper addresses the attendees at the Ray Wirth Awards Banquet.

Our bylaws address academies. At this Annual Meeting our Academy for Pharmacy Technicians

Let me share with you the wildly important goals of executives from the national pharmacy organiza|7| www.KPHANET.org

tions that participated in the recent NASPA meeting: Doug Hoey, National Community Pharmacists Association: Change PBMs and managed care with model legislation, practice transformation, lower cost overall and increase scope of practice.” Tom Menighan, American Pharmacists Association:, “Promote consumer access and coverage.” Steve Anderson, National Association of Chain Drug Stores: “Future value target initiatives; shift to health and wellness, DIR Fee Reform and Opioid Abuse Epidemic.” Mike Maddux, American College of Clinical Pharmacy: Comprehensive Medication Management Optimization and advancing the practice. Todd Sorensen, American Association of College of Pharmacy: Advance collaborative relationships with primary care; promote Pharmacists for Healthier Lives Campaign.” Why did I share these “wildly important goals”? Because they are ours as well! Our Pharmacist Association should be for all pharmacists no matter the practice environment. The time is right, the time is now! I invite you to join this wildly important goal and advocate for ALL Pharmacy! and the patients we serve.

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Save the Date! KPhA Legislative Conference Griffin Gate Marriott Resort Lexington, KY November 1-2, 2019

MY KPhA Rx KPhA: Your Professional Resource in Good Times and Bad By Mark Glasper KPhA Executive Director/CEO

ucts they dispense. Please join us in our fight to preserve pharmacist jobs because we are stronger together. We have countless ways you can become even more engaged in your profession by working with us.

Benefits YOU Can Use You also can look to KPhA as your ongoing resource for support. Peer-to-peer networking is so important when times are tough and KPhA proIf you read pharmacy news and/or participate in vides many opportunities for you to do just that pharmacy social media, then I’m sure you’re aware through our Annual Meeting, Legislative Conferof the layoffs affecting our profession. As painful as ence, local District meetings and our new Sip & the news is for those affected and even for those Mingle networking events. You’ll see friends, make who are not, the ongoing commentary on social new acquaintances and uncover job leads you never media has demonstrated the open wound that exists knew existed. between many pharmacists and the pharmacy orKPhA has a new Career Center on the KPhA webganizations that represent them. site, www.kphanet.org. Hundreds of jobs from all KPhA is dedicated to the welfare of all pharmacists practice settings and from around the country are in this Commonwealth. Therefore, we believe it is posted there every day. You can even have job essential we respond directly to the recent concerns openings sent automatically to your e-mail inbox. expressed by pharmacists across Kentucky. PharAnd, don’t forget that KPhA can be your resource macists are experiencing massive layoffs or drastic for relief pharmacy work. Be sure to add yourself cuts in weekly hours, often leading to loss of much to our web page listing available relief pharmacists. needed health and retirement benefits. You also can reach out to your peers through KPhA Works on Behalf of YOU KPhA social media. Our Facebook and Twitter While we recognize the pharmacy industry is shift- pages provide you with unlimited opportunities to ing, KPhA will not stand by and let pharmacists be ask questions, find answers and network. taken advantage of or simply removed from pracJust as important, KPhA is your legislative and regtice. Pharmacists are essential members of the health care team, and Kentucky cannot continue to ulatory voice in Kentucky. We work year round afford to lose more pharmacists due to preventable with the legislators who represent you. And, we stay abreast of new regulations by representing your measures. interests at Kentucky Board of Pharmacy meetings. KPhA is working toward three strategic areas to It’s here that we make your concerns known should address these concerns: Provider Status, PBM repractice issues impact patient safety, including your form, and Expansion of Patient Centered Services. own. Until we accomplish these initiatives, pharmacists If you’re a KPhA member, we thank you for your will remain vulnerable to job loss. Pharmacists support. If not, we have unlimited value to share must be paid adequately for the services they provide. KPhA recognizes that pharmacists practicing with you. Just contact me at 502-227-2303 or mglasper@kphanet.org and I will help you discover in community and health-system pharmacies are all that KPhA has to offer. Or, join KPhA now! ready and willing to start billing for their services. Additionally, community and chain pharmacies alike cannot keep operating with negative margins and unknown chargebacks months after point of sale. They must be paid adequately for the prod|9| www.KPHANET.org

2019 KPERF Golf Scramble

Pictured: Bob Oakley, Joel Thornbury and Joe Carr

Chris Palutis sinks a putt on the green.

Players getting started at the golf scramble.

J Leon Claywell takes a shot while his team looks on.

Angela Brunemann drives the ball down the fairway.

Winners Circle

First Place: Chris Palutis, Rick Dunn, Chip Diehl and Mackenzi Neal Second Place (tie): Don Kupper, Chris Killmeier, Bob Smith and Tom Lucas Clark Kebodeaux, Charles Davis, Travis Smith and Kadin Ashley Last Place: Angela Brunemann, Eric Nordman, Hillary Ruth and Brooke Ross Longest Drive: Men: Travis Smith Women: Mackenzie Neal Closest to the Pin: Men: Charlie Clifton Women: Mackenzie Neal

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Sip & Mingle Networking Sponsor by Novo Nortis KPhA members attended the Sip & Mingle Networking event at Tonyâ&#x20AC;&#x2122;s of Lexington. Attendees enjoyed networking, appetizers and a presentation by Novo Nortis.

KPhA President Chris Palutis pictured with his wife Consuelo Palutis.

Kim Croley and Chris Clifton network at the Sip & Mingle.

Joel Thornbury and Ron Poole Connect during the Sip & Mingle.

Robert Croley and Joe Carr network at the Sip & Mingle.

Watch for more local Sip & Mingle events being hosted near you! KPhA Chris Palutis addresses the Sip & Mingle attendees. |12| Kentucky Pharmacists Association | July/August 2019

House of Delegates Report House of Delegates Summary 2019 KPhA House of Delegates | June 21-22 | Griffin Gate Marriott Resort & Spa | Lexington, KY Tyler Stevens—2019 Speaker of the House of Delegates Ben Mudd—2019 Vice Speaker of the House of Delegates Joe Fink, PharmD—Parliamentarian

*To include Vice Speaker nominee (s) Motion was made to accept the Reference Committee appointments, seconded. Motion carried. The minutes from the November 2, 2018 meeting in Louisville, KY in conjunction with the KPhA Legislative Conference were presented.

At the 2019 KPhA House of Delegates members from Motion was made to approve the November 2, 2018 House throughout the Commonwealth gathered to discuss, debate of Delegates minutes as presented, seconded. Motion carand make recommendations to not only shape KPhA, but also ried. to push forward our profession. KPhA President Chris Palutis presented to the Membership a brief report of his Presidential year in review. KPhA Treasurer Duane Parsons presented to the Membership a brief report of the financials for 2018. Executive Director Mark Glasper presented to the Membership a report from the Executive Director’s Desk for 2018. All reports can be found on the website under the House of Delegates page. KPhA Chair Chris Harlow recognized the outgoing 2018-2019 KPhA Board of Directors.

KPhA House of Delegates members discuss the Telepharmacy Position statement. Opening Session Speaker Tyler Stevens convened the Opening Session on the KPhA House of Delegates on Friday, June 21, 2019, at 11a.m. Delegates were slated in accordance with the updated KPhA Bylaws, and annual reports of the association were presented. The Invocation was given by Jessika Chinn. Duane Parsons led everyone in the Pledge of Allegiance Speaker Stevens led the Oath of a Pharmacist. Delegates present: 67 Total Delegates Sam Willett chaired the credentialing process as Secretary Brooke Hudspeth was unable to attend the meeting. Sam reported that 34 Delegates were needed for a Simple Majority vote and 50 were needed for a 3/4 Majority vote. The Reference Committee was appointed by Speaker Stevens Chair- Ben Mudd, Vice Speaker of the House of Delegates Committee Members- Sam Willett, Kim Croley, Joe Carr, Kyle Harris, Scotty Reams, Jae Seo

Richard Slone, KPhA Government Affairs chair presents to the House of Delegates. Duane Parsons, Treasurer, Cassy Hobbs, Director, Jeff Mills, Director, Blake Wiseman, Director, Joel Thornbury, Past President Representative, Dharti Patel, Director University of Kentucky College of Pharmacy Student, Stephen Drog, Director University of Sullivan College of Pharmacy and Health Sciences Student Richard Slone presented to the Membership a brief report from the Kentucky Pharmacists Political Advisory Committee on behalf of KPPAC Chair Matt Carrico. |13| www.KPHANET.org

KPERF Chair Bob Oakley presented to the Membership a report from the KPERF Board of Directors. The KPERF Board has sold the physical headquarters building to KPhA effective June 1, 2019. The building sale ends the KPERF Capital Building Fund Campaign. KPERF is kicking off its new campaign, KPERF Center of Excellence, at this Annual Meeting. If you would like to donate to the Center of Excellence Campaign, please see any KPhA Staff or KPhA/KPERF Board of Director.

The voting was conducted for the 2019-2020 Vice Speaker of the House of Delegates between the two candidates: Kyle

Speaker Stevens reported that due to the interest of time, all Committee Reports are available online for viewing. The committee reports were referred to the Reference Committee. Nominations for Vice Speaker of the House of Delegates for the 2019-2020 Year were opened. The following Members were nominated for Vice Speaker: Kyle Harris & Martika Martin Motion was made to accept the nominations for 2019-2020 Vice Speaker of the House of Delegates, seconded. Motion carried.

Ralph Bouvette, Trish Freeman and Misty Stutz along with their table discuss telepharmacy.

Motion was made to recess the meeting until Saturday, June Harris and Martika Martin. The votes were tabulated by the 22, 2019, seconded. Motion carried. credentialing committee and announced at the meeting was the winner, Martika Martin. She will be the KPhA Vice Closing Session Speaker of the House of Delegates for the 2019-2020 year. The Kentucky Pharmacists Association House of Delegates Congratulations Martika! resumed the June 2019 meeting at 3:10 p.m. on Saturday, Vice Speaker Ben Mudd gave the Reference Committee ReJune 22, 2019. port as follows. This includes the recommendations from the Richard Slone presented to the Membership the Government House of Delegates as well. Affairs Report and the committee’s recommendation for diProfessional Affairs Committee Recommendation: rection of the legislative issues facing pharmacy. Motion was made to accept the Government Affairs Com- KPhA Position Statement on Telepharmacy mittee report, seconded. Motion carried. KPhA supports the use of telepharmacy technology to provide patient access to the services of a pharmacist when the use of such technology benefits the patient and community. KPhA supports the use of telepharmacy technology when limited to suitable functions of pharmacy operations and patient care that improve patient outcomes, expand access to healthcare, and enhance patient safety when direct on-site pharmacist oversight is unachievable. Regarding remote dispensing as a specific activity accomplished through the use of telepharmacy technology, KPhA supports the following limitations when the act of dispensing is completed by a certified technician under remote supervision of a pharmacist, and not under immediate supervision as defined in KRS 315.010.

Members recite The Oath of a Pharmacist.

Geographical restrictions: A remote dispensing site shall not be authorized if a community retail pharmacy is located within 10 miles of the proposed remote dispensing site.

Supply and Demand: Prior to authorizing the license of a remote dispensing site, the Board of Pharmacy shall consider the availability of pharmacists, the population of the community and the community’s need for the service.

Delegates present: 57 Secretary Brooke Hudspeth gave the credential report. Brooke reported that 29 Delegates were needed for a Simple Majority 3. and 43 were needed for a ¾ Majority vote. 2019-2020 Vice Speaker of the House of Delegates |14| Kentucky Pharmacists Association | July/August 2019

Technician Qualifications: A remote dispensing site shall be staffed with a certified pharmacy technician with at least 2000 hours of community or dispensing pharmacy technician experience in Kentucky after having acquired

certification.

November

Supervision limitations: A pharmacist performing remote supervision shall not supervise more than one (1) remote dispensing site and a “home pharmacy” shall not own more than one (1) remote site.

KPhA Board of Directors Recommendation to update House of Delegates Structure ARTICLE 9 – HOUSE OF DELEGATES 9.1 Composition. 9.11 The House of Delegates shall be composed of representatives from each local association and other groups recognized by the Board of Directors. All delegates and alternates of the House of Delegates shall be members of the Kentucky Pharmacists Association. 9.12 Each past president of the Association shall be a delegate for a period of four years from expiration of the individual’s term of office as Chair of the Board of Directors. 9.13 All officers and directors of the Association shall be exofficio, voting members of the House. 9.14 The Kentucky Alliance of Pharmacy Students and the Sullivan University College of Pharmacy APhA-ASP Chapter shall be represented in accordance with Article 9.17.

Kyle Harris addresses the House of Delegates. Amendment to Professional Affairs Committee Recommen- 9.15 Other groups recognized by the Board of Directors shall dation: be entitled to two delegates.

9.16 Any KPhA member who holds office in any national pharmacy organization may be granted a seat in the House of KPhA supports the use of telepharmacy technology to provide Delegates at the discretion of the Board of Directors upon patient access to the services of a pharmacist when the use of request of that individual. such technology benefits the patient and community. KPhA supports the use of telepharmacy technology when limited to 9.17 Each local association, as defined by the Board of Directors, shall be entitled to representation in the House by one suitable functions of pharmacy operations and patient care delegate for the first five members of the Kentucky Pharmathat improve patient outcomes, expand access to healthcare, cists Association and one additional delegate for each addiand enhance patient safety when direct on-site pharmacist tional twenty members or major fraction thereof. oversight is unachievable. KPhA Position Statement on Telepharmacy Technology

Regarding remote dispensing as a specific activity accomplished through the use of telepharmacy technology, KPhA supports the following limitations when the act of dispensing is completed by a certified pharmacy technician under remote supervision of a pharmacist, and not under immediate supervision as defined in KRS 315.010. 1.

9.18 Delegate allocation for local associations shall be based upon the last known address of each KPhA member as of March 31 of each year. 9.2 Recognition. 9.21 Any organization of pharmacists desiring to be represented in the House may petition in writing for recognition by the Board.

Geographical restrictions: A remote dispensing site shall not be authorized if a community retail pharmacy is located within 10 miles of the proposed remote dispensing site. 9.22 Recognition of any group shall continue until revoked by the Board and approved by a majority vote of the members Supply and Demand: Prior to authorizing the license of a present at a meeting of the House. remote dispensing site, the Board of Pharmacy shall consider the availability of pharmacists, the population of the 9.3 Delegates community and the community’s need for the service. 9.31 Delegates shall be chosen in the manner selected by the Certified Pharmacy Technician Qualifications: A remote recognized group. dispensing site shall be staffed with a certified pharmacy technician with at least 2000 hours of community or dis- 9.32 Each organization shall name alternate delegates who shall serve in the absence of the organization’s delegate(s). pensing pharmacy technician experience in Kentucky after having acquired certification. 9.33 Each delegate shall have one vote. No delegate shall Supervision limitations: A pharmacist performing remote have more than one vote by virtue of any dual capacity. supervision shall not supervise more than one (1) remote dispensing site and a “home pharmacy” shall not own more than one (1) remote site.

ACTION OF HOD: Refer to BOD to bring to the HOD in

9.34 Delegates shall be allocated on the basis of Kentucky Pharmacists Association membership on March 31 of each year. 9.35 Not less than 30 days preceding the Annual meeting each |15| www.KPHANET.org

recognized organization should provide a list of delegates and KPhA member for 12 months. alternates to the Executive Director. 1.143 3rd year Pharmacy Technician Member is defined as ACTION OF HOD: Refer to OAC for review over the next any individual who is a Registered Pharmacy Technician in good standing with the Board of Pharmacy and has been a year. KPhA member for 24 months. Technician Academy Recommendations: 1.144 4th year Pharmacy Technician Member is defined as Technician Tiered Membership any individual who is a Registered Pharmacy Technician in We are requesting the By-Law Article 1- Membership section good standing with the Board of Pharmacy and has been a KPhA member for 36 months. 1.14 be revised to include pharmacy technicians. The new verbiage suggested is “A New Practitioner 1st year active 1.145 5th year Pharmacy Technician Member is defined as member is defined as an active member who has held a liany individual who is a Registered Pharmacy Technician in cense to practice pharmacy for less than 12 months or who good standing with the Board of Pharmacy and has been a has been graduated from an Accredited Pharmacy Technician KPhA member for 48 months or more. Education program and is registered with the state of Kentucky to practice as a Technician.” The suggested changes are ACTION OF HOD: Accept as amended. recommended for second and third-year practitioners also. The 2019-2020 KPhA Board of Directors were installed at the The current rate of membership is $50 per year for Pharmacy Closing House of Delegates. Technician members. The KPhA Board welcomes: We propose the following membership tiers and fees for PharChris Palutis, KPhA Chair macy Technicians: Pharmacy Technician Student Free Don Kupper, KPhA President New Practitioner 1st Year

$20

Joel Thornbury, KPhA President-Elect

New Practitioner 2nd Year

$30

Chris Killmeier, Treasurer

New Practitioner 3rd Year

$40

Cathy Hanna, Director

Pharmacy Technician

$50

Cassy Hobbs, Director Jeff Mills, Director* Scotty Reams, UKCOP Student Director Jae “Anthony” Seo, SCOPHS Student Director Ben Mudd, Speaker of the House of Delegates Martika Martin, Vice Speaker of the House of Delegates *Director unable to attend the closing House of Delegates meeting. Installation to follow at the next KPhA Board Meeting.

KPhA President Chris Palutis joins a table for discussion. Amendment Technician Membership Recommendation (By Laws) 1.14 Technician Members. Any individual who is a Registered Pharmacy Technician in good standing with the Board of Pharmacy is eligible for technician membership. Technician members shall not be eligible to vote or hold office in the Association except as may be provided by Article 9.15.

The 2019 House of Delegates, once again, was a time for discussion and debate. This is when we decide the next steps of our KPhA and look forward to more involvement and discussion in the House as we advance our profession. Speak up to become involved, serve on a committee, become a delegate in the House and voice our stance. Thank you to all members who have the desire and willingness to serve not only our patients, but our profession as well. KPhA looks forward to seeing everyone involved in the next House of Delegates meeting at the Legislative Conference November 1-2, 2019 at the Griffin Gate Marriott, Lexington, KY. There will be further discussion at that time to decide the policies and procedures from KPhA for Telepharmacy in Kentucky. Make plans now to join the discussion!

1.141 1st Time Pharmacy Technician Member is defined as any individual who is a Registered Pharmacy Technician in good standing with the Board of Pharmacy and has joined KPhA for the first time. 1.142 2nd year Pharmacy Technician Member is defined as any individual who is a Registered Pharmacy Technician in good standing with the Board of Pharmacy and has been a |16| Kentucky Pharmacists Association | July/August 2019

Check out more pictures from the KPhA Annual Meeting & Convention on the KPhA Facebook page!

KPPAC Reception

Matt Carrico, KPPAC Chair, welcomed guests at the KPPAC reception.

Rep. Danny Bentley speaks to the KPPAC reception attendees.

Rep. Derek Lewis addresses the KPPAC attendees.

Rep. Robert GoForth addresses the KPPAC reception attendees.

KPPAC reception attendees network at the West Sixth Green Room in Lexington.

L to R: Sam Willett, Cathy Hanna, Rep. Danny Bentley, Ralph Bouvette and J Leon Claywell

Donate online to the Kentucky Pharmacists Political Advocacy Council Go to www.kphanet.org and click on the Advocacy tab for more information about KPPAC and the donation form. |17| www.KPHANET.org

KPhA Honors Dean Stowe Resolution to Recognize Dean Cindy Stowe as an Honorary Member of the Kentucky Pharmacists Association WHEREAS, throughout her career Dr. Cindy Stowe has worked tirelessly to advance the practice of pharmacy and promote the value of pharmacists as members of the healthcare team; WHEREAS, Dr. Stowe has served as Dean of the Sullivan University College of Pharmacy for the past 5 years where her vision and leadership have inspired faculty, preceptors and students; WHEREAS, Dean Stowe has been a long-standing member and contributor to the Kentucky Pharmacists Association, providing staunch support to the KPhA as it worked to advance its mission; WHEREAS, through her vast knowledge and experience in pharmacy practice, Dean Stowe has assisted KPhA and the broader pharmacy and healthcare communities in countless ways, serving as an expert voice regarding the practice of pharmacy; WHEREAS, through active engagement in KPhA and through her service as Chair of the KPhA Leadership Committee, Dean Stowe has served as a role model to pharmacists and student pharmacists, demonstrating the value of professional association involvement in advancing professional goals and creating a lasting legacy for future student pharmacists; WHEREAS, Dean Stowe will be leaving Kentucky on June 25, 2019 and relocating to Arkansas where she will assume the role of Dean at the University of Arkansas for Medical Sciences; WHEREAS, Dean Stoweâ&#x20AC;&#x2122;s knowledge, insight and commitment to KPhA and the profession will be sorely missed; NOW THEREFORE BE IT RESOLVED, that the KPhA House of Delegates bestow upon Dr. Stowe the title of Honorary Member of the KPhA in expression of our sincere appreciation for her unwavering support of KPhA and the profession of pharmacy.

Reminder: Safe Disposal of Controlled Substances went into Effect on July 14, 2018 SB 6 which requires the pharmacy to inform patients about safe disposal of controlled substances, took effect on July 14, 2018. The pharmacy can inform patients by posting a sign or by written or verbal communication. KPhA sells signage (13" x 25") for $10.60 (members) and $15.90 (non-members) with shipping/taxes included. Purchase from KPhA online: www.kphanet.org/store

|18| Kentucky Pharmacists Association | July/August 2019

July CPE Article Proton Pump Inhibitor (PPI) Use and Deprescribing By: Hayley Ziegler, PharmD, MBA and Mary K. Probst, PharmD, BCACP, BCGP The authors declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-19-007-H01-P &T 1.0 Contact Hours (0.10 CEU) Expires 08/01/22

KPERF offers all CE articles to members online at www.kphanet.org

Pharmacist Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1.

Describe the current approved indications and recommended duration of therapy for PPI use

Discuss adverse effects resulting from acute and chronic use of PPIs

Identify appropriate tapering regimens to avoid the return of symptoms after PPI discontinuation

Pharmacy Technician Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1.

Recognize commonly used PPIs

List adverse effects resulting from acute and chronic use of PPIs

Identify appropriate durations of therapy of PPIs in most patients

Proton pump inhibitors (PPI) are one of the most commonly prescribed medications globally. Consumer reports show that in 2012 PPIs accounted for $9.5 billion in sales in the United States.1 Numerous trials have emerged analyzing PPI prescribing trends and have shown a consistent and significant increase in use. This rise in utilization could be attributed to healthcare providers and patients underestimating the risks of chronic PPI use. For years, PPIs were thought to be relatively benign. With the increase in their prescribing, a multitude of adverse effects have been observed due to short- and, more so, their long-term use. In addition to overuse, studies have shown that up to 70% of patients who are prescribed a PPI do not have a clear, documented indication.2 Pharmacists and pharmacy technicians are some of the most accessible healthcare providers. The inclusion of pharmacy professionals in interdisciplinary teams has shown to reduce unnecessary PPI use, as well as facilitation of patient education, dose changes, monitoring, and alerting the prescribers of ongoing symptoms.3 By understanding appropriate indications and durations of therapy for individual agents, pharmacists and pharmacy technicians can play a large role in better patient care and improved outcomes.

cells. This mechanism allows prevention or repair of existing damage and irritation to the gastrointestinal mucosa. Irritation which could otherwise result in unpleasant symptoms such as throat burning, belching, and chest pain.4 There is little difference between the various PPIs in terms of efficacy, pharmacokinetics, and adverse effect profile.5 Each PPI has multiple FDA-approved indications, as well as off-label uses. Most include erosive esophagitis, duodenal ulcer, gastric ulcer, symptomatic gastroesophageal reflux disease (GERD) (without lesions), and heartburn. Off-label uses include nonsteroidal anti-inflammatory drug (NSAID)induced ulcer prevention and treatment, and dyspepsia. An all-inclusive list of each PPI, FDA-approved indication, and recommended durations of therapy can be seen in Table 1.

Short- and Long-term Adverse Effects As mentioned previously, evidence from studies has emerged that suggests an association between PPI use and multiple adverse effects. The majority of the studies were retrospective and observational in nature and revealed mild to moderate associations but did not prove cause and effect.6

One such organization that provides a review of published literature regarding emerging concerns related to long-term use of PPIs is the Mayo Clinic. There were several adverse There are six PPIs currently approved by the United States effects that were observed in chronic PPI use including hypoFood and Drug Administration (FDA). These include those magnesemia, vitamin B12 deficiency, bone fractures, Clostridiavailable over the counter (omeprazole, esomeprazole, and oides difficile infection (CDI), acute and chronic kidney dislansoprazole) and those only available with a prescription ease, dementia, and community-acquired pneumonia (CAP). (pantoprazole, dexlansoprazole, and rabeprazole). These medications inhibit gastric acid secretion by inhibiting hydro- The Mayo Clinic divided these adverse effects into categories of association as likely causative, association unclear, and gen, potassium-ATPase enzymes found on gastric parietal What are PPIs?

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Table 1 â&#x20AC;&#x201C; FDA-Approved Indication and Recommended Durations of Therapy 11-16 Medication Omeprazole

Esomeprazole

FDA-Approved Indication Erosive Esophagitis Duodenal Ulcer

4-8 weeks, additional 4-8 weeks may be considered if no response 4 weeks, may require additional 4 weeks

Gastric Ulcer

4-8 weeks

Symptomatic GERD (without lesions)

4 weeks

Heartburn

14 days

Erosive Esophagitis

4-8 weeks, additional 4-8 weeks if incomplete healing 4 weeks, may require additional 4 weeks if no resolution 6 months

Symptomatic GERD Prevention of NSAID-induced gastric ulcer Heartburn Pantoprazole Lansoprazole

Dexlansoprazole

Rabeprazole

Recommended Duration of Therapy

Erosive Esophagitis Associated with GERD Erosive Esophagitis

14 days

Symptomatic GERD

8 weeks, additional 8 weeks if not healed after initial duration 8 weeks, additional 8 weeks may be considered if recurrence or not healed after initial duration 8 weeks

Duodenal Ulcer

4 weeks

Gastric Ulcer

8 weeks

NSAID-associated Gastric Ulcer (Healing)

8 weeks

NSAID-associated Gastric Ulcer (Prevention) Heartburn

12 weeks

Erosive Esophagitis

8 weeks

Symptomatic GERD

4 weeks

Symptomatic GERD (nonerosive)

4 weeks

Erosive or Ulcerative GERD

4-8 weeks

Duodenal Ulcer

14 days

weeks

1. Long-term and high dosage use of PPIs should only occur under the supervision of a prescriber due to need for frequent monitoring for symptom relief and adverse effects.16 association unlikely causative, based on observations trials (Table 2).6 I will review each of these associations in more detail and highlight the available evidence to provide clarity surrounding their observations.

more than one year. Upon discontinuation of PPI therapy, these patientâ&#x20AC;&#x2122;s serum magnesium levels normalized. A metaanalysis of 109,798 patients observed a 43% increased risk of hypomagnesemia in patients taking PPIs. In 2011, the FDA Hypomagnesemia released a safety warning recommending routine monitoring of serum magnesium levels in those receiving long-term PPI First described in 2006, hypomagnesemia associated with PPI therapy.6 use was observed in patients who had been taking PPIs for |20| Kentucky Pharmacists Association | July/August 2019

Table 2 – Risks Associated with Long-Term PPI Use6 Adverse effect

Relative risk/Odds ratio (95% CI)

Quality of evidence

Hypomagnesemia

1.43 (1.08-1.88)

Low

Vitamin B12 deficiency

1.65 (1.58-1.73)

Low

1.26 (1.16-1.36) for hip fractures

Low

Likely causative

Association unclear Bone fractures

1.33 (1.15-1.54) for fractures at any site Clostridioides difficile infection

1.74 (1.47-2.85)

Low

Chronic kidney disease

1.50 (1.14-1.96)

Very low

Dementia

1.44 (1.36-1.52)

Very low

1.27 (1.11-1.46)

Very low

Unlikely causative Community-acquired pneumonia Vitamin B12 Deficiency

ed that histamine 2 receptor antagonists (H2RAs) were associated with an increased risk of CDI. This suggests the role of Gastric acid is necessary to facilitate the absorption of vitamin acid suppression in CDI development. A review of observaB12 in the terminal ileum. A study by Kaiser Permanente tional studies with 288,620 patients revealed a 65% increase showed a 65% increased risk for vitamin B12 deficiency in in CDI incidence among patients receiving PPIs, as well. 6 patients who received PPI treatment for greater than two Acute and Chronic Kidney Disease years compared to those who did not receive PPI treatment. However, it is not recommended by current treatment guideSeveral studies have revealed an association between use of lines to monitor serum vitamin B12 levels in patients receivPPIs and acute kidney injury (AKI) and chronic kidney dising long-term PPI therapy.6 It may be warranted to assess serum vitamin B12 levels if a patient exhibits signs and symp- ease (CKD). In the Atherosclerosis Risk in Communities Study, 10,482 patients with normal baseline renal function toms of vitamin B12 deficiency such as low hemoglobin, fa7 were followed for a median of 13.9 years. Results revealed tigue, heart palpitations, and altered mental status. that those who used PPIs had a 50% greater risk of CKD deBone Fractures velopment and a 64% increased risk of AKI. The proposed mechanism of CKD development is acute interstitial nephriMany studies have shown an increased risk of bone fractures tis, which if left untreated, could result in nephron injury.6 in individuals on continual PPI therapy. Several proposed Dementia mechanisms of this adverse effect include reduced calcium absorption resulting in decreased bone mineral density and inhibition of osteoclast activity. A meta-analysis of 18 obser- Recent prospective trials have suggested that long-term PPI use is associated with an increased risk in dementia. Accumuvational studies showed that PPI use was associated with a .6 lation of amyloid-β peptides is a presumed cause of Alzhei33% increase in fracture risk at any site mer’s disease. Studies have shown that lansoprazole has led Although observational studies have shown increased fracture to higher concentrations of amyloid-β in the brains of mice. risk, it cannot be concluded that long-term PPI use signifiPPIs increase amyloid synthesis and decrease amyloid degracantly affects the rate of bone density loss. In a study of 104 dation in the brain, as well. A prospective trial of 3076 papatients, 52 of whom used PPIs for greater than or equal to tients found a 38% increased risk of dementia and 44% infive years, and 52 non-PPI users, there was no significant dif- creased risk of Alzheimer’s disease in PPI users. Another ference between the two groups in mean T scores of the femo- study of 73,679 patients found a 44% increased risk of demenral neck, trochanter, total hip, and L1 through L4 vertebrae or tia among those receiving PPIs regularly.6 in overall bone mineral density.6 CAP CDI Unlike the other adverse effects which are associated with A link between PPI use and the development of CDI has been chronic use of PPIs, the incidence of CAP was observed with suggested by past studies. A meta-analysis of 42 observational recent initiation of PPI treatment, defined as less than or studies showed an increased risk of first incident and recurrent equal to seven days from beginning therapy. A meta-analysis CDIs in those receiving chronic PPI therapy. It was also not- of eight observational studies showed an increased overall risk |21| www.KPHANET.org

of pneumonia in those who used PPIs. Subgroup analysis 3. showed that greater risk of developing pneumonia was associated with higher doses of PPI and risk decreased with longer duration of therapy.6 4. Deprescribing To avoid the potential adverse effects that were previously described, it is important to identify those patients eligible for 5. deprescribing. Deprescribing, or discontinuation as it is also referred to in the literature, can mean many things. Its definition includes stopping, stepping down, or reducing doses of a medication to improve patient outcomes or reduce complexity. Stopping can be done either by abrupt discontinuation or 6. a tapering regimen. In the instance of PPIs, stepping down involves either abrupt discontinuation or tapering followed by initiation of an H2RA. Reducing a PPI could be achieved by recommending intermittent use, on-demand use, or initiation 7. of a lower dose. Intermittent use is described as daily intake for a finite period to produce resolution of symptoms or healing of lesions. On-demand use is defined by intake until resolution of symptoms, at which point the PPI is discontinued. The PPI is resumed at return of symptoms.3 8. In patients taking PPIs long-term, abrupt discontinuation is often recommended against due to risk of hypergastrinemia and rebound acid hypersecretion that can occur. In addition, the majority of patients who experience rebound symptoms after PPI discontinuation have relief of symptoms after re9. initiation of a PPI.8 It is for this reason that a tapering regimen is often recommended. The dose taper is based on the patient’s current dose of PPI. If the patient is not taking the minimum dose, they should be instructed to decrease their dose by 50% every two to four weeks until it is discontinued. 10. If the patient is taking the lowest possible dose, the patient should be instructed to take the dose every other day for two to four weeks.9 The patient’s symptoms should be monitored 11. for worsening, and if this occurs, the PPI can be resumed at the previous dose. An alternative recommendation is to initiate an intermittent H2RA daily as needed to alleviate these 12. symptoms.10 Conclusion

Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Can Fam Physician. 2017 May; 63(5): 354-364. Kinoshita Y, Ishimura N, Ishihara, S. Advantages and disadvantages of long-term proton pump inhibitor use. J Neurogastroenterol Motil. 2018 Apr; 24(2): 182-196. Li, X. (2004). Comparison of inhibitory effects of the proton pump-Inhibiting drugs omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole on human cytochrome p450 activities. Drug Metabolism and Disposition, 32(8), pp.821-827. Nehra, A., Alexander, J., Loftus, C. and Nehra, V. (2018). Proton Pump Inhibitors: Review of Emerging Concerns. Mayo Clinic Proceedings, 93(2), pp.240-246. Vitamin deficiency anemia. Mayo Clinic website. https://www.mayoclinic.org/diseasesconditions/vitamin-deficiency-anemia/symptomscauses/syc-20355025. Published 2016 Nov; accessed 2019 May. Haastrup P, Paulsen MS, Begtrup LM, Hansen JM, Jarbol DE. Strategies for discontinuation of proton pump inhibitors: a systematic review. Fam Pract. 2014; 31(6): 625-630. Bundeff AW, Zaiken K. Impact of clinical pharmacists’ recommendations on a proton pump inhibitor taper protocol in an ambulatory care practice. J Manag Care Pharm. 2013; 19(4): 325-333. Proton pump inhibitor (PPI) deprescribing algorithm. Deprescribing.org. Published 2016 Sept; accessed 2019 May. Prilosec [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2008. Nexium [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2014.

13. Protonix [package insert]. Konstanz, Germany; Wyeth Pharmaceuticals, Inc.; 2012.

PPIs are some of the most commonly used medications in the United States. Until recently, they were thought to have very 14. Prevacid [package insert]. Deerfield, IL; Takeda Pharmafew adverse effects. Trials have revealed numerous potential ceuticals America, Inc.; 2012. adverse effects as a result of short- and long-term use. It is the responsibility of the pharmacist and pharmacy technicians to 15. Dexilant [package insert]. Deerfield, IL; Takeda Pharmaceuticals America, Inc.; 2012. be aware of appropriate indications for PPIs and to be able to identify patients who might benefit from deprescribing. 16. Aciphex [package insert]. Charlotte, NC; FSC Laboratories, Inc.; 2014. References 1.

Proton pump inhibitors (PPI) medicines review. Consum- 17. Whetsel T, Zweber A. Chapter 13: Heartburn and dyspepsia. In: Krinsky DL, Ferreri SP, Hemstreet B, et al. er Reports website. Handbook of nonprescription drugs: an interactive aphttps://www.consumerreports.org/cro/2013/07/bestproach to self-care, 19th edition; 2017. drugs-to-treat-heartburn-and-gerd/index.htm. Published 2013 July; accessed 2019 Apr.

Marks DJB. Time to halt the overprescribing of proton pump inhibitors. Pharm J. 2016 Aug 8; 8(8).

|22| Kentucky Pharmacists Association | July/August 2019

July 2019â&#x20AC;&#x201D; Proton Pump Inhibitor (PPI) Use and Deprescribing 1. Which of the following PPI medications is NOT available over the counter for patients to access without a prescription or monitoring for appropriate duration of therapy? a. b. c. d. 2.

Omeprazole Pantoprazole Esomeprazole Lansoprazole Regarding omeprazole therapy, which of the following indications is appropriately matched with the approved duration of therapy?

a. b. c. d. 3.

Symptomatic GERD without lesions; 8 weeks Heartburn; 4 months of needed Erosive esophagitis; 4-8 weeks Gastric ulcer; 14-21 days Which of the following adverse effects is associated with recent initiation of a PPI?

a. b. c. d. 4.

Acute kidney injury Community-acquired pneumonia (CAP) Vitamin B12 deficiency Dementia In patients taking a PPI long term, which of the following deprescribing techniques is often recommended AGAINST due to the risk of hypergastrinemia and rebound acid hypersecretion?

Switching from a PPI to a H2RA Decreasing the dose of the PPI to the next lowest dose c. Changing to every other day dosing d. Stopping the PPI completely 5. Based on the Mayo Clinicâ&#x20AC;&#x2122;s literature review of emerging concerns, which of the following adverse effects associated with long-term PPI use has been found to have a likely causative association?

Take 20 mg twice daily for one week, then 20 mg daily for one week, then 10 mg daily for one week, then discontinue b. Take 20 mg twice daily for two weeks, then 10 mg twice daily for one week, then 20 mg daily for one week, then 10 mg daily for one week, then discontinue c. Take 20 mg twice daily for three weeks, then 10 mg twice daily for three weeks, then 10 mg daily for three weeks, then 10 mg every other day for three weeks, then discontinue d. Take 20 mg twice daily for six weeks, then 10 mg twice daily for six weeks, then 10 mg daily for six weeks, then 10 mg every other day for three weeks, then discontinue 7. Which of the following is an appropriate recommendation regarding the duration of lansoprazole therapy in a patient experiencing heartburn? a. b. c. d. 8.

2 weeks 4 weeks 8 weeks 12 weeks Which of the following is an FDA-approved indication of rabeprazole?

a. b. c. d. 9.

NSAID-associated gastric ulcer Heartburn Erosive esophagitis Duodenal ulcer A patient is seen by their primary care provider (PCP) and diagnosed with symptomatic GERD

a. b.

a. b. c. d. 6.

Hypomagnesemia Bone fractures Dementia Community-acquired pneumonia (CAP) Your patient is currently taking omeprazole 40 mg twice daily for maintenance of erosive esophagitis. The patient and provider have come to you regarding a plan for discontinuation of therapy to minimize return of symptoms and prevent relapse as the patient has been on PPI therapy for over a year. What is your suggestion for the most tolerable tapering regimen?

without lesions. Which of the following is an appropriate initial duration of therapy for this patient? a. b. c. d.

2 weeks of daily PPI, then reassess 4 weeks of daily PPI, then reassess 8 weeks of daily PPI, then reassess 12 weeks of daily PPI, then reassess

10. The results of the Atherosclerosis Risk in Communities Study revealed that there was a 50% greater risk of developing __________________ in patients taking a PPI. a. b. c. d.

Acute kidney injury (AKI) Dementia Chronic kidney disease (CKD) Vitamin B12 deficiency

|23| www.KPHANET.org

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

Expiration Date: 08/01/2022 Successful Completion: Score of 80% will result in 1.0 contact hour or .10 CEUs. TECHNICIANS ANSWER SHEET July 2019 — Proton Pump Inhibitor (PPI) Use and Deprescribing (1.0 contact hour) Universal Activity # 0143-0000-19-007-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. 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 Achieved 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 If yes, please explain on a separate sheet. Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #__________________________ Birthdate _______ (MM)_______(DD)

PHARMACISTS ANSWER SHEET July 2019 — Proton Pump Inhibitor (PPI) Use and Deprescribing (1.0 contact hour) Universal Activity #0143-0000-19-007-H01-P Name _______________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D

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 Achieved 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 If yes, please explain on a separate sheet. Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy |24| Kentucky Pharmacists Association | July/August 2019

Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines The following broad guidelines should guide an author to  completing a continuing education article for publication in The Kentucky Pharmacist.  



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

Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not  pertinent to technicians, that needs to be stated clearly at the beginning of the article.

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Include 3 to 5 objectives using SMART and measurable verbs.

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Include a quiz over the material. Usually between 10 to 12 multiple choice questions. Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers. When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article. Articles should address topics designed to narrow gaps between actual practice and ideal practice in pharmacy. Please see the KPhA website (www.kphanet.org) under the Education link to see previously published articles. Articles must be submitted electronically to the KPhA director of communications and continuing education (info@kphanet.org) by the first of the month preceding publication.

|25| www.KPHANET.org

August CPE Article Testosterone Replacement Therapy in Elderly Men By: Chelsey Llayton, PharmD The author declares that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-19-008-H01-P &T 1.0 Contact Hour (0.10 CEU) Expires 8/01/22

KPERF offers all CE articles to members online at www.kphanet.org

Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1.

Recognize symptoms and potential causes of hypogonadism

Compare treatment options for hypogonadism

Review safety and efficacy to safely advise on testosterone replacement

Describe appropriate administration of testosterone dosage formulations

State the appropriate monitoring for a patient receiving testosterone replacement therapy

or radiation to the testes and trauma.3 Low levels of LH, FSH, and testosterone is classified as secondary hypogonadTestosterone levels are known to gradually decrease in men ism which can be caused by conditions such as: hyperprolacas they age. The European Male Aging Study demonstrated tinemia, severe obesity, hypothalamic or pituitary tumors, the an average decrease in total testosterone of 8.6% and free tesuse of glucocorticoids, or androgen-deprivation therapy with tosterone of 30% over 4 decades of 3,369 men in 8 countries.1 gonadotropin-releasing hormone agonists, androgenicâ&#x20AC;&#x201C; Hypogonadism in males is due to low testosterone levels and anabolic steroid withdrawal syndrome, head trauma, and is associated with many distressing symptoms including fapituitary surgery or radiation.3 tigue, decreased muscle mass and strength, joint and muscle Treatment of Low Testosterone pain, increased waist size and difficulty losing weight, decreased libido, difficulty maintaining and establishing erecTreatment options vary based on the type of hypogonadism tions, changes in sleep patterns, and trouble concentrating.2,4 present. If a patient has secondary hypogonadism, agents that However, there has been conflicting data regarding the safety increase testicular output of testosterone or block the metaboand efficacy of testosterone replacement therapy in elderly lism of testosterone may be tried before testosterone therapy if men (age â&#x2030;Ľ65 years). the patient wishes to preserve fertility.2,3 These include clomiphene which antagonizes the negative feedback of estradiol, Physiology of Testosterone increasing levels of LH and FSH; human chorionic gonadoTestosterone is produced through a negative feedback mechatropin (HCG) which stimulates the production of testosnism. Low levels of testosterone stimulate the release of gonterone; or anastrozole which blocks the metabolism of testosadotropin-releasing hormone (GnRH) from the hypothalaterone to estradiol through aromatase.2 Primary hypogonadmus which triggers the pituitary gland to release luteinizing ism requires testosterone replacement therapy.2 Lifestyle hormone (LH) and follicle-stimulating hormone (FSH).2,3 modifications may also be tried before medications and/or in LH and FSH then stimulate Leydig cells to produce testosconjunction with pharmacologic therapy. Weight loss terone and Sertoli cells to facilitate spermatogenesis in the through aerobic and weight-resistant activities is associated testes.2,3 Testosterone can either be metabolized to estradiol with an increase in testosterone because aromatase is stored through aromatase or dihydrotestosterone through 5-alpha in adipose tissue.2 Therefore, the more adipose tissue a pareductase.2 If the testes are unable to produce testosterone tient has, the more aromatase present to break down testosdespite normal or high levels of LH and FSH, this is known terone.2 Smoking and excess alcohol intake can also lead to as primary hypogonadism which can be caused by conditions androgen deficiency and erectile dysfunction.2 such as: Klinefelter syndrome, cryptorchidism, HIV infection, Introduction

|26| Kentucky Pharmacists Association | July/August 2019

Table 1: Advantages and Disadvantages of Available Testosterone Formulations Formulation

Typical Starting Doses

Intramuscular: testosterone cypionate or enanthate

75–100 mg IM/wk or 150–200 mg IM every 2 wk or

Infrequent dosing

Requires IM injection

Intramuscular:

750 mg IM, followed by 750 mg at wk 4, then 750 mg every 10 wk

Infrequent dosing

Peaks and troughs in concentration associated with fluctuations in symptoms Requires IM injection of a large volume

Buccal bioadhesive tablet

30 mg twice daily

Easy administration

Possible gum-related adverse effects

Nasal gel

11 mg 2-3 times daily

Rapid absorption

Possible nasal irritation

Infrequent dosing

Dosing frequency Requires surgical insertion

testosterone undecanoate

Pellets

Transdermal patch Topical gel or cream

600-1200 mg pellets every 3-5 months, number of pellets vary 1-2 patches, 2-4 mg every 24 hr 50-100mg/day

Advantages

Disadvantages

Peaks and troughs in concentration associated with fluctuations in symptoms

Must avoid vigorous activity for week after insertion Infrequent dosing

May need 2 patches/day

Easy administration Flexibility of dosing

Possible skin irritation Risk of transfer

Well tolerated

Possible skin irritation

If testosterone replacement therapy is the best option for the patient, there are various dosage forms to consider which are listed in table 1. An intramuscular injection can be given weekly, bi-weekly, or every 10 weeks depending on dosage form, however, peaks and troughs in concentrations of testosterone may lead to fluctuations in symptoms.2,3 A buccal bioadhesive tablet may be applied to the gums twice daily but gum-related adverse events have been reported in 18% of patients.3 A nasal gel requires dosing two or three times daily and may cause nasal irritation.3 Implantable pellets require surgical insertion subcutaneously every 3 to 5 months and vigorous activity should be avoided for up to 7 days after insertion.2,3 Topical formulations include a 24-hour patch, commercial gels or compounded creams or gels. Compounding a cream or gel allows for individualized dosing based on patient lab values and symptoms.2 Topical creams or gels should be applied to a clean, dry area with a large surface area but one that is easy to cover such as axilla, upper arms, shoulders, or thighs to avoid accidental transference to young children, women, and pets.2 Patients need to keep the area dry for ≥2 hours so they should avoid swimming, showering, or excessive sweating in that time.2 Monitoring Requirements Treatment with testosterone requires close monitoring of lab

values, adverse events, and improvement of symptoms. Potential adverse effects include acne, mood swings and aggression, testicular atrophy (shrinking of the testes), gynecomastia, increase in prostate specific antigen (PSA), increased estradiol, and increased hemoglobin and hematocrit levels.2,3 Recommendations for monitoring values can be found in table 2. Testosterone, estradiol, hemoglobin, and hematocrit levels should be measured at 3 to 6 months after initiation, then annually per the Endocrine Society guidelines.3 Professional Compounding Centers of America (PCCA) recommends more frequent monitoring at 4-6 weeks after initiation, then every 3-6 months, and annually once stable.2 In general, target concentrations should be in the mid-normal range for testosterone, 350-750 ng/dL.3 If hematocrit levels become higher than normal (>54%), testosterone therapy should be stopped until they return to normal and then restarted at a lower dose.3 PSA should be measured 3 to 6 months after initiation then in accordance with guidelines for prostate cancer screening depending on the age and race of the patient.2,3 A patient should obtain urological consultation if there is an increase in PSA ≥1.4 ng/mL within a year of initiating testosterone therapy, a confirmed PSA >4 ng/mL at any time, or substantial worsening of lower urinary tract symptoms (LUTS).3 Lastly, bone mineral density should be measured 1|27| www.KPHANET.org

Table 2: Recommended Monitoring Parameters of Testosterone Replacement Therapy Monitoring Parameter Total testosterone Estradiol Hemoglobin and hematocrit PSA

Bone Mineral Density

Frequency of Monitoring 3-6 months after initiation, then annually (per the Endocrine Society) OR 4-6 weeks after initiation, then every 3-6 months, and annually once stable (per PCCA)

3-6 months after initiation then in accordance with guidelines for prostate cancer screening

1-2 years after initiation

Notes Target concentrations should be in the midnormal range (350-750 ng/dL)

For hematocrit levels >54%: stop testosterone therapy until returned to normal, restart at a lower dose Refer to urology for: Increase in PSA ≥1.4 ng/mL within a year of initiating testosterone, confirmed PSA >4 ng/mL at any time, and/or substantial worsening of LUTS Recommended in patients with osteoporosis or a history of low trauma fractures

2 years after initiation in patients with osteoporosis or a histo- cancer risk calculator, moderate LUTS, or severe cardiovasry of low trauma fractures.2 cular, renal or hepatic disease.4 Testosterone Use in Elderly Men

Results of the T-Trials

Previous studies of the effects of testosterone in older men have not been conclusive. While most have shown a significant increase in sexual function, some have shown an improvement in physical performance testing, such as walking speed and distance, and change in lean body mass while others have not.5-9 In 2003, the Institute of Medicine concluded that evidence demonstrating that testosterone treatment in older men with low testosterone was beneficial was insufficient and recommended that the National Institute on Aging (NIA) fund a coordinated set of trials to assess the benefit and risk of treatment in this population.4 As a result, the NIA funded the Testosterone Trials (TTrials); a set of 7 doubleblind, placebo-controlled trials in 788 men with a mean age of 72 years at 12 US academic medical centers.4 In order to participate, subjects must have been eligible for 1 of the 3 main trials which included the Sexual Function Trial, the Physical Function Trial, and the Vitality Trial.

The outcomes of the seven TTrials can be seen in table 3; the three main trials will be discussed here. The primary outcome of the Sexual Function Trial was the change in baseline score for sexual activity (question 4) on the Psychosexual Daily Questionnaire.10 Subjects in the treatment group showed improvement in sexual activity with a treatment effect of 0.58 (p<0.01).10 Testosterone treatment was associated with increased libido and erectile function (p<0.01 for both).10 Men in the treatment group were also more likely to report improved sexual desire since the beginning of the trial (p<0.01).10

Patients were assigned to either testosterone (1% gel in a pump bottle) or placebo gel similar in appearance, consistency, and odor.4 Subjects were started at 5 g daily which was titrated based on testosterone levels at 1, 2, 3, 6, and 9 months to obtain a testosterone concentration within normal range for men 19-40 years of age.4 Subjects were included if they were age ≥65 years and had an average serum testosterone ≤275 ng/dL of 2 morning readings.4 Subjects were excluded if they had a history of prostate cancer or any other cancer, a high risk of prostate cancer based on the prostate

The Physical Function Trial’s primary outcome was the fraction of men who increased the distance walked in the 6minute walk test by ≥50 meters.10 Self-reported mobility and function were also assessed using physical function domain scale of the 36-item Medical Outcomes Short Form Survey (SF-36).10 Testosterone did not substantially increase the percentage of men who increased the distance walked in 6 minutes by ≥50 meters from baseline (OR 1.42, p=0.20) or the mean difference in change from baseline (4.09m, p=0.28).10 However, men in the treatment group were more likely to report that their walking ability had improved since the beginning of the trial (p=0.002).10 The primary outcome of the Vitality Trial was the percentage of men whose score on the Functional Assessment of Chronic Illness Therapy (FACIT)–Fatigue scale increased by ≥4 points.10 The treatment group did not have a significant dif-

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Table 3: Summary of the Outcomes and Results of the Seven TTrials

Trial Sexual Function

Physical Function

Vitality

Cognitive Function

Anemia

Bone

Cardiovascular

Primary Outcome Change from baseline in score for sexual activity (question 4) on the Psychosexual Daily Questionnaire

Results for Primary Outcome Treatment effect of 0.58; p<0.01

Fraction of men who increased the distance walked in the 6-minute walk test by ≥50 meters from baseline

No significant difference among groups, OR 1.42; p=0.20

Percentage of men whose score on the Functional Assessment of Chronic Illness Therapy– Fatigue scale increased by ≥4 points Change from baseline in score for delayed paragraph recall by the Wechsler Memory Scale, Revised, Logical Memory II Increase in hemoglobin by ≥1.0 g/dL and correction of anemia in those with unexplained mild anemia Change from baseline to 12 months in vBMD of trabecular bone in lumbar spine assessed using QCT Change from baseline to 12 months in noncalcified coronary artery plaque volume, determined by CTA

No significant difference among groups, OR 1.23; p=0.30

Additional Results/Comments Testosterone treatment was associated with increased libido and erectile function (p<0.01 for both) Men in the treatment group were more likely to report improved sexual desire since the beginning of the trial (p<0.01) Mean difference in change from baseline was 4.09m; p=0.28 Men in the treatment group were more likely to report that their walking ability had improved since the beginning of the trial (p=0.002) Men in the treatment group were more likely to report that their energy was better at the end of the trial (p<0.001)

No significant difference among groups, treatment effect of 0.07; p=0.88

Did not improve visual memory, spatial ability, immediate paragraph recall, executive function, global cognitive function, or subjective memory complaints either

OR 31.5; p=0.002

Mean increase in hemoglobin from baseline was 1.1 mg/dL; p=0.016

OR 6.8, p<0.001

Did not measure fracture risk

Treatment associated with median change of 28 vs 8 mm3 in plaque volume, OR 41; p<0.003

Need a larger and longer trial to determine if increased plaque volume is associated with increased cardiovascular risk

ference in vitality from placebo as shown by an increase of ≥4 testosterone were more likely to report that their energy was points on the FACIT-Fatigue scale (Odds ratio (OR) 1.23, better at the end of the trial (p<0.001).10 The adverse events p=0.30).10 Similarly with the other main trials, men receiving reported in the TTrials demonstrates that treatment with tes|29| www.KPHANET.org

tosterone is not without risk. More men in the treatment arm experienced increases in PSA ≥1.0 ng/mL (23 vs 8).4 Prostate cancer was diagnosed in one man receiving testosterone during the year of treatment, there were none diagnosed in the placebo arm. In the year after the trial, two men in the treatment arm were diagnosed and one in the placebo arm was diagnosed. More men on testosterone also experienced polycythemia with hemoglobin ≥17.5 g/dL compared to placebo (7 vs 0).4 There was not found to be difference in cardiovascular events between the two groups as there were seven total in each.4

If there is an increase in PSA ≥1.4 ng/mL or a level >4 pg/ mL the patient should be referred for a consult with urology.3 If hemoglobin or hematocrit levels become higher than normal, testosterone therapy should be stopped until they return to normal and the dose of testosterone decreased when reinitiated.3 Finally, symptoms should be assessed along with patient labs to monitor for improvement and the continued need for therapy. References 1.

Wu F, Tajar A, Pye S et al. Hypothalamic-Pituitary-Testicular Axis Disruptions in Older Men are Differentially Linked to Age and Modifiable Risk Factors: The European Male Aging Study. J Clin Endocrinol Metab. 2008; 93 (7): 2737-45.

Biundo B. Low Testosterone in Men – Male Hypogonadism Packet. PCCA. 2016. Document #9874.

Bhasin S, Brito J, Cunningham G, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018; 103(5): 1715-1744.

Snyder P, Bhasin S, Cunningham G, et al. Lessons from the Testosterone Trials. Endocrine Reviews. 2018; 39 (3): 369-86.

Snyder P, Peachy H, Hannoush P, et al. Effect of Testosterone Treatment on Body Composition and Muscle Strength in Men Over 65 Years of Age. J Clin Endocrinol Metab. 1999; 84 (8): 2647-53.

Page S, Amory J, DuBois Bowman F, et al. Exogenous Testosterone Alone or With Finasteride Increases Physical Performance, Grip Strength, and Lean Body Mass in Older Men with Low Serum T. J Clin Endocrinol Metab. 2005; 90 (3): 1502-10.

Travison T, Basaria S, Storer T et al. Clinical Meaningfulness of the Changes in Muscle Performance and Physical Function Associate with Testosterone Administration in Older Men with Mobility Limitation. J Gerontology. 2011; 66 (10): 1090-99.

Srinivas-Shankar U, Roberts S, Connolly M , et al. Effects of Testosterone on Muscle Strength, Physical Function, Body Composition, and Quality of Life in Intermediate- Frail and Frail Elderly Men: A Randomized, Double-Blind, Placeb0- Controlled Study. J Clin Endocrinol Metab. 2010: 95 (2): 639-50.

Gray P, Singh A, Woodhouse L, et al. Dose-Dependent Effects of Testosterone on Sexual Function, Mood, and Visuospatial Cognition in Older Men. J Clin Endocrinol Metab. 2005; 90 (7): 3838-46.

Conclusion The benefit of testosterone replacement in symptomatic men ≥65 years and older is variable. Sexual function was improved in men treated with testosterone gel compared to placebo, but little to no improvement was measured in physical function, vitality or cognitive function, though patients did report perceived improvement.4,10-11 Volumetric bone density (vBMD) of trabecular bone in the lumbar spine was significantly increased over one year of treatment compared to placebo, however, fracture risk was not assessed in the Bone Trial so the clinical benefit on bone health remains unknown.12 There are also adverse effects to consider with testosterone replacement therapy. PSA levels were increased ≥1.0 ng/mL in significantly more men in the treatment group compared to placebo; one of those men was diagnosed with prostate cancer in the year of treatment, and two more were diagnosed in the following year compared to one in the placebo group.4 The Anemia Trial showed that hemoglobin was significantly increased in the treatment group compared to placebo, and while that was beneficial for patients who are anemic for unknown causes, the risk of polycythemia is increased in men who are not anemic and treated with testosterone.4 The cardiovascular risk associated with testosterone use remains unclear from the TTrials. While the number of cardiovascular events did not vary between the treatment and placebo groups, noncalcified coronary artery plaque volume was significantly increased in the treatment group of the Cardiovascular Trial.4 A larger trial with a longer follow-up period is necessary to determine if this surrogate marker is associated with increased cardiovascular risk.

10. Synder P, Bhasin S, Cunningham G, et al. Effects of Testosterone Treatment in Older Men. NEJM. 2016; 374 (7): 611-24. 11. Resnick S, Matsumoto A, Stephens-Shield A, et al. Testosterone Treatment and Cognitive Function in Older Men with Low Testosterone and Age-Associated Memory Impairment. JAMA. 2017; 317 (7): 717-27.

12. Synder P, Kopperdahl D, Stephens-Shields A, et al. Effect of TestosAs with any treatment option, benefit versus risk must be asterone Treatment on Volumetric Bone Density and Strength in Older sessed for and discussed with each individual patient. TestosMen with Low Testosterone. JAMA. 2017; 177 (4): 471-79. terone therapy is not recommended for all men aged ≥65 years, however, those who are symptomatic and have low testosterone levels may see a benefit from treatment with testosterone. Due to potential serious adverse events, close monitoring is essential if testosterone replacement is chosen as the best option. PSA and hemoglobin/hematocrit levels should be measured at baseline and at least 3-6 months after initiation.3

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August 2019 — Testosterone Replacement Therapy in Elderly Men 1.A 65-year-old man presents with hypogonadism, obesity, COPD, hypertension, and hypothyroidism. Which of this patient’s past medical history is a potential cause of hypogonadism? a. COPD b. Hypertension c. Hypothyroidism d. Obesity 2.Which symptom would be consistent with a low concentration of testosterone? a. Weight loss b. Priapism c. Fatigue d. Acne 3.Which medication would help block the metabolism of testosterone?

6.Potential efficacy of testosterone treatment was demonstrated for which effect with a statistically significant difference from placebo in the primary outcome of a TTrial? a. Walking distance b. Vitality c. Sexual activity d. Delayed paragraph recall 7.Where is an appropriate location to apply testosterone gel? a. Forearm b. Foot c. Hands d. Upper shoulders 8.True or False: an implantable testosterone pellet may be placed by a pharmacist in a pharmacy?

a. True b. False 9.JD is a 70-year-old patient with a PMH of hypertension, a. Anastrozole stroke 10 years ago, and a hip fracture 4 years ago, who has b. Clomiphene been treated with testosterone gel for two years. What c. Estrogen would be an appropriate monitoring value for testosterone d. HCG 4.A patient on testosterone therapy reports to the pharmacy therapy to obtain at the next follow-up based on this pawith complaints of having symptom control some of the tient’s PMH? time but with random periods of worsening symptoms, dea. BMD spite being adherent. Based on this complaint, what testos- b. Estradiol terone formulation is the patient likely taking? c. PSA d. SCr a. Buccal adhesive tablet 10.How long after initiation of testosterone replacement b. Short-acting injection treatment should a patient’s PSA be measured? c. Topical gel d. Transdermal patch a. 1 month 5.What is an example of an adverse event a patient may b. 3 months experience from taking testosterone? c. 12 months d. 24 months a. Testicular atrophy b. Decreased libido c. Joint pain d. Headache

KPERF Launches New Continuing Education Online Platform We have transitioned to a new Continuing Education platform. In the past year we have integrated online CPE, but it was not a comprehensive online solution. Now, when you complete your CPE article activities online the credits will be automatically sent to CPE Monitor. You can also begin an activity, pause, and come back to complete the credits. You will also receive an email once your activity is complete, so that you can keep track of the activities you complete. We will continue to allow for mailed quiz submissions, but highly recommend that you try out the new platform! Please contact Sarah Franklin (sarah@kphanet.org or 502.227.2303) with any questions. We are happy to assist you in obtaining your FREE CPE credits through The Kentucky Pharmacist! 2019 Articles: www.kphanet.org/the-kentucky-pharmacist-cpe-articles-2019 2018 Articles: https://www.kphanet.org/2018-continuing-education-articles

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Expiration Date: 8/01/22 Successful Completion: Score of 80% will result in 1.0 contact hours or .10 CEUs. TECHNICIANS ANSWER SHEET. August 2019 â&#x20AC;&#x201D; Testosterone Replacement Therapy in Elderly Men (1.0 contact hours) Universal Activity # 0143-0000-19-008-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 2. 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 Achieved 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 If yes, please explain on a separate sheet. Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

PHARMACISTS ANSWER SHEET August 2019 â&#x20AC;&#x201D; Testosterone Replacement Therapy in Elderly Men (1.0 contact hours) Universal Activity # 0143-0000-19-008-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________

PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. 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

Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation |32| Kentucky Pharmacists Association | July/August 2019

Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

Give Back with AmazonSmile! Did you know that Amazon donates 0.5% of the price of your eligible AmazonSmile purchases to the Kentucky Pharmacy Education and Research Foundation Inc.? This contribution supports our educational initiatives. All you need to do is: Step One: Go to Smile.Amazon.com (https://smile.amazon.com/ch/31-1012133) Step Two: Choose the Kentucky Pharmacy Education and Research Foundation Inc. as your charity. Step Three: Whenever you are shopping, start at Smile.Amazon.com Take advantage of this easy way to shop and help the KPERF!

Save the Date! KPhA Annual Meeting & Convention Louisville Marriott Downtown June 11â&#x20AC;&#x201D;14, 2020

Campus Corner UK College of Pharmacy Strengthens Efforts to Address Alumni Needs the College on professional accomplishments. Mejia will also manage job postings within the College’s LinkedIn page and alumni groups and assist with regular communication between the College and alumni. In addition to Mejia, Kacie Miller was recruited to the College to serve as the assistant director of philanthropy, a new position created to help the College’s mission of increasing scholarship opportunities for students. Miller will work alongside senior director of philanthropy Mary Beth Neiser, helping match student need with alumni giving priorities. Miller will also help develop the College’s monthly giving subscription program, which aims to provide a simple and more affordable giving option for alumni and friends.

The UK College of Pharmacy recently hired Rosa Mejia and Kacie Miller in an effort to create a more robust focus on student and alumni development and success. In addition, NiMiller joined the College in January 2019. She previously cole Keenan has been promoted to the role of Director of Stu- worked with UK’s Office of Technology Commercialization dent Success and Career Development. and UK’s Office of Philanthropy. She has several years of experience in fundraising with corporate and foundation doKeenan will work with students to help identify, prepare for, nors. Prior to coming to UK, Miller worked in marketing and and procure various professional opportunities and career communications at liberal arts colleges throughout Kentucky. placements, including but not limited to residency training, A lifelong Kentucky native, she received a B.A. from Western fellowships, and graduate programs. She will also oversee Kentucky University and an M.S. from the University of Keninitiatives involving student health and well-being. tucky. “I’m excited and honored to join the College of PharMejia, the new director of alumni relations joined the College macy. The College has an outstanding reputation throughout on May 13, 2019, with a goal of increasing alumni engagethe country and I’m looking forward to meeting our alumni ment and providing additional value to our alumni network. and helping them find ways to get involved with our current She will work closely with Keenan and the College’s Office of students and educational programs and initiatives." Student Success & Wellness to help new graduates navigate a R. Kip Guy, dean of the UK College of Pharmacy noted, more competitive job market. Keenan and Mejia hope to fos“With the nationally tightening job market in pharmacy and ter a young alumni network that provides career tools, access continued increases in costs of pharmacy education, the Colto resume workshops, career counseling, mentorship opportulege has recognized that we need to do more to prepare our nities, and resources for alumni to engage at every stage of students to successfully compete for jobs and to help our their career. alumni to retain and transition between jobs. We also need to Mejia brings several years of experience in student engageensure that we can offset the increased tuition costs for attendment and most recently served as a recruiting and admissions ing the College with need-based financial aid. These hires coordinator at the College of Public Health. Mejia came to represent a concerted effort to organize our efforts to best UK from Houston, Texas where she received a Bachelor of serve our past, present, and future students." Arts degree in Biology and a Master of Arts degree in Higher Education Administration from Sam Houston State University. “I am thrilled to be at a college with such a great reputation and alumni base. I look forward to connecting with graduates and discovering how the College can continue to add value,” said Mejia. She noted, “With how competitive the job market is, I think it’s important that our alumni be able to take full advantage of the incredible network we have. I want to ensure they get the resources they need from us.”

jobs.kphanet.org

Mejia’s role will also include managing the dean’s annual tour throughout Kentucky, as well as Homecoming events, overseeing alumni boards, and connecting alumni to current students. Alumni are encouraged to contact Mejia with questions regarding class reunions, volunteer opportunities, or to update |34| Kentucky Pharmacists Association | July/August 2019

THE location for pharmacy job seekers + employers for targeted positions.

Thank You for Your Service Please join us in thanking our Board of Director members who completed their terms for their service to KPhA and its members. We recognize you for your individual contributions to the success of KPhA.

KPhA Treasurer Duane Parsons receives a recognition award from 2018-2019 KPhA Chair Chris Harlow.

2018-2019 KPhA Chair Chris Harlow recognizes Joel Thornbury as the past president representative

2018-2019 Chair Chris Harlow recognizes outgoing Board of Directors member Jeff Mills.

Mark Glasper and President Chris Palutis present Chair Chris Harlow with a recognition award for his term as Chair.

Speaker of the House Tyler Stevens receives a recognition award from 20182019 Chair Chris Harlow.

Dharti Patel, UK College of Pharmacy Representative and Stephen Drog, SUCOPHS pictured with Chair Chris Harlow.

KPhA sends email announcements weekly. If you arenâ&#x20AC;&#x2122;t receiving: eNews, Legislative Updates and other important announcements, send your email address to info@kphanet.org to get on the list. |35| www.KPHANET.org

Welcome to KPhA! We’re so happy to have you! The list reflects new memberships received from May1, 2019— June 30, 2019 Christina Amburgey Pharmacist

Michael Perdue Pharmacist

Amanda Blankenship Pharmacist

Kara Sermersheim Pharmacist

Curtis Bradley Pharmacist

Julie Spivey Pharmacist

Janna Kaufman Pharmacist

Nicole Wallace Technician

Leo Parrino Pharmacist

David Whittaker Pharmacist

Jacob Williams Pharmacist

MEMBERSHIP MATTERS: To YOU, To YOUR Patients To YOUR Profession!

Member Spotlight Nancy Rath, CPhT recently retired as instructor in the Pharmacy Technician Program at Sullivan University, after 8 years of service. Nancy was singularly devoted to her students, giving up many hours of her own time to tutor students and design activities to help her students learn. “I found the work at the Sullivan University College of Pharmacy to be so gratifying. I especially enjoyed teaching the pharmacology, pharmaceutical calculations, and anatomy & physiology classes," Nancy said. In her previous career, Nancy was a medical technologist in the chemistry lab at Jewish Hospital in Louisville. She became a Certified Pharmacy Technician in 2011. "Nancy's dedication to the education of pharmacy technician students is unrivaled. In my time working with her, she spent countless hours outside of the classroom tutoring and working with students. She was dedicated to her students' success,” Sarah Lawrence, previously worked alongside Nancy at Sullivan University. “Since CPhT’s are taking on ever increasing responsibility in varied settings, quality education that prepares them for their expanding roles is critical. Our goal is always to deliver excellent, caring service to patients….so, I believe that a strong academic foundation is the key to insuring the continued success of our profession,” Nancy said. Nancy continues to combine her love of learning with her passion for music as the owner of Premier Piano Studio, where she gives piano lessons to children and adults. She remains a dedicated advocate for pharmacy technician education and advancement

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6. See It All KPhA is the only statewide pharmacy organization that represents all pharmacists in all practice settings—you can learn about all the opportunities available within pharmacy and gain insights from pharmacists representing a variety of practice settings.

7. Develop Your Leadership Skills Participate as an active leader in a variety of committees and volunteer leadership positions that will develop your skills as you give back to your profession.

1. Strengthen Your Career KPhA members enjoy educational opportunities designed to increase knowledge and keep up with the latest information.

2. Advance Patient Care

8. Make a Positive Impact By joining KPhA, you are taking a step to ensure the future of the profession in Kentucky. We can’t do this important work without YOU.

The more you learn about drug and treatment updates through our publication, The Kentucky Pharmacist, as well as through attending OUR KPhA meetings, the better equipped you are to help your patients.

9. Make the Connection

3. Network with Others in Your Field

KPhA partners with many industry partners that offer discounts or important expertise that can positively impact your pharmacy.

KPhA members are invited to join their colleagues at the KPhA Annual Meeting & Convention and the Legislative Conference.

4. Advocate for Your Profession By joining KPhA, you are supporting the only organization representing the unified voice of all pharmacists. During the past year, KPhA’s work on health care legislation and regulation increased policy makers’ awareness of the pharmacist’s role in health care. KPhA continues to work

5. Proclaim Your Professionalism Adding your name to the ranks of your colleagues who are members declares your pride in the profession. Support KPhA’s advocacy efforts as we work with policy makers to implement health care reform legislation and as we continue to advocate for regulations that positively impact the profession.

10. Gain the Competitive Edge KPhA gives you exclusive access to unique experiences, career information, and resources designed to meet your needs and provide support as you advance in your career.

JOIN TODAY WWW.KPHANET.ORG

Academy of Pharmacy Technicians Bluegrass Community and Technical College Pharmacy Technician Graduation Class 2019 As the responsibilities pharmacists perform increase, the demand for high quality pharmacy technicians continues to rise. Many pharmacies and healthcare systems have difficulty finding qualified candidates to fill these technician positions. Pharmacy managers and trainers spend time and money to hire and train technicians; and, oftentimes, they experience high turnover rates. To address this problem, more and more pharmacy technician education programs have been developed across the nation. The goal of these programs is to provide well-trained and educated pharmacy technicians who are committed to the pharmacy profession. The Pharmacy Technology program at the Bluegrass Community and Technical College (BCTC) is an ASHP accredited pharmacy technician education program. We celebrated our third year on Motherâ&#x20AC;&#x2122;s Day with 15 graduates in the Class of 2019. Pharmacy Technology at the Bluegrass Community

BCTC graduates pose and Technical College in Lexington offers students for a photo. two college credentials for pharmacy technicians: an entry level pharmacy technology certificate, and an advanced level pharmacy technology diploma. Students can finish the program within 12 months. The program collaborates with the UK Healthcare Pharmacy Department for assistance in education and job placement. Education at BCTC focuses on realistic hands-on training; including skills practice in a mock pharmacy lab, and externships at several pharmacy clinical sites. Students take the PTCB as their exit exam from the program. When students graduate, they have the knowledge, skills, and certification necessary to be employed in many pharmacy settings. Besides BCTC, there are other pharmacy technology programs in Kentucky that offer a similar education to students. The Jefferson Community and Technical College serves the Louisville area. The Western Community and Technical Col- Somerset Community lege, Somerset Community College, and Hazard Community and Technical Col- College graduate. lege serve the other regional areas. These programs will help support the upcoming changes for the PTCE candidate requirements which will be effective January 1st 2020. Congrats again to all our graduates! They sure will be great members of your pharmacy teams.

|38| Kentucky Pharmacists Association | July/August 2019

Welcome New officers for the KPhA Academy of Pharmacy Technicians 2019-2020 Chair – Devin Wallace Devin Wallace is the founder of Wallace Ventures, a consulting group helping healthcare organizations successfully navigate regulatory compliance offering onsite consultation, education, competency evaluations & assessments. Currently he is also the consulting Regulatory Compliance Specialist with VCA covering USP compliance of over 900 U.S. and Canadian sites. With 18 years of pharmacy experience, Devin has held multiple leadership positions in clinical and non-clinal arenas, including compounding, automation, patient medication reconciliation, safety & regulatory compliance, medical sales, consulting, and education. As a member of the Colorado Academy of Pharmacy Technicians he assisted in increasing membership and advocacy of pharmacy technicians, writing and presenting two ACPE CE’s on USP<800>.

1st Director – Sara Sauer Sara Sauer, Assistant Professor of Pharmacy Technology at Bluegrass Community and Technical College, has been a certified pharmacy technician since 2008. She has work experience in both ambulatory and hospital pharmacy settings. As Program Director, she established the pharmacy technician education program at BCTC in 2016. She continues to build relationships with the local workforce to provide training to pharmacy technicians in the central Kentucky area. Mrs. Sauer is highly involved in education and professional development for pharmacy technicians at the national level, including the PTEC (Pharmacy Technician Educator Council) and ASHP (American Society of HealthSystem Pharmacists). She has the vision to better the career path of pharmacy technicians in Kentucky by raising the earnings, career awareness, and public recognition of this increasingly important profession.

Continuing to helping positively move the healthcare industry forward he is active in publishing articles on 2nd Director – Sarah Lisenby LinkedIn and recently launching PharmTech Podcast. Sarah Lisenby obtained her NaEscaping the sanitary conditions of his career he is also a tional Technician Certification chicken farmer, avid outdoorsman, and traveler. in 2004 and her B.A. in English Vice Chair - Jessica Salmons Jessica Salmons is a family oriented person. She has worked at Rx Discount Pharmacy for over 15 years. During her time she has held many responsibilities including working in hospice pharmacy, in the retail pharmacy, and in the business office managing contracts, claims, and accounts payable. She is a past KPhA Technician of the Year recipient and continues to work toward the advance of our profession.

from the University of Louisville in 2010. She has worked in community pharmacy for over 17 years and in hospital pharmacy for 6 years. Her accomplishments include implementation of automated dispensing cabinets and an electronic medical record during her hospital career. She served as lead technician on each implementation team and her responsibilities included training staff and building a medication dictionary. She will be serving as a coordinator for the Office of Experiential Education as well as teaching in the Pharmacy Technician Program at Sullivan College of Pharmacy and Health Sciences.

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Pharmacy Policy Issues Pharmacy Policy Issues: Language Translation Services for Patients Author: Kelly A. Sarna, Pharm.D., is a 2019 graduate of the University of Kentucky College of Pharmacy. A

native of New Lenox, IL, she completed her pre-professional education at the University of Illinois. Issue: Recently, I have noticed signs in local clinics and the hospital about the availability of translator services for patients whose primary language is not English. Has something changed to create an expectation that such services be available? It also brings to mind issues with HIPAA – are there any concerns related to HIPAA and the protected health information that will be relayed through the translator? Discussion: Language barriers are prominent in the United States. They can pose a problem for healthcare providers who are limited by their English only speaking skills. These providers often serve diverse populations, and despite most Americans using English as a primary language this is not always the case. According to the 2011 census, 20.8% of the United States population speak a language other than English at home. This statistic has ballooned by 158.2% from 1980 to 2010, making this an ever more likely problem for health care providers, independent of their practice setting. The census bureau also evaluated English-speaking ability, and a combined 22.4% of the total surveyed population either spoke English “not well” or “not at all”.1 The historical increase in these numbers have led to the presence of interpreter services at more clinics and pharmacies to assist healthcare professionals in providing adequate care to all patients.

Interpreters can be a member of a covered entity’s workforce such as a bilingual employee, volunteer, or staffed interpreter. Other interpreters that are not directly employed by the covered entity are deemed business associates.3 Healthcare providers are required to train employees on HIPAA policies, but they are not required to ensure that business associates are HIPAA compliant. They can, however, establish a contract with an interpreter service and arrange that they participate in HIPAA training if they so choose.2 In this way, a covered entity can provide consistency in the level of privacy that they offer their patients. As providers, this is also an opportunity to advocate for patients and ensure they receive the privacy and respect they deserve. Alternatively, a patient may also elect a family member or close friend as an interpreter for their healthcare encounters.3 In these cases, the healthcare provider may either ask for the patient’s consent to disclose their information to the designated person or use professional judgement to infer that the patient would not object to the information being discussed.5

It has been identified that non-English speaking patients are less likely to have a regular primary care physician as a direct result of the language barrier between patient and healthcare provider. This results in missed opportunities for preventative care measures. Additionally, those non-English speaking paBecause of the apparent need for these services given the col- tients who can access the healthcare system often receive a lower quality of care due to their inability to understand their lected data, legislation has been passed in order to compensate for language barriers associated with healthcare. Section provider6. Providing language services can increase access to healthcare for the non-English speaking population. Improv1557 of the Patient Protection and Affordable Care Act of 2010 is the civil rights provision which prohibits discrimina- ing communication between the patient and healthcare protion in certain health programs or activities based on race and vider lessens these disparities in health outcomes between English and non-English speakers, as well as allowing health national origin. One of the requirements of the law is to ensure covered entities “take reasonable steps to provide mean- care providers to provide high-quality and dignified care to their patients. ingful access [to healthcare] to each individual with limited English proficiency.” One of these reasonable steps is to proHave an Idea?: This column is designed to address timely vide language assistance services. Covered entities must post and practical issues of interest to pharmacists, pharmacy intaglines in the top 15 languages spoken by individuals with terns and pharmacy technicians with the goal being to enlimited English proficiency in that region (Figure 1). The tacourage thought, reflection and exchange among practitionglines inform patients in their primary language that interers. Suggestions regarding topics for consideration are welpreter services are available for them if they require language come. Please send them to jfink@uky.edu. assistance.4

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Annual Meeting & Convention

Thank you to our Annual Meeting & Convention Exhibitors AbbVie Women's Health, Adapt Pharma, Amarin Pharma, AmerisourceBergen, APCI, APMS, APSC, Arbor Pharmaceuticals, AstraZeneca, Best Computer Systems, Inc., Cardinal Health, Centor, Compliant Pharmacy Alliance, DNA Project Consulting, Enlighten Wellness, Flash Returns Pharmacy, GeriMed, GM Hemp Co, Gulf Coast Pharmaceuticals, JCAP, KASPER, Kentucky Renaissance Pharmacy Museum, KHIE, Kroger (Cincinnati & Louisville), Liberty Software, Magna Pharmaceuticals, McKesson Corporation, Med Alliance, Mt. Folly Enterprises, NeoMed, Northern Kentucky Pharmacists Association, NovoNordisk, ParaPro, Pfizer, Pharmacists Mutual, Pharmacy Development Services, QS/1, Samuels Products, Smith Drug Co., UK CAPPS

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Pharmacy Law Brief The Judicial Branch of Government

Author: Joseph L. Fink III, BSPharm., JD, DSc (Hon), FAPhA, Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy

Question: The court system seems like a mystery to me. How is it decided whether a case goes to federal or state court? It seems that the only time we really hear anything about the courts is when they decide to take up a case or to announce a decision. Perhaps this is the least known branch of government. Can you shed some light on that? Response: There are several ways to classify courts. Let’s first differentiate federal courts from those in the state court system. There are two ways a matter can get into federal court; all other disputes go to state court. Federal jurisdiction or authority to decide a matter is based on either [1] the existence of a “federal question”, meaning that the issue in the case arises under the U.S. Constitution, a federal statute or regulation from a federal administrative agency, or [2] the parties to the lawsuit are citizens of different states, so called “diversity jurisdiction.” In that second situation there also is a requirement that the amount in controversy must be at least $75,000. If neither of those two circumstances exists, then the matter will be appropriately handled by a state court.

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.

only questions of law may be basis for appeal; questions of law were terminally answered by the jury at the trial court level. Those questions of law can be thorny, explaining why judicial decisions at the appellate level are frequently “split decisions”, i.e., 2-1, 5-4, etc.

Those numbers from split decisions bring us to consideration of headcount of judges. In the federal system most U.S. Court of Appeals decisions come from a three judge panel. On occasion a decision at that level will be made en banc, meaning that all the judges on that court hear the case collectively. Typically this approach is used for complex cases or Kentucky has two U.S. District Courts, one for the Eastern District based in Lexington and one for the Western District those deemed to be of great importance. It can also be used to based in Louisville. The Eastern District also has court opera- reconsider a decision by a three judge panel on the matter. If that were to occur with a case arising from Kentucky the mattions in Ashland, Covington, Frankfort, London and Pikeville. The Western District has additional locations in Bowl- ter would go before the U.S. Court of Appeals for the Sixth Circuit, based in Cincinnati, which has sixteen judges to haning Green, Owensboro, and Paducah. dle appeals arising from U.S. District Courts in Kentucky, One might think those criteria for getting into federal court Michigan, Ohio, and Tennessee. Contrast that with the Kenwould mean that few cases go there. Au contraire, nationtucky Court of Appeals that has fourteen members. The U.S. wide during 2018 U.S. District Courts, those at the lowest Supreme Court has nine justices and the Kentucky Supreme level of the system where cases originate, handled over Court has seven justices. 277,000 civil matters and over 81,000 criminal cases. During Another point deserving of emphasis is that the level of proof the same year U.S. Courts of Appeals, the next step up the required in various matters can differ. In a criminal matter judicial ladder, handled nearly 28,000 civil matters and althe guilt of an accused must be established “beyond a reasonmost 10,000 criminal appeals. Each year the U.S. Supreme Court receives requests to hear about 7,000 cases and actually able doubt.” In a civil law matter, to prevail the plaintiff must establish his or her case with a “preponderance of the eviagrees to grant hearings for somewhere between 100-150 dence”, meaning 50.1 percent. matters. A trial court has one judge presiding and two types of questions arise. Questions of fact, e.g., was that the correct medication dispensed to the patient, are answered by the jury while questions of law, e.g., may that type of question be asked by one of the attorneys or that item introduced into evidence, are answered by the judge. Appellate courts, on the other hand, have multiple judges with the reason being that

One final area of emphasis relates to serving as a juror. This is an important civic duty that should not be shirked. What if you had a case being heard in court? Would you want it heard by jurors who never held positions of responsibility or those who had nothing better to do? Certainly not. A call for service as a juror is important and should be honored if at all possible.

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Pharmacy Policy Issues References Cont. from Pg. 40. 1. Camille Ryan. Language Use in the United States: 2011. American Community Survey Reports, ACS-22. U.S. Census Bureau, Washington, DC. 2013. 2. U.S. Department of Health & Human Services. “Business Associates”. HHS.gov, 26 July 2013, www.hhs.gov/hipaa/forprofessionals/privacy/guidance/business-associates/index.html. 3. U.S. Department of Health & Human Services. “760-Must a Covered Health Care Provider Obtain Authorization to Use or Disclose PHI to an Interpreter.” HHS.gov, 24 Dec. 2015, www.hhs.gov/ hipaa/for-professionals/faq/760/must-a-covered-provider-obtainindividual-authorization-to-disclose-to-an-interpreter/index.html. 4. U.S. Department of Health & Human Services. “Section 1557: Ensuring Meaningful Access for Individuals with LEP.” HHS.gov, 25 Aug. 2016, www.hhs.gov/civil-rights/for-individuals/section1557/fs-limited-english-proficiency/index.html. 5. 65 FR 82802, Dec. 28, 2000, as amended at 67 FR 53270, Aug. 14, 2002

Save the Date!

6. Jacobs, Elizabeth A. et al. “Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services.” American Journal of Public Health 94.5 (2004): 866–869.

KPhA Annual Meeting & Convention Louisville Marriott Downtown June 11—14, 2020

Submit Questions: jfink@uky.edu

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2019â&#x20AC;&#x201D;2020 KPhA BOARD OF DIRECTORS

Misty Stutz, Crestwood mstutz@sullivan.edu

Chris Palutis, Lexington chris@candcrx.com

Chair

*At-Large Member to Executive Committee

Don Kupper, Louisville donku.ulh@gmail.com

President

KPERF BOARD OF DIRECTORS

President-Elect

Bob Oakley, Louisville rsoakley21@gmail.com

Chair

Joel Thornbury, Pikeville jthorn6@gmail.com

Secretary

Clark Kebodeaux, Lexington clark.kebodeaux@uky.edu

Secretary

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Treasurer

Chris Killmeier, Louisville cdkillmeier@hotmail.com

Treasurer

Chris Killmeier, Louisville cdkillmeier@hotmail.com

Past President Representative

Don Kupper, Louisville donku.ulh@gmail.com

President, KPhA

Chris Harlow, Louisville cpharlow@gmail.com Directors

Kimberly Croley, Corbin kscroley@yahoo.com

Angela Brunemann, Union Angbrunie@gmail.com

Kevin Lamping, Lexington klamping@riteaid.com

Matt Carrico, Louisville* matt@boonevilledrugs.com

Paul Easley, Louisville rpeasley@bellsouth.net

Jessika Chinn, Beaver Dam jessikachilton@ymail.com

Sarah Lawrence, Louisville slawrence@sullivan.edu

Scotty Reams, London scotty.reams@uky.edu

University of Kentucky Student Representative

Chad Corum, Manchester pharmdky21@gmail.com

KPERF ADVISORY COUNCIL Matt Carrico, Louisville matt@boonevilledrugs.com

Cathy Hanna, Lexington channa@apscnet.com

Kim Croley, Corbin kscroley@yahoo.com

Cassy Hobbs, Louisville cbeyerle01@gmail.com

Kimberly Daugherty, Louisville kdaugherty@sullivan.edu

Anthony Seo, Louisville jseo0516@my.sullivan.edu Jeff Mills, Louisville jeff.mills@nortonhealthcare.org Richard Slone, Hindman richardkslone@msn.com Ben Mudd, Lebanon* Speaker of the House bpmu222@gmail.com Martika Martin, Somerset Vice Speaker of the House 12marmar@gmail.com

Sullivan University Student Representative

Mary Thacker, Louisville mary.thacker@att.net

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.twitter.com/KPhAGrassroots www.youtube.com/KyPharmAssoc

“Our profession–Pharmacy– has a responsibility to the public second to no other profession. Our activities must be coordinated with the best interest of the medical profession and of the public. We should become more aggressive in relating our contributions to the improved health care of every community. Our objective– to develop a better understanding, both infra and inter professionally, and with the public. We are in business for health—the GOOD health of every community. Let it be known!” - From The Kentucky Pharmacist, August 1969, Volume XXXII, Number 8

Frequently Called and Contacted Kentucky Pharmacists Association 96 C Michael Davenport Blvd. Frankfort, KY 40601

Pharmacy Technician Certification Board (PTCB) 2215 Constitution Avenue

Kentucky Regional Poison Center (800) 222-1222

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American Pharmacists Association (APhA)

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National Community Pharmacists Association (NCPA)

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(502) 456-1821 (fax) www.kshp.org info@kshp.org

Alexandria, VA 22314 (703) 683-8200

KPhA Staff Mark Glasper Executive Director mglasper@kphanet.org Sarah Franklin Director of Communications & Continuing Education sarah@kphanet.org Angela Gibson Director of Finance & Administrative Services agibson@kphanet.org Jody Jaggers, PharmD Director of Public Health jjaggers@kphanet.org Jessica Johnson, PharmD Director of Pharmacy Education Jessica@kphanet.org

Michele Pinkston, PharmD, BCGP Director of Emergency Preparedness Michele@kphanet.org Lisa Atha Office Assistant/Member Services Coordinator latha@kphanet.org

THE

Kentucky PHARMACIST 96 C Michael Davenport Blvd. Frankfort, KY 40601