Ohio Pharmacist Journal 12 - 2010 December by Kathy Wotruba

OHIO PHARMACIST Volume 59, No. 12 â&#x20AC;˘ December 2010

Award-Winning Journal

Home-Study CE

New Drugs: ella, Jevtana, Krystexxa and Lastacaft

Home-Study CE

Something else OPA Member Completes Homeland Security Training

OPA:

Your Prescription for a Happy Holiday

Ohio Pharmacists Association

Midyear Meeting McKesson Healthy Living Pharmacists: Key to Patient Care Tour Stops in Ohio Nov. 7, 2010

ohio pharmacist

OHIO PHARMACIST

in this issue

OPA:

Your Prescription for a Happy Holiday

Volume 59, No. 12 • December 2010

articles

on the cover

13 Increased Rx Drug Abuse in Rural Teens 14 OPA Member-Get-A-Member Campaign

7 16 16

17 OPA Student Rotations 19 State Board of Pharmacy Seeks Nominations 19 Research Forum Seeks Abstracts 19 Web Watch: Online Journal, Member Promo, Online Shopping, Legislative Information

OPA Calendar

Executive Director’s Comments

5-9 6-8

10-12 13 14 18 20 26

22 Opportunities, News 23 Continuing Education Quiz

support our advertisers McKesson

APSC

ASHP Midyear Clinical Meeting, Anaheim, CA State Board of Pharmacy Meetings

january

15 Legislative Update

OPA Member Completes Homeland Security Training

december

in every issue Advertisers

McKesson Health Mart Tour in Ohio

opa calendar 2010 -2011

20 2010 Editorial Index

New Drugs: ella, Jevtana, Krystexxa, and Lastacaft Thomas A. Gossel, R.Ph., Ph.D. and J. Richard Wuest, R.Ph., PharmD

State Board of Pharmacy Meetings Resolutions & Bylaws Meeting Disease State Management Task Force Meeting Pharmacist Preparedness Task Force Meeting Legal & Regulatory Meeting OPF Board of Trustees Meeting

february

17 PRO, Inc.

3 7-9

18 Pharmacists Mutual 22 Logix, Inc.

OPA Executive Committee and Board of Trustees Meetings State Board of Pharmacy Meetings

24 Pharmacy Quality Commitment editorial office

Copyright © 2010 the Ohio Pharmacists Association. The Ohio Pharmacist is the official journal of the Ohio Pharmacists Association, published monthly. The Ohio Pharmacist is distributed to OPA members, paid through allocations of membership dues. Non-member yearly subscription rate is $30 in the U.S., $60 outside the U.S. All views expressed in articles are those of the writer, and not necessarily the official position of the Ohio Pharmacists Association. Editorial, Advertising, and Executive Offices at 2155 Riverside Drive, Columbus, OH 43221-4052. Phone 614.586.1497 FAX 614.586.1545 E-mail opa@ohiopharmacists.org Website http://www.ohiopharmacists.org

Ohio Pharmacists Association for pharmacists. for patients. for you.

The Mission of the Ohio Pharmacists Association is to unite the profession of pharmacy, and encourage interprofessional relations while promoting public health through education, discussion and legislation.

december 2010

officers, board of trustees, staff District 1: Mike Wascovich, R.Ph., 9500 Euclid Ave., Cleveland, OH 44195, 216.445.2357, wascovm@ccf.org District 2: Kevin Secrest, R.Ph., PharmD, 3340 Dorr St., Toledo, OH 43607, 419.531.2836, kevinsecrest@yahoo.com District 3: Kim Broedel-Zaugg, R.Ph., PhD, 525 S. Main St., Ada, OH 45810, 419.772.2281, k-broedel-zaugg@onu.edu District 4: Norbert Kinross, Jr., R.Ph., PharmD, 6301 Snidercrest Rd., Mason, OH 45040, 513.871.0725, nkinross@aol.com District 5: Ron Seigla, R.Ph., 194 Martha Avenue, Centerville, OH 45458, 937.433.7192, pills194@att.net District 6: Jeff Hill, R.Ph., 931 SR 28, Milford, OH 45150, 513.831.8211, pharmacy@hillscompounding.com District 7: Larry Schieber, R.Ph., 212 Lancaster Pike, Circleville, OH 43113, 740.474.1971, Schieberpharmacy@gmail.com District 8: Robbin Sizemore, R.Ph., PharmD, 39480 Mount Union Rd., Rutland, OH 45775, 740.709.6025, robbinsizemore@yahoo.com District 9: Brian Goshe, R.Ph., 75 Marion St., Dublin, OH 43017, 614.315.9359, bgoshe@columbus.rr.com District 10: Chet Kaczor, R.Ph., PharmD, 113 Fox Glen Dr. E, Pickerington, OH 43147, 740.380.8232, chesterkaczor@gmail.com District 11: Eric Graf, R.Ph., 8614 Hartman Road, Wadsworth, OH 44281, 330.335.2318, egraf@ritzmanrx.com District 12: Jerry Liliestedt, R.Ph., 339 E. Maple, Suite 100, N. Canton, OH 44720, 330.498.5017, jnliliestedt@abshealth.com District 13: Rudy Gulstrand, R.Ph., MBA, 2787 Tonawanda Dr., Rocky River, OH, 44116, 440.567.1473, rgulstrand@att.net District 14: Greg Krieger, R.Ph., 961 Augusta Dr., Youngstown, OH 44512, 330.629.1332, gpk71@aol.com Immediate Past President: Dale Bertke, R.Ph., 15203 Schmitmeyer-Baker Rd., Minster, OH 45865, 419.678.9000, kdbertke@gldstr.com University of Toledo: Scarlett Lynn, scarlett.lynn@rockets.utoledo.edu Ohio Northern University: Emily Kruckeberg, e-kruckeberg@onu.edu Ohio State University: Simon Pence, simonpence@gmail.com University of Cincinnati: Eric Gillespie, gillesec@mail.uc.edu University of Findlay: Kyle Dresbach, dresbachk@findlay.edu Northeastern Ohio Universities: Christina Droney, cdroney@neoucom.edu

President Matthew Fettman, R.Ph.

2915 West Tuscarawas St. Canton, OH 44708 330.454.5151 matthewfettman@neo.rr.com

President-Elect Steve Burson, R.Ph.

4111 Executive Parkway Westerville, OH 43081 614.898.3246 steve.burson@kroger.com

Vice President Tom Whiston, R.Ph. 25 S. Main Street Mt. Gilead, OH 43338 419.946.6492 twhiz@aol.com

Executive Committee Member-At-Large Ralph Foster, R.Ph. 3699 Scioto Run Blvd. Hilliard, OH 43026 614.876.9857 pharmosu56@aol.com

Treasurer Joseph Sabino, R.Ph., M.S . 2155 Riverside Drive Columbus, OH 43221 614.586.1497 jsabino@ltcrxsolutions.com

Association Staff

Ernest E. Boyd, Pharmacist, CAE, Executive Director Amy Bennett, R.Ph., Assistant Executive Director and Editor Kathy Nameth, R.Ph., Director of Continuing Education Curtis D. Black, R.Ph., PhD, Faculty-in-Residence Kelly Vyzral, Director of Government Affairs Dominic Bartone, R.Ph., Director of Independent SIG Kathy Wotruba, Director of Membership & Information Services Antonio Ciaccia, Director of Marketing and Public Affairs Donna Wittich, Administrative Assistant Janice Johnson, Administrative Assistant/Trade Show Manager BertĂŠ Graham, Administrative Assistant

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Ohio Pharmacists Foundation Board Randall Myers, R.Ph., President Curtis Black, R.Ph., Ph.D., Vice President Donald Bennett, R.Ph., MBA, Treasurer Matthew Buderer, R.Ph., FIACP John Coughlin, R.Ph. Kathy Karas, R.Ph. Debbie Lange, R.Ph. Deirdre Myers, R.Ph. Tom Stahl, R.Ph.

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executive director’s comments Ohio Celebrates Another National Leader – Al Barber ! Ernest E. Boyd, Pharmacist, CAE

I had the privilege of attending the Annual Meeting of the American Society of Consultant Pharmacists (ASCP), where OPA member Al Barber was Al Barber, PharmD, CGP, FASCP (left) with Ernie Boyd following Al’s instalinstalled as President. Al has been a very active lation as president the of the American member of OPA, speaking at last year’s Annual Society of Consultant Pharmacists. Conference and attending our most recent meeting of the DSM Task Force. He has been a great resource for me and OPA especially with regard to one of the companies providing MTM through long term care issues, but he’s also an example of a community pharmacies. In this pilot, we are trypharmacist who understands that all pharmacists ing to match pharmacies that have had problems must work together to achieve positive outcomes implementing an MTM program with pharmacists, for pharmacy. In addition to being able to personASCP members, and others who would be willing ally congratulate Al on his instalto either conduct MTM in the local lation, I was able to get a stronger pharmacy, or do training to help idea of the value of ASCP to all “...he’s also an example of a the pharmacy get started. This pharmacists. pharmacist who understands is a great example of the positive As I attended meetings and things that can occur with a closer toured the ASCP bookstore, it was that all pharmacists must relationship between the state clear to me that many of the activiwork together to achieve posiand national associations. OPA ties that our consultant pharmawill continue to work with Al and cists have done for years are now tive outcomes for pharmacy.” John to strengthen our relationbeing developed in community ship in areas where there is strong pharmacies. I had a chance to chat overlap. with the ASCP Executive Director, John Feather, We celebrate all of Ohio’s national officers, CAE, about these changes. including current APhA President-Elect MarialLook at MTM as an example. Consultant pharice Bennett and National Association of Boards of macists have been evaluating the appropriateness Pharmacy (NABP) President Bill Winsley. And, of drug therapy, documenting their services, and Jenelle Sobotka was just elected APhA Presidentadvising physicians for a number of years. ASCP Elect! All of these individuals are actively involved has developed sophisticated tools and learning with OPA in various ways, and I’ve had recent devices to help our consultant pharmacists perform meetings with the executive directors of these astheir tasks. A number of these programs and tools sociations. It is a real tribute to our state that so may be of interest to all pharmacists. many great leaders are coming from Ohio. ASCP has been using the concept of “Senior At OPA’s 2011 Annual Conference you will Care Pharmacists” for years. The idea is that there have the opportunity to meet the new NCPA is a specific body of knowledge that is needed to (National Community Pharmacists Association) meet the needs of our seniors who take medicaExecutive Director Kathleen Jaeger, and NABP tions. Again, thinking of the average OPA memExecutive Director Carmen Catizone. ber, older patients are the primary group that OPA is pleased to continue to work closely with we are dealing with. OPA has been an affiliate our national associations, and is especially proud of ASCP, and has worked with the state chapter this year to loan our leaders to the nation. OPA when asked, and I see a closer relationship develmembers stand ready to help any of you meet your oping over time. national goals. OPA is part of a pilot program with Mirixa,

ohio pharmacist

continuing education for pharmacists Volume XXVIII, No. 12

New Drugs: ella, Jevtana, Krystexxa and Lastacaft Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio and J. Richard Wuest, R.Ph., PharmD, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio Dr. Thomas A. Gossel and Dr. J. Richard Wuest have no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on alcaftadine (Lastacaft™), cabazitaxel (Jevtana®), pegloticase (Krystexxa™) and ulipristal (ella®). Objectives. At the conclusion of this lesson, successful participants should be able to: 1. identify the new drugs by generic name, trade name and chemical name when relevant; 2. select the indication(s), pharmacologic action(s) and clinical applications for each drug; 3. recognize important therapeutic uses for the drugs and their applications in specified pathologies; and 4. demonstrate an understanding of adverse effects and toxicity, significant drug-drug interactions, and patient counseling information for these drugs. The drugs discussed within this lesson (Table 1) are indicated for treatment of a variety of conditions. The lesson provides an introduction to the new drugs and is not intended to extend beyond a brief overview of the topic. The reader is, therefore, urged to consult each product’s Prescribing Information leaflet (i.e., its label; package insert), Medication Guide when available and other references for detailed descriptions including out-

Gossel

Wuest

comes of comparative clinical trials with similar drugs.

Alcaftadine (Lastacaft™)

Many clinical studies have documented the efficacy of topical antihistamines in the management of allergic conjunctivitis and these drugs are treatments of choice for this disorder. FDA has approved a new antihistamine, alcaftadine (Lastacaft), for topical use in the eyes. Indication and Use. The drug is an H1 histamine receptor antagonist indicated for the prevention of itching associated with allergic conjunctivitis. Safety and effectiveness in pediatric patients ≤2 years of age have not been established. Allergic Conjunctivitis. Allergic conjunctivitis is the most common clinical form of ocular allergy, and the underlying immune reaction tends to be mediated by immunoglobulin E (IgE). It is a localized allergic condition, often associated with rhinitis but usually observed as the sole or prevalent allergic sensitization. Other symptoms occur in 40 to 60 percent of persons with allergies. Allergic 7

conjunctivitis ranges in severity from mild forms, which can still interfere with quality of life, to severe reactions characterized by potential impairment of visual function. The term allergic conjunctivitis refers to a collection of hypersensitivity disorders that affect the lid, conjunctiva and/or cornea. Various clinical manifestations are included in the classification of ocular allergy and are divided into two main groups: (1) the more frequent seasonal form and (2) perennial allergic conjunctivitis, which may also be referred to as rhinoconjunctivitis or conjunctivorhinitis, depending on the primary symptom. Itching of both eyes is the hallmark symptom of allergic conjunctivitis. Accompanying symptoms such as lacrimation (tearing), red eye, foreign body sensation and edema (swelling) frequently accompany itching. Bilateral dilatation of the conjunctival blood vessels is noted. Serum IgE levels may be elevated. Conjunctival scrapings often reveal mast cells and eosinophils. Histamine is one of the mediators released by mast cells following specific allergen binding to the IgE presented on the cell surface. This mediator is the primary contributor to signs and symptoms of the immediate reaction that characterizes allergic conjunctivitis. The usual treatment of allergic conjunctivitis involves nonspecific

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Table 1 Selected new drugs Generic Applicant/Sponsor/ (Proprietary) Distributor Name Alcaftadine Vistakon (Lastacaft™) Pharmaceuticals, LLC

Indication

Cabazitaxel sanofi-aventis (Jevtana®) U.S. LLC Pegloticase Savient (Krystexxa™) Pharmaceuticals, Inc. Ulipristal Watson Pharma, Inc. (ella®)

Metastatic prostate cancer previously treated with a docetaxelcontaining treatment regimen

Solution for intravenous infusion

Chronic gout in adult patients refractory to conventional therapy

Solution for intravenous infusion

Prevention of pregnancy following unprotected intercourse or a known or suspected contraceptive failure

Tablets

measures such as application of cold dressings, artificial tears and avoidance of offending allergens. These measures, however, are typically ineffective by themselves or not very practical. Pharmacologic treatment, therefore, often proves necessary, and drugs that antagonize histamine action play an important role in terms of symptom relief. Since the conjunctiva is an accessible mucosa, topical application of antihistamines logically appears as the ideal approach for the treatment of allergic conjunctivitis. Many studies have shown topical antihistamines to be equally or even more effective than oral or nasally applied topical treatments. At the same time, even though topical antihistamines typically offer more rapid relief of ocular symptoms than their oral counterparts, studies of their long-term efficacy have generally yielded inconsistent results. Mechanism of Action. Alcaftadine is an H1 histamine receptor antagonist and inhibitor of the release of histamine from mast cells.

ohio pharmacist

Dosage Form

Itching associated Ophthalmic with allergic solution conjunctivitis

Decreased chemotaxis and inhibition of eosinophil activation have also been demonstrated. Adverse Effects. The most common ocular adverse reactions, occurring in <4 percent of drugtreated eyes, were eye irritation, burning and/or stinging on instillation, eye redness and itching. The most common non-ocular adverse reactions, occurring in <3 percent of subjects in premarketing clinical trials, were nasopharyngitis, headache and influenza. Warnings, Precautions and Contraindications. The following warnings and precautions are listed for Lastacaft. • To minimize the risk of contamination, the dropper should not be touched to any surface, and the bottle kept tightly closed when not in use. • The drops should not be used to treat contact lens-related irritation; the preservative benzalkonium chloride may be absorbed onto soft contact lenses. These lenses should be removed prior to instillation of the drops and not be 8

reinserted until after 10 minutes following drug administration. No contraindications are listed. Drug Interactions. No drugdrug interactions are listed. Dosage and Availability. Lastacaft ophthalmic solution contains alcaftadine 0.25 percent and is instilled one drop in each eye once daily. The product should be stored under refrigeration at 15° to 25°C (59° to 77°F). Patient Information. Patients should be advised not to touch the dropper tip to any surface. They should also be instructed not to wear contact lenses if their eye is red and not to treat any contact lens-related irritation with the solution. Contact lenses should be removed prior to drug instillation and not reinserted until after 10 minutes of administering the drug.

Cabazitaxel (Jevtana ® )

FDA approved the chemotherapy drug cabazitaxel (Jevtana) to treat advanced prostate cancer that worsens despite use of docetaxel (Taxotere), the standard drug therapy. In a single trial involving 755 men, the new drug, which was given an expedited six-month review, extended survival from a mean of 12.7 months for patients receiving mitoxantrone (Novantrone) plus prednisone to a mean of 15.1 months, a positive difference of 2.4 months of survival. Indication and Use. Jevtana is indicated in combination with prednisone for treatment of patients with hormone-refractory (castration-resistant, castrationrecurrent, androgen-independent) metastatic prostate carcinoma previously treated with a docetaxelcontaining treatment regimen. Prostate Cancer. An estimated 217,730 new cases of prostate cancer will be diagnosed in men living in the United States this year. Prostate cancer is the most frequently diagnosed cancer in men. Incidence rates have changed substantially over the past two decades, in large part reflecting changes in prostate

cancer screening with the prostatespecific antigen (PSA) blood test. After increasing from 1988 to 1992, declining from 1992 to 1995, and again increasing from 1995 to 2001, rates have been decreasing since 2001 by 4.4 percent per year. Still, with approximately 32,050 deaths projected for 2010 in the United States, prostate cancer is the second-leading cause of cancer death in men (trailing lung cancer, which is the primary cause of cancer-related death in men in this country). Although death rates have decreased more rapidly among African American than among Caucasian men since the early 1990s, rates in African Americans remain more than twice as high as those in white men. Well established risk factors for prostate cancer are age, race/ ethnicity and family history of the disease. About 63 percent of all prostate cancer cases appear in men aged 65 and older. African American men and Jamaican men of African descent have the highest prostate cancer incidence rates in the world and are more likely to die from the disease than Caucasian men in all age groups. The cancer is common in North America and northwestern Europe, but less common in Asia and South America. Recent genetic studies strongly suggest that familial predisposition is positively related to prostate cancer risk. When compared to men without a family history, men with a first-degree relative (father or brother) are two to three times more likely to develop prostate cancer. Men with more than one first-degree relative with prostate cancer are three to five times more apt to develop the cancer. A diet high in animal fat may also be a risk factor. There is evidence that the risk of dying from prostate cancer may increase with obesity. Testosterone is a stimulus for prostate cancer development. Initially, affected patients experience rapid and effective symptomatic disease responses following surgical (orchiectomy) or medical (e.g., gonadotropin releasing hormone

[GnRH] agonists such as leuprolide or goserelin) castration either with or without an antiandrogen. Unfortunately, within 18 to 24 months postcastration, nearly all of these patients will progress to hormonerefractory prostate cancer, an incurable disease with a median survival rate of 18 to 20 months when treated with the standard of care (i.e., docetaxel plus prednisone). In addition to Jevtana, another prostate cancer therapy (sipuleucel-T [Provenge]) was also approved this year. Mechanism of Action. Cabazitaxel is a microtubule inhibitor that binds to tubulin and promotes its assembly into microtubules and therefore simultaneously inhibits their disassembly. This leads to stabilization of microtubules, which results in the inhibition of mitotic and interphase cellular functions. In other words, the drug interferes with cell division and growth of cancer cells in the prostate gland. Adverse Effects. Most common adverse reactions (≥10 percent) were neutropenia, anemia, leukopenia, thrombocytopenia, diarrhea, fatigue, nausea, vomiting, constipation, asthenia, abdominal pain, hematuria, back pain, anorexia, peripheral neuropathy, fever, dyspnea, cough, arthralgia and alopecia. Warnings, Precautions and Contraindications. Jevtana’s label contains a boxed warning (Figure 1). The following warnings and precautions are listed. • Neutropenic deaths have been reported. Blood counts should be monitored frequently to determine if initiation of G-CSF (granulocyte-colony stimulating factor) and/or dosage modification is needed. Primary prophylaxis with G-CSF should be considered in patients with high-risk clinical features. • Severe hypersensitivity reactions can occur. Patients should be premedicated with corticosteroids and H2 antagonists, and the infusion discontinued immediately if hypersensitivity is observed. • Mortality related to diarrhea 9

Figure 1 Boxed Warning for Jevtana Neutropenic deaths have been reported. In order to monitor the occurrence of neutropenia, frequent blood cell counts should be performed on all patients receiving Jevtana. Jevtana should not be given to patients with neutrophil counts of ≤1,500 cells/mm3. Severe hypersensitivity reactions can occur and may include generalized rash/erythema, hypotension and bronchospasm. Severe hypersensitivity reactions require immediate discontinuation of the Jevtana infusion and administration of appropriate therapy. Patients should receive premedication. Jevtana must not be given to patients who have a history of severe hypersensitivity reactions to Jevtana or to other drugs formulated with polysorbate 80.

has been reported. Patients should be well hydrated and treated with antiemetics and antidiarrheals as needed. If Grade ≥3 diarrhea is observed, dosage should be modified. • Renal failure, including cases with fatal outcomes, has been reported. The cause should be identified and managed aggressively. • Patients ≥65 years of age were more likely to experience fatal outcomes not related to disease progression and certain adverse reactions, including neutropenia and febrile neutropenia. Patients should be monitored closely. • Patients with impaired hepatic function were excluded from the randomized clinical trial. Hepatic impairment is likely to increase cabazitaxel blood concentrations. The drug should not be given to patients with hepatic impairment. • Jevtana can cause fetal harm when administered to a pregnant woman. Contraindications. • The drug should not be used in patients with neutrophil counts of ≤1,500/mm3.

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Table 2 Patient information for Jevtana • Educate patients about the risk of potential hypersensitivity associated with Jevtana. Confirm that patients do not have a history of severe hypersensitivity reactions to cabazitaxel or to other drugs formulated with polysorbate 80. Instruct them to immediately report signs of a hypersensitivity reaction. • Explain the importance of routine blood cell counts. Instruct patients to monitor their temperature frequently and immediately report any occurrence of fever to the treating oncologist. • Explain that it is important to take oral prednisone as prescribed. Instruct patients to report if they were not compliant with their oral corticosteroid regimen. • Explain to patients that severe and fatal infections, dehydration, and renal failure have been associated with cabazitaxel exposure. Tell them they should immediately report fever, significant vomiting or diarrhea, decreased urinary output, and hematuria to the treating oncologist. • Inform patients about the risks of drug interactions and importance of providing a list of prescription and non-prescription drugs to the treating oncologist. • Inform elderly patients that certain side effects may be more frequent or severe.

• Jevtana is contraindicated in patients who have a history of severe hypersensitivity reactions to cabazitaxel or to other drugs formulated with polysorbate 80. Drug Interactions. No formal drug-drug interaction studies have been reported; however, the drug should be used with caution in patients taking concomitant drugs that induce or inhibit CYP3A. Prednisone or prednisolone administered in 10 mg daily doses does not affect the pharmacokinetics of cabazitaxel. Dosage and Availability. The recommended dose is 25 mg/ m2 administered every three weeks as a one-hour intravenous infu-

ohio pharmacist

sion along with oral prednisone 10 mg administered daily throughout Jevtana treatment. The product is supplied as a kit with one singleuse vial containing 60 mg cabazitaxel in 1.5 mL, plus a separate vial containing approximately 5.7 mL of 13 percent ethanol in water for injection. The kits should be stored at 25°C (77°F) with excursions permitted between 15° to 30°C (59° to 86°F). Patient Information. FDAapproved patient counseling information for cabazitaxel is shown in Table 2.

Pegloticase (Krystexxa™)

A new drug to treat serious cases of gout won FDA approval in September, 2010. The drug, pegloticase (Krystexxa), offers a new approach to reducing blood levels of uric acid, the causative factor that produces gout symptoms. Krystexxa was the second new drug approved for gout after nearly 40 years; the other agent was febuxostat (Uloric), approved in 2009. Indications and Use. Krystexxa is indicated for treatment of chronic gout in adult patients refractory to conventional therapy. It is not recommended for treatment of asymptomatic hyperuricemia. Gout refractory to conventional therapy occurs in patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at their maximum medically appropriate dose or for whom these drugs are contraindicated. Gout. Gout is the clinical manifestation of uric acid (as needle-sharp sodium monourate) crystals deposited in the joints. Approximately six million adults in the United States are affected. The incidence has been increasing over the decades; between the mid-1960s to mid-1990s, the prevalence of gout in most Westernized countries rose by 200 to 300 percent. Gout is the most common inflammatory disease in men older than 30 years. In spite of well understood pathophysiology, gout 10

remains a challenge to manage. Uric acid (as urate) is the metabolic end product of purine metabolism in humans. Accumulation of urate beyond its solubility point (6.8 mg/dL) defines hyperuricemia, a necessary condition for development of gout. Urate is synthesized in the liver from dietary purine compounds and the endogenous pathway of newly synthesized purine. Released into the circulation almost exclusively in its soluble form, it is filtered in the proximal tubules of the kidney. Hyperuricemia develops due to overproduction, accounting for 10 to 15 percent of hyperuricemia cases, or underexcretion (excretion less than 30 mg/day), which accounts for approximately 85 to 90 percent of cases, or by a combination of these factors. Acute gout flares present as warmth, swelling, erythema and pain of abrupt onset in the involved joint, often appearing in the early morning and reaching peak levels over the next eight to 12 hours. The pain is extreme, and patients often cannot wear stockings or touch bed sheets during flares. Nighttime occurrence is common, with chills, fever and malaise usually part of the initial presentation. The most commonly involved joint is the first metatarsophalangeal (big toe) eventually involved in more than 90 percent of cases. Other sites include ankles, knees, elbows, wrists and fingers. Acute gout flares are common in the lower extremities due to the lower temperature in these joints, which favors the precipitation of uric acid crystals. Common precipitants of flares include acute illness (trauma, sepsis, surgery), alcohol abuse, starvation, excessive intake of foods rich in purines and certain medications including salicylates, thiazides and cyclosporine. The condition has been called the “disease of kings” because it can be precipitated by a diet rich in red meat, seafood and alcohol, food items that once were available only to persons of nobility. Today’s rise in the incidence of hyperuricemia and gout is associ-

ated with increased consumption of animal-based proteins and fructose-sweetened beverages, and coincides with increasing rates of obesity, metabolic syndrome, type 2 diabetes, renal failure, and cardiovascular disease. Frequent, recurrent acute attacks often lead to chronic tophaceous gout. Tophi are deposits of urate crystals in soft tissue such as the upper ridges of the ear, or over osteoarthritic nodes in the joints, especially in older women. Tophaceous gout may lead to excessive morbidity and if untreated, can cause joint erosion and destruction. Polyarticular (more than one joint) tophaceous gout may present as subcutaneous nodules that can mimic rheumatoid arthritis. The goal of therapy is to lower serum urate concentrations to <6 mg/dL, which has been shown to reduce the frequency of gout attacks and the size of tophi. The most common approach to uratelowering is reduction of uric acid production with allopurinol, a xanthine-oxidase inhibitor. Another strategy to lowering urate is increasing renal uric acid excretion with the uricosuric agent probenecid. A third approach to therapy, the one exemplified by the newly approved drug, is conversion of urate to allantoin, a more soluble and easily excreted end product of purine metabolism, by administration of recombinant uricase (urate oxidase). Mechanism of Action. Krystexxa is a recombinant uricase that achieves its therapeutic effect by catalyzing the oxidation of uric acid to allantoin, thereby lowering serum uric acid. Pegloticase (also referred to as PEG uricase) consists of recombinant mammalian uricase (primarily porcine, with a C-terminal sequence from baboon uricase) conjugated with multiple strands of polyethylene glycol (PEG). The attachment of inert PEG strands to the recombinant protein lengthens its circulating half-life and diminishes protein immunogenicity. Adverse Effects. The most common adverse reactions (oc-

curring in at least 5 percent of Krystexxa-treated patients) are gout flares, infusion reactions, nausea, contusion or ecchymosis (bleeding under the skin), nasopharyngitis, constipation, chest pain, anaphylaxis and vomiting. Warnings, Precautions and Contraindications. The following warnings and precautions are listed for Krystexxa. See Boxed Warning for Krystexxa (Figure 2.). • Anaphylaxis occurred in patients treated with Krystexxa. Anaphylaxis generally manifests within two hours of the infusion; however, delayed-type hypersensitivity reactions have also been reported. The drug should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis. Patients should be premedicated with antihistamines and corticosteroids and be closely monitored for an appropriate period of time for anaphylaxis after administration of the drug. • Infusion reactions occurred in patients treated with Krystexxa. The drug should be administered in a healthcare setting and by healthcare providers prepared to manage infusion reactions. Patients should be premedicated with an antihistamine and corticosteroid and monitored closely for signs and symptoms of infusion reactions. In the event of an infusion reaction, the infusion should be slowed, or stopped and restarted at a slower rate. If a severe infusion reaction occurs, infusion should be discontinued and treatment instituted as needed. The risk of an infusion reaction is higher in patients who have lost therapeutic response. • An increase in gout flares is frequently observed upon initiation of antihyperuricemic therapy, including treatment with Krystexxa. If a gout flare occurs during treatment, the drug need not be discontinued. Gout flare prophylaxis (i.e., NSAIDs or colchicine) upon initiation of treatment is recommended for at least the first six months of therapy unless medically contraindicated or not tolerated. 11

Figure 2 Boxed Warning for Krystexxa • Anaphylaxis and infusion reactions have been reported to occur during and after administration of Krystexxa. • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within two hours of the infusion. However, delayed-type hypersensitivity reactions have also been reported. • Krystexxa should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions. • Patients should be premedicated with antihistamines and corticosteroids. • Patients should be closely monitored for an appropriate period of time for anaphylaxis after administration of Krystexxa. • Monitor serum uric acid levels prior to infusions and consider discontinuing treatment if levels increase to above 6 mg/dL, particularly when two consecutive levels above 6 mg/dL are observed.

• Krystexxa has not been formally studied in patients with congestive heart failure, but some patients in clinical trials experienced exacerbation. Caution should be exercised when using Krystexxa in patients with congestive heart failure and they should be monitored closely following infusion. A contraindication to drug use is glucose-6-phosphate dehydrogenase (G6PD) deficiency. Before starting Krystexxa, patients at higher risk for G6PD deficiency (e.g., those of African and Mediterranean ancestry) should be screened due to the risk of hemolysis and methemoglobinemia. Drug Interactions. No formal drug-drug interaction studies have been conducted. Because anti-pegloticase antibodies appear to bind to the PEG portion of the drug, there may be potential for binding with other PEGylated products. The impact of anti-PEG antibodies on patients’ responses to other

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PEG-containing therapeutics is unknown. Dosage and Availability. The recommended dose and regimen of Krystexxa for adult patients is 8 mg given as an intravenous infusion, over no less than 120 minutes, every two weeks. The optimal treatment duration has not been established. The drug is supplied in a single-use 2 mL glass vial to deliver Krystexxa as 8 mg of uricase protein in 1 mL volume. The drug must be stored in its original carton and maintained at all times under refrigeration between 2° to 8°C (36° to 46°F). It should be protected from light, and not shaken or frozen. Patient Information. An FDA-approved Medication Guide must be dispensed with each new and refilled prescription for Krystexxa.

Ulipristal (ella ® )

With about three million unintended pregnancies each year in the United States, half of these occur among women who are using a regular method of contraception. On occasion, a woman needs a backup contraceptive method when her regular method fails – a condom breaks or a diaphragm slips, or, she forgets to take her pill. Intercourse can also be unplanned or unwanted. Emergency contraception, which prevents pregnancy after unprotected sexual intercourse, therefore, provides a second chance for women who are at risk of unintended pregnancy. Ulipristal is a newly approved means for emergency contraception. Its advantages, compared with levonorgestrel or mifepristone, are two-fold: overall higher efficacy and effectiveness between 72 hours and 120 hours following unprotected intercourse. Note that the manufacturer spells the drug’s proprietary name with a lower-case “e.” Indications and Use. ella is a first in-class progesterone modulator classed as an agonist/ antagonist emergency contraceptive that is indicated for prevention

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of pregnancy following unprotected intercourse or a known or suspected contraceptive failure. The drug is not intended for routine use as a contraceptive. Unintended Pregnancy. Unintended pregnancy is a major public health concern. It is associated with increased risk of morbidity for women, and untoward health behaviors during pregnancy, such as delay in prenatal care, that are associated with adverse outcomes. Emergency contraception is, therefore, defined as the use of a drug or device as an emergency measure to prevent unwanted pregnancy following unprotected intercourse. Intercourse that occurs on days within the fertile window (the six days leading to and including the day of ovulation) may result in fertilization. The lifespan of sperm in the female genital tract is about five days. Women who are at risk of an unintended pregnancy within five days of intercourse are candidates for emergency contraception. As with all methods of contraception, emergency contraception is not intended for use by pregnant women. Moreover, attempts to show that emergency contraception reduces abortion rates have so far failed. Before approval of the new drug, the progestin levonorgestrel was the only drug marketed in the United States for emergency contraception. Levonorgestrel received FDA approval for emergency contraception in 1999 for prescription marketing. It was subsequently switched to OTC status with an age restriction (OTC) approved in 2006 for women 18 and older, and in 2009 for age 17 and over. Mechanism of Action. Taken immediately before ovulation is to occur, ella postpones follicular rupture. The likely primary mechanism of action of ulipristal for emergency contraception is, therefore, by inhibition or delay of ovulation; however, alterations to the endometrium that may affect implantation may also contribute to its efficacy. Adverse Effects. The most 12

common adverse reactions (≥5 percent) in clinical trials were headache, abdominal pain, nausea, dysmenorrhea, fatigue and dizziness. Warnings, Precautions and Contraindications. The following warnings and precautions are listed for ella. • ella is not indicated for termination of an existing pregnancy. Pregnancy should be excluded before administering the drug. • Women who become pregnant or complain of lower abdominal pain after taking ella should be evaluated for ectopic pregnancy. • The drug may alter the next expected menses. If menses is delayed beyond one week, pregnancy should be ruled out. • ella does not protect against sexually transmitted disease or HIV infection. The only contraindication to the drug is in known or suspected pregnancy. Drug Interactions. No formal drug-drug interaction studies have been undertaken. However, drugs or herbal products that induce certain enzymes, such as CYP3A4, may decrease the effectiveness of ella. Dosage and Availability. One tablet should be taken orally (with or without food) as soon as possible, within 120 hours (five days) after unprotected intercourse or a known or suspected contraceptive failure. If vomiting occurs within three hours of drug intake, consideration should be given to repeating the dose. The drug may be taken at any time during the menstrual cycle. The tablet containing 30 mg ulipristal is provided in an aluminum blister and marked “ella” on both sides. Tablets should be stored at 20° to 25°C (68° to 77°F). The blisters should be kept in their outer carton to protect from light. Patient Information. FDAapproved information for patient counseling is provided in Table 3.

Overview and Summary

Four newly approved drugs are

Table 3 Patient information for ella • Instruct patients to take this drug as soon as possible and not more than 120 hours after unprotected intercourse or a known or suspected contraceptive failure. • Advise patients that they should not take the drug if they know or suspect they are pregnant, and that the drug is not indicated for termination of an existing pregnancy. • Advise patients to contact their healthcare provider immediately in case of vomiting within three hours of taking the tablet, to discuss whether to take another tablet. • Advise patients to seek medical attention if they experience severe lower abdominal pain three to five weeks after taking the drug in order to be evaluated for an ectopic pregnancy. • Advise patients to contact their healthcare provider and consider the possibility of pregnancy if their period is delayed after taking ella by more than one week beyond the date it was expected. • Advise patients not to use the drug as routine contraception, or to use it repeatedly in the same menstrual cycle. • Advise patients that ella may reduce the contraceptive action of regular hormonal contraceptives and to use a reliable barrier method of contraception after using ella, for any subsequent acts of intercourse that occur in that same menstrual cycle. • Inform patients that ella does not protect against HIV-infection and other sexually transmitted diseases/ infections. • Advise patients that they should not use the drug if they are breastfeeding.

now available to treat four unrelated conditions. Three are unique drugs that add to therapies available to treat the conditions for which they are approved: ella is an emergency contraceptive that inhibits or delays ovulation; Jevtana, approved for treatment of refractory prostate cancer, inhibits cancer cell division and growth; and Krystexxa, approved to treat

serious cases of gout, lowers blood uric acid levels by metabolizing it into a harmless substance that is excreted in the urine. The fourth is Lastacaft, which joins several other available ophthalmic antihistamines for use in treating allergic conjunctivitis.

The authors, the Ohio Pharmacists Foundation and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the information contained herein. Bibliography for additional reading and inquiry is available upon request.

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

Please turn to Correspondence Course Quiz on page 23.

Program 0129-0000-10-012-H01-P Release date: 12-15-10 Expiration date: 12-15-13

CE Hours: 1.5 (0.15 CEU) The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Increased Rx Drug Abuse in Rural Teens Jordan Counts, PharmD Candidate, Ohio Northern University and OPA Extern Drug abuse was formerly a concern of metropolitan living. The sanctity of rural neighborhoods offered protection for our youth against the “evils” of the “big city” drug problem. That has all changed now, according to recent survey results released by researchers at the 13

University of Kentucky College of Medicine. Overall, non-medical prescription drug use or “drug abuse” has risen over 200 percent among U.S. teens, and rural teens seem to be contributing more than ever to the problem. Urban teens comprised just over half of the survey respondents; rural teens made up 17 percent; and the remaining data were collected from teens in suburban areas. According to the results of the survey, rural teenagers mirrored their urban counterparts in terms of their heroin, cocaine, marijuana, and hallucinogen use. Where they stood apart was in their abuse of prescription drugs. Thirteen percent of rural teens reported abusing prescription drugs compared to 11 percent of urban teens. Further study also revealed that pain relievers were used by rural teens for non-medical purposes more frequently than by urban teens, 11.5 vs. 10.3 percent, respectively. Finally, the survey identified enrollment in school and a two-parent household as protective factors for prevention of teenage drug abuse. These results only add to the increasing evidence of the prevalence of drug abuse, and specifically prescription drug abuse, among our youth. It also proves that the problem is no longer limited by geography or any other matter. Prescription drug abuse can be found anywhere, even your community. Pharmacists can help combat the problem by offering education and awareness. Instruct your patients to properly and securely store their medications, inform them about the dangers of keeping old and outdated drugs around the house, and make them aware of prescription take-back programs. Pharmacists can also help by providing educational programs to high schools and various other youth groups on the dangers of prescription drug abuse. As a healthcare provider, we must take an active role in preventing and alleviating this increasing problem.

december 2010

Ohio Pharmacists Association’s Member-Get-A-Member Referral Program

OPa Membership Rx 2011 A Prescription for Professional Growth

PASS IT ON and EARN $$ Earn a $25 VISA gift card for each new member you recruit & you could win a $500 Visa Gift Card! Plus your new member also earns a $25 VISA gift card!

Pass It On: Peace of Mind. Personal Growth. Protection. It Pays to Recruit!

The OPA Membership Rx 2011 referral program offers you a chance not only to introduce your colleagues to the many benefits and opportunities of membership, but also to earn rewards for yourself. You’ll receive a $25 VISA gift card for every new member* you recruit and we’ll give the member you recruit a $25 VISA gift card for joining! Plus - for each new member you recruit, your name will be placed in a drawing for a $500 Visa Gift Card! It’s our way of saying Thank You!

Recruiting New Members is easy!

Talk to your colleagues about the value OPA brings to the profession and to you personally. Then simply provide prospective members with a copy of the membership application below. You’ll be supporting them in advancing their careers and gaining support for your profession. Remember, it’s your association. *New Member - Anyone who has not previously belonged to the Ohio Pharmacists Association or who has not been a member in the last two years.

OHIO PHARMACISTS ASSOCIATION 2011 Membership Application

To start receiving your OPA member benefits more quickly, join securely online at www.ohiopharmacists.org/join.

Referred by (current OPA Member only)______________________________________________________________________ NEW MEMBER INFORMATION Name_____________________________________________________

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Company Address___________________________________________

Home Ph. (_____)_______________ Cell Ph.(______)_____________

City____________________________State________Zip___________

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Home

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Providing your e-mail address allows OPA to send instant alerts about important pharmacy-related news. OPA does not sell or distribute member e-mail addresses.

OPA MEMBERSHIP CATEGORIES (please select one) 

Active Member $235 (entitled to full membership benefits)

 1st Year Pharmacist $75 (2010 Graduate) (entitled to full membership benefits for discounted rate of $75)

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Joint with Spouse Active Member $120  Retired Member $100 (active member pays full rate and both members (entitled to full membership benefits; are entitled to full membership benefits) must be 65 and retired from full-time practice)



2nd Year Pharmacist $160 (2009 Graduate) (entitled to full membership benefits for discounted rate of $160)

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Associate Member $175 (a non-voting membership category for nonpharmacists interested in supporting the pharmacy profession)

PAYMENT  Check Made Payable to Ohio Pharmacists Association and enclosed OR Please Bill My Credit Card  VISA  MASTERCARD Acct #_________________________________________Exp. Date_______Sec. Code______ Name on Card ______________________________ Billing Address_________________________________________________City, State Zip______________________________________________

(If different from above)

Mail your completed application to: Ohio Pharmacists Association, 2155 Riverside Dr., Columbus, OH 43221

Credit card payments may also be made by phone at 614.586.1497 or by fax to 614.586.1545. Or join securely online at: www.ohiopharmacists.org/join Membership dues may constitute an ordinary and necessary business expense, but are not a charitable deduction. A portion of dues, however, is not deductible as an ordinary and necessary business expense to the extent that OPA engages in state or federal lobbying. The non-deductible portion of the dues for 2011 is 15%.

This offer is valid October 15, 2010 - March 31, 2011

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legislative update Kelly Vyzral, Director of Government Affairs This month’s Legislative Update focuses on federal legislative issues. include HSAs (health savings accounts), HRAs (Health Reimbursement Accounts) and FSAs (Flexible Spending Accounts.) Effective January 1, 2011, OTC drugs and biologicals will need a doctor’s prescription to be defined by the IRS as a qualified medical expense. This is in response to Health Care Reform legislation. •Participants will still be able to use their tax advantaged health care accounts for purchases of ALL OTC drugs, as long as they have a doctor’s prescription. •The rule takes effect January 1, 2011 and applies to purchases on or after January 1, 2011, regardless of plan year. The new rules do not affect drugs purchased before January 1, 2011, but for which reimbursement is not made until on or after January 1, 2011. The only acceptable form of documentation for reimbursement for OTC drugs is a doctor’s prescription, as regulated by state law. •Insulin, medical devices (crutches, blood sugar monitors, etc.), and items such as bandages, contact lens solution, denture bond, etc. remain eligible and will not require a prescription. One of the most noticeable immediate effects of the new rules is that, beginning January 1, 2011, HSA, HRA and FSA debit cards cannot be used to purchase over-the-counter drugs because current debit card systems are not capable of recognizing and differentiating when over-the-counter drugs are obtained in conjunction with a prescription. However, because many current debit card systems are not capable of compliance with the new rules, and in order to help with the significant changes to existing systems necessary to reflect the statutory change, IRS will not challenge the use of health FSA and HRA debit cards for expenses incurred through January 15, 2011. On and after January 16, 2011, over-the-counter drug purchases must be substantiated as having been made with a prescription prior to reimbursement, meaning that these debit cards will no longer be able to be used for purchases of over-the-counter drugs.

S. 3397: The Secure and Responsible Drug Disposal Act

This law will allow patients who lawfully obtain controlled substances to transfer them to a government or private entity for disposal. Under the provisions of the new law, the U.S. Attorney General will issue regulations governing the transfer of controlled substances for disposal to prevent diversion. Long-term care facilities will also be permitted to dispose of controlled substances on behalf of their patients or former patients. Current restrictions by the DEA require that certain unused, expired or unwanted medications be relinquished only to an individual authorized by the DEA. This caveat has made take-back and disposal programs extremely difficult. The legislation would ease these restrictions and make it easier to operate local take-back programs. Each state’s Attorney General would have the authority to authorize groups to run take-back or mail-in programs. Additionally, the House legislation would require EPA and DEA to work together on a public education and outreach program, and would require EPA to initiate a study analyzing the environmental impact of medications in the water supply. OPA will continue to keep an eye on the Ohio Attorney General’s office for rules regarding drug disposal programs.

DEA Eases ‘Nurse as Agent’ Restrictions for Long-Term Care Pharmacists and Patients

DEA clarified that a practitioner may use an authorized agent to transmit prescriptions for controlled substances in Schedules III-V ONLY. This policy also provided guidance on establishing a valid agency relationship including the requirement that the agency relationship be explicit and transparent. DEA suggested that the practitioner, the agent, and the dispensing pharmacist have authorization in writing and on file with all three parties, in addition to the agent’s employer.

If you have any questions or comments about the issues mentioned in this article, please contact Kelly Vyzral, Director of Government Affairs, at 614.586.1497 or kvyzral@ohiopharmacists.org.

Medical Savings Accounts Have New Rules for OTC Reimbursements

The IRS has issued rules regarding changes in how tax-advantaged medical savings accounts can be used. Tax-advantaged medical savings accounts 15

december 2010

OPA Member Completes Homeland Security Training

McKesson Health Mart Healthy Living Tour Stops in Ohio Recognizing that pharmacists play an important role in managing diabetes patients, McKesson launched the nationwide Health Mart Healthy Living Tour featuring a mobile screening unit that travels across the country to raise diabetes awareness. Sponsored by Health Mart Pharmacy, Bayer Diabetes Care, and Novo Nordisk, the tour focuses on identifying persons at risk for diabetes and encouraging them to utilize their pharmacist in managing their condition. In Ohio, the Healthy Living Tour stopped at Mako’s Health Mart Pharmacy in Uhrichsville, Davis Health Mart Drug in Caldwell, Shriver’s Health Mart Pharmacy in New Lexington, and Circleville Apothecary Health Mart Pharmacy. During the tour’s stop at Circleville Apothecary, owner Bob Mabe, R.Ph. and his staff offered blood pressure, total cholesterol, blood glucose and hemoglobin A1c screenings in the van. In addition, University of Toledo pharmacy extern Matthew Wiggins gave a presentation on diabetes management.

Mary Ann Janning, R.Ph., a Franklin County and Columbus Medical Reserve Corp (MRC) volunteer, recently completed Homeland Security training at the Center for Domestic Preparedness (CDP) in Anniston, Alabama. The CDP is operated by the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA), and is the only federally chartered Weapons of Mass Destruction training facility in the nation. Training at CPD’s campus in Anniston includes healthcare and Public Health training at the Noble Training Facility, the nation’s only hospital facility dedicated to training hospital and healthcare professionals in disaster preparedness and response. Classroom instruction involving chemical, biological, radiological, and nuclear warfare training comprised the first week of the program. This facility featured civilian training exercises in a true toxic environment using chemical agents. The advanced hands-on training enables responders to effectively prevent, respond to, and recover from real-world incidents involving acts of terrorism and other hazardous materials. Practicing with a simulated real world incident was an ideal way to practice and apply concepts learned. The second week involved leadership training for an expanding incident and the emergency response challenges that arise with multiple agencies, jurisdictions, and circumstances. The responders had to utilize all aspects of emergency preparedness, starting from notification of an incident to the response of the incident through to the recovery phase. Mary Ann stated, “The CDP courses teach critical skills and allowed me to apply those skills to practice so that I can effectively participate in the response effort of local incidents, as well as other possible threats to our nation’s well being.” Mary Ann is an OPA member and serves on OPA’s Pharmacist Preparedness Task Force.

Bob Mabe, R.Ph. (left) and newly licensed son Stephen Mabe, R.Ph., PharmD fielded patients’ questions during health screenings in the van.

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OPA Student Rotations

University of Findlay student Jennifer Remot spoke on hydration in older adults at the Hilliard Senior Center during her rotation at OPA.

Jennifer Remot, PharmD Candidate, University of Findlay; OPA Extern As the light at the end of the tunnel begins to brighten, many pharmacy students start to ask themselves, “Where do I go from here?” For the past five to seven years, we have been molded to be an ideal pharmacist, so upon graduation we can better patient health in the community. But who is an ideal pharmacist? Is it someone who works as a clinical pharmacist at a 1,000-bed hospital, or is it an independent pharmacist in a town of 500, or is it a pharmacist who serves in the Ohio legislature? College does not prepare us for what we can become outside the traditional pharmacist. We enter and leave pharmacy school with two major paths to choose from: institutional and community. My rotation at the Ohio Pharmacists Association (OPA) broke the image of a traditional pharmacist and allowed me to explore different aspects of pharmacy and the importance of protecting pharmacy as a profession. September was an important political month, as the politicians to be elected would affect the practice of pharmacy and our future. The Association speaks on behalf of the best interests of pharmacy, especially for those groups that do not understand the value of the pharmacist. It is hard to describe all the lessons I learned from my experiences at OPA. I have gained respect for all the pharmacist members and OPA staff for the work they do to protect the profession. If I had to choose one lesson that I learned from my rotation at OPA, it would be to be an active pharmacist, whether it is with local, state, or national associations, or all of the above. Get involved. The profession of pharmacy is only protected by the people who fight for it. Being involved in an association like OPA also helps build strong relationships with other healthcare associations. The Ohio Prescription Drug Abuse Task Force is a great example of multiple healthcare organizations/associations, political parties, and law enforcement getting together and making a difference in the community. Attending these meetings showed me how important it is to get our views across, especially in areas that pharmacists are primarily affected. Another advantage of association involvement is getting your individual voice heard to make a difference, whether in disagreement with a state legislator or in MTM program changes. OPA has the pharmacists and resources available. I would recommended a rotation at the Ohio Pharmacists Association to any pharmacy student, as I feel there is an unconventional lesson of phar-

macy to be learned here. It is like being backstage of a large Broadway production. With associations like OPA, the profession of pharmacy will continue to grow. My rotation at OPA has changed my outlook on pharmacy and the opportunities I thought I was limited to. I feel confident leaving here, knowing I am going to help improve pharmacy as a profession.

Pharmacists Rehabilitation Organization, Inc. Save a career . . . a family . . . a life! PRO, Inc., the Pharmacist Recovery Network of Ohio, can confidentially help you get help for a pharmacist experiencing problems caused by alcohol or drug use. Please do not wait until the impaired pharmacist gets so impaired that he/she injures someone or is arrested for diverting controlled substances and subjects himself to license suspension or revocation. Please call any of the following PRO, Inc. pharmacist volunteers for more information. Mike Quigley Jim Liebetrau Dave Merk Tom Oswald Scott Patton Tom Foti Butch Smith Ralph Homer Nick Kallis Matt Nourse Gary Rutherford

Toledo Cincy/Dayton Cleveland Akron Central OH SE Ohio N. Central OH Cleveland Central OH Southern OH Central OH

419.531.5486 859.586.2384 440.888.9103 330.472.0699 614.738.8039 330.339.8202 740.726.2214 440.235.5574 614.527.1992 740.820.5687 614.296.0622

OPA: 614.586.1497 • OSHP: 740.373.8595 17

december 2010

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State Board Seeking Nominations

Web Watch

www.ohiopharmacists.org

Are you interested in helping to shape the practice of pharmacy in Ohio? The Ohio Pharmacists Association is looking for pharmacists interested in serving on the Ohio State Board of Pharmacy. Every year, the Governor appoints two pharmacists to serve four-year terms. The Board’s primary purpose is to protect the citizens in Ohio by insuring safe drug distribution. The practice of pharmacy is changing rapidly and your expertise is invaluable to the practice of pharmacy, as well as to the citizens of Ohio. As a Board member, you will be involved in licensure, rule making, and disciplinary hearings. You will be asked to evaluate new technology, standards of practice, and information distribution systems. January 6, 2011 is the deadline for submitting nominations to the OPA Board of Pharmacy Vacancy Subcommittee. For more information and the application form, please go the OPA homepage at www.ohiopharmacists.org and click on Seeking Nominations for the State Board of Pharmacy under the Hot News section.

Check Out Online Journal, Member Promotion, Shopping, Legislation Information Kathy Wotruba, Director of Membership & Information Services New! OP Journal Available Online. Can’t wait for the Ohio Pharmacist journal to hit your mailbox? Each month, beginning with this issue, the Ohio Pharmacist journal will be available in PDF format on the OPA website. It will be located on the Members Only page under News & Info in the article entitled Ohio Pharmacist Online. Grassroots Membership - Member Get a Member. Introduce your colleagues to the many benefits and opportunities of OPA membership. You’ll receive a $25 VISA gift card for every new member you recruit and we’ll give your new member a $25 VISA gift card for joining! Plus, for each new member you recruit, your name will be placed in a drawing for a $500 Visa Gift Card! Simply provide prospective members with a copy of the Member-Get-a-Member application located in the Hot News on the OPA home page and on page 14 of this issue. *New Member is defined as anyone who has not previously belonged to the Ohio Pharmacists Association or who has not been a member in the past two years. Holiday Shopping Help! Need last minute gifts this holiday season? Shop online using the Good Search/Good Shop link on the OPA home page. Not only will you be able to shop from the comfort of your home, but the Ohio Pharmacists Foundation can earn up to 30 percent on your purchases. You may also login at http://www. goodsearch.com/toolbar/ohio-pharmacists-foundation-opf. Legislative Status Report for Pharmacy. Federal health care reform and pending state legislative issues may have a serious impact on your practice. The Legislative Status Report for Pharmacists is a feature designed to keep OPA members current on any pending pharmacy-related legislation. The report is updated as needed and is located in the News & Info area of the Members Only page. If you have any feedback or suggestions regarding the website, please contact kwotruba@ ohiopharmacists.org.

16 th Annual Ohio Research Forum Friday, April 8, 2011 Columbus Convention Center You are invited and encouraged to submit an abstract for the 2011 Annual Ohio Research Forum. This program, in conjunction with OPA’s Annual Conference, was created to provide an opportunity for pharmacists, faculty, residents and students to display and discuss pharmacy practice-based research, and to share the outcomes of that work with Annual Conference attendees. The program has capacity for platform and poster presentations. Submission deadline is February 25, 2011. The online abstract form can be accessed at www.ohiopharmacists.org. If you have questions, contact Curt Black (curt.black@utoledo.edu) or Amy Bennett (abennett@ohiopharmacists.org).

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2010 Editorial Index American Pharmacists Association OPA Member Candidates, May, p. 22 Recognizing OPA members, Apr, p. 17 Board of Pharmacy Appointments, Aug, p. 18 Nominations solicited, Dec, p. 19 Public Member Appointed, Feb, p. 18 BWC Rx Abuse Seminar, Nov, p. 20 Colleges/Schools of Pharmacy Cedarville: Pharmacy Camp, Feb, p. 22 ONU: Awards, Apr, p. 22; Dee Dee Myers and ASP Chapter Recog- nized, Nov, p. 21; Discovery Channel Profiles Series, Jun, p. 22 OPA Annual Conference Student High- lights, Sep, p. 20 OSU: Students Strengthening Global Connections, Jun, p. 20 UF: H1N1 Clinic, Jan, p. 26; HRSA Awards, Mar, p. 22; Drug Collec- tion, Apr, p. 22 DEA DEA Disposal Day, Sep, p. 13 E-Prescribing Controlled Substances, Jul, p. 18 “Nurse as Agent,” Dec, p. 15 Pharmacist’s Manual Revised, Nov, p. 14 Education/Continuing Education CE Opportunities for RPhs and Techs, Apr, p. 13 CE Reporting, Apr, p. 19 CE at Sea, Mediterranean, Jan, p. 5; Feb, p. 18; Apr, p. 20 CE Statement Changes, Feb, p. 19 Chronic Obstructive Pulmonary Disease Treatment, Sep, p. 7 Chronic Obstructive Pulmonary Disease Understanding, Aug, p. 7 Jurisprudence: Rx Drug Abuse Respon- sibility of Pharmacies and RPh, Jan, p. 14 New Drugs: Actemra, an Interleukin-6 Receptor Inhibitor, Jul, p. 7 New Drugs: Ampyra, Carbaglu, Vpriv, Xiaflex, Oct, p. 7 New Drugs, Arzerra, Istodax, Kalbitor, Stelara, Apr, p. 7 New Drugs: Asclera, Prolia, Provenge, Nov, p. 7 New Drugs: ella, Jevtana, Krystexxa, Lastacaft, Dec, p. 7 New Drugs: Multaq, Livalo, Mar, p. 7 New Drug: Victoza, Jun, p. 7 OTC Cough and Cold: Antihistamines, Nasal Decongestants, Antitussives, Feb, p. 7

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OTC Cough and Cold: Background and Analgesics/Antipyretics, Jan, p. 7 Systemic Lupus Erythematosus, May, p. 7 Health Care Reform AMP Update, Sep, p. 17 Health Care Reform, Apr, p. 16; May, p. 14-17 Immunizations Cell-based Production of Flu Vaccine, Apr, p. 18 Google Flu Shot, Nov, p. 12 H1N1 Influenza Status, Apr, p. 18 Human Rabies, Jul, p. 15 Influenza Free Zone Certificate, Nov, p. 12 Training Program, Mar, p. 16 Seasonal Flu Update, Oct, p. 13 In Memoriam Faith Amuzu, Mar, p. 22 Alvin “Danny” Baumal, Dec, p. 22 Jack Karlin, Mar, p. 22 Gordon Knight, Dec, p. 22 Legislative/Legal Federal Legislation HR 4213: DME Pharmacy Accredita- tion Exemption, Apr, p. 16 HR 5234: PBM Audit Reform and Transparency Act of 2010, Sep, p. 16 HR 5235: Medicare Access to Diabetes Supplies Act, Sep, p. 16 HR 5809: Safe Drug Disposal Act of 2010, Sep, p. 16 S. 3397: Secure and Responsible Drug Disposal Act, Sep, p. 16; Dec, p. 15 S. 3543: MTM Expanded Benefits Act of 2010, Sep, p. 16 Federal Issues 340B Program, May, p. 15 AMP Update, Sep, p. 17; Oct, p. 15 Congress Coming to Town, Sep, p. 16 DEA: Nurse as Agent, Dec, p. 15 DME Step-Up, May, p. 17 DMEPOS Accreditation, Aug, p. 15 E-Prescribing Controlled Substances, DEA interim rule, Jul, p. 18 Health Care Reform, Apr, p. 16; May, p. 14 Long Term Care New Requirements, May, p. 15 Manufacturing, New Definition, May, p. 15 Medicaid Generic Drug Reimburse- ment (AMP Fix), May, p. 14 Medical Savings Accounts and OTC Reimbursement Rules, Dec, p. 15 Medicare DME Accreditation Exemp- tion, May, p. 14 Medicare Part D Donut Hole, May, p. 15

National Provider Identifier, Jan, p. 22; Apr, p. 19 PBM Transparency, May, p. 14 Pseudoephedrine Update, Jun, p. 18 Red Flag ID Theft, Jul, p. 18 RPh-Delivered MTM, May, p. 15 Victory with AMP Rule, Oct, p. 15 State Legislation HB 1: Budget, Prompt Pay, Oct, p. 14 HB 237: Cancer Protection Bill, Oct, p. 14 HB 267: Ohio Official Rx Program, Oct, p. 14 HB 357: Dispensing During Public Health Emergencies, Jan, p. 22 HB 453: Rx Drug Coverage, Apr, p. 16; Oct, p. 14 HB 547: Narcotics Abuse Prevention Act, Jul, p. 17; Nov, p. 18 HB 499: Medicaid Bundling, Aug, p. 15 HB 513: Disease Management, Aug, p. 15 SB 133: Cancer Protection Bill, Oct, p. 14 SB 154: Pharmacy Relationship, Feb, p. 17; Mar, p. 19; Apr, p. 16; Oct, p. 15 SB 203: Pharmacy Technician, Dead- lines Apr, p. 16 SB 277: Medicaid Dispensing Fee, Jul, p. 17; Oct, p. 15 SB 283: Medicaid Bundling, Aug, p. 15 State Issues Best Rx, Jun, p. 18 Drug Disposal Drop Boxes in Ohio, May, p. 17 Medicaid Program Changes, Mar, p. 19 State Attorney General Small Business Initiative, Sep, p. 17 Medicaid/Medicare Medicaid Program Changes, Mar, p. 19 Medicaid Bundling Rules, Aug, p. 15 Medicinal Garden at Governor’s Residence Ceremony, May, p. 20 Support Needed, Jan, p. 20 VAAC Contributes to Garden, Jul, p. 13 Miscellaneous Cardiac Arrest Survivor Honors Rescuers and Donates AED, Aug, p. 14 Disposal Day, American Medicine Chest, Oct, p. 15 Ernest Boyd Earns Honorary Degree, Jul, p. 21 Fall Prevention Older Adults, Jul, p. 18 Human Rabies Prevention & Treat- ment, Jul, p. 15 McKesson Tour in Ohio, Dec, p. 16

Ohio Attorney General Small Business Initiative, Sep, p. 17 OPA Member Attends Homeland Security Training, Dec, p. 16 Patient Assistance Program, Nov, p. 19 Pharmacy Audit Help, Aug, p. 21 USP Convention 2010, May, p. 20 Vial of Life Program, Feb, p. 22 National Association of Chain Drug Stores (NACDS) RxIMPACT on Capitol Hill, Jun, p. 18 Victory with AMP Rule, Oct, p. 15 National Community Pharmacists Association (NCPA) Annual Convention, Aug, p. 21 Victory with AMP Rule, Oct, p. 15 Ohio Pharmacists Association AED Donation to OPA, Aug, p. 14 Award Nomination Form, Aug, p. 16 Bylaws, Proposed Changes, Feb, p. 21 Call for Committees, Apr, p. 21 Candidate Review, Jan, p. 23 Committee Directory, Oct, p. 20 Election Nomination, Aug, p. 19 Media Award Solicit, Nov, p. 20 Member promo, Dec, p. 14 Membership Rx: OPA & Kroger, Sep, p. 19 New Staff: Antonio Ciaccia, Feb, p. 18 Shining Stars, Jun, p. 21 Social Media, Expanding Network, Apr, p. 15 OPA Editorials Dangerous Side of Safety, (exec message), Sep, p. 6 Heading Toward Success, (pres message), Oct, p. 6 Honored to Serve You, (pres message), May, p. 6 Inaugural Sebok Lecture Series ONU (exec message), Feb, p. 6 Independents Day (exec message), Apr, p. 6 Leadership: We Need You, (exec message), Jun, p. 6 New Year’s Resolutions (pres message), Jan, p. 6 Ohio Celebrates Another Ohio Leader, (exec message), Dec, p. 6 Pharmacists: Agents of Change, (exec message), Nov, p. 6 Pharmacists’ Critical Role Recognized, (exec message), Jul, p. 6 Prescription Drug Abuse, (pres message), Aug, p. 6 Pseudoephedrine Sales and Pharma- ceutical Waste, (pres message) Mar, p. 6 OPA Meetings Annual Conference Award recipients, Jun, p. 14

Highlights, May, p. 18 House of Delegates Report, Jun, p. 15 Media Award Solicit, Nov, p. 20 PAC Breakfast, Jun, p. 18 Promo, Feb, p. 13-16, Mar, p. 13 Sponsors, Jun, p. 13; Sep, p. 20 Student Annual Conference High- lights, Sep, p. 20 Student Volunteers, Jun, p. 19 Trade Show/Career Fair, Mar, p. 17 Licensure Ceremony, Oct, p. 22 Long Range Plan Highlights, Aug, p. 22 Midyear Meeting, Aug, p. 13; Sep, p. 15; Dec, p. 21 Technician Seminars, Jan, p. 22; Jun, p. 20; Jul, p. 21 Young Pharmacist Leadership Confer- ence, Nominations, Apr, p. 19 Ohio Research Forum Abstract call, Dec, p. 19 Podium presentations, Oct, p. 17 Poster presentations, Sep, p. 20 Pharmacy Technicians CE Opportunities for RPhs and Techs, Apr, p. 13 Education seminars Spring program promo, Jan, p. 22 Summer program promo, Jun, p. 20, Jul, p. 21 Poison Prevention Prevent Poisonings in Communities, Jan, p. 25 PRO, Inc. Contacts, Feb, p. 19, Apr, p. 19 Public Relations Pharmacy Month, Sep, p. 17 Rx Drug Abuse Ohio Task Force, May, p. 17; Oct, p. 18 Prescription Drug Abuse, (pres message), Aug, p. 6 Responsibility of RPh/Pharmacies, Jan, p. 14 Salary Survey OPA 2009 Salary Survey, Mar, p. 14 Student News/Presentations OPA Conference Highlights, Sep, p. 20 Rotations Dan Clewell, Feb, p. 16 Jennifer Remot, Dec, p. 17 Web Watch Dues Renewal/History, Mar, p. 13 E-Mail Security, Jan, p. 22 GoodSearch/GoodShop, Jun, p. 21 Online Invoicing, Aug, p. 20 Online Shopping, Nov, p. 21

OPA Journal Available Online, Dec, 19 Public Relations Materials, Jul, p. 21 Recruiting New Members, Feb, p. 19 Red Flag Rule/Credit Card Security, Oct, p. 21 Salary Survey 2009, Apr, p. 21 Social Networking, May, p. 20 Advertising Index AmerisourceBergen/Good Neighbor Pharmacy, Jan, p. 13; Mar, p. 5; May, p. 13; Jul, p. 14; Sep, p. 14; Nov, p. 13 APSC, Jan, p. 19; Feb, p. 20; Mar, p. 20; Apr, p. 14; May, p. 16; Jun, p. 17; Jul, p. 20; Aug, p. 5; Sep, p. 18; Oct, p. 5; Nov, p. 17; Dec, p. 5 Cardinal Health, Jul, p. 19 CE at Sea, Jan, p. 5; Feb, p. 18; Apr, p. 20 Forest Labs, inserts Nov Logix, Jan, p. 23; Feb, p. 21; Mar, p. 22; Apr, p. 22; May, p. 22; Jun, p. 22; Jul, p. 22; Aug. p. 22; Sep, p. 22; Oct, p. 22; Nov, p. 22; Dec, p. 22 McKesson, Jan, p. 2; Feb, p. 2; Mar, p. 2; Apr, p. 2; May, p. 2; Jun, p. 2; Jul, p. 2; Aug. p. 2; Sep, p. 2; Oct, p. 2; Nov, p. 2; Dec, p. 2 NEOUCOM, Nov, p. 16 PAAS, Aug, p. 21 Pfizer, May, p. 5 Pharmacists Mutual, Jan, p. 24; Feb, p. 5; Mar, p. 21; Apr, p. 5; May, p. 21; Jun, p. 5; Jul, p. 5; Aug, p. 17; Sep, p. 5; Oct, p. 16; Nov, p. 5; Dec, p. 18 Pharmacy Quality Commitment, Jan, p. 28; Feb, p. 24; Mar, p. 24; Apr, p. 24; May, p. 24; Jun, p. 24; Jul, p. 24; Aug, p. 24; Sep, p. 24; Oct, p. 24; Nov, p. 24; Dec, p. 24 Pharmstaff, Jan, p. 26 PRO, Inc, Feb, p. 19; Apr, p. 19; Dec, p. 17 QS/1, Mar, p. 18 University of Findlay, Apr, p. 21

Ohio Pharmacists Association

Midyear Meeting

November 7, 2010

Pharmacists: Key to Patient Care

Thanks to Sponsors American Pharmacy Services Corporation Pfizer, Inc. december 2010

opportunities, news S & L Solutions, LLC

As a business partner, S & L can provide short and long-term solutions to satisfy all of your pharmacist staffing and recruiting needs. Employment inquiries welcome. Call 1.888.273.0325 or visit our website at www. sandlsolutions.com.

GlaxoSmithKline is working with pharmacies in the Columbus, Ohio area to pilot a Recycling Program for GSK respiratory inhalers collected from July 2010 through July 2011. To enroll, call 888.825.5249, M-F, 8-6 EST.

News From Our Members Amy Schwan, R.Ph. spoke to the Four County Young-At-Heart group on the dangers of flu in older adults and encouraged influenza vaccines. She practices at the Medicine Shoppe in Bellevue.

More Opportunities on the Career Center and Classifieds sections at www.ohiopharmacists.org Barry Klein, R.Ph., president of Klein’s Pharmacy in Cuyahoga Falls, was recipient of the Margaret Clark Morgan Foundation’s Compass Award for his service to individuals affected by mental illness. Tim Ulbrich, R.Ph., PharmD presented “Good Medicine with Mary Sheehan” on HCTV on the topic of self care. Tim is assistant professor in the Department of Pharmacy Practice at Northeastern Ohio Universities College of Pharmacy. Adam Bodak, R.Ph., PharmD of Solon was recently deployed to Iraq with the 256th Combat Support Hospital, which is headquartered in Twinsburg. Jon Sprague, R.Ph., Ph.D. coauthored a chapter in Information Assurance and Security Ethics in Complex Systems: Interdisciplinary Perspectives, exploring ethical and privacy issues of electronic health records. Jon is dean of the Ohio Northern University College of Pharmacy. Robert “Doc” Schlembach, R.Ph., Ph.D. continues to serve as Dean Emeritus,

ohio pharmacist

In Memoriam Alvin “Danny” Baumal, R.Ph. 1929-2010

A graduate of the OSU College of Pharmacy, Danny served most of his pharmacy career in the community setting as coowner of Cedar-Lee Rexall Drug in Cleveland Heights and Ohio and Campus Drug in Shaker Heights. Gordon William Knight, R.Ph. 1931-2010

Gordon Knight owned and operated several pharmacies in the Clintonville area of Columbus and was very active with several community organizations. He was a 1953 graduate of the University of Pittsburgh College of Pharmacy.

College Historian, student advisor, and a member of the alumni affiliate board at the University of Toledo College of Pharmacy, where he taught from 1954 to 1989. Until recently, he practiced part time at the Cordelia Martin Pharmacy serving the homeless and economically disadvantaged.

Deceased Pharmacists •Marie H. Graham, R.Ph., 68, Westerville, October 18 •Janet J. Roberts, R.Ph., 81, Uhrichsville, October 17 •Maria-Chrisi White, R.Ph., 70, Chillicothe, October 21 •Alvin "Danny" Baumal, R.Ph., 81, Cleveland, October 24 •Gordon William Knight, R.Ph., 79, formerly of Columbus, October 26

continuing education quiz

Please print.

Program 0129-0000-10-012-H01-P 0.15 CEU

Name________________________________________________ Address_____________________________________________

New Drugs: ella, Jevtana, Krystexxa and Lastacaft

City, State, Zip______________________________________ Return to Correspondence Course, OPA, 2155 Riverside Drive, Columbus, OH 43221-4052

1. Alcaftadine is an antagonist for which of the following types of receptors? a. Alpha-adrenergic c. Cholinergic b. Beta-adrenergic d. Histamine 2. The mediator for the receptors referred to in question #1 is released by: a. beta cells. c. mast cells. b. corneal cells. d. retinal cells.

10. Acute gout flares are common in the lower extremities due to the: a. pull of gravity on circulating blood. b. lower temperature in these joints. c. higher number of capillaries there. 11. Pegloticase catalyzes the oxidation of uric acid into: a. salicylic acid. c. sorbic acid. b. allopurinol. d. allantoin.

3. The preservative in Lastacaft ophthalmic drops that may be absorbed onto soft contact lenses is: a. benzalkonium chloride. c. povidone iodide. b. methyl paraben. d. thimerosal sodium. 4. Jevtana is indicated in combination with which of the following for treatment of hormone-refractory metastatic prostate carcinoma? a. Allopurinol c. Methotrexate b. Prednisone

12. Ecchymosis refers to: a. abnormal hair growth. c. bleeding under the skin. b. atopic dermatitis. d. chronic nose bleeds. 13. Krystexxa is contraindicated in patients with a deficiency in: a. catechol-O-methyl transferase. b. cytochrome P-450 oxygenase. c. glucose-6-phosphate dehydrogenase. d. gluconate-alpha reductase.

5. Which of the following groups of American men have the highest prostate cancer incidence rate? a. African descent c. European descent b. Asian descent

14. ella is a first in-class modulator of: a. estrogen. b. progesterone. 15. All of the following new drugs in this lesson are unique and add to available therapies EXCEPT: a. ella. c. Krystexxa. b. Jevtana. d. Lastacaft.

6. Cabazitaxel interferes with: a. oxygenation and respiration. b. cell division. c. mitochondrial transcription. d. cell wall development. 7. Jevtana’s Boxed Warning states that blood cell counts of which of the following should be frequently monitored? a. Eosinophils c. Leukocytes b. Granulocytes d. Neutrophils

Completely fill in the lettered box corresponding to your answer. 1. 2. 3. 4. 5.

8. The recommended dose of Jevtana is 25 mg/m2 administered: a. every week. c. every three weeks. b. every two weeks. d. every four weeks. 9. Uric acid is the metabolic end product of the metabolism of: a. purine. c. pyridine. b. purinethol. d. pyridoxine.

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

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

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

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

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

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

 I am enclosing $2 for this month’s quiz.  I am enclosing $20/$30 for quizzes published in 2010. (Please circle amount. $30 includes Jan. law CE.)  I have already remitted $20/$30 for quizzes published in 2010. Make all checks payable to Ohio Pharmacists Association. 1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor) 2. Did it meet each of its objectives (p. 7)?  yes  no If no, list any unmet_______________________________ 3. Was the content balanced and without commercial bias?  yes  no 4. Did the program meet your educational/practice needs?  yes  no 5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

To receive CE credit, your quiz must be postmarked no later than December 15, 2013. A passing grade of 80% must be attained. CE statements of credit are mailed February, April, June, August, October, and December. Only current OPA members may receive CE credit for this lesson.

december 2010

OHIO PHARMACIST 2155 Riverside Drive Columbus, OH 43221

Prsrt STD U.S. Postage PAID Columbus, Ohio Permit No. 1560

ADDRESS SERVICES REQUESTED

A continuous quality improvement program can be a lifesaver ...

Yep, weâ&#x20AC;&#x2122;re a lifesaver!

Protect your patients. Protect your pharmacy. Errors can injure your patients and put your pharmacy in financial jeopardy. Pharmacy Quality CommitmentÂŽ (PQC) is a continuous quality improvement (CQI) program that supports you in responding to issues with provider network contracts, Medicare Part D requirements under federal law, and mandates for CQI programs under state law. Implemented, pharmacies improve efficiency, increase patient safety, and decrease error rate through an analysis of quality-related events.

Call toll free (866) 365-7472 or go to www.pqc.net for more information. PQC is brought to you by your state pharmacy association.