Pharmacy journal of new england summer 2014 by CT Pharmacists Association

Vol 11 No.2 Summer 2014

Summer 2014

Pharmacy Journal of New England

Emergency Department Discharge Prescription Program: Accountable Continuity of Care Could Your Hospital Make You Sick? Planning for the New Retirement Financial Forum

Why is that Pharmacist Asking So Many Questions? Rx and the Law

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Pharmacy Journal

Vol 11 • No. 2 Pharmacy Journal of New England • Summer 2014

of New England

Help Your Patients Stay Safe this Summer

Editors

David Johnson Margherita R. Giuliano, R.Ph., CAE

Dear Readers,

Managing Editor

Whether your customers and patients are jetting off overseas or enjoying the sun, holidays can bring a whole host of unwanted health problems. Use the summer season as a starting point for conversations about general health and wellness advice.

Ellen Zoppo CPA

Design & Production

Some talking points to share with your patients could include:

Kathy Harvey-Ellis MPhA

• Avoid wearing perfume or hairspray while you’re away, as bugs love the smell. Make sure your holiday first aid kit includes an insect repellent containing an ingredient called DEET if you’re travelling somewhere hot.

The Pharmacy Journal of New England is owned and published by the Massachusetts Pharmacists Association and the Connecticut Pharmacists Association. Opinions expressed by those of the editorial staff and/or contributors do not necessarily reflect the views or policies of the publisher.

• Being aware of what you eat and drink can help reduce the chances of ‘Delhi belly.’ Avoid ice in drinks or eating fruit that may have been washed in tap water and use bottled water when brushing teeth. In addition, always wash hands before eating and dry with a clean cloth . • Certain medical conditions can reduce the efficiency of the body’s cooling mechanisms - diabetes, obesity and chronic heart failure can increase the risk of heat stroke. Remind your patients at risk of heat stroke that it’s important to find time to rest in the shade, particularly after a swim or a games where they can become overexerted, or lose fluids through sweating. •

While in the shade continue to sip cool fluids but avoid alcohol.

•

Medicines are best bought at home before you go on vacation.

Sincerely,

Readers are invited to submit their comments and opinions for publication. Letters should be addressed to the Editor and must be signed with a return address. For rates and deadlines, contact the Journal at (860) 563-4619. Pharmacy Journal of New England 35 Cold Spring Road, Suite 121 Rocky Hill, CT 06067-3167 members@ctpharmacists.org

Submitting Articles to the Pharmacy Journal of New England™ The Pharmacy Journal of New England™ is the product of a partnership between the Connecticut Pharmacists Association and the Massachusetts Pharmacists Association. The Journal is a quarterly publication. All submitted articles are subject to peer review. In order to maintain confidentiality, authors’ names are removed during the review process. Article requirements must conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1982;96 (1part1):766-71). We strongly encourage electronic submissions. PJNE does not assume any responsibility for statements made by authors.

Please submit manuscripts to: Margherita R. Giuliano, RPh Executive Vice President Connecticut Pharmacists Association

Contents 02

08 26 30 32 47

David Johnson Executive Vice President Massachusetts Pharmacists Association

PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: ezoppo@ctpharmacists.org

U.S. News New England States Feature: Implementation of an Emergency Department Discharge Prescription Program Pharmacy Marketing Group: Rx and the Law, Financial Forum From the Colleges Continuing Education for Pharmacists 1

U.S. News More Stressed College Students Ordering Medication Online Nearly one-third of college students turn to prescription drugs during final exam time, and an increasing number of them are ordering the drugs from the Internet without a prescription, according to the results of a recent poll. The poll, now in its second year, was conducted by Zogby Analytics on behalf of the Digital Citizens Alliance, a coalition whose mission is to improve safety and reduce crime on the Internet. A total of 311 current and recently graduated college students completed an online survey from May 1 to May 13, 2014. Of the students surveyed, 72% said that sharing prescription medications with friends was somewhat or very common among college students. Overall, 32% of students surveyed said they or their friends had taken prescription medications as study aids during final exams. Among those who had used medications, 33% obtained the drugs without a physician’s prescription. Both the percentage of students who used prescription drugs and the percentage of those who obtained them without a prescription were slightly increased compared with the results from the 2013 poll. Men were more likely to use medications to help them study than women; approximately 38% of men reported using prescription drugs, compared with 26% of women. In addition, 31% of students said they or a friend had shared a legally prescribed medication with someone else, an 8% increase from last year. Students residing in the southern part of the United States were more likely to share prescriptions than those from other regions, the survey found. A greater percentage of students also reported obtaining prescription medications through the internet this year. Approximately 28% of respondents said they or a friend had ordered drugs online without a prescription, up 13% from 2013. “We know that there are 19.7 million college students from the 2011 Census. Perhaps more than 5 million are using the Internet to obtain prescription medication to help cope with finals and other high pressure situations,” said Adam Benson, Deputy Executive Director of the Digital Citizens Alliance in a press release. “Last year’s survey showed there was a 2

large number of students making these purchases. To see an increase like this is a sign that both Universities and parents need to ask some new questions of students.” http://www.pharmacytimes.com/news/More-Stressed-College-Students-OrderingMedications-Online

FDA outlines expectations for human drug compounders, including registered outsourcing facilities In early July, the U.S. Food and Drug Administration issued several policy documents regarding compounded drug products for human use, as part of the agency’s continuing effort to implement the compounding provisions of the Drug Quality and Security Act (DQSA), enacted in November 2013. The policy documents consist of a draft interim guidance, a proposed rule, a final guidance, and two revised requests for nominations for the bulk drug substances lists. “Providing clarity to the compounding industry on the agency’s expectations for these unapproved drug products is a priority for the agency,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “These actions are essential next steps in providing the compounding industry with the appropriate tools to comply with the law and advancing the FDA’s efforts to continue protecting patients.” The documents available are: • Draft interim guidance that describes the FDA’s expectations regarding compliance with current good manufacturing practice (CGMP) requirements for facilities that compound human drugs and register with the FDA as outsourcing facilities under section 503B of the Federal Food, Drug, and Cosmetic Act (FD&C Act). The guidance focuses on CGMP requirements related to sterility assurance of sterile drug products and the general safety of compounded drug products. • A proposed rule that would revise the FDA’s current list of drug products that may not be compounded because the drug products have been withdrawn or removed from the market because they were found to be unsafe or not effective. The proposed rule would modify the description of one drug product on the list and add 25 drug products to the list.

Pharmacy Journal of New England • Summer 2014

The list set forth in the proposed rule would apply to both compounders and outsourcing facilities seeking to compound drugs for human use under sections 503A and 503B, respectively. • Final guidance for individuals or pharmacies that intend to compound drugs under section 503A, now that the FD&C Act has been amended by the DQSA. The guidance generally restates the provisions of section 503A, describes the FDA’s interim policies with respect to specific provisions that require implementing regulations or other actions, and contains a non-exhaustive list of potential enforcement actions against individuals or pharmacies that compound human drug products in violation of the FD&C Act. • Two Federal Register Notices state the FDA is reopening the nomination process for two lists of bulk drug substances (active pharmaceutical ingredients) that may be used to compound drug products. One list is for drug products compounded in accordance with section 503A, and the other list is for drug products compounded in accordance with section 503B of the FD&C Act. In response to a December 2013 request for nominations, the agency received nominations that were not for bulk drug substances used in compounding, and that did not provide sufficient information to justify inclusion of the substances on the lists. The FDA is providing more detail on what information is needed to evaluate the nominations for placement on the lists. The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm403507.htm CDC: Policy Impact: Prescription Painkiller Overdoses

CDC: Policy Impact: Prescription Painkiller Overdoses In a period of nine months, a tiny Kentucky county of fewer than 12,000 people sees a 53-year-old mother, her 35-yearold son, and seven others die by overdosing on pain medications obtained from pain clinics in Florida. In Utah, a 13-year-old fatally overdoses on oxycodone pills taken from a friend’s grandmother. A 20-year-old Boston man dies from an overdose of methadone, only a year after his friend also died from a prescription drug overdose. These are not isolated events. Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs. Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription painkillers—also called opioid pain relievers. The unprecedented rise in overdose deaths in the US parallels a 300% increase since 1999 in the sale of these strong painkillers. These drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined. The misuse and abuse of prescription painkillers was responsible for more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years. More than 12 million people reported using prescription painkillers nonmedically in 2010, that is, using them without a prescription or for the feeling they cause. About one-half of prescription painkiller deaths involve at least one other drug, including benzodiazepines, cocaine, and heroin. Alcohol is also involved in many overdose deaths. How Prescription Painkiller Deaths Occur Prescription painkillers work by binding to receptors in the brain to decrease the perception of pain. These powerful drugs can create a feeling of euphoria, cause physical dependence, and, in some people, lead to addiction. Prescription painkillers also cause sedation and slow down a person’s breathing. 3

U.S. News

continued

A person who is abusing prescription painkillers might take larger doses to achieve a euphoric effect and reduce withdrawal symptoms. These larger doses can cause breathing to slow down so much that it stops, resulting in a fatal overdose. Almost all prescription drugs involved in overdoses come from prescriptions originally; very few come from pharmacy theft. However, once they are prescribed and dispensed, prescription drugs are frequently diverted to people using them without prescriptions. More than three out of four people who misuse prescription painkillers use drugs prescribed to someone else. Most prescription painkillers are prescribed by primary care and internal medicine doctors and dentists, not specialists. Roughly 20% of prescribers prescribe 80% of all prescription painkillers. Understanding the groups at highest risk for overdose can help states target interventions. Research shows that some groups are particularly vulnerable to prescription drug overdose: • People who obtain multiple controlled substance prescriptions from multiple providers—a practice known as “doctor shopping.” • People who take high daily dosages of prescription painkillers and those who misuse multiple abuse-prone prescription drugs. •

Low-income people and those living in rural areas.

• People on Medicaid are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkillers overdose. One Washington State study found that 45% of people who died from prescription painkiller overdoses were Medicaid enrollees. • People with mental illness and those with a history of substance abuse. Where overdose deaths are the highest The drug overdose epidemic is most severe in the Southwest and Appalachian region, and rates vary substantially between states. The highest drug overdose death rates in 2008 were found in New Mexico and West Virginia, which had rates nearly five times that of the state with the lowest rate, Nebraska. 4

What Can We Do? There are many different points of intervention to prevent prescription drug overdoses. States play a central role in protecting the public health and regulating health care and the practice of the health professions. As such, states are especially critical to reversing the prescription drug overdose epidemic. The following state policies show promise in reducing prescription drug abuse while ensuring patients have access to safe, effective pain treatment. Thirty-six states have operational Prescription Drug Monitoring Programs. Prescription Drug Monitoring Programs (PDMPs) are staterun electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They are designed to monitor this information for suspected abuse or diversion—and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions. CDC recommends that PDMPs focus their resources on • patients at highest risk in terms of prescription painkiller dosage, numbers of controlled substance prescriptions, and numbers of prescribers; and • prescribers who clearly deviate from accepted medical practice in terms of prescription painkiller dosage, numbers of prescriptions for controlled substances, and proportion of doctor shoppers among their patients. CDC also recommends that PDMPs link to electronic health records systems so that PDMP information is better integrated into health care providers’ day-to-day practices. State benefits programs (like Medicaid) and workers’ compensation programs should consider monitoring prescription claims information and PDMP data (where applicable) for signs of inappropriate use of controlled prescription drugs. For patients whose use of multiple providers cannot be justified on medical grounds, such programs should consider reimbursing claims for controlled prescription drugs from a single designated physician and a single designated

Pharmacy Journal of New England • Summer 2014

pharmacy. This can improve the coordination of care and use of medical services, as well as ensure appropriate access, for patients who are at high risk for overdose. States should ensure that providers follow evidence-based guidelines for the safe and effective use of prescription painkillers. Swift regulatory action taken against health care providers acting outside the limits of accepted medical practice can decrease provider behaviors that contribute to prescription painkiller abuse, diversion, and overdose.

to undergo percutaneous coronary intervention (PCI). After PCI, dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is the standard of care to prevent thrombotic complications. A retrospective, observational, pilot study published ahead of print in the American Journal of Therapeutics examines the comparative efficacy of prasugrel, the drug previously identified as most effective in a landmark study, and clopidogrel at a loading dose higher than that employed in said study.

States can enact and enforce laws to prevent doctor shopping, the operation of rogue pain clinics or “pill mills,” and other laws to reduce prescription painkiller diversion and abuse while safeguarding legitimate access to pain management services. These laws should also be rigorously evaluated for their effectiveness.

The newer study enrolled patients with ACS who underwent PCI and received a 600-mg loading dose of clopidogrel or a 60-mg loading dose of prasugrel followed by daily maintenance doses of 75 mg and 10 mg, respectively, for 2 years. The study period was between July 1, 2009, and June 30, 2011, and 221 patients participated.

Effective, accessible substance abuse treatment programs could reduce overdose among people struggling with dependence and addiction. States should increase access to these important programs.

Loading doses of clopidogrel and prasugrel are often given to achieve maximal platelet inhibition quickly (although prasugrel’s onset of action is faster than clopidogrel’s). A higher loading dose of clopidogrel (600 mg in this study vs 300 mg in a previous study) was used because this drug has a slow onset of action requiring activation by P450 isoenzymes. A higher clopidogrel loading dose (600 mg) has also been associated with lower rates of ischemic complication and death.

http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

Prasugrel or Clopidogrel in ACS: A Headto-Head Study Acute coronary syndrome (ACS) is a killer—it’s the leading cause of death in the United States. Patients who experience ACS are whisked into the cardiac catheterization lab

The primary efficacy end point was composite of death from

Drug Overdose Rates by State, 2008

U.S. News

continued

cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke occurring through 1 year. When patients died during the study, investigators attempted to identify cause of death using medical records or death certificates.

patients and 20% were reported among patients with unknown vaccination status. Among unvaccinated patients who contracted measles, 85% refused vaccinations for religious, philosophical, or personal reasons.

Primary efficacy end point was similar in the 2 treatment groups, as were bleeding events. The previous study had identified higher rates of adverse events with prasugrel, and this study did not replicate those findings.

Although measles elimination has been maintained and vaccine coverage is high, the report suggests that importations and outbreaks among unvaccinated communities still pose a threat.

The authors conclude that prasugrel is at least as effective and safe as clopidogrel in patients with ACS undergoing early invasive management.

“Coverage varies at the local level, and unvaccinated children tend to cluster geographically, increasing the risk for outbreaks,” the report notes. “Thus, maintaining high measles vaccination coverage is critical to prevent large measles outbreaks in the United States.”

US Measles Cases Reach 20-Year High From January 1 to July 11, 2014, there have been 566 confirmed measles cases reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). This is the highest number of cases since measles elimination was documented in the U.S. in 2000. A CDC previous study evaluated measles cases reported by states and found that the number reported from January 1 to May 23, 2014 was the greatest number reported during the first 5 months of a year since 1994. Patients with measles have ranged in age from 2 weeks to 65 years and 52% were aged 20 years and older. Of the 288 patients at that time, 43 (15%) were hospitalized and no deaths have been reported. Cases have been reported in 18 states and New York City, with most occurring in Ohio (138), California (60), and New York City (26). Of cases through May 23, 97% were associated with importations from at least 18 countries. A total of 45 direct importations were reported, 49% of which were in patients returning from the Philippines. Other importations were associated with travel from countries belonging to the World Health Organization Western Pacific, South-East Asia, European, Americas, and Eastern Mediterranean regions. The report also found that 15 outbreaks accounted for 79% of reported measles cases, including the largest outbreak reported in the country since elimination. The ongoing outbreak has been associated with 138 cases so far, occurring mostly among unvaccinated Amish communities in Ohio. A majority of all cases (69%) occurred among unvaccinated 6

Health care professionals should remind patients traveling internationally about the increased risk of measles and encourage vaccination. The measles, mumps, and rubella (MMR) vaccine is recommended for all children, with the first dose given at age 12 to 15 months and a second dose at age 4 to 6 years. Children and adolescents who have not received 2 appropriately spaced doses are recommended to receive catch-up vaccination. Adults are recommended to receive at least 1 dose of the MMR vaccine, and health care personnel, college students, and international travelers should receive 2 appropriately spaced doses. http://www.pharmacytimes.com/news/US-Measles-Cases-Reach-20-Year-High

Could Your Hospital Make You Sick? Victoria Nahum thought 2006 had just been a really bad year. After years of suffering symptoms including fatigue, sore muscles and rashes, Nahum’s doctors identified the source of her malaise: Her left breast implant was coated in slime that was the result of a staph infection on the implant from when it had been placed six years earlier in Macon, Georgia. Six months later, Nahum’s son Josh fractured his skull in a sky diving accident in Longmont, Colorado, landing in an Intensive Care Unit there. He was recovering well – until he contracted a bacterial infection in his cerebrospinal fluid that pushed his brain onto his spinal cord, turning him into a quadriplegic before killing him. That same year, Nahum’s father-in-law contracted pneumonia during his hospitalization for a heart attack in Rochester,

Pharmacy Journal of New England • Summer 2014

New York. After the initial shock of her son’s death wore off, Nahum says that she started to put the puzzle pieces together. “I went to the [Centers for Disease Control and Prevention] and said, ‘What is this?’ It can’t just be a coincidence that three of us were harmed in a year,” she says. With CDC support, Nahum, 58, who lives in Atlanta, started the Safe Care Campaign, which works with hospitals throughout the nation to prevent hospital-acquired infections. The CDC released data in March showing that 1 in 25 hospital patients in the U.S. is at risk of developing an HAI, and an estimated 721,800 occur annually. Scott Fridkin, the deputy surveillance branch chief in the Division of Healthcare Quality Promotion at the CDC, calls this “a fairly huge problem,” adding that there’s some evidence that HAI occurrence has decreased. The most common infections, Fridkin says, are pneumonia, diarrhea and urinary tract infections. The real issue is that hospitals are full of germs, and patients invariably pass infections on to each other – if not directly, then through the doctors and nurses with whom they come into contact. Patients can also contract infections from bacteria that live on devices like catheters. Nahum’s son Joshua most likely developed his infection from bacteria living on the tube leading to his brain during his ventriculostomy, a surgical procedure that relieves swelling in the brain. Nahum’s own infection occurred during her breast implant surgery. While controlling the spread of bacterial infections during surgery is usually not feasible for patients, there are certain measures they can take during their hospital stays to minimize their risk of infection. 4 Things Patients Can Do to Prevent HAIs • “Hand hygiene is the basic foundation of all safe care,” Nahum says. “That’s how you pass germs around, so wash your hands frequently – and that means the doctor, nurse and friends because that’s how you are going to get infected. Patients have to know that it’s OK to say ‘Please wash your hands before you touch me.’” Soap and water will do the trick, and that combo trumps hand sanitizer, which does not kill clostridium difficile, commonly known as C. diff, a bacte-

rial infection that causes severe diarrhea. Gloved hands also need to be washed. • Communicate with your health care team, Fridkin says. “Patients should ask every day if they still need the invasive devices that they may be using.” Also ask if prescribed antibiotics are really necessary, since antibiotic resistance is one of the causes of circulating bacterial infections – and that occurs because of over-usage of certain antibiotics, Fridkin explains. If your antibiotic is truly necessary, he adds, take it as prescribed and report any adverse effects. • Choose your visitors well. Bring an advocate with you to the hospital – be it a friend or loved one – “someone who can kind of be the eyes and ears that you don’t have at the moment,” Nahum says. At the same time, leave anyone who is frail or sick at home, and same goes for children. “Visitors also need to be vigilant about washing hands because infections can travel outside of the hospital, putting others at risk. C.diff and methicillin-resistant Staphylococcus aureus, commonly known as MRSA, are both on the rise in people who have never been hospitalized. • Do your homework on hospitals and choose wisely. Nahum says that hospitals have become more accountable about reporting their rates of HAIs, and the Centers for Medicare & Medicaid Services provides incentives for compliant hospitals. Medicare’s “Hospital Compare” website contains this comparative information. State health departments are also a good source of information on hospitals’ infection rates. http://health.usnews.com/health-news/patient-advice/articles/2014/06/25/could-yourhospital-make-you-sick _________________________________________________________________________

Visit MPhA’s Career Site today! http://mpha.associationcareernetwork.com Your destination for exciting Pharmacy job opportunities.

New England States Connecticut

President’s Message Dear CPA Members: During the dog days of summer, we at the Connecticut Pharmacists Association are still busy with the following developments from the state legislature’s short session, monitoring the implementation of the new Medical Cannabis regulations in our state, and planning the Fall CE programs.”

Professional Pharmacy Performance Award Sponsored by Professional Pharmacy Personnel, Inc. Phil Hritcko, President

Our Annual Meeting is scheduled for Thursday, October 23, 2014 at the Fox Tower at Foxwoods, as part of the 10th Annual New England Pharmacists Convention. We cordially invite you to join us that evening as we celebrate the next generation of pharmacists with the presentation of the Connecticut Pharmacists Foundation’s scholarships as well as the wide range of awards given to pharmacists. There is still time to nominate someone, and I encourage you to take a moment to take our quick awards survey and nominate someone who is making a difference. Awards include: Bowl of Hygeia Award Sponsored by the American Pharmacists Association Foundation and the National Alliance of State Pharmacy Associations with support from Boehringer Ingelheim Presented annually to a pharmacist with an outstanding record of community service, that, apart from his/her specific identification as a pharmacist, reflects well on the profession of pharmacy. The recipient must be a pharmacist licensed in Connecticut, a member of the Connecticut Pharmacists Association, must be living (the award is not presented posthumously), must not have been a previous recipient and is currently not serving, nor has served within the immediate past two years as an officer of the CPA in other than an ex-officio capacity. Distinguished Young Pharmacist Award Sponsored by Pharmacists Mutual Insurance Companies 8

The goal of the award is to encourage the newer pharmacists to participate in association and community activities. The award is presented annually to recognize one such person for involvement and dedication to the practice of pharmacy. The recipient must be a pharmacist licensed in CT who has practiced 9 years or less, is a member of the CPA, practicing in community, institutional, managed care or consulting pharmacy and who has participated in national or state pharmacy associations, professional programs, and/or community service.

Presented annually to a pharmacist licensed to practice pharmacy in Connecticut who has performed outstanding services to the profession of pharmacy. The recipient does not have to be a CPA member. Upsher-Smith Excellence in Innovations award Sponsored by Upsher-Smith Laboratories The recipient of this award is a practicing pharmacist who is a member of the Connecticut Pharmacists Association and has demonstrated Innovative Pharmacy Practice resulting in improved patient care. Daniel C. Leone Pharmacist of the Year This award is presented annually to a CPA pharmacist member (cannot be presented posthumously) who demonstrates a proactive and unique approach to pharmacy practice. CARDINAL Health Generation Rx Champion This new award honors a pharmacist who demonstrates outstanding commitment to raising awareness of the dangers of prescription drug abuse in the general public and in the pharmacy community. The award is also aimed at improving education efforts aimed at patients, youth and members of the community. In recognition, Cardinal Foundation will make a $500 donation to a charity of the recipient’s choice. Please take a moment to think about recognizing your fellow pharmacists. We have created a quick and easy survey which will only take a moment to complete. We want to ensure that the role of pharmacists in our ever changing health care landscape continue to be acknowledged for the contributions they bring. See you at the Convention!

Pharmacy Journal of New England â&#x20AC;˘ Summer 2014

Medical Cannabis Symposium Nearly 180 healthcare professionals, including pharmacists and physicians, gathered at Aquaturf in Southington on June 25, 2014 to learn about the clinical implications of medical cannabis. Sponsored by the Connecticut Pharmacists Association, this event allowed the attendees to learn about the medicinal properties of the marijuana plant, the ongoing clinical trials involving different strains of the cannabis plants, as well as the state regulations for prescribing and dispensing marijuana. The speakers at the symposium included Dr. Mark Ware from McGill University in Canada and Executive Director of CCIC; Alex Makriyannis, PhD, Northeastern University; State of Connecticut Drug Control Division Director John Gadea, RPh; Deepak Dâ&#x20AC;&#x2122;Souza, MD from Yale University; and Alan Shackelford, MD from Amarimed, Inc., based in Denver, CO.

Nicole Liedke, a pharmacist with the DB Wellness dispensary, is interviewed by Channel 8 News at the June 25th Medical Cannabis Symposium sponsored by the Connecticut Pharmacists Association.

These speakers presented a variety of topics, ranging from neuropsychiatric effects of cannabis to clinical considerations and patient safety, in formal didactic lectures. Also present at the symposium were representatives from the four licensed growing producers, which are scheduled to have medical cannabis ready for the market by August. The state has also licensed six dispensaries that were preliminarily approved and will begin providing medical cannabis to registered patients by the end of the summer. Connecticut legalized medical marijuana in October 2012, and the first dispensaries are scheduled to open in August, 2014. Thus far, over 2,000 patients have been certified by their physicians as eligible to benefit from medical cannabis and this number is expected to grow according to State Department of Consumer Protection. It is important to note that Connecticut is the only state that requires a primary healthcare provider to certify the eligibility of the patients and for dispensaries to be run by a licensed pharmacist.

A full house listens to a presentation by Dr. Mark Ware of the Canadian Consortium for the Investigation of Cannabinoids.

____________________________________ Save the Dates! Connecticut Pharmacists Association Fall CE Series September 18th in Farmington November 19th in Trumbull December in Central Connecticut 5 hours of Live CE including 1 hour of Law Visit www.ctpharmacists.org for more information 9

New England States

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Massachusetts President’s Message On behalf of the Board of Directors and Staff of the Massachusetts Pharmacists Association (MPhA), I hope you are all enjoying your summer. As we approach the fall, plans for the New England Pharmacists Jim Gagnon, President Convention (NEPC) on Oct. 23 & 24 at Foxwoods Resort Casino begin to take shape. MPhA is proud to partner with the Connecticut Pharmacists Association and the Rhode Island Pharmacists Association in hosting Lucinda Maine, Ph.D, R.Ph, the Executive Vice President and CEO of the American Association of Colleges of Pharmacy (AACP). The NEPC will feature her keynote address, “I Think I Can See It From Here,” which is sure to resonate with attendees. The NEPC will also grant attendees up to 12.5 CEs, with the opportunity to take specialized certificate programs in Medication Therapy Management and Diabetes. At the annual awards banquet, MPhA will recognize this year’s achievers in the profession, while also welcoming its new Board of Directors for 2014-15. For these reasons and many more, you will not want to miss the 2014 New England Pharmacists Convention. The MPhA Board of Directors was shaken up by the announcement that the President-Elect, Timothy Fensky, resigned his position on the Board to accept a position on the Massachusetts Board of Registration in Pharmacy. We congratulate him for making this commitment and are confident he will serve as he served the MPhA Board, with a deep and abiding concern for the profession. In his place, Vice President Susan Holden will step up and become our next President. James Scanlon, who was to become the Vice President will now move into the position of President-Elect, and Karen Horbowicz will become our Vice President. We are in good hands. 10

Regarding recent legislation, on July 10th, the Governor signed into law the long-awaited pharmacy oversight law that was originally filed in response to the New England Compounding Center tragedy. Under the law, Chapter 159 of the Acts of 2014, new license categories were established for sterile compounding pharmacies, complex non-sterile compounding pharmacies and nonresident pharmacies. The bill’s many provisions impact all pharmacists and a detailed summary of the bill can be found under the State tab of the Advocacy section of the MPhA website. For the most part, we are pleased with the final version of the bill. MPhA was instrumental in shaping this new law, changing it from a largely punitive act to one that will ensure public safety but provide transparency and fairness to pharmacists. Examples include retaining a majority of pharmacists on the board; requiring CE in sterile and complex non-sterile CE for only those pharmacists that practice in these settings; requiring regulations that ensure that fines are commensurate with the violation; training for inspectors; and transparent documents on which inspections will be based. MPhA also worked to modify a biosimilars substitution bill to ensure that pharmacists are not burdened with prescriber notification of the interchange, which was required in the earlier versions of this bill. At the July 31st deadline, the legislature passed “An Act to increase opportunities for long-term substance abuse recovery,” which requires pharmacists: “Except in cases where the practitioner has indicated “no substitution,” thepharmacist shall dispense: an interchangeable abuse deterrent product if one exists; or, if none exists, a less expensive, reasonably available, interchangeable drug productas allowed by the most current formulary or supplement thereof.” Unfortunately, two bills championed by MPhA have not yet been passed. An Act Regulating Pharmacy Audits passed the Senate on July 31st, but was not taken up by the House. An Act Authorizing Certain Pharmacy Interns to Administer Immunizations was also not taken up by the close of formal session. Both bills have a chance to

Pharmacy Journal of New England • Summer 2014

pass during the legislature’s informal sessions that will continue until Dec. 31st, and we will do all that we can to make this happen. As I enter my final months as President of the MPhA Board, I want to thank the Board and Staff for helping to make my tenure so productive and enjoyable. I wish Susan Holden the best of luck in her new role next year as President, and look forward to continuing to serve the MPhA Board as Chairman.

Face of Pharmacy On March 18, scores of Massachusetts pharmacists and pharmacy students descended on the State House to advocate for passage of bills concerning healthcare provider status, allowing pharmacy interns to immunize, and regulation of pharmacy audits. The attendees visited legislators in small groups to share their views.

Kristin Glab, MCPHS Worcester

Pharmacy students listen in the balcony at the Massaschusetts State House, at the Face of Pharmacy on March 17, 2014.

Stephanie Lewis, MCPHS Boston

MPhA Foundation Honors Student Leaders at Spring Conference In the first year of its expanded scholarship program, the MPhA Foundation awarded four $1000 scholarships to a deserving student from each of Massachusetts’ four pharmacy schools at MPhA’s Spring Conference on April 17, 2014.

Lucy West, Northeastern University

The Foundation is pleased to announce the following scholarship recipients: (pictured to the right) Kristin Glab, MCPHS-Worcester Stephanie Lewis, MCPHS-Boston Lucy West-Northeastern University, Bouvé College of Health Sciences School of Pharmacy

Victoryn Williams, WNE University

Victoryn Williams-Western New England University College of Pharmacy

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New Hampshire Legislative Update: There were a number of pharmacy-related bills this 2014 legislative session. The legislature finished their business during the first week of June. Some key bills that will affect pharmacists are: House Bill 584 – Relative to covered prescription drugs. Sponsored by Representative Cindy Rosenwald, this bill would require insurers to allow covered persons to purchase their 90-day supply of covered prescription drugs at the pharmacy of their choice. Passed the House with an Amendment in January and then passed the Senate in April. It will now move through the enrolled bills process and will make its way to the Governor’s desk. House Bill 1219 – Relative to the work schedules of pharmacists. Sponsored by Representative William Hatch, this bill would establish requirements for the staffing and work schedule for a pharmacy by a pharmacist. Violations would be subject to disciplinary action by the board of pharmacy. The key provision in this bill is that a pharmacist working longer than 5 consecutive hours in a work day SHALL take a 30-minute rest break. A public hearing was held in the House Executive Departments and Administration Committee in February. A work session was held on this bill, and the debate in the committee centered around the needs of the different practice sites for pharmacy, the current labor law, and the public safety of patients. The bill was sent to interim study for more work over the summer. In November, the bill will come out with a recommendation, and a new bill can also be filed in the fall. House Bill 1344 - Relative to the disposal of sharps waste by retail establishments. Sponsored by Representative Andrew White, this bill would require pharmacies and retail establishments that sell sharps to accept and dispose of sharps waste. A public hearing was held in the House Environment and Agriculture Committee in January. The bill was sent to interim study for more work to be done over the summer, and there have already been two work sessions on the bill. They discussed the report issued by the 2008 Commission to Develop Alternatives to the Disposal of Medical Sharps in Household Waste, but the committee feels more work needs 12

to be done because of recent incidents of batches of needles found in towns in New Hampshire. Items to be discussed this summer will include the cost issue – who will pay for the disposal of used sharps – the manufacturer, the pharmacist or the consumer, what is the best way to increase education and awareness surrounding this issue, and the committee will look at the cost of mail-back envelopes and explore the possibility of installing drop boxes in the community. In November, the bill will come out with a recommendation, and a new bill can be also be filed in the fall.

New Hampshire’s Prescription Drug Monitoring Program (PMP) New Hampshire’s Prescription Drug Monitoring Program (PDMP) development is now in “the home stretch.” Three major hurdles were cleared in the past few months that will now pave the way for its implementation. The first major hurdle was to create the position of program director of the PMP. Although the Department of Justice’s Harold Roger’s Grant provided funding for the project, the money had to be “moved” into the Board of Pharmacy Budget. This move will allow the Board and the State to create the position, provide salary and benefits, and clear the way to hire someone to lead the project. In the beginning, the project will be staffed by one full time person and one part time person. The director’s position was first posted internally within the NH Human Resource network then to the general public. Applicants had to have a pharmacy background, possess strong project management skills, computer and analytical skills, develop project strategy, promote the project statewide, and manage all vendor and stakeholders’ concerns. Interviews were held during the week of May 1, , and a director was hired, pending the approval of the Board. The second major task was the approval of the PMP Rules by JLCAR, the Joint Legislative Committee for Administrative Rules. JLCAR provides legislative oversight for all of the State agencies and subsequent laws that were passed within its domain. When SB286 was written and then passed into law, the Board of Pharmacy was given the task to write the rules that are consistent with its implementation. Pharmacists who are dispensers, and physicians and other providers will use these rules as a guide in the day to day operation of the

Pharmacy Journal of New England • Summer 2014

program. The rules also allow for delegates; physicians will be allowed to give specific team members access to the PMP database, under their authority. This will allow the provider to have all necessary documentation available prior to seeing the patient. The third hurdle was tackling the Vendor Request for Proposal (RFP) process. This process will choose a vendor who will be contracted to “house” the program within the Board of Pharmacy. At the beginning of the process, potential vendors had to respond to a 92 page document that outlined specifics for hardware, software, security requirements, and their prior experience in PMP operations. Interested parties submitted their proposals by the January 31, 2014 deadline. The Board’s Vendor Selection Sub-Committee has reviewed the proposals, follow-up interviews were conducted during the week of February 24, 2014, and announcement of the vendor is forthcoming. The next phase will be communication and outreach. The PMP Advisory Council will now further the process of educating providers and dispensers through various programs to ensure successful execution of the project. After many long months and hard work done almost entirely by volunteers, the PMP appears to be a project that will help more patients safely, efficiently and lawfully.

RX IMPACT—Andrew Brueckner MCPHS University PharmD Candidate Hello Pharmacists, My name is Andrew Brueckner and I am a second year pharmacy student at MCPHS-University, Manchester. Almost a year ago, I was selected as a student representative for the New Hampshire Pharmacist Association (NHPA). Our pharmacist association was built around the concept of protecting the rights of pharmacists, driving the profession of pharmacy forward, and providing pharmacists with the tools and resources necessary to deliver the best patient care. My passion for pharmacy advocacy grew as I worked along with the devoted board members of the NHPA. I later became the Policy Chair for our chapter of the American Pharmacist Association (APhA), which has exposed me to national pharmacy issues as well as revealing opportunities for advancing the profession. Based on my work with the national and state based pharmacists associations, I was nominated and

selected to participate in the National Association of Chain Drug Stores (NACDS) RxIMPACT Day on Capitol Hill to represent MCPHS-University. I am excited to tell you about my experience. RxIMPACT took place on March 12-13 2014, during which 54 pharmacy students and over 200 pharmacists from across the nation came together in Washington, D.C. to meet with members of the United States Congress and advocate for our profession. The first day was “RxIMPACT “U” Academy.” During this day, we discussed general talking points that we could use to describe the importance of pharmacists within the community and to help educate the Members of Congress before presenting our “asks.” A few interesting points included: • Pharmacists have one of the highest approval ratings of any profession in the country. • Pharmacists are within the top three most trusted professionals for honesty and ethics for more than 10 years. • Pharmacists are the most accessible source of health services; 92% of people in the United States live within 5 miles of a pharmacy. • Pharmacists save health care dollars; ChecKmeds North Carolina program showed that face-to-face medication therapy management (MTM) delivered a return of $13.55 for every $1 invested. • Face-to-face retail counseling in the community setting showed better returns versus a phone call from a mail order pharmacist. • According to the CDC, pharmacies account for 20% of immunizations. • Innovative pharmacy services do even more to improve patient health and quality of life. During the second half of the first day, we had guest speakers including James Paluskiewicz (Deputy Chief of Staff, Office of Michael C. Burgess R-TX), Dr. Nick Dorich (Manager, Pharmacy Care of NACDS), Dr. Cynthia J Boyle (FAPhA and Assistant Professor at the University of Maryland), and Dr. Alex Adam (NACDS Director of Pharmacy Programs). These speakers provided an overview of how to successfully voice our proposals to the Members of Congress, build relationships and maintain connections long after the event.

New England States

continued

The second day we put our newfound skills to the test. The attendees of the program were broken into 37 groups, each including 4 to 5 members from similar areas of the U.S. I was the only person at the event from New Hampshire so I was matched with the University of New England professor Dr. Kenneth “Mac” McCall, Rite Aid pharmacist Travis Mitchell, and Nicole Chasse, a pharmacy student from University of New England. Mac, who is also the president of the Maine Pharmacist Association (MPA), has been an extremely active advocate for pharmacy and was an inspiring person to work with. He works closely with the NHPA and is aware of all the issues we are fighting for here in New Hampshire and happily helped me represent our state. Our day was packed with meetings in both the House of Representatives and the Senate: • • • • • • •

Office of Representative Niki Tsongas (Mass03) Office of Senator Jeanne Shaheen (NH) Office of Representative Jim McGovern (Mass-02) Office of Representative Chellie Pingree (Maine-01) Office of Representative Carol Shea-Porter (NH-01) Office of Representative Ann McLane Kuster (NH-02) Office of Senator Susan Collins (Maine)

We decided to focus on three bills. The first was the newly introduced (March 11, 2014) bill, H.R. 4190, which would allow pharmacists to be recognized as healthcare providers under Medicare Part B. Currently, pharmacists lack the recognition as a provider by third party payers, including Medicare and Medicaid, which has limited the number and types of services pharmacists can provide, despite being qualified to do so. The main points that we discussed were that retail pharmacists are often the most readily accessible healthcare providers. Such access is vital in reaching the medically underserved. Without ensuring access to healthcare services for this vulnerable group, it will be difficult for the nation to achieve the aims of healthcare reform. This bill would not change the scope of practice of pharmacists within their respective states, rather it would allow for pharmacists to receive compensation for services we already provide. The last two bills we spoke about were key pharmacy provisions in the proposed Part D rule and the need for a transition period for implementation of average manufacturer price (AMP)-based federal upper limits (FULs). The proposed Part D 14

rule changes include: • Provision that will allow any willing pharmacy to be able to participate in a network and utilize preferred cost sharing. This will help provide increased beneficiary access and reduce barriers to care, especially in rural areas and for patients who face cultural linguistic challenges. • Provision to expand the proposed Part D beneficiary eligibility for medication therapy management (MTM). Poor adherence contributes to increased costs to the U.S. Health care system estimated at $290 billion and by expanding the eligibility, MTM services provided by pharmacists can decrease spending by both the patients and the Medicare program • Pertaining to the generic drug reimbursement in Part D, we suggested new standards on pricing updates on a regular basis to allow for more clarity so pharmacies can produce efficient business plans to address the fluctuations in prices. The standards should help achieve a more efficient and effect Part D program, as well as increasing health outcomes and cost savings. We also asked the members to consider the concerns of stakeholders and encourage CMS to allow states a one-year transition period for implementation of the final AMP-based FULs and corresponding dispensing fee changes following the July 2014 publication of the AMP-based FULs. Currently, most states are not ready to implement the changes so allowing for an additional year will help meet our goal to provide the time needed to effectively transition. Overall, my trip was a great success and an amazing learning experience. All the Members of Congress from New Hampshire that I met were co-sponsors for the 2013 MTM bill and it was apparent that they want to work with us knowing that we save money, but more importantly, we help improve the lives of the people in our nation. The most important concept that I learned from RxIMPACT was that as pharmacists and pharmacy students we have an ongoing commitment to advancing our profession and increasing the value of the practice of pharmacy. In order for change to happen, we need to actively support and communicate our vision with our elected officials and influence their perspective of pharmacy. New Hampshire is a small state and we need to come together as a group and speak and/or act on our own behalf.

Pharmacy Journal of New England • Summer 2014

If we do not fight for pharmacy, then who will? I would like to thank you for reading about my experience and if anyone has any further questions about becoming involved with pharmacy advocacy, please feel free to contact me at andrew.brueckner@my.mpchs.edu or contact the New Hampshire Pharmacists Association.

New Hampshire Pharmacists Are Recognized at Annual Holiday Party The MCPHS University Manchester sponsored the Annual Holiday Reception on Wednesday, December 18, 2013 at the Manchester Country Club. The celebration was sponsored with support from the NHPA, the NH Society of Health-System Pharmacists (NHSHP) and the NH Independent Pharmacy Association (NHiPA). Due to space constraints in the winter PJNE edition, we are now presenting the following recipients who are so deserving of these prestigious awards. Vahrij Manoukian is the 2013 recipient of the Cardinal Health Generation RX Champions Award. Prescription drug abuse is a problem that is all too familiar to Vahrij and his family. In 2004, his son lost his battle with drug addiction when he died from a prescription drug overdose. Since this time, Vahrij has tirelessly fought against prescription drug abuse so that other families don’t endure the same struggle that his family has.

dispose of unwanted prescription drugs. He continues to work at the Hollis collection site during their bi-annual collection. In addition, Vahrij has been one of the main supporters of the Prescription Drug Monitoring program in NH. After over 7 years of advocacy effort and decision on Vahrij’s part,to have this program instated, he was able to witness former Governor Lynch sign the bill into law in June of 2012. Vahrij has also served on the NH Board of Pharmacy for 10 years. combat the abuse and misuse of prescription drugs. The 2013 NH Pharmacy Technician of the Year Awards is Heather Radwan. Heather has been working at Bedford Pharmacy for four years, and in that time, has risen from front store clerk to Compounding Laboratory Supervisor. She has attended national compounding seminars and has recently completed the American College of Apothecaries Aseptic Training course in Tennessee. Heather is extremely dedicated to pharmacy technician practice and is committed to learning new skills. She teaches compounding techniques to other staff members as well as pharmacy students completing rotations at Bedford Pharmacy. Heather’s technical knowledge has been described as a tremendous value when creating new compounding formulas or in improving upon existing ones. In addition, Heather has demonstrated exemplary devotion to serving patient care needs.

In Memorium:

Vahrij Manoukian and his guest Alison Pyle.

Vahrij has been a dedicated pharmacist for over 35 years and has built a thriving business as owner of Hollis Pharmacy. Throughout his career, he has taken a strong stance against prescription drug abuse and misuse. He has participated in panel discussions at local high schools talking about the dangers of prescription drug abuse. In 2010, he worked with the Hollis Police Department to implement the Prescription Drug Take-Back Program which allows people to responsibly

John W. Styles of Franklin, NH passed away on March 10, 2014. He graduated from Groveton High School in 1947 and attended Massachusetts College of Pharmacy, where he graduated in 1955. The same year, he was drafted and serve in the US Navy until 1957. He served as a pharmacist at the Portsmouth Naval Hospital in Portsmouth VA. He was a hospital and retail pharmacist for 47 years when he retired. John was a Freemason for 64 years, affiliated with the Gilkey F & AM Lodge 101 in Groveton. He was predeceased by his wife Janice McGorry Styles of 47 years and brother Robert B. Styles. John is survived by his daughter, sons and grandchildren. Remember, save the dates for all of our upcoming CE programs: September 7, 2014, SERESC, Bedford, NH December 7, 2014 SERESC, Bedford, NH 15

New England States

continued

Vermont

that medication discharge summaries be provided to a patient’s pharmacy upon discharge from hospital or long term care, pilot programs will be conducted at two medical centers to achieve that end.

The Vermont Pharmacists Association (VPA) continues to promote the profession by providing quality continuing education and actively participating in state legislative and rulemaking processes.

The VPA provided testimony in support of sister organization Vermont Retail Druggists’ successful legislation regulating PBMs, which includes requirements for 14-day prompt pay and 7-day MAC list updating. PBMs also must annually report “spread pricing” profits to the state, disclosing the aggregate difference between amounts reimbursed to pharmacies and amounts charged to health insurers.

President’s Message

2014 marks the first full year of Act 75 “An act relating to strengthening Vermont’s Jim Godfrey President response to opioid addiction and methamphetamine abuse,” and Governor Peter Shumlin devoted most of his State of the State address to the opiate and heroin crisis. There are new requirements for prescribers and pharmacists to register with the 2009 Vermont Prescription Monitoring System and query VPMS as required by law and board rules. The law also permits interstate sharing of data at some time in the future. A photo ID must be shown for controlled substance pickup at pharmacies, and pseudoephedrine sales reported through NPLEx software. Specific procedures govern prescribers issuing replacements for lost or stolen controlled substance prescriptions. Act 75 also promotes screening for opioid addiction, and referral for treatment as well as establishing an opioid antagonist pilot program running through 2015 to reduce overdose death. Should the pilot succeed, we expect to see increased dispensing of narcotic antagonists both by prescription and by collaborative practice agreement. As dispensers of controlled substances, pharmacists are indeed at the front lines of the prescription drug abuse battle. Representatives of the VPA were active in providing testimony on Act 75. Some VPA efforts bring non-legislative solutions. As a result of proposed legislation, the VPA has obtained a commitment from Vermont’s two leading insurers to facilitate medication synchronization by allowing early and/or partial refills, with full dispensing fee to pharmacy and pro-rated copay to patient. And, in response to proposed legislation 16

The state of Vermont and Green Mountain Care Board continue to advance plans for a Single-Payer health care system beginning in 2017. Unfortunately details on how Single-Payer will be paid for remain elusive, and statutory deadlines to release this financing plan have been missed. The VPA continues to advocate for the role of pharmacy in this system and has made it clear that the State, as insurer, must protect itself and the consumer by requiring full PBM transparency. Congratulations to the 66 members of the 2017 graduating class of the Albany College of Pharmacy and Health Sciences (ACPHS), Colchester, VT campus! The VPA also wishes to thank ACPHS students participating in Vermont Pharmacists Day at the statehouse in Montpelier. At this important event, we maintain visibility and build upon our relationships with elected representatives and appointed officials who make critical decisions affecting our profession. I would also like to announce VPA scholarship winners and future Leaders of Pharmacy: Jen Garas, Samantha Graham, Abigail Kwakye, Carolina Lopez-Juarez, Kate-Lyn Smith, and Marci Wood. As we continue our mission to provide quality continuing education, I remind pharmacists to accrue their live credits for 2015 license renewal by attending the VPA fall meeting at the Colchester, VT campus of the Albany College of Pharmacy and Health Sciences. Watch for details on the Vermont Pharmacists Association website vtpharmacists.com. Jim Godfrey, RPh President

Pharmacy Journal of New England • Summer 2014

Maine Husson ASP & PDC Chapters Donates $1,000 to MPA The Husson University School of Pharmacy Academy of Student Pharmacists and Phi Delta Chi donated $1,000 to MPA at the 2014 Spring Convention in Freeport, Maine. Meagan Rusby, Husson Pharmacy Class of 2016, presented the award to MPA President, Kenneth McCall. While accepting the generous gift, President McCall stated, “On behalf of the MPA Board, I wish to express our sincere appreciation for this gift from the Husson ASP & PDC chapters. I’m inspired by these student-pharmacists and their outstanding service-leadership.” The donation from the Husson School of Pharmacy was the result of months of fundraising to help cover legal fees associated with the lawsuit against Maine’s drug importation ordinance.

MPA Fall Convention, Trade Show, and Award Banquet The Maine Pharmacy Association Fall Convention and Trade Show has lined up outstanding speakers to educate our pharmacy community on topics relevant to the profession. Also included in the continuing education options are immunization training and CPR recertification. The convention is scheduled to run from September 5-7, 2014 at the Hollywood Casino, Bangor, Maine with our annual awards ceremony being held on Saturday, September 6, 2014. For more information please visit MPARX.com.

Paul Chace with his wife, Karen Chace.

Meagan Rusby, Husson University CO ‘16, presents a check to MPA President Kenneth McCall.

Maine Pharmacist Paul Chace Recognized at APhA 2014 Annual Meeting Mr. Paul Chace was recognized at the APhA 2014 Annual Meeting in Orlando, Florida, as a 2013 Bowl of Hygeia Award recipient. Established in 1958, the Bowl of Hygeia Award recognizes pharmacists who possess outstanding records of civic leadership in their communities and encourages pharmacists to take active roles in the affairs of their respective communities. The Bowl of Hygeia is the most widely recognized international symbol for the pharmacy profession and is considered one of the profession’s most prestigious awards. The Bowl of Hygeia Award is sponsored by the American Pharmacists Association Foundation and the National Alliance of State Pharmacy Associations and is awarded by participating state pharmacy associations with support from Boehringer Ingelheim. Mr. Paul Chace was honored by the Maine Pharmacy Association for his outstanding commitment to his community and the profession of pharmacy. 17

2013 Recipients of the “Bowl of Hygeia” Award

Charles D. Sands III Alabama

Martie Lamont Alaska

Kathryn Labbe Arizona

Karrol Fowlkes Arkansas*

Vicki Fowlkes Arkansas*

Helen K Park California

Ronald Kennedy Colorado

Gregory L Hancock Connecticut

David W. Dryden Delaware

Judith Martin Riffee Florida

William Lee Prather Georgia

Selma Yamamoto Hawaii

Mark Johnston Idaho

Garry Moreland Illinois

Patrick Cashen Indiana

Bernard Cremers Iowa

Leland Hanson Kansas

J Leon Claywell Kentucky

Douglas Boudreaux Louisiana

Paul Chace Maine

Angelo C. Voxakis Maryland

John R Reynolds Massachusetts

Nancy J W Lewis Michigan

Harvey Buchholz Minnesota

Clarence DuBose Mississippi

Kenneth W. Schafermeyer Missouri

Carla Cobb Montana

Scott E Mambourg Nevada

Cheryl A Abel New Hampshire

Eileen Fishman New Jersey

Phil Griego New Mexico

James R. Schiffer New York

Jean Douglas North Carolina

Laurel Haroldson North Dakota

Kenneth S. Alexander Ohio

Eric Winegardner Oklahoma

Wayne Kradjan Oregon

Edward Bechtel Pennsylvania

Daniel Mahiques-Nieves Puerto Rico

Linda A Carver Rhode Island

Linda Reid South Carolina

Ann M Cruse South Dakota

Kenneth Smith Tennessee

Leticia Van de Putte Texas

Dominic DeRose Utah

The “Bowl of Hygeia”

Leo H Ross Virginia

Janet Kusler Washington

Russell Jensen Wisconsin

Timothy Seeley Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program. *husband and wife co-recipients

10th Annual New England Pharmacists Convention October 23rd & 24th, 2014

The Fox Tower at Foxwoods Resort Casino, Ledyard, CT

Registration Information

Presented By The Connecticut Pharmacists Association, The Massachusetts Pharmacists Association, & The Rhode Island Pharmacists Association www.nepharmacists.org info@nepharmacists.org

New England Pharmacists Convention 500 W. Cummings Park, Suite 3475 Woburn, MA 01801

Schedule of Events Thursday Programming October 23, 2014 7:30 a.m. – 8:00 a.m. Certificate Program Registration & Continental Breakfast 8:00 a.m. – 5:00 p.m. Delivering Medication Therapy Management Services in the Community Certificate Program

Hotel Information The Fox Tower at Foxwoods Resort Casino 39 Norwich Westerly Road Ledyard, CT 06339 Phone: 1.866.646.0050 Website: www.foxwoods.com

The special room rate is $125 plus tax, per night, for a single/double room. To make a reservation call 1-866-646-0050 or register at: https://resweb.passkey.com/go/nepharm2014. Deadline for the special rate is October 1.

8:00 a.m. - 5:00 p.m. Pharmaceutical Care for Patients with Diabetes Certificate Training Program 12:00 p.m. – 1:00 p.m. Convention Check In & Registration Regular Programming Begins at 1:00 p.m. 1:00 p.m. – 2:30 p.m. New Cholesterol Guidelines:Changes in Care for Pharmacists

0106-9999-14-023-L01-P; Application-based Activity (0.15 CEUs)

Speaker: William L. Baker, Pharm.D., BCPS (AQ Cardiology) Assistant Professor of Pharmacy & Medicine University of Connecticut Schools of Pharmacy & Medicine At the end of this program the pharmacist shall be able to: 1. Compare and contrast the new cholesterol guidelines with previous measures 2. List the patient populations that will benefit most from statin therapy 3. Expand the pharmacist’s patientcounseling skills to improve outcomes in lipid management 2:30 p.m. – 2:45 p.m. Break

The Fox Tower at Foxwoods Resort Casino, October 23rd and 24th, 2014 2:45 p.m. – 4:15 p.m. The War on Antibiotic Resistance: The Role of the Pharmacist

5:20 p.m. - 6:00 p.m. MPhA Foundation Reception

0106-9999-14-024-L01-P; Knowledge-based Activity (0.15 CEUs)

6:00 p.m. - 7:00 p.m. Cocktail Reception

Speaker: Dora E. Wiskirchen, PharmD, BCPS, Assistant Professor of Pharmacy Practice, University of Saint Joseph School of Pharmacy

7:30 p.m. - 9:30 p.m. CPA Annual Installation and Awards Banquet Dinner MPhA Annual Installation and Awards Banquet Dinner RIPA Annual Installation and Awards Banquet

At the end of this program the pharmacist shall be able to: 1. Define the problem of antibiotic resistance 2. Identify local trends in antibacterial resistance among causative pathogens 3. List appropriate antibiotic treatment recommendations based on risk factors for drug-resistant organisms. 4. Discuss new antibiotics recently approved or currently in development 5. Discuss the effectiveness of antibiotic stewardship initiatives 4:20 p.m. - 5:20 p.m. Safely Compounding Quality Medications: Making the grade

0106-9999-14-025-L03-P; Knowledge-based Activity (0.1 CEUs)-LAW CE

Friday Programming October 24, 2014 6:00 a.m. - 8:00 a.m. Check In & Registration/Exhibitor Set-Up 6:30 a.m. – 8:00 a.m. Breakfast Symposium: Open to the first 250 attendees! Promoting Better Diabetes Management for Patients

0106-9999-14-026-L01-P; Knowledge-based Activity (0.15 CEUs)

Speakers: Omar Allibhai PharmD, R.Ph Compounding Fellow, Waltham, MA Janelle Ogle CPhT Director of Quality Assurance Johnson Compounding and Wellness

Speaker: Fei Wang , M.Sc., Pharm.D., BCPS, FASHP, Associate Clinical Professor, University of Connecticut, Dept. of Pharmacy Practice. Hartford Hospital, Adult Primary Care Clinic

At the end of this program the pharmacist shall be able to: 1. Describe the importance and process of USP’s establishment of standards for sterile pharmacy compounding. 2. List the top 3 criteria that are of concern to inspectors based on 797 3. Identify the four Compounded Sterile Preparation (CSP) Risk-Level Categories for compounding sterile preparations 4. Describe the guidelines for assigning beyond-use dates by types of formulations. 5. Discuss the urgency for standard interpretation of 797 guidelines that don’t create barriers to compliance

At the end of this program the pharmacist shall be able to: 1. Describe the basic pathophysiology changes associated with type 1 and type 2 diabetes and how they affect therapy decisions. 2. Describe the current standards for glucose, blood pressure and cholesterol immunizations, and sick day rules for the patient with diabetes. 3. Discuss the advantages of biosimilar insulins. 4. List the benefits and challenges of inhaled and oral insulin products on the horizon.

5:20 p.m. - 6:00 p.m. CPA Business Meeting

7:15 a.m. - 8:15 a.m. Continental Breakfast

8:00 a.m. – 8:15 a.m. Welcome: Karen Hoang, Pharm.D., BCNP, President, CPA; Susan Holden, Pharm.D., BCACP, President, MPhA; and Anita N. Jackson, Pharm.D., President RIPA 8:15 a.m. - 9:15 a.m. Keynote Address “I Can See It From Here”

0106-9999-14-027-L04-P; Knowledge-based Activity (0.1 CEUs)

Speaker: Lucinda Maine, Executive Vice President and CEO, AACP At the end of this program the pharmacist shall be able to: 1. Recall the updated JCPP Vision for Pharmacy and describe how it has changed over the past decade 2. Describe the Pharmacist’s Patient Care Practice model and identify how it applies it to their practice 3. Identify opportunities for advancing pharmacy practice at the local, regional and national levels 9:25 a.m. – 10:25 a.m. Cannabis Therapeutics: Past, Present and Future

0106-9999-14-028-L01-P; Knowledge-based Activity (0.1 CEUs)

Speaker: Mark Ware, MBBS MRCP(UK) MSc Director of Clinical Research of the Alan Edwards Pain Management Unit, McGill University Health Centre, Executive Director of Canadian Consortium for the Investigation of Cannabinoids. At the end of this program the pharmacist shall be able: 1. To review the history of development of cannabis for medical purposes 2. To examine existing medical and legal options for using cannabinoids as therapeutics 3. To discuss the future of cannabinoids in medicine 10:25 a.m. - 11:00 a.m. Break

Schedule of Events 11:00 a.m.-12:00 p.m. Navigating the Legal and Regulatory Landscape of Naloxone (Narcan) in New England 0106-9999-14-029-L03-P; Applicationbased Activity (0.1 CEUs)

Speaker: Jeffrey Bratberg, PharmD, URI College of Pharmacy, Kingston, RI At the end of this program the pharmacist shall be able to: 1. Compare and contrast regulations and statutes relating to prescribing and dispensing naloxone between MA, CT, and RI 2. Describe the implementation of a naloxone collaborative practice agreement in community pharmacies 3. Develop a roadmap for pharmacistled advocacy in expanding access to naloxone 12:00 p.m. -2:00 p.m. Lunch,Exhibit Hall,Poster Presentation 12:30 p.m. - 1:00 p.m. Product Theater 2:00 p.m. - 3:00 p.m. Track I: Rational Use of Opioids in Chronic Non-Terminal Pain ACPE: 0106-9999-14-030-L01-P; Application-based Activity (0.1 CEUs) Speaker: Sister Michaela Serpa, Pharm.D., YNHH-St. Raphael Campus, New Haven, CT At the end of this program the pharmacist shall be able to: 1. Distinguish between acute and chronic pain 2. Select opioids for initial and breakthrough doses 3. Explain the role of opioid contracts in managing patients in the ambulatory setting 4. Identify the top opioid prescribing issues 5. Explain the role of the pharmacist in monitoring chronic pain patients in the ambulatory setting. 6. Counsel patients and caregivers about the safe use of ER/LA opioid analgesics, including proper storage and disposal

10:00 a.m. – 11:00 a.m. Interviewing Techniques Paul LaRochelle, Jr. Pharm.D.

2. Discuss the impact of n-3 and omega-3 fatty acid supplementation on cardiovascular event rates. 3. Discuss the value of good nutrition and physical activity in the promotion of health.

11:15 a.m. - 12:30 p.m. Career Path: Roundtable Discussion Moderated by Barbara Perry, Pharm. D., MPH, R. Ph.

Track IV: New England College “Pepto Bowl” Student and Pharmacists SelfCare Championship ACPE: 0106-9999-14-033-L04-P (0.1 CEUs)

Track II: Immunization Update 2014: Why Do We Still Have VaccinePreventable Diseases ACPE: 0106-9999-14-031-L01-P; Applica-

Jeffrey Bratberg, Pharm.D., URI College of Pharmacy. Kingston, RI

Student Programming

tion-based Activity (0.1 CEUs)

Speaker: Jennifer Ellis Girotto, Pharm.D., BCPS Associate Clinical Professor of Pharmacy Practice, UConn School of Pharmacy, Storrs, CT At the end of this program the pharmacist shall be able to: 1. Describe the reasons why vaccinepreventable diseases reemerge 2. Illustrate the pharmacist’s role in advocating for and providing immunizations 3. Summarize recent updates to the US Immunization Schedules 4. Compare and contrast available influenza vaccine products (2014-15 season) 5. Review new technology aimed at commercializing pain-free injection systems Track III: Nutritional Supplements to Reduce Cardiovascular Events – Where is the Evidence? ACPE: 0106-9999-14-032-L01-P; Knowledge-based activity (0.1 CEUs)

Speaker: Diana M. Sobieraj, Pharm. D., Assistant Professor, University of Connecticut School of Pharmacy, Storrs, CT At the end of this program the pharmacist shall be able to: 1. Describe the current evidence relating to benefits and harms of the use of multivitamins for the prevention of cardiovascular disease.

At the end of this program the pharmacist shall be able to: 1. Identify products (and active ingredients) routinely used for safe and effective use in self-care conditions 2. Explain the efficacy, dosage, adverse effects, and administration of nonprescription medicines 3. Counsel on non-pharmacologic measures for the treatment of common self-care ailments

You may attend any track. You do not have to stay in the same room for all 4 sessions.

Continuing Education Credits The Connecticut Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Attendees can earn up to 11.5 hours (1.15 CEUs) of continuing education credit which includes 2 hours (0.2 CEUs) in pharmacy law.

Registration Information

Online Registration: Please go to www.nepharmacists.org to register. Deadline for online registration is October 15, 2014. Fax or Mail: Fax form with credit card information to: 781-933-1109. Please make all checks payable to the New England Pharmacists Convention. Mail form to NE Convention, c/o MPhA., 500 W. Cummings Park, Suite 3475, Woburn, MA 01801. Please complete all portions of the registration form. If you register after October 15, there will be an additional $10 fee.

3:10 p.m. - 4:10 p.m. Track I: 2014 Oncology Update-New Drugs, New Roles for Pharmacists

ACPE: 0106-9999-14-034-L01-P; Knowledgebased Activity (0.1 CEUs)

Speaker: Anne McDonald, Pharm.D., BCOP; Clinical Pharmacy Specialist, Oncology; Brigham & Women’s Hospital, Boston, MA At the end of this program the pharmacist shall be able to: 1. Describe the roles of available treatment modalities in cancer therapy. 2. Characterize the most common side effects of chemotherapy. 3. Discuss appropriate supportive care therapies in the management of CINV, neutropenia, cachexia, and cancerrelated pain. 4. Review transition of care opportunities for pharmacists in the oncology setting. 5. Review changes in the FDA drug approval process and the potential impact on patient care. Track II: HIV – Is there an end in sight? ACPE: 0106-9999-14-035-L01-P; Knowledge-based Activity (0.1 CEUs

Speaker: Jack Ross MD, Hartford Hospital, Hartford, CT At the end of this program the pharmacist shall be able to: 1. Recall the drugs used in HIV treatment. 2. Explain the rationale for using HAART combinations. 3. Describe the major toxicities associated with HIV treatment. 4. Explain current and future modalities to prevent transmission of HIV. Track III: The Role of the Pharmacist in Managing Patients with Obesity

ACPE: 0106-9999-14-036-L01-P; Knowledgebased Activity (0.1 CEUs)

Registration Questions: Please contact MPhA at 781-933-1107 or at info@nepharmacists.org Cancellations must be made in writing to MPhA. Registration cancellations received prior to 9/30/14 will be refunded less a $25 processing charge per registrant. Cancellations received after 9/30/14 will not be refunded. Continuing Education Information: In order to receive a statement of credit uploaded to CPE Monitor, participants must complete an evaluation and CE registration form, in addition to attending the program in its entirety.

Speaker: Lisa DeGennaro, Pharm.D., BCPS, CDE, Assistant Professor of Pharmacy Practice, USJ School of Pharmacy, Hartford, CT At the end of this program the pharmacist shall be able to: 1. Summarize updates to the 2013 AHA/ ACC/TOS obesity clinical guidelines. 2. Describe the pharmacist’s role in assessing, advising, and assisting patients who need to lose weight. 3. Review the risks and benefits of pharmacologic therapy or bariatric surgery as an adjunct to lifestyle modifications 4. Review opportunities for the pharmacist in post-bariatric surgery medication management 4:20 p.m. - 5:20 p.m. Track I: A Team Approach to the Care of Patients with Chronic Pain

ACPE: 0106-9999-14-038-L01-P; Knowledgebased Activity (0.1 CEUs)

Speaker: Jayne Pawasauskas, PharmD, BCPS, Clinical Associate Professor URI College of Pharmacy, Kingston, RI At the end of this program the pharmacist shall be able to:: 1. Define the role of the pharmacist in acute in-patient management of pain 2. Explain opioid rotation utilizing an evidence-based approach to monitoring for safety parameters 3. Recognize the role of the pharmacist in facilitating discharge from a hospital setting

At the end of this program the pharmacist shall be able to:: 1. Identify the personal and socioeconomic burden associated with HCV infection. 2. Describe the current state of HCV-1 treatment, specifically the complex pharmacology of current combination treatment regimens. 3. Assess the role pharmacoeconomic factors have on the development of individualized HCV treatment regimens. 4. Evaluate emerging treatment options and their potential roles in the treatment and cure of HCV. Track III: Wound Care

ACPE: 0106-9999-14-039-L01-P; Knowledgebased activity (0.1 CEUs)

Speaker: Carol Jones, Senior EOCN Nurse, VNA Care Network, Worcester, MA At the end of this program the pharmacist shall be able to: 1. Differentiate between the types of wounds 2. Describe the wound healing process 3. Identify risk factors and outcomes of poor wound healing 4. Assist patients and providers with selection of appropriate products and wound dressings

Track II: Managing Hepatitis C: The Role of the Pharmacist

ACPA: 0106-9999-14-037-L01-P; Applicationbased Activity (0.1 CEUs)

Speaker: Eric Kuszewski, PharmD, BCACP. Clinical Pharmacy Specialist Anticoagulation and Specialty Clinics VA Connecticut Healthcare System, West Haven, CT 23

To Register Online, please visit www.nepharmacists.org.

Registration Form

Bundled CE Options

Convention Registration Rates

Member rates apply for members of CPA, MPhA (MA), NHPA, Delivering Medication Therapy Management in the Community & RIPA, VTPA, and MPARX. Friday CE** MTM Registration Deadline: September 30, 2014 Full Convention* Member $415.00 Non-Member $475.00 (includes CE, Reception, Friday breakfast, Includes Friday CE offerings, breakfast, lunch, and Exhibit Hall lunch & exhibit hall) Member $179.00

Pharmaceutical Care for Patients with Diabetes Certificate Training Program & Friday CE* *

Non- Member $229.00

Diabetes Registration Deadline: September 30, 2014 Member $419.00 Non- Member $479.00

Thursday Only*

(includes CE and Reception) Member $99.00

Includes Friday CE offerings, breakfast, lunch, and Exhibit Hall

Non- Member $119.00

**does not include reception or banquet

Friday Only*

Additional Offerings

(includes CE, breakfast, lunch & exhibit hall) Member $139.00

Installation & Awards Banquet (includes Foundation cocktail reception with one free drink ticket)

Non-Member $179.00

Student: $35.00 *selections do not include Certificate Programs or Banquet Dinner

Certificate Program Fees Delivering Medication Therapy Management in the Community

MTM Registration Deadline: Member $349.00

Non- Member $399.00

CPA $60.00 per person #___________

MPhA $60.00 per person #_________

RIPA $100.00/couple

#__________

RIPA $60.00/person

Please note: Foundation cocktail reception free with Thursday registration or Full Conference registration.

$30.00 per person #_____

Pharmaceutical Care for Patients with Diabetes Certificate Training Program

Diabetes Registration Deadline: September 30. 2014 Member $345.00

Select Banquet:

Guest Friday Lunch & Exhibit Hall (does not include CE offerings)

$35.00 per person #_____ GuestName________________________________________

Non-Member $399.00

Both Certificate Programs include breakfast, lunch and a break

**For all programs, please cite Source Code 10015 when registering online or via phone.

Total Amount: $

Name: ______________________________________________________________________________________ Prefix

First

Middle Initial

Last

Printed Name of Contact: _____________________________________________________________________ Mailing Address: City: __________________________________________State: _______ Zip: _____________ Telephone: _____________________________________Email: _______________________________________ State Association & Member Number: ____________________________________________________________ Practice Setting_______________________________________________________________________________ Optional

Students Only: University/College___________________________________________________Year of Grad.______________ Currently Enrolled

Payment Method: Credit Card:

VISA

AMEX

Check

(payable to New England Pharmacists Convention)

Credit Card #:___________________________Security Code#: ________ Expiration Date: ______________ Card Holders Name:__________________________________________________________________________ Signature:____________________________________________________ Date: __________________________ 24

Certificate Programs

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacist & Patient-Centered Diabetes Care Certificate Training Program October 23, 2014 8:00 a.m. to 5:00 p.m. The Pharmacist and Patient-Centered Diabetes

Care Certificate Training Program is an intensive educational experience designed to equip pharmacists with the knowledge, skills, and confidence needed to provide effective, evidencebased diabetes care. Five self-study modules provide comprehensive instruction in current diabetes concepts and standards of care. The live seminar incorporates case studies and hands-on skills training focused on the situations most likely to be encountered—as well as the services most needed—in community and ambulatory care practice settings. Participants will gain experience evaluating and adjusting drug therapy regimens for patients with type 1 and type 2 diabetes, counseling patients about lifestyle interventions, analyzing and interpreting self-monitoring of blood glucose results, and assessing the overall health status of patients to identify needed monitoring and interventions. The goals of the certificate training program are to: • Provide comprehensive instruction in current standards of care for patients with diabetes. • Increase pharmacists’ confidence in serving as the drug therapy expert on the diabetes health care team.

• Refresh pharmacists’ knowledge of the pathophysiology of diabetes and the acute and long‐term complications of the disease. • Familiarize pharmacists with important concepts in nutrition, exercise, and weight control that contribute to optimal diabetes care. • Offer hands-on training in diabetes-related devices and physical assessment skills relevant to optimal diabetes care. • Introduce pharmacists to the many varied ways in which they can help to improve health outcomes among patients with diabetes. This entire certificate training program will offer you the opportunity to earn up to 23 hours (2.3 CEUs) of continuing pharmacy education credit. SEMINAR AGENDA: Welcome & Introduction Comprehensive Care Needs Intensifying Drug Therapy Nutrition Counseling Insulin Therapy Hands-On Assessments Special Situations in Diabetes Management Next Steps and Resources Closing Remarks

Faculty: Kristen Rychalsky, Pharm D. Inpatient Clinical Pharmacist VA Connecticut Healthcare System CONTINUING PHARMACY EDUCATION (CPE) CREDIT: RELEASE DATE : 2/1/2012 Successful completion of the live seminar component involves passing the final exam with a grade of 70% or higher and demonstrating competency in blood pressure testing, self-injection techniques, diabetic foot exam, and blood glucose testing. Successful completion of these components will result in 8 contact hours of continuing pharmacy education (0.8 CEUs) ACPE UAN: 202-999-12-107-L04-P Successful completion of the self-study component involves passing the self-study assessment with a grade of 70% or higher and will result in 15.0 contact hours of continuing pharmacy education credits (1.5 CEUs) ACPE UAN: 202-999-12-108-H04-P The Pharmacist & Patient-Centered Diabetes Care was developed by the American Pharmacists Association and is cosponsored by the American Association of Diabetes Educators.

Delivering Medication Therapy Management Services October 23, 2014 8:00 a.m. to 5:00 p.m. Updated for 2014, Delivering Medication Therapy Management Services is an innovative and interactive certificate training program that explores the pharmacist’s role in providing MTM services to patients. Pharmacists have a tremendous opportunity to receive reimbursement for monitoring and improving medication use in patients with complex medication regimens. This practice-based activity teaches pharmacists the essential skills necessary to become a successful MTM practitioner. The certificate training program will enhance pharmacists’ clinical expertise in evaluating complicated medication regimens, identifying medication-related problems, and making recommendations to patients, caregivers, and health care professionals. T The certificate training program is conducted in three parts: a self-study activity and pre-seminar exercise, a live interactive training seminar, and a post-seminar exercise. The goals of the certificate training program are to: • Advance public health and patient care through improved medication use. • Provide training to enhance pharmacists’ ability to effectively provide MTM services. • Motivate increased numbers of pharmacists to establish MTM services. • Communicate benchmark practices for providing MTM services.

SEMINAR AGENDA: The Patient Interview Pre-Seminar Case Review: Communication Barriers Case Study: William Documentation The Medication Therapy Review Case Study: Carl Setting Therapeutic Goals Medication-Related Action Plan Standardized Case Review: Toni Recommendation to Other HealthCare Professionals Cultural Sensitivity The Senior Patient Case Study: Donna Staying Current Standardized Case Review: Toni Implementation SWOT Analysis Setting Business Goals and Recruiting Patients Billing Concepts, CPT Coding, and Measuring Outcomes Take Home Points and Post-Seminar Assignment Patient Case Assessment Discussion Evaluation and Adjournmen

Faculty: Susan Holden, Pharm.D. Clinical Pharmacy Specialist VA Boston Healthcare System West Roxbury, MA Alexandria Dunleavy, Pharm.D. Staff Pharmacist Walmart Pharmacy Worcester, MA Successful completion of the self-study component will result in 10 contact hours of continuing pharmacy education credit (1.0 CEUs). ACPE UAN: 202-999-12-002-H04-P Successful completion of the live seminar component will result in 8 contact hours of continuing pharmacy education credit (0.8 CEUs). ACPE UAN: 202-999-12-001-L04-P Successful completion of the post-seminar exercise will result in 3.0 contact hours of continuing pharmacy education credit (0.3 CEUs). ACPE UAN: 202-999-12-003-H04-P Activity Requirements: Internet connectivity and Adobe Acrobat Reader are required for

participation in this activity.

This entire certificate training program will offer you the opportunity to earn up to 21 hours (2.1 CEUs) of ACPE-accredited continuing pharmacy education credit.

Feature

Implementation of an Emergency Department Discharge Prescription Program: Accountable Continuity of Care

By Sister Michaela Serpa, F.S.E., Pharm.D., Janet Kozakiewicz, Pharm.D., M.S. FASHP, and Gillian Kuszewski, Pharm.D., BCPS

Patients who present to the Emergency Department (ED) are either admitted or discharged. Research and outcomes of services provided to patients admitted from the ED has been a focus in many areas including cardiovascular, pain management, and infectious disease. Patients admitted are more critical and their health concerns must be addressed in a timely manner. According to a report from Press Ganey, this may result in a delay addressing the health needs of those patients who will be discharged directly from the ED. 1 Health-systems pharmacists are called upon to address the continuity of care for patients. This challenge is of prime importance in light of the Affordable Care Act which promotes the formation of “accountable care organizations” (ACOs) to improve health care quality and control healthcare costs.2 Developing programs to provide continuity of care, to bridge the gap between inpatient and outpatient, requires 26

collaboration of the health-care team. Patients discharged from the ED are given instructions from a provider, further instructions from a nurse, and instructions for follow-up with a primary care provider. Yet, according to a New England Journal of Medicine report, Americans receive only 82% of recommended health counseling and education for their conditions and less than 60% of recommended care regarding medications.3 Patients who do not fill discharge prescriptions (primary non-adherence) and fail to comply with the physician’s treatment plan, risk experiencing serious consequences such as increased mortality. 4 Non-adherence to medication may be due to lack of perceived need for the medication, limited access to medications, cost, or fear of adverse effects. Counseling by a skilled pharmacist and providing a venue to easily fill the prescription addresses these potential causes of non-adherence after

Pharmacy Journal of New England â&#x20AC;˘ Summer 2014

discharge. Continuity of care ensures progression toward an accountable care model. This study describes the initiation of a pharmacist-led discharge prescription program in the Emergency Department. It details a collaborative model whereby patients discharged from the Emergency Department have their prescriptions filled onsite and receive complete medication counseling from a pharmacist. Methods This program was initiated in a 511-bed acute care, community teaching hospital equipped with a decentralized pharmacy satellite in the ED, a designated ED pharmacist, and an on-site, outpatient pharmacy as part of the healthcare system. The program was developed in collaboration with the chief physician and nursing manager of the ED. Physicians, physician assistants, and nurses were instructed to notify the ED pharmacist when patients had prescriptions for discharge. The pharmacist obtained consent to fill the prescriptions, demographic, allergy, and insurance information before facilitating the delivery of the written prescription(s) to the outpatient pharmacy. A colored paper designating the patientâ&#x20AC;&#x2122;s name and number of prescriptions was developed as a Fast Pass for the outpatient pharmacy. Patients were counseled on their medications and provided a Fast Pass to present to the pharmacy when picking up the prescriptions. A map was provided to guide the patient to the pharmacy before exiting the facility. When the ED pharmacist was not available, or if patients with minor injuries or illnesses received timely treatment and discharge, providers directed patients to the outpatient pharmacy with prescriptions and a Fast Pass. The outpatient pharmacy staff identified patients from the ED who were given the Fast Pass. The Fast Pass was collected from the patient picking up the prescription and served as a data collection tool. The process flow is detailed in Figure 1. A modified procedure was required if there was no pharmacist present or if patients underwent rapid evaluation and discharge. The modified procedure is detailed in Figure 2. The number of patients discharged home from the ED during the study period was provided by the hospital data warehouse. Total prescription retail, total cost, gross margin, and margin percent were compiled from the outpatient pharmacy computer system, QS1ÂŽ.5 The Fast Pass allowed

the recording of number of patients, number of prescriptions, and date. The results of the first seven weeks of the ED Continuity of Care Program were compared to the previous seven weeks prior to program implementation. Results The study was conducted over seven weeks (35 weekdays). The ED prescription discharge program was used 51% of the days (18 of 35 days). A mean of 4.5 prescriptions [range of 1 to 13 per day] were filled each day (Figure 3). Eighty-one prescriptions were filled for 37 patients with a mean of 2.2 prescriptions per patient. Of participating patients, 89% (33 of 37 patients) were not re-admitted to the ED within 30 days of discharge. The outpatient pharmacy filled 4374 and 3955 prescriptions during the study period and comparator period respectively. This increase of 419 prescriptions retailed $40,000 more than the comparator period (Table 1). Prescriptions from the ED accounted for 19.3% (81 of 419) of the increased prescription volume during the study period. There was an increase in total cost which resulted in a gross margin $3,600 less than the comparator period. The margin percent for the study period was 2.8% less than the comparator period. Survey of pharmacists and technicians demonstrated that some prescriptions required intervention including prior authorization, change of dose or directions, and change of medication to a formulary alternative preferred by the insurance. A survey was provided to nurses and providers, but insufficient response was received to conclude results. Limitations Patients were identified by collecting the Fast Pass. This could have resulted in incomplete data collection due to the following: failure to give the Fast Pass to the patient, failure of patient to present the Fast Pass to the outpatient pharmacy, failure of the pharmacy to collect the Fast Pass. Also, the Fast Pass did not allow collection of prescription-specific data. Continuity of the program was largely dependent on the availability of the ED pharmacist. Due to days off, vacation time, meetings or other conflicts, the availability of the ED pharmacist was limited to 18 days. The short-term duration of this study provided limited data. Discussion The prevention of non-adherence to the treatment pre27

Feature

continued

scribed by the healthcare provider is an essential component of a quality healthcare model. Health-systems pharmacists are called upon to address the continuity of care for patients. A successful pharmacist-led discharge prescription program was initiated in the Emergency Department at our institution. This program required collaboration of the healthcare team. During the study period of seven weeks, 37 patients received their prescriptions and comprehensive counseling by a pharmacist via our service. Potentially, more than 500 patients per year could receive this service at our institution; at an average of 2.2 prescriptions per patient, this would equate to 1100 prescriptions per year. The program provided convenient access to fill discharge prescriptions and continuity of care for ED patients. The interdisciplinary approach allowed for an expanded role and demonstrated the importance of the ED pharmacist. Further expansion of this program may provide benefits to quality of healthcare, continuity of care, patient satisfaction scores, positive gross margin and margin percent. Evidence of financial gains may allocate funding for an additional technician or pharmacist to provide more consistent services. Future evaluation of this program may benefit from a longer study period and may include: readmission rates versus comparator, number of patients who permanently transfer prescription services to the on-site pharmacy, medications prescribed most frequently, financial evaluation for those specific prescriptions, and patient satisfaction. Identifying most frequently prescribed medications may facilitate growth and adaptation of the program for this specific patient population.

Figure 1: Standard Procedure for ED Discharge Prescription Program Prescription Written for Discharge

Provider/Nurse notifies ED pharmacist

ED pharmacist proceeds

1. Patient Consent

2. Accountable Care Facts. Council of Accountable Physician Practices: American Medical Group Foundation. http://www.accountablecarefacts.org/ (accessed 22 Dec 2011). 3. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the Unites States. N Engl J Med. 2003; 348(26):2635-2645. 4. Jackevicius CA, Li P, and Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008; 117:10281036. 5. QS/1速 PrimeCare. Sales Analysis Report. J M Smith Corporation. Client Version 191.8.89. Database 19.1. Service Pack 8. Clinical Release Date 8/25/11.

3. Insurance Information

Patient counseled by ED Pharmacist

Hard copy delivered to outpatient pharmacy

References 1. Press Ganey. Emergency Department Pulse Report: Tips for ED Administrators. 2010. http://www.pressganey.com/Documents/research/hospitals/ ED%20Resources/Hospital_Admin_Tip_Sheet_2010.pdf?viewFile (accessed 16 October 2011).

2. Demographic Information

Patient Mobile

YES Patient Picks up prescription(s)

NO Pharmacist delivers to patient

4. Allergy Information

Pharmacy Journal of New England • Summer 2014

Figure 2: Modified Procedure of ED Discharge Prescription Program( No pharmacists present)

Figure 3: Number of Prescriptions filled per day

Prescriptions Written for Discharge

Provider/Nurse obtains patient consent

Patient given Fast Pass

Patient directed to outpatient pharmacy

Table 1. Prescription Volume and Fiscal Comparison

Outpatient pharmacy

Patient counseled by Pharmacist

# Prescriptions

Study Perioda

Medication dispensed

Total Cost Total Retail Gross Marginb Margin Percent

4374

321,477

373,774

52,296

13.99

Comparator Perioda 3955

277,174

333,114

55,940

16.79

Difference(loss)c

44,303

40,660

(3,643)

(2.80)

419 d

a: 7-week period b: Total Retail - Total Cost = Gross Margin

c: Study Period - Comparator Period = Difference d: Discharge program total prescriptions = 81 of 419 (19.3%)

BuySell_ad_5x7half_Layout 1 1/27/13 2:12 PM Page 3

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Your Local Specialist Jack Collins, R.Ph. jackc@buy-sellapharmacy.com Tel: 1-(203)-395-6243

3. DO NOT engage in conversations, information sharing or negotiations with ANY buyer without professional representation, particularly if contemplating a sale to a chain. Thirteen years of experience selling pharmacies has shown us time after time that direct engagement rarely—if ever—gets the independent owner the best price or the best deal.

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1-(877)-360-0095 www.buy-sellapharmacy.com 29

Pharmacy Marketing Group

Rx and the Law By: Don R. McGuire Jr., R.Ph, JD This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

Why is that pharmacist asking so many questions? One of the duties required of pharmacists under OBRA ’90 is that a Drug Utilization Review (DUR) be performed. In the years since, the profession has developed specialized areas of DUR, such as medication reconciliation in the hospital setting. In the end, a healthcare professional should make sure that the patient is on the correct drugs for their condition(s), that they are taking them at the correct dosages, and that all the medications work together. The professional best suited to provide this service, whatever you call it, is a pharmacist. What does the pharmacist need in order to provide this service effectively? Up to date patient information and an up to date medication list are key. Reasonable efforts to obtain this information should be made by the pharmacist or their staff. Patients are sometimes reluctant to provide this information. It may be a privacy concern, embarrassment, or it may be that they don’t understand why it is needed by the pharmacist. Patient education may be helpful in the latter case. In the hospital setting, an accurate list upon admission may difficult to obtain initially, but with the help of the physician’s office, and many times the patient’s community pharmacist, the blanks can easily be completed. Medication reconciliation is also important at discharge. Discontinued or changed dosages are communicated to the patient. The patient should give this new information to their community pharmacist and pharmacists should be looking for it if they are aware of any hospital admissions or procedures. Continued focus on continuum of care will allow all pharmacists to better serve their patients through increased access to current information. In the end, the pharmacist must proceed with the information at hand. The patient should understand that the quality 30

of the DUR depends on the information that the pharmacist has to use. We cannot force patients to provide the necessary information. However, the pharmacist should document their attempt to gather it if they cannot obtain it. Once the review is finished, the key to a successful DUR encounter is to take action with any findings that are out of the ordinary. This may mean having a discussion with the patient about their condition and/or their therapy. Many times these conversations can clear up any misinterpretations or other mistakes. A well-informed patient can be a good ally to make sure that their therapy is appropriate. But at other times, a call to the prescriber about one or more drugs that are causing concern, or have the potential to cause a problem, is required. Again, documentation is key. Make good notes about the conversations or phone calls. Record the date, time, participants, and the content of the discussions. If changes to therapy need to be made, make sure that the changes are well-documented also. Don’t assume that someone else has discussed your concerns with the patient or has interacted with the prescriber. Many times the pharmacist is the last line of protection for the patient. This doesn’t excuse those professionals who have acted before you, but in most situations, there is no one to take action after you. There are also situations where prescribers will not change the ordered therapy. The pharmacist must then act to protect the patient within their professional boundaries. A previous article in this series discussed refusing to fill prescriptions. The patients’ health and well-being depend on all healthcare professionals doing their respective jobs to the best of their abilities. For pharmacists, one aspect of this means doing your best to gather patient information, performing a thorough DUR, and carrying through with any needed recommendations. Your patients may not realize that this is going on behind the scene, so educate them about what you are doing to protect them. They should value your service even more.

Pharmacy Journal of New England • Summer 2014

Financial Forum This series, Financial Forum, is presented by PRISM Wealth Advisors, LLC and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

While the Idea of Retirement Has Changed, Certain Financial Assumptions Haven’t We’ve all heard about the “new retirement”, the mix of work and play that many of us assume we will have in our lives one day. We do not expect “retirement” to be all leisure. While this is becoming a cultural assumption among baby boomers, it is interesting to see that certain financial assumptions haven’t really changed with the times. In particular, there are two financial misconceptions that baby boomers can fall prey to – assumptions that could prove financially harmful for their future. #1) Assuming retirement will last 10-15 years., as previous generations of Americans did. Today, both men and women who reach 65 can anticipate around 20 additional years of life. It’s important to note that this is just an average; a quarter of people reaching 65 will live beyond 90 and ten percent will live another five years or more. However, some of us may live much longer. The population of centenarians in the U.S. is growing – the Census Bureau counted 53,364 folks 100 years or older in 2010 and showed a steady 5.8 percent rise in centenarians since the previous count in 2000. It also notes that between 1980 and 2010 centenarians experienced a population boom, with a 65.8% rise in population, in comparison to 36.3% overall. If you’re reading this article, chances are you might be wealthy or at least “affluent.” And if you are, you likely have good health insurance and access to excellent health care. You may be poised to live longer because of these two factors. Given the landmark health care reforms of the Obama administration, we could see another boost in overall American longevity in the generation ahead. Here’s the bottom line: every year, the possibility is

increasing that your retirement could last 20 or 30 years … or longer. So assuming you’ll only need 10 or 15 years worth of retirement money could be a big mistake. Many people don’t realize how much retirement money they may need. There is a relationship between Misconception #1 and Misconception #2 … #2) Assuming too little risk. Our appetite for risk declines as we get older, and rightfully so. Yet there may be a danger in becoming too risk-averse. Holding onto your retirement money is certainly important; so is your retirement income and quality of life. There are three financial issues that can affect your quality of life and/or income over time: taxes, health care costs and inflation. Over time, even 3-4% inflation gradually saps your purchasing power. Your dollar buys less and less. Here’s a hypothetical challenge for you: for the rest of this year, you have to live on the income you earned in 1999. Could you manage that? This is an extreme example, but that’s what can happen if your income doesn’t keep up with inflation – essentially, you end up living on yesterday’s money. Taxes may be higher in the years ahead. So tax reduction and tax-advantaged investing have taken on even more importance whether you are 20, 40 or 60. Health care costs are climbing – we need to be prepared financially for the cost of acute, chronic and long-term care. As you retire, you may assume that an extremely conservative approach to investing is mandatory. But given how long we may live - and how long retirement may last growth investing is extremely important. No one wants the “Rip Van Winkle” experience in retirement. No one should “wake up” 20 years from now only to find that the comfort of yesterday is gone. Retirees who retreat from growth investing may risk having this experience. How are you envisioning retirement right now? Has your vision of retirement changed? Is retiring becoming more and more of a priority? Are you retired and looking to improve your finances? Regardless of where you’re at, it is vital to avoid the common misconceptions and proceed with clarity. Pat Reding and Bo Schnurr may be reached at 800-288-6669 or pbh@berthelrep.com.

From the Colleges

University of Connecticut School of Pharmacy Helping the Uninsured As an employee of a local retail pharmacy, David Sugrue has seen firsthand people’s frustrations with their health insurance. So Sugrue, a UConn pharmacy student, said he was interested when offered an opportunity to help people enroll for health care coverage under the federal Patient Protection and Affordable Care Act and Connecticut’s health exchange, Access Health CT.

Windham and Tolland counties, one of the areas in the state with the highest rate of medically uninsured.

After 45 hours of training in the new law and community outreach, Sugrue is one of nine UConn “assisters” who have dedicated their spare time to helping people obtain health insurance at the non-profit Access Community Action Agency in Willimantic, Conn.

U.S. Rep. Joe Courtney, D-2nd District, also praised the UConn students’ efforts at an enrollment fair in Rockville, Conn. Courtney pointed out that Connecticut currently leads the country in health insurance enrollment under the ACA. The state has far surpassed its goal of 100,000, with 126,000 individuals currently enrolled. .

“We’re here to promote outreach and educate people in the law, “ Sugure said during a break in the recent health insurance enrollment fair. “We’re not trying to play politics or steer people toward any particular plan. We’re here to give them the knowledge they need to choose health insurance, and to let them know we have the resources to help.” All of the UConn assisters are affiliated with the School of Pharmacy. Peter Tyczkowski, the school’s coordinator of educational outreach, says the program exposes students to the larger world of health care policy and its impact both on the pharmacy profession and the patients pharmacists serve. “These students have an opportunity to see history in action and they are part of it,” Tyczkowski says. “This is something they will remember for the rest of their lives.” The UConn students visit the Access Community Action Agency about once a week to provide in-person assistance to individuals as they come or as part of a pre-arranged appointment. They also participate in regional health insurance enrollment fairs on weekends. The Access agency in Willimantic is the regional outreach office for 32

Shirley Reimann, the Access agency’s director of social services and a key staff navigator for the enrollment program, says the students are “tremendous. “[They] are coming down here to help with open enrollment, and they are organizing events to help enroll UConn students.”

“What you are doing is an essential service,” Courtney told the student assisters. UConn President Susan Herbst said the students’ outreach mission is a great example of the kind of community engagement university leaders encourage of students as part of the school’s academic plan. “A research university like UConn should be a leader in trying to solve society’s biggest problems – energy, poverty, health care,” Herbst said. at the event “I could not be more proud of our students today.” Cassandra Doyno, also a pharmacy graduate student, said the assister program has really opened her eyes about the diverse roles pharmacists play in their communities, and how pharmacists can make a difference in people’s lives. These UConn pharmacy students are helping people obtain health insurance as part of the federal Affordable Care Act. The students completed 45 hours of training to prepare for the Health Care Assisters Program. (Photo courtesy of Jun Wang.))

Working with enrollees, she said a lot of people are intimidated by the new law and cautious about exploring it. “A lot of people have a stigma about Medicaid,” Doyno says. “

Pharmacy Journal of New England • Summer 2014

They don’t know that it is not just a program for poor people. It’s something for all people. Educating people is the biggest challenge.” Pharmacy student Jun Wang says the hours spent in training and working with individuals to line up care are worth it when the students see someone benefit from their new health insurance.

“People come in here mad, and they walk out happy. That shows how the Affordable Care Act can help,” Wang says. The nine UConn pharmacy students active in this project will receive up to $18,000 for their work helping with enrollment as part of a federal grant through Access Health CT. They have decided to donate the money to their preferred pharmacy student professional organizations.

University of St. Joseph School of Pharmacy Message from the Dean Dear Colleagues: Sincere salutations from us to you. I am pleased to inform you that the Inaugural Class of 55 students were awarded the Doctor of Pharmacy Degree during the Commencement activities at the University of Saint Joseph on May 11, 2014. These graduates are heading into endeavors all over the country, have accepted offers in various pharmacy practices including the U.S. Navy, and residencies, and other post-graduate training. Now we have alumni and thank you for being instrumental in accomplishing this critical milestone. Please enjoy reading these few briefs and know that you are highly appreciated. Best, Joseph Ofosu, Dean, University of Saint Joseph School of Pharmacy

Inaugural Class Graduates

Publications

The Hooding, Oath and Awards Ceremony for the inaugural Doctor of Pharmacy Class of the University of Saint Joseph was held on Friday, May 9, 2014 at the Hoffman Auditorium of the Bruyette Athenaeum on the main campus of the University. The fifty-five graduates were assisted in donning their doctoral hoods by members of the School of Pharmacy faculty. They were then lead in reciting the Pharmacist’s Oath by Dean Joseph R. Ofosu. Nineteen awards were presented to members of the class in recognition of their service, leadership and academic achievement, and the officers of the Class of 2014 presented a gift to the School of Pharmacy. The ceremony was followed by a reception in the lobby of the Athenaeum.

Wiskirchen DE, Nordmann P, Crandon JL, Nicolau DP. In vivo Efficacy of Human Simulated Regimens of Carbapenems and Comparator Agents against NDM-1 Producing Enterobacteriaceae. Antimicrob Agents Chemother 2014; 58(3):1671-7. Wiskirchen DE, Nordmann P, Crandon JL, Nicolau DP. Efficacy of Humanized Carbapenem and Ceftazidime Regimens against Enterobacteriaceae Producing the OXA-48 Carbapenemase in a Murine Infection Model. Antimicrob Agents Chemother 2014; 58(3):1678-83. Summa, MA. Treating Head Lice: Primer for the Community Pharmacist. Pharm J of New Engl 2014;11(2):41-51. Summa, MA. Onychomycosis. Core Content Rev Fam Med 2014; 45(2):466. 33

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USJ Launches Medicine Garden Many of todayâ&#x20AC;&#x2122;s most commonly used medications were originally derived from plant sources. The USJ Medicine Garden Project will feature a garden of live medicinal plants for public awareness and education. The project represents a collaborative effort between local campuses and the surrounding community. Student and faculty volunteers from the USJ School of Pharmacy will work to repair and revive a currently unused garden space located in the historic Elizabeth Park in Hartford. By partnering with the Connecticut College Office of Sustainability, the garden will be designed for both efficiency and sustainability, a core mission of the non-profit Elizabeth Park Conservancy. Regular public viewings and tours will be held, presenting an opportunity for pharmacy students to engage in community service while fostering their growth as professionals, leaders and community members. On Saturday, May 24th, ground was broken and a raised bed was built to contain the medicinal plants. Over the next month the medicinal herbs will be planted and signs will be put up to educate the public about the botanical origins of medicines.

Habitat for Humanity USJ SOP teamed up with Thrivent Builds with Habitat for Humanity to help build a home in Bristol, CT for a local family in need. As future pharmacists, we believe everyone should have the right to adequate health care. Habitat for Humanity believes that everyone also has the right to a decent place to live. This nonprofit organization is dedicated to constructing, rehabilitating, and preserving homes but none of this is possible without the help of volunteers.

USJ Medicine Garden

Poster Presentations Doreen E. Soldato, Ola Ghoneim, Ivan Edafiogho, Joseph R. Ofosu. Developing Pharmacy Student Empathy Using Mock HIV Anti-Retroviral Therapy Regimens: A Learning Activity. American Association of Colleges of Pharmacy (AACP) Annual Meeting, Chicago, IL July 13-17, 2013 Gancarczyk V, Goldstein SW, Ghoneim OM. Biodirected Synthesis of Substituted Phenoxyacetic Acid Derivatives as Anti-Autism Serotonergic Ligands. American Chemical Society-North Eastern Regional Meeting (ACS-NERM), Poster Presentation, Undergraduate Session, New Haven, CT, October 23-26, 2013 Kent CN, Ghoneim OM, Goldstein SW. Pd-Catalyzed Amination of Arylhalides towards Efficient Synthesis of Sterically Demanding N-Arylpiperazines. American Chemical Society-North Eastern Regional Meeting (ACS-NERM), Poster Presentation, Undergraduate Session, New Haven, CT, October 23-26, 2013

____________________________________ Visit CPAâ&#x20AC;&#x2122;s Career Site today! http://pharm.ct.associationcareernetwork. com/ Your destination for exciting Pharmacy job opportunities.

Habitat for Humanity Group

Pharmacy Journal of New England • Summer 2014

Massachusetts College of Pharmacy and Health Sciences – Boston Dear Colleagues, On behalf of President Charles F. Monahan Jr. and Provost Douglas Pisano I bring you greetings from the School of Pharmacy Boston at MCPHS University. Another successful academic year has come to Dean Paul DiFrancesco an end and on May 10, we held our first university-wide commencement ceremonies at Gillette Stadium. It was the first commencement ceremony in the history of the stadium. Robert Kraft, chairman and CEO of the New England Patriots, made the opening remarks and presented President Monahan with an official Patriots jersey embroidered with the “MCPHS University” on one side and the number 1 on the other side. The keynote address was given by Sandra Fenwick, president and CEO of Children’s Hospital Boston. She also received an honorary degree. Gregory Laham, a university trustee and owner of Sullivan’s Pharmacy in Roslindale, was awarded the university medal for his years of service. Approximately 1,400 students received diplomas from across our three campuses. I am proud to say that the School of Pharmacy-Boston graduated more than 350 students. Most

of our graduates received their PharmD degree but many also received their Bachelor’s Degree in Pharmaceutical Sciences, Health Care Business and Toxicology. Also included were a number of students who received their Master’s Degree in Pharmaceutical Sciences, Pharmacoeconomics, Pharmaceutics, Pharmacology, and Drug Regulatory Affairs and Health Policy. One graduate received a PhD in Pharmaceutics. I am pleased to report that more than 40 of our PharmD graduates are moving on to complete post graduate studies and have been accepted in residency and fellowship programs both locally and across the country.

Faculty Awards Our faculty, who are responsible for the success of our students, have been busy with their teaching, research, and service activities. Three of our faculty received awards for their excellence as voted by our students. Dr. Paul Kiritsy received Teacher of the Year in Pharmacy Practice. Dr. Alejandro PinoFigueroa received Teacher of the Year in Pharmaceutical Sciences. Dr Kristin Zimmerman received the Faculty Preceptor of the Year Award. On the day prior to commencement an awards lunch event was held for the students who received awards. More than thirty students were given awards based on several categories including academics, professionalism, community service, and entrepreneurship.

Robert Kraft, owner of the New England Patriots, presents MCPHSu President Charles F. Monahan with a MCPHS-personalized Patriots jersey. (at left, Monahan with Kraft).

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MCPHS 2014 graduation was held at Gillette Stadium.

New Faculty This past year some new faculty have joined our programs. Dr. Jennifer Fraser has the role of Experiential Education Coordinator on the Boston campus. Previously, she was a pharmacy manager for CVS where she was a preceptor for MCPHS University students. Jennifer graduated in 2010 from Worcester/Manchester Doctor of Pharmacy program, and graduating with Cum Laude honors in three years from UMass Amherst in 2007 with a Bachelor’s in Chemistry. Dr. Gretchen Jehle is a Pharmacy Experiential Education coordinator based on the Worcester campus. She received a B.S. from Providence College and her PharmD from MCPHSWorcester/Manchester in 2003. Her pharmacy experience includes practice in community pharmacy at Walgreens since 2001 as a pharmacy intern/pharmacist/pharmacy manager. Dr. David Mantus joins us as an Associate Professor and new Director of the Drug Regulatory Affairs programs. He has extensive teaching experience here as an adjunct faculty member in Regulatory Affairs and Drug Development

since 2001. Over the last ten years he has also served as Vice President of Regulatory Affairs for Cubist Pharmaceuticals and then Sention Inc. He also holds an adjunct faculty position at Framingham State University where he has taught courses in chemistry and health science. His credentials include a PhD and Masters in Chemistry from Cornell as well as a Post Doctorate in Biomedical Engineering. He has numerous publications and presentations in his field including being the coauthor with Provost Douglas Pisano of: “ FDA Regulatory Affairs: A Guide for Prescription Drugs, Medical Devices, and Biologics” now in its second edition. Finally, I wanted to thank you all personally for what you do for our profession and in serving the public. Our students are fortunate to have you as mentors and role models. Paul DiFrancesco, EdD, MPA, RPh Dean, School of Pharmacy Boston

Pharmacy Journal of New England • Summer 2014

Massachusetts College of Pharmacy and Health Sciences – Worcester/Manchester Dear Colleagues, We are proud to announce that we graduated 275 students from the Worcester/ Manchester Doctor of Pharmacy Program. It was an historic occasion as the commencement ceremonies were held at the home of the New England Patriots, Gillette Stadium, which was a first for MCPHS University and for the stadium. Fortunately it was a sunny day and the event was extremely well received and attended with Patriots owner Robert Kraft receiving the loudest applause for his address. We are now looking forward to beginning a new academic year in the fall of 2014. I hope everyone has a productive and enjoyable summer. All the best, Michael J. Malloy, PharmD, Dean and Professor

School of Pharmacy is Well-Represented at Professional Meetings MCPHS University School of Pharmacy–Worcester/ Manchester had an outstanding presence at the American Society of Heath-System Pharmacists (ASHP) Midyear Meeting and the American Pharmacists Association-Academy of Student Pharmacists (APhA-ASP) Midyear Regional Meeting (MRM) for chapters in Regions 1 and 2. The ASHP clinical meeting and exhibition was held on December 7-11, 2013 in Orlando, FL. Seventy-seven students and 28 faculty members showcased a total of 57 posters and one podium presentation.

Awards Dr. Cheryl Abel was awarded the Bowl of Hygeia by the New Hampshire Pharmacists Association (NHPA) on December 18, 2013 at the MCPHS University/New Hampshire Board of Pharmacy Annual Holiday Reception. This prestigious

award is sponsored by the American Pharmacists Association (APhA) Foundation and National Alliance of State Pharmacy Associations and recognizes a pharmacist in each state who has provided outstanding community service that reflects well on the profession. At the MCPHS University School of Pharmacy-Worcester/ Manchester annual awards ceremony held on May 5, 2014, three faculty members were recognized for their outstanding service to the university and its students: Kevin Kearney received the MCPHS School of Pharmacy W/M Academic of the Year for Pharmacy Science. Anna Morin received the MCPHS School of Pharmacy W/M Academic of the Year for Pharmacy Practice. Maryann Cooper received the MCPhS School of Pharmacy W/M Preceptor of the Year.

Dr. Alice Gardner’s Sabbatical Stint in Australia Dr. Alice Gardner, Pharmaceutical Sciences, was on a sabbatical leave from May to November 2013 at the Woolcock Institute of Medical Research, University of Sydney, Australia. This is a world renowned institution specializing in research associated with “lung transplant medicine, sleep disorders, and respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), lymphangioleiomyomatosis (LAM), and pulmonary fibrosis (Woolcock Institute Website)”. Dr. Gardner’s sabbatical was hosted by Dr. Judith Black, who is an expert in asthma and is the leader of the Cell Biology group at the Woolcock Institute. Dr. Gardner’s project goal was to examine the effect of inhibiting the activity of a major lung enzyme elevated in asthma, phosphodiesterase 4, and determine whether its inhibition would improve the transport of albuterol across the epithelial barrier. She returned in time to teach pharmacology before the Fall 2013 semester ended.

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Poster Presentations 2013 ASHP Midyear Regional Meeting Poster Presentations Faculty Posters Desai S, Lee Z, Wolfson E, Coppenrath V. Evaluative survey of a PharmD elective course: selected topics in clinical research design. Dolley S, Morin A. Long term use of enoxaparin for thromboprophylaxis in a psychiatric patient with a patient with a mechanical heart valve. Drobny D, Roggie S, Carey K, Knee A, Adams D. Clinically relevant warfarin medication interactions in the inpatient setting. Hahn E, Key S, Malloy M, Silva M. Acute pancreatitis associated with antipsychotic use: review of case reports. Lee Z, Desai S, Wolfson E, Coppenrath V. Evaluation of a high-dose simvastatin prescription practices at a community health center. Nemeth C, Romine-Nelson A, Kanaan AO, Spooner LM, Sullivan K, Abraham G. Analysis of a computerized compliance report; the possible limitations of computerized generated reports. Romine-Nelson AR, Nemeth CA, Kanaan AO, Sullivan K, George SV. The need to continually educate prescribers regardless of their level of training; our experience with computerized provider order entry. Shah S, Malloy M, Comee M, Silva M. Pay for delay settlements: an evaluation of anticompetitive effects. Steinberg M, Pervanas H. Evaluation of inhaler use in ambulatory and hospitalized patients. Steinberg M. Evaluation of the introduction of weekly current event discussions as a learning activity in aninternal medicine advanced pharmacy practice experiential rotation. Stevenson J, Kopcza K, Horton E, Lamothe A, Fisher D. Incidence of and risk factors for vancomycininduced nephrotoxicity in pediatric patients receiving treatment greater than 48 hours. 38

Willett KC, Kelleher JA, Abel C. Patient perceptions and changes to lifestyle after student-pharmacist driven medication review services. Yu J, Kopcza K, Horton E. Evaluation of antibiotic sensitivity patterns in pediatric patients admitted with urinary tract infections.

Publications Gunzner-Toste J, Zhao G, Bauer P, Baumeister T, Buckmelter AJ, Caligiuri M, Clodfelter KH, Fu B, Han B, Ho Y,Kley N, Liang X, Liederer B, Lin J, Mukadam S, Oâ&#x20AC;&#x2122;Brien T, Oh A, Reynolds DJ, Sharma G, Skelton N, Smith CC, Sodhi J, Wang W, Wang Z, Xiao Y, Yuen P, Zak M, Zhang L, Zheng X, Bair KW, Dragovich PS. Discovery of potent and efficacious urea-containing nicotinamide hosphoribosyltransferase (NAMPT) inhibitors with reduced CYP2C9 inhibition properties. Bioorganic & Medicinal Chemistry Letters. 2013. 23(12):3531-3538. Kelleher J, Sing NC, Kwok H, Devine C, Pervanas HC. Assess the knowledge and perceptions of middleschool and high school aged students about alcohol and drug abuse. Pharmacotherapy. 2013;33(10)e182-e200. Pervanas H. Process improvement for a medication assistance program in an ambulatory care clinic. In: Westberg SM, Currie JD, Garwood CL, et al, eds. ACCP Ambulatory Care Pharmacistâ&#x20AC;&#x2122;s Survival Guide, 3rd ed. Lenexa, KS: American College of Clinical Pharmacy, 2013. Zeineldin R. Nanotechnology for cancer diagnosis. In Kinam Park (Ed.). Biomaterials for cancer therapeutics, Woodhead Publishing Limited, Cambridge, UK, 2013. pp.137-164.

Pharmacy Journal of New England • Summer 2014

Northeastern University Greetings alumni, colleagues and friends. We are pleased to provide readers of the Pharmacy Journal of New England with this update of recent activities at Northeastern University School of Pharmacy. As the 2013-14 academic year has ended and we enjoy the summer term, complete with warm weather and the sense of renewal that accompanies it, I’m reflecting on what another remarkable year we’ve had in the school of pharmacy. The school, college and university all continue to make strides with respect to academic quality, experiential education and use-inspired research. Intellectual rigor, innovation, and leadership underlie the many successes we are seeing among faculty, students and alumni. The constant pursuit of excellence in our work, whether it be in the classroom, experiential or laboratory settings, drive us to new levels of achievement. And it’s being seen in the form of research, grants, awards, elections, and rankings. You’ll see that we have much to celebrate, with many good things on the horizon.

Faculty News Recent Honors and Recognitions: Mansoor Amiji, PhD, Distinguished Professor and Chair of the Department of Pharmaceutical Sciences, has been selected as a 2014 Controlled Release Society (CRS) College of Fellows awardee. This prestigious distinction recognizes his outstanding contributions to the field of biomaterials, advanced drug and gene delivery systems and nanotechnology applications, and to CRS. The award will be presented at the CRS annual meeting in July. William A. Gouveia, MS, FASHP. On May 15, 2014, at its Annual Honors and Award Banquet, Massachusetts Society of Health-System Pharmacists (MSHP) conferred the status of ‘Honorary Member’ to William A. Gouveia, in recognition of his decades of service to MSHP, ASHP and the pharmacy profession at large. In addition, the ‘MSHP Outstanding Service Award’ has now been renamed the ‘William A. Gouveia Outstanding Service Award’. John R. Reynolds, PharmD, Dean and Professor, was selected by the Massachusetts Pharmacists Association as the recipient of the 2013 Bowl of Hygeia Award for outstanding com-

munity service. Reynolds was presented the award at the Annual Awards Banquet in October 2013. Ganesh Thakur, PhD, Assistant Professor of Pharmaceutical Sciences, received the Schumacher Award for distinguished scholarship in May 2014. Michael Gonyeau, PharmD, Clinical Professor, was inducted as a Fellow into the National Academies of Practice in April 2014. Anita Young, EdD, Director of Continuing Professional Education, was elected Secretary/Treasurer of District I of the National Association of Boards of Pharmacy at the October joint meeting of NABP and AACP. Recent Hires and Promotions: Gregory Miller, PhD, joins Northeastern as Associate Professor in the Department of Pharmaceutical Sciences. Roman Manetsch, PhD, joins Northeastern University as Professor, with a joint appointment in the Departments of Pharmaceutical Sciences, Chemistry and Chemical Biology. Carla Bouwmeester, MS, PharmD, BCPS, promoted to Associate Clinical Professor. Margarita DiVall, PharmD, BCPS, promoted to Clinical Professor. Grants: Mansoor Amiji, PhD, awarded $427,625 from the National Institutes of Health for his work entitled “Targeted Platinates/ siRNA Combination Therapy for Resistant Lung Cancer”; and awarded a $50,000 Northeastern University Tier-1 Grant for his work entitled “A Cyber-Physical Platform for Rapid Development of Nano-Delivery Systems”. Heather Clark, PhD, awarded $1,641,973 from NIH/NINDS (R01) for her work entitled “Polymer-Free Nanosensors for Monitoring Biochemical Dynamics in Dendritic Spines” and awarded $250,000 from an Anonymous Corporate Grant for her work entitled “The NanoClinical Analyzer”; Jennifer Morales, a graduate student in Dr. Clark’s lab, was awarded a $44,000 National Science Foundation Graduate Research Fellowship for her work entitled “Fluorescent DNA-Dendrimer 39

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Nanosensors for Dopamine Sensing”. Roger Edwards, ScD, awarded $38,585 in supplemental contracts from the Massachusetts Department of Public Health/Adcare Educational Institute of Massachusetts for his work entitled “Becoming Baby Friendly Technical Assistance Project” and awarded a $7,000 subcontract from Tufts 2013 Innovations in Education Intramural Grant Program for his work entitled “Improving Medical Student Training in Lactation Practices through an Interactive Computer-Based Curriculum for Medical Students”. Roger Giese, PhD, awarded $1,234,100 from the National Institute of Environmental Health Sciences for his project entitled “Discovery of Xenobiotics Associated with Preterm Birth”. Torbjorn U.C. Jarbe, PhD, awarded $229,891 by the National Institutes of Health for his work entitled “Endogenous/ Exogenous Cannabinoids: A Comparison”

and Jay West, PhD, awarded $193,125 by the National Institutes of Health for their work entitled “Novel Probes for N-acylethanolamine-hydrolyzing acid amidase function”. Steven Pizer, PhD, awarded $78,256 by the VA Boston Healthcare System for his work entitled “Instructor and Technical Consultant to Health Care Financing & Economics group at VA Boston/South Huntington”. Christopher Skipwith, PhD, awarded a $41,500 Ford Foundation Postdoctoral Fellowship from The National Academies and awarded a $92,000 Postdoctoral Science Research Fellowship from UNCF/Merck Science Initiative for his work entitled “A Platelet Mimetic-Based Approach to Detect Markers of Restenosis”. Vladimir Torchilin, PhD, awarded $372,034 from the National Institutes of Health for his work entitled “Multifunctional matrix metalloprotease-2-sensitive anti-cancer nanopreparations”.

.Alexandros Makriyannis, PhD, awarded $483,515 by the National Institutes of Health for his work entitled “Molecular Basis of Cannabinoid Activity”. Spiro Pavlopoulos, PhD, Kumara Subramanian, PhD,

Richard Deth, PhD Retires from Northeastern After more than 37 years in his distinguished academic career, Professor Richard Deth has retired as a faculty member at Northeastern University. During his tenure, Professor Deth served many roles including the Director of Pharmacy Program and Chairman of the Department of Pharmaceutical Sciences, before deciding to focus solely on his research interests. His lab was the first to characterize the implications of dopamine D4 receptor-mediated phospholipid methylation in neuronal synchronization, especially in attention-related disorders. Along with teaching several pharmacology graduate and undergraduate courses for all these years, Professor Deth has been a mentor to 17 PhD students, along with a number of other graduate and undergraduate students, visiting scientists, and post-doctoral associates. He believes that the true value of science lies in its implications and relevance to the everyday life.

Pharmacy Journal of New England • Summer 2014

Student News: Lucianne West elected APhA-ASP National President-Elect: In a very happy moment for the School of Pharmacy, Lucianne West, a current P2 student in the PharmD program, assumed the position of National President-elect of American Pharmacists Association - Academy of Student Pharmacists (APhA- ASP) during the annual meeting of APhA in March 2014. This position involves service and leadership for approximately 34,000 student pharmacist members of APhAASP across the country. As President-elect, she will serve on the APhA Foundation Board. As President (2015-16 academic year), she will serve a one-year term on the APhA Board of Trustees. Matthew Schmidt Receives Hodgkinson Award Matthew Schmidt, a P4 student in the PharmD program, has been awarded the Harold D. Hodgkinson Achievement Award. The Hodgkinson Award is a university-wide award and one of the highest honors that a senior at Northeastern University can receive. The award recognizes distinguished scholastic achievement with due consideration of character, personality, qualities of leadership, cooperative work experience and service in voluntary organizations and activities. Abhijit Kulkarni, a doctoral student working in the lab of Dr. Ganesh Thakur, received first prize at the 2014 American Association of Pharmaceutical Scientists Northeast Regional Discussion Group’s Conference for his podium presentation on cancer-related research entitled “Expeditious Microwaveassisted Synthesis of 4BP-TQS, an ago-PAM of a7 nAChRs, its Stereochemical Requirement and the Target Amino Acids Responsible for Activity”. He presented his research in Cambridge, England last month. Michael Johnson, a PhD student working in Dr. Makriyannis’ lab, was awarded the 2014 John L. Neumeyer Research Achievement Award. Michael’s research involves the comprehensive study of endocannabinoid metabolizing enzymes—including a potential biomarker for breast cancer—and the development of a therapeutic nanoplatform that targets these proteins.

Alumni News: Paul Szumita, Clinical Pharmacy Practice Manager and

Director of the PGY2 Critical Care Pharmacy Residency at Brigham and Women’s Hospital, and Adjunct Clinical Associate Professor, was selected as a 2014 AACP Master Preceptor Recognition Program recipient. Paul is currently a preceptor for Northeastern and a graduate of Northeastern University School of Pharmacy.

School News and Upcoming Events: Northeastern University School of Pharmacy was excited to welcome pharmacy educators and researchers from around the world to the 18th International Social Pharmacy Workshop (ISPW). The ISPW was held at Northeastern from August 5-8, 2014. The ISPW is a biennial conference that convenes educators, social scientists and scholars whose work focuses on psychosocial aspects of medication use and delivery of pharmacy services. With representatives from more than 30 countries, the ISPW provides valuable networking opportunities that facilitate collaborations across institutions, systems, and international boundaries. The 2014 conference theme was “The Changing Face of Pharmacy: Engaging Across Professions to Advance Health in our Communities.” The School of Pharmacy is pleased to announce the launch of a new collaboration with Cubist Pharmaceuticals, Inc., to offer its Post-Doctoral PharmD Pharmaceutical Industry Fellowship Program. Cubist Pharmaceuticals is a biopharmaceutical company that focuses on the research, commercialization and creation of pharmaceutical products that address unmet medical needs in the acute care environment. The fellowship provides PharmD graduates with in-depth experiences in a biopharmaceutical industry setting as well as teaching and research opportunities in an academic/clinical setting. The 30th Annual John W. Webb Lecture on excellence in health-system pharmacy management will be held at Northeastern University on Monday, October 27, 2014 at 5:00 pm . This year’s lecture award winner and speaker is Charles E. Daniels, BS Pharm, MS, PhD, from the University of California, San Diego. Please email schoolofpharmacy@neu. edu to receive details of the event as they become available.

Continuing Pharmacy Education: For more information on our ongoing programs, please visit our web-site: http://www.rxce.neu.edu. 41

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WNE University I am excited to share some of the great things taking place in the College of Pharmacy. Our thanks to everyone who has participated in our successes; our growth is a collective success borne from the commitment of dedicated individuals and supported by a University steadfast in the development of a quality program.

Trail Blazers – Medical Reserve Corps Training The College of Pharmacy’s Class of 2017 joined the first wave of academic institutions across the country that has recognized the critical role of trained pharmacists in emergency preparedness, response and recovery on local, regional and national levels. Following the tragic events of 9/11, and confirmed through the large number of natural and manmade disasters across the nation in the past decade, Medical Reserve Corps (MRC) was formed to meet the needs of communities before, during and after an emergency or disaster. The MRC is connected to the offices of the US Surgeon General and local public health departments. MRC volunteers are locally based, trained, and credentialed individuals from both medical and non-medical backgrounds. Kim Tanzer, Pharm.D., Assistant Dean for Experiential Affairs,

organized the March training for the 75 COP learners from the Class of 2017 and interested staff and faculty. The daylong training consisted of three modules: An Introduction to Emergency Preparedness, An Introduction to Incident Command System, and Psychological First Aid (PFA) – An introduction to holistic safety and support immediately following emergencies or disasters.

The training facilitators were extremely pleased to have the COP involvement. Kathleen Conley Norbut, Hampden County MRC coordinator stated “It is exciting to see the leadership of the College of Pharmacy reaching out to the city of Springfield and the region to connect its resources for the mutual benefit of student education and skills development with community leaders and residents on public health initiatives. It cannot be overstated what a critical role pharmacists have in public health emergency response – our very own disasters have proven this to be true. We are extraordinarily fortunate to have the Western New England University and specifically the College of Pharmacy leadership, understand the importance of the professional skills that they have to offer to Springfield and the surrounding communities. I was honored to be part of the training that benefits learners, Western New England University, and the region.”

AACP Walmart Scholar Program Winners Nika Bejou (Faculty Mentor: Clinton Mathias) and Farbod Khaleghi (Faculty Mentor: Ronny Priefer) were selected as recipients for the 2014 AACP Walmart Scholars Program. There were 83 other student/faculty recipients for the program. Through the scholarship program, recipients are able to strengthen their skills and prepare for a career in academic pharmacy. This is accomplished by participating in programs and activities at the 2014 AACP Annual Meeting and seminars. Scholarship recipients and their faculty mentors receive $1,000 travel scholarships to attend the AACP Annual Meeting and the AACP Teachers Seminar in Grapevine, Texas in July 2014.

To the left, are the AACP scholarship winners with their faculty mentors. From L to R: Faculty Mentor Dr. Clinton Mathias, learner Nika Bejou, learner Farbod Khaleghi, and Faculty Mentor Dr. Ronny Priefer.

Pharmacy Journal of New England • Summer 2014

Script Your Future, Wilbraham Senior Center In February, COP learners and nursing students from American International College partnered to promote medication adherence and general health awareness as part of the Script Your Future campaign. The focus of the campaign was on medication adherence related to chronic disease states such as diabetes, heart disease, and respiratory disease. Nearly 3 out of 4 Americans may not take their medication as directed, and more than one-third of medication-related hospitalizations are linked to poor medication adherence. Learners and students conducted blood pressure screenings, blood sugar testing, medication adherence A student takes a woman’s blood pressure at WNE’s Script Your Future event in February. counseling, and demonstrations on proper use of respiratory inhalers and glucometers.

“Springfield Senior Spectacular” at Basketball Hall of Fame Faculty and learners participated in the Springfield Senior Spectacular at the Basketball Hall of Fame in October for the second year. This free community event featured exhibits, informational seminars, workshops, demonstrations and entertainment designed to appeal to older adults and caregivers. Approximate 900 guests attended the event. Third year pharmacy learners, alongside faculty, provided information on high blood pressure, answered medication questions, and provided blood pressure screening services.

Team Robinson at the Heart Walk In April fifty-seven learners and faculty members from the College of Pharmacy walked together as “Team Robinson” at the 2014 Pioneer Valley Heart Walk. Each year, the American Heart Association hosts Heart Walks across the country to promote physical activity and increase awareness of a heart-healthy lifestyle. The Heart Walk is the American Heart Association’s main event for raising funds to support research and help those affected by heart diseases. This year, through walker registration and Red Heart donations, the College of Pharmacy community donated $881 to the American Heart Association.

Continuing Education Conferences The College of Pharmacy hosted the Fourth Annual Continuing Pharmacy Education & Preceptor Conference for Registered Pharmacists at Western New England University. The May 2014 program provided insight into legal issues impacting the pharmacy profession, preceptor development, and updates on clinical therapeutics. Participants received five contact hours of continuing education credits, including two contact hours in pharmacy law. A Continuing Pharmacy Education Conference on “Prescription Drug Overdose and Antidote Updates 2014” for Registered Pharmacists & Technicians, supported by an unrestricted educational grant from BTG International Inc., took place at Western New England University on June 3, 2014. The program provided updates on trends of prescription drug overdose, prevention and management of common drug overdoses as well as introducing emerging antidote therapies. It also provided a review of the pharmacology of selected antidotes and discussed current recommended antidotes stocking levels in hospitals. Speakers included emergency medicine physicians and clinical pharmacy specialists who are on the frontline managing overdosed patients and who are experts in this field. Participants received six contact hours of continuing education credits.

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Program News The College of Pharmacy and seven other higher education institutions in the Pioneer Valley saw a need to address stronger interprofessional healthcare education among the institutions. The Healthcare Interprofessional Education (HIPE) of Pioneer Valley was created last year with representatives from the eight participating institutions (American International College, Bay Path College, Elms College, Holyoke Community College, Springfield College, Springfield Technical Community College, Western New England University and Westfield State University) to address that need. In February, HIPE of Pioneer Valley provided its first professional development seminar entitled: “Raise Your IPE IQ.” The intent of the program was to raise the awareness of faculty from the eight institutions regarding the necessity for interprofessional healthcare education for the benefit of the diverse healthcare professions and the patients they serve. The keynote speaker, Dr. Kevin Hinchey, Chief Academic Officer and Senior Vice President at Baystate Medical Center, and the presenting HIPE members stressed the need for interprofessional practice, which necessitates that the professions are first interprofessionally educated. All of the educational institutions were made aware that many of their accrediting bodies are now adding or requiring interprofessional healthcare education in their standards.

Faculty/staff news David Baker, J.D., MBA, R.Ph., Assistant Professor of Pharmaceutical and Administrative Sciences and Izabela Collier, Pharm.D., CDE, Clinical Assistant Professor of Pharmacy Practice had their manuscript entitled “Implementation of a pharmacist-supervised outpatient diabetes treatment clinic” published in the American Journal of Health-Systems Pharmacy, Vol. 71, pp 27-36, Jan 1, 2014. Dr. Baker and Dr. Collier presented at the Lilly International Conference on College and University Teaching and Learning in Bethesda, MD in May. Their conference presentation was entitled “Developing an Active Learning, Experiential Communications Course for Non-Communication Majors.” Dr. Baker had a book review published in the American Journal of Pharmaceutical Education (Volume 78, Issue 1, 44

2014: Article 24): Buerki RA, Vottero LD. Pharmacy Ethics: A Foundation for Professional Practice. Washington, DC: American Pharmacists Association; 2013. Dr. Collier had a peer-reviewed publication in American Journal of Health-System Pharmacy 2014 entitled: “Implementation of a pharmacist-supervised outpatient diabetes treatment clinic.” Dr. Collier received the BusinessWest’s 40 Under Forty Class of 2014 award. Daniel Kennedy, Ph.D., Assistant Professor of Pharmaceutical and Administrative Sciences published three abstracts and had three conference presentations in December. At the December Acoustical Society of America Conference in San Francisco, Dr. Kennedy’s coauthor Dr. Bart Lipkens presented “Concentration of blood components by acoustic radiation force.” (authors: Kennedy DR, Gerhardson T, Sporbert B, Mealey D, Rust MJ, Lipkens B). At the December American Society of Hematology Meeting in New Orleans, Dr. Kennedy orally presented “Development of Second Generation Thiol Isomerase Inhibitors to Prevent Thrombus Formation” (authors: Kennedy DR, Nag, PP, Galinski CN, Bowley S, Bekendam RH, Dilks JR, Scalise AA, van Hessem L, Pu, J, Pilyugina T, Dandapani S, Munoz B, Flaumenhaft R) and presented via poster “The concentration and separation of blood components using acoustic radiation force” (authors: Kennedy DR, Sporbert B, Gerhardson T, Mealey D, Rust MJ, Lipkens B). Shamima Khan, Ph.D., MBA, Assistant Professor of Pharmaceutical and Administrative Sciences gave a podium presentation at the Obesity Research Conference held at the Department of Medicine, Obesity Research Center, St. Luke’sRoosevelt Hospital Center in NYC in January. The title of her presentation was “Prevalence of Food Insecurity, Overweight, Obesity and Utilization of Food Assistance Program in a Vermont Middle School.” She presented the same information at the Obesity Research Center, St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, College of Physicians & Surgeons in February. Clinton Mathias, Ph.D., Assistant Professor of Pharmaceutical and Administrative Sciences chaired a session at the May 2014 Annual Meeting of the American Association of Immunologists in Pittsburgh. The session is the AAI High

Pharmacy Journal of New England • Summer 2014

School Teachers Summer Research Program Workshop: Lessons in Immunology. He was awarded a 2014 AAI Undergraduate Faculty Travel Grant. The grant will provide support of up to $1,250 for him and up to $1,000 for his undergraduate student worker, Logan Carlson, to attend the meeting. Dr. Mathias also is in charge of coordinating the summer research program for high school teachers this year. Dr. Mathias’ manuscript entitled “Pro-inflammatory role of Natural Killer cells in Allergic Airway Disease” was published in Clinical and Experimental Allergy. Eric Nemec II, Pharm.D., Clinical Assistant Professor of Pharmacy Practice had a peer-reviewed publication in Currents in Pharmacy Teaching and Learning 2014 entitled “A survey of grading scale variations in doctor of pharmacy programs.” Katelyn Parsons, Pharm.D., Clinical Assistant Professor of Pharmacy Practice had a peer-reviewed publication in American Journal of Health-Systems Pharmacy 2013 entitled “Use of an instant messaging application to facilitate pharmacy students learning during medical rounds.” Ronny Priefer, Ph.D., Professor of Pharmaceutical and Administrative Sciences, with help from Dr. Collier; Kam Capoccia, Pharm.D., BCPS, Clinical Associate Professor of Pharmacy Practice; and Michael Rust, Ph.D., Assistant Professor of Biomedical Engineering, is working to develop a new and less painful self-monitoring device for monitoring diabetes. The researchers invented the “breathalyzer” as a non-invasive alternative to pricking one’s finger, which is currently the best way to monitor blood glucose levels. Western New England University has applied for a patent for the handheld device designed to use multilayer nanotechnology to detect acetone levels in the breath of diabetics, which correlates to blood glucose levels. It is scheduled for an extensive clinical study proposed to last approximately eight months using many volunteers. The test patients will use both the new breathalyzer technology and the finger-prick method, with a diary of all results and a log of everything eaten. Dr. Priefer presented his research to the American Association of Pharmaceutical Scientists at its annual meeting and exposition in San Antonio in November.

Device Development (M2D2) Center Venture Competition in March. Dr. Priefer was invited to give a talk at Google Headquarters in San Francisco about the breathalyzer in August. Lucia Rosé, Pharm.D. AAHIVP, Clinical Assistant Professor of Pharmacy Practice had a peer-reviewed publication in the Pediatric Infectious Disease Journal 2014 entitled “The quest for the best metric of antibiotic use and its correlation with emergence of resistance.” Her article entitled “Sofosbuvir-a NSSB inhibitor for the treatment of chronic hepatitis C infection” was approved for publication later in 2014 in the Annals of Pharmacotherapy. Corey Scheer, Pharm.D., Clinical Assistant Professor of Pharmacy Practice had a peer-reviewed publication in The Mental Health Clinician 2013 entitled “Electronic cigarettes in smoking cessation.” Natalia Shcherbakova, Ph.D., Assistant Professor of Pharmaceutical and Administrative Sciences had her paper titled “Community pharmacists, Internet and social media: An empirical investigation” published in the Research in Social & Administrative Pharmacy at http://www.rsap.org/article/ S1551-7411%2813%2900248-9/abstract Shusen Sun, Pharm.D., Clinical Assistant Professor of Pharmacy Practice, received a grant from BTG International for a CE program entitled “Prescription drug overdose and antidote update for 2014.” Dr. Sun was invited to speak at the Global Emergency Medicine Meeting in Shenzhen, China in June. The intent of the meeting is to bring new ideas to emergency medicine, emergency nursing, and pre-hospital care in China.

Appointments Dr. Kennedy was nominated to the represent the Biological Sciences section on the American Association of Colleges of Pharmacy CAPE editorial board.

Drs. Priefer and Rust presented a poster focusing on the breathalyzer at the 3rd Annual New Massachusetts Medical 45

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Husson University Husson University School of Pharmacy Earns Full Accreditation The Accreditation Council for Pharmacy Education (ACPE) has taken action to grant full accreditation status to Husson University’s School of Pharmacy. ACPE sets the standards for the education of pharmacists. Their action reflects the successful completion of the School’s candidacy accreditation stage. Combined with accreditation from the New England Association of Schools and Colleges (NEASC), the Husson University School of Pharmacy holds the highest levels of accreditation available to educational institutions with professional pharmacy degree programs. “The success of the first graduating class impressed the ACPE evaluation team”, says School of Pharmacy Founding Dean Rodney A. Larson, Ph.D., R.Ph. “With a 100% pass rate on the national boards, this class demonstrated that our program does an outstanding job of preparing students for rewarding and high-paying careers as professional pharmacists.” On average, practicing pharmacists earn $116,670 per year or $56.09 per hour. It is not unusual for a Pharm.D. graduate to command a six-figure salary upon entering the field. More than 75 percent of Husson University Pharm.D. students in their final year of study received job offers before they graduated and 100% were employed within six months of graduation. Larson continued: “Our pharmacy program is also improving the delivery of health care in rural Maine. In small towns across our state, rural pharmacists are administering vaccinations and monitoring the blood pressure of thousands of individuals who might not otherwise seek out medical attention because they live in remote locations. In helping to bring knowledgeable pharmacists to those in need, we’re not only improving healthcare, we’re providing the business community with workplace ready employees who can contribute to making retail pharmacies, rural hospitals and grocery stores more successful. Everyone benefits – the graduates who get great jobs, the businesses that hire them and the rural communities they serve.” Earning ACPE accreditation is a singular achievement for the Husson University School of Pharmacy. Provost Lynne CoyOgan Ed.D. observed: “Earning ACPE accreditation represents 46

the culmination of a rigorous peer review process. In order to earn this mark of excellence, a new school needs to meet 30 rigorous standards and progress from pre-candidate to candidate to full accreditation status over a 4-5 year period. Once a program graduates its first class, it is eligible to be considered for the awarding of full accreditation.” Husson University President and CEO Robert A. Clark, Ph.D., values the accreditation process: “A candidate school is visited by an external peer review team on an annual basis. These site team visits engage in a systematic review of the School and its mission to prepare future pharmacists. The visits are quite helpful and provide useful advice on how to improve the program. We’ve always come away from an accreditation team visit with a number of great suggestions.” Students must complete at least two years’ worth of prerequisites before they can matriculate into the professional phase. At any given time, the Husson University School of Pharmacy has roughly 240 students enrolled in the four-year professional program. Ninety-five individuals have graduated to date. “Healthcare accounts of one-sixth of the U.S. economy and America’s aging population is increasing demand for individuals with healthcare knowledge and experience. With programs in pharmacy, counseling, health education, nursing, occupational therapy, physical therapy, healthcare studies and health sciences, Husson University has become one of Maine’s leading providers of healthcare education,” says Clark. The idea of opening a School of Pharmacy at Husson College (later to become Husson University) originated about 10 years ago. It was solidified in 2007 when Dr. Rodney Larson was hired as the founding dean and ACPE approved the University’s strategic plans to create the School. Since then, the School of Pharmacy has seen significant growth. Currently there are 34 faculty and staff members employed at the School. In addition, the School has formed valuable relationships with preceptors (e.g., practicing pharmacists, physicians, etc.,) throughout the state and country who assist in training Husson students as part of their required internship experiences.

Continuing Education for Pharmacists Updates in the Management of Stable Chronic Obstructive Pulmonary Disease By: Author: Jessica S. Triboletti, PharmD, BCACP Clinical Pharmacy Specialist, Primary Care, RL Roudebush Veterans Affairs Medical Center (Indianapolis, IN) 0106-9999-14-022-H01-P (1.5 CEU hours)

Learning Objectives: At the conclusion of this lesson, participants should be able to: 1. Recall treatment algorithms and common pharmacologic agents used for treatment of COPD. 2. Interpret strategies identified in the 2011 GOLD guideline update which are used to assign patients into treatment groups. 3. Given a case example, appropriately assign a patient into a treatment group and select appropriate pharmacologic and nonpharmacologic therapy. 4. List advantages and disadvantages involved in using phosphodiesterase- 4 inhibitors for the management of severe COPD.

Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs characterized by persistent airflow limitation that is not fully reversible. Medications used in the management of COPD are not curative, but the disease is treatable with proper use of available therapeutic agents and preventable by reducing exposure to risk factors. Several guideline updates and new medications for COPD management have emerged in recent years.

Brief Review of Pathophysiology and Disease State Background Pharmacologic Treatment Options: Airflow limitation due to COPD is progressive and associated with abnormal inflammatory response to noxious particles or gases. The airflow limitation is caused by several disease processes including small airway disease and parenchymal destruction. Small airway disease refers to airway inflammation and subsequent remodeling, whereas parenchymal destruction refers to loss of alveolar attachment and decreased elastic recoil. Together, these processes result in mucus hypersecretion, air trapping, and

ultimately airflow limitation. Each of these components may be present to varying degrees in each individual patient, and therefore each patient’s COPD symptoms and traits are somewhat unique. The term “chronic bronchitis” is often used to refer to the small airway component of COPD, and is defined in the clinical setting as presence of cough or sputum production for a duration of greater than or equal to three months for at least two consecutive years. The term “emphysema” has historically been used interchangeably with COPD, but in actuality it refers more specifically to destruction of gas exchanging surfaces of alveoli. Patients affected by COPD often have comorbidities related to their respiratory condition. Extrapulmonary effects of COPD secondary to ongoing shortness of breath include unintentional weight loss, nutritional deficits, and skeletal also been associated with a higher occurrence of myocardial infarction, angina, osteoporosis, respiratory infection, depression, diabetes, and sleep disorders. Additionally, a higher incidence of lung cancer has been found in patients with COPD, however it is not known if the two are directly linked or if it is due to common risk factors. Prevention of COPD progression is a key component of disease state management, and the primary method of preventing progression is to reduce or eliminate exposure to risk factors. The number one risk factor associated with COPD worldwide is tobacco smoking. The effect of tobacco smoking on COPD is dose related (i.e. higher number of packyears smoking, higher risk and severity of COPD). Additional risk factors for COPD include indoor and outdoor air pollution, and occupational exposure to dusts and chemicals. Environmental risk factors aside, several host factors can cause predisposition to COPD including abnormal lung growth and development, prior respiratory infections, and alpha-1 antitrypsin deficiency. Respiratory dysfunction and airflow limitation is evaluated using a combination of symptom assessment and spirometry, a type of pulmonary function test (PFT) that measures volume and speed of inhalation and exhalation. Diagnosis of COPD should be considered in any individual 47

Continuing Education for Pharmacists continued with dyspnea, chronic cough (productive or nonproductive), and/or sputum production. Guidelines also recommend spirometry as a part of diagnosis, with a ratio of Forced Expiratory Volume in One Second (FEV1) to Forced Vital Capacity (FVC) less than 70% (FEV1/FVC < 0.7) as the diagnostic criteria. Less than 70% is the threshold that suggests airflow limitation is not fully reversible. Spirometry is the gold standard for COPD diagnosis because it is widely accessible, easily reproducible, and relatively inexpensive. The primary clinical guidelines utilized in COPD management are entitled Global Initiative for Chronic Obstructive Lung Disease (GOLD). The GOLD guideline is a global initiative and consists of a consensus report that is updated annually. GOLD guidelines are available at www. goldcopd.com. There were several updates included in the most recent GOLD guideline. To summarize, treatment objectives were organized into two groups: immediately relieve and reduce impact of symptoms and reduce risk of adverse events that impact health in the future. FEV1 was deemed an unreliable marker of severity of symptoms on its own, therefore higher emphasis was placed on symptom scoring and two validated symptom scoring surveys were recommended for use in clinical practice. The term “stage” was replaced with the term “grade” when classifying COPD severity, and a new assessment system that draws together impact of patient symptoms and assessment of future risk was introduced.1

Symptom Scoring and Assessment The December 2011 GOLD Guideline update suggests a stronger emphasis on symptom scoring based on patients perception of impact on daily life activities when compared to previous years. They endorse two validated symptom scoring surveys: the Modified Medical Research Council Questionnaire for Assessing the Severity of Breathlessness (mMRC) and the COPD Assessment Test (CAT) (Refer to Figures 1 and 2). GOLD guidelines suggest that one of these two surveys is administered to each patient as a part of the diagnostic and staging process. Both of the surveys are relatively simple and short in length; however the CAT is comprehensive of various aspects of COPD while mMRC focuses more specifically on severity of breathlessness. The clinical utilization of these surveys has not yet been fully established. For the mMRC test, scores range from zero to four, with zero being minimal symptoms and four being severe symptoms. CAT test scores range from zero to forty, with zero being minimal symptoms and forty being severe symptoms. These symptom scores are used as part of the algorithm for 48

placing the individual into a treatment group and selecting appropriate therapy.1

Determining COPD Grade In addition to obtaining a symptom score, the guidelines also suggest placing the patient into a “grade” category (Refer to Table 1). The grade is based on the results of spirometry, specifically the percent of predicted FEV1.1

Using Symptom Score and COPD Grade to Determine Treatment Group Both the symptom score and COPD Grade are used to determine treatment group. In addition, the number of COPD exacerbations the individual has experienced in the previous twelve months is also considered (Refer to Figure 3).1 The symptom scoring surveys are listed along the bottom axis. Based on the patients symptom score, the severity of symptoms can be determined. Subsequently, along the vertical axis, the GOLD Grade is used to specify “low” or “high” risk. If the patient has had two or more COPD exacerbations in the past year, that automatically places them in the “higher risk” category.1

COPD Maintenance and Treatment The first step in COPD treatment is reduction of exposure to risk factors, specifically tobacco cessation when applicable. Smoking is associated with a greater rate of airflow decline and increased mortality associated with COPD. Tobacco cessation has been shown to be the most successful and cost effective method of preventing disease progression, and is an area where pharmacists can serve an important role. It is also imperative that COPD patients receive appropriate vaccination with annual trivalent influenza vaccine as well as pneumococcal vaccine to reduce risk of respiratory infection. An important education point for patients with regard to COPD is that none of the existing medications have been shown to modify the long-term decline in lung function, therefore pharmacotherapy is used to decrease symptoms, complications, or both. Goals of therapy for COPD are to prevent disease progression, relieve symptoms, improve exercise tolerance, improve health status, prevent and treat exacerbations and complications, reduce mortality, and minimize adverse effects of treatment. Along with elimination or minimization of risk factors, pharmacologic therapy is warranted for patients in all treatment groups. After the appropriate treatment group is determined, pharmacologic therapy can be individualized for the patient.1

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Group A It is suggested that patients who are included in treatment less symptoms) initiate treatment with a short-acting bronchodilator such as a short-acting beta agonist or short-acting anticholinergic. Short-acting bronchodilators are used for acute relief of intermittent symptoms (“rescue medication”). Short-acting bronchodilators increase FEV1 by altering airway smooth muscle tone, widening airways, and improving emptying of the lungs. If symptom relief is not sufficient with one short-acting bronchodilator, a combination of both can be used to maximize the bronchodilation effect through two different mechanisms. Combination products may also be helpful in challenging adherence situations.1 The most common short-acting beta agonist is albuterol (via inhaler or nebulization) which has a short onset of action (less than five minutes) and relatively short duration of action (less than four hours). Adverse effects such as tachycardia, tremor, insomnia and headache are predictable and dose dependent. Trade names for albuterol inhalers include Proair® and Ventolin®.1 Ipratropium (Atrovent®) is the most common short-acting anticholinergic (via inhaler or nebulization). Ipratropium has an onset of action of approximately fifteen minutes and duration of action about six to eight hours. It is generally well tolerated with adverse effects including dry mouth and metallic taste.1 Combination products of short-acting beta agonist plus short-acting anticholinergic include Combivent® inhaler, and Duoneb® solution for nebulization. Traditional Combivent® inhalers are currently being transitioned to Combivent Respimat® inhalers, which are propellant-free. Traditional aerosolized Combivent® will only be available for a limited time, and will be completely phased out by the end of 2013. The Food and Drug Administration has ordered this change under the Clean Air Act and it is consistent with the changes that have taken place with other inhalers containing Chlorofluorocarbon (CFC) based on the Montreal Protocol, intended to help protect the ozone layer. While most CFC inhalers have already made the transition, Combivent® was granted an extension to accommodate the challenges in converting a medication with more than one ingredient.2,3 It is important for pharmacists to become familiarized with the differences between traditional Combivent® inhalers and Combivent Respimat® as patients may need assistance in learning to use their new device. The Respimat® device must first be prepared by removing the clear base and recording the discard date (3 months from date of cartridge

insertion) on the device. A new cartridge should be inserted into the device, piercing a hole so that medication can be released. The clear base is then replaced and should not be removed again for the entire duration that the inhaler is used. It needs to be primed by holding the inhaler upright and turning the clear base in the direction of the white arrows. The orange cap is flipped open and a dose is released by pressing the dose-release button. After a spray is visible, the device is ready for use. It is important to note that Respimat® inhalers contain 120 doses compared to 200 doses in the traditional inhalers. However, only one puff is required per dose compared to two puffs via the traditional inhaler. There is no need to shake the device prior to inhaling a puff of medication. Patients may notice that the spray does not feel as powerful as a puff from the traditional CFC inhaler. The device contains a dose counter and displays a “red zone” when there is a one week supply of medication remaining.2 Theophylline is the most commonly used methylxanthine and is mentioned in the guideline as an alternative therapy for treatment of COPD. Use of this agent, however, has fallen out of favor due to serious adverse effects, variable metabolism, drug interactions, and need for therapeutic monitoring.1 Group B A long-acting bronchodilator should be added for patients who are included in treatment Group B (low risk, more symptoms). Regular use of long-acting bronchodilators (“controller medication”) for patients with chronic symptoms is more effective and convenient for patients, as it reduces the need for repeated use of short-acting agents. Long-acting agents are not effective during acute episodes of shortness of breath. As with short-acting bronchodilators, mechanisms of action of different types of agents can be combined to maximize bronchodilation effect.1 Long-acting beta agonists relax airway smooth muscle tissue by stimulating beta-2 adrenergic receptors. The onset of action is between five and twenty minutes and the duration is generally twelve hours. The most commonly used long-acting beta agonists include formoterol (Foradil®), salmeterol (Serevent®) , and arformoterol (Brovana®). Indacaterol (Arcapta Neohaler®) is the newest addition to this class, and is unique in that its duration of action is approximately twenty-four hours, therefore dosed once daily. It is delivered via inhaler device that punctures a medication-containing capsule prior to inhalation. Adverse effects of long-acting beta agonists are similar to those of short-acting beta agonists. There is no evidence that the boxed warning for increased asthma-related deaths 49

Continuing Education for Pharmacists continued with use of long-acting beta agonists applies to the COPD population.1,4 Long-acting anticholinergics block acetylcholine’s effect on muscarinic receptors. The typical onset of action is fifteen minutes and duration is 24 hours. There is currently only one long-acting anticholinergic available (tiotropium, Spiriva®). Similar to indacaterol, it is delivered via inhaler device that punctures a medication containing capsule prior to inhalation. Adverse effects of long-acting anticholinergics are similar to those of short-acting anticholinergics. Use of concomitant long and short acting anticholinergics is not recommended due to increased risk of systemic anticholinergic adverse effects.1 Group C According to GOLD guidelines, when patients progress into treatment Group C (high risk, less symptoms), an inhaled corticosteroid should be added to their regimen. Inhaled corticosteroids reduce the frequency of COPD exacerbations and may decrease the rate of decline in lung function, but do not improve COPD-related mortality.1 Commonly used inhaled corticosteroid include mometasone (Asmanex Twisthaler®), fluticasone (Flovent®), and budesonide (Pulmicort Flexhaler®). They are dosed twice daily and are common utilized as part of a combination product with a long-acting beta agonist. Patients should be counseled to rinse their mouth after each use in an effort to reduce risk of developing oral candidiasis infection. With higher doses of inhaled corticosteroid use, increased risk of osteoporosis and pneumonia have been observed. Combination inhaled corticosteroid plus long-acting beta agonist include budesonide/formoterol (Symbicort®), mometasone/formoterol (Dulera®), and fluticasone/ salmeterol (Advair®).1 Use of corticosteroids in maintenance therapy is not recommended due to a poor risk to benefit ratio. Chronic use of oral corticosteroids is associated with muscle weakness, elevated blood pressure, elevated blood glucose, weight gain, and mood changes, and therefore are reserved for the setting of short-term use for COPD exacerbations. 1 Group D Patients in treatment Group D (high risk, more symptoms) have the most severe disease and are typically maximized on inhaled therapy. At this point in the course of the disease, patients benefit from treatment with shortacting beta agonist, long-acting beta agonist, long acting anticholinergic, and inhaled corticosteroid.1 50

For patients who have persistent uncontrolled symptoms despite maximal inhaled therapy, there is a novel agent available that is taken by mouth once daily. Roflumilast is the only medication currently available in the class of phosphodiesterase-4 (PDE4) inhibitors. It is thought to work by reducing inflammation in lung tissue through inhibition of breakdown of intracellular cyclic-AMP. Roflumilast (Daliresp®) is indicated for decreasing risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations.1,5,6 When roflumilast originally pursued approval in 2010, it was declined by the FDA. It showed a moderately improved FEV1 over baseline, but a 14% discontinuation rate due to gastrointestinal adverse effects and several adverse psychiatric adverse effects were observed including three completed suicides and two suicide attempts in active drug groups during clinical trials. After more data was collected, roflumilast was approved in 2011. Information was obtained primarily from eight placebo-controlled clinical trials involving 9394 patients. Roflumilast demonstrated reduced rate of exacerbations by 15% and 18% in two 12-month trials. Additionally, number of exacerbations per patientyear was 1.1 versus 1.3 (placebo) in one trial and 1.2 versus 1.5 (placebo) in another clinical trial. The patient population that received the most benefit from use of roflumilast were patients with severe COPD associated with chronic bronchitis, at least one exacerbation in the previous year, and at least a 20 pack-year history of smoking. It should be noted that in clinical studies that showed reduction in COPD exacerbations, use of an inhaled corticosteroid was prohibited.6 There are some important adverse effects to consider prior to initiating therapy with roflumilast. Common adverse effects observed in clinical studies include diarrhea (9.5%), weight decrease (7.5%), nausea (4.7%), headache (4.4%), back pain (3.2%), insomnia (2.4%), dizziness (2.1%), and abdominal pain (1- 2%). In addition, several psychiatric effects were observed in clinical studies including one completed suicide and two suicide attempts in roflumilast groups versus one instance of suicidal ideation in placebo groups. Among all eight trials, 5.9% of patients treated with roflumilast reported some degree of adverse psychiatric reactions versus 3.3% in placebo groups. Given the occurrence of psychiatric adverse effects, roflumilast should be used with caution in patients with a history of mental health disorders.7-9 Roflumilast use is contraindicated in patients with moderate to severe liver impairment (Childs-Pugh class

Pharmacy Journal of New England • Summer 2014

B or C). No dosage adjustments are required for patients with renal impairment. 5 For a summary of treatment recommendations for treatment groups A through D, refer to Table 2.

Conclusion COPD is a progressive respiratory disease that is associated with irreversible airflow limitation. Risk factor minimization is a key step in preventing onset and progression of COPD, therefore tobacco cessation should be kept as high priority in patients who smoke. Proper medication management is another important component of slowing disease progression and pharmacists can play an important role in collaboration with physicians and pulmonologists. The most recent GOLD guidelines recommended a new strategy for symptom scoring and treatment groups, which are then utilized to select appropriate medication management. Roflumilast (PDE-4 inhibitor) has been included in the most recent guideline update as a potential add-on therapy to help reduce COPD exacerbations in patients with severe COPD to associated with chronic bronchitis and a history of exacerbations.

Figure 1. Modified Medical Research Council Questionnaire for Assessing the Severity of Breathlessness (mMRC)

References 1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease NHLBI/WHO Report: Executive Summary. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, December 2011 Update. Available at: http://www.goldcopd.com. 2. Combivent® and Combivent Respimat® website information. Accessed 15 November, 2012. Available at: www.combivent.com. 3. PL Detail-document, New Formulation: Combivent Respimat. Pharmacist’s Letter/ Prescriber’s Letter. September 2012. 4. Arcapta® [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; July 2011. 5. Daliresp® [package insert]. St. Louis, MO: Forest Laboratories; February 2011. 6. PL Detail-document, New Drug: Daliresp (roflumilast). Pharmacist’s Letter/ Prescriber’s Letter. July 2011. 7. Gross NJ, Giembycz MA, Rennard SI. Treatment of chronic obstructive pulmonary disease with roflumilast, a new phosphodiesterase-4 inhibitor. COPD 2010;7:141-53 8. Ulrik CS, Calverley PM. Roflumilast: clinical benefit in patients suffering from COPD. Clin Respir J 2010;4:197-201. 9. Fabbri LM, et al. Roflumilast in moderate-tosevere chronic obstructive pulmonary disease treated with long acting bronchodilators: two randomised clinical trials. Lancet 2009: 374;695-703.

Figure 2. COPD Assessment Test

Grade Description 0 Is not troubled with breathlessness except with strenuous exercise 1 Is troubled by shortness of breath when hurrying on level ground or walking up a slight hill 2 Walks slower than people of the same age on level ground because of breathlessness, or has to stop for breath when walking at own pace on level ground 3 Stops for breath after walking about 100 meters or after a few minutes on level ground 4 Is too breathless to leave the house or is breathless when dressing or undressing

Figure 3 Classification of COPD Treatment Groups A,B, C, or D.

Table 1. Classification of Severity of Airflow Limitation in COPD (Based on post-brochodilator FEV1 in Patients with FEV1/FVC <0.7

GOLD Grade1

Mild

GOLD Grade 2

Moderate

FEV1 >80% of predicted 50% < FEV1< 80% of predicted

GOLD Grade 3

Severe

30% < FEV1< 50% of predicted

GOLD Grade 4

Very Severe

FEV1 < 30% of predicted

Continuing Education Quiz Updates in the Management of Stable Chronic Obstructive Pulmonary Disease Utilize the following scenario to answer questions 1 and 2. Patient RS is a 62YOM who presented to his primary care doctor with increased coughing and dyspnea over the past 6 months. He reports that symptoms used to be intermittent and usually only upon exercise, but now occur on a daily basis. It is found that his FEV1/FVC ratio is 0.65 and FEV1 is 70% of predicted. During his appointment, he was administered the CAT test and scored 23. RS has a 30 pack year history of smoking. He has no prior history of established respiratory disease. ---------1. What treatment group is RS classified as currently? A) Group A; low risk, less symptoms B) Group B; low risk, more symptoms

4. PD is a 52YOM with COPD. He has had gradual worsening of shortness of breath. Spirometry showed FEV1/FVC of 55% and FEV1 63% of predicted. His current medications include tiotropium once daily and albuterol HFA as needed. Which of the following is the most appropriate course of action? A) Discontinue tiotropium and start salmeterol/fluticasone 250/50 B) Add fluticasone 110mcg 2 puffs 2 times/ day C) Change tiotripium to salmeterol 1 puff 2 times/day D) Add salmeterol 1 puff 2 times/day 5. All of the following adverse effects have been associated with roflumilast except: A) Insomnia B) Hypokalemia

C) Group C; high risk, less symptoms

C) Psychiatric adverse effects including suicidality

D) Group D; high risk, more symptoms

D) Gastrointestinal intolerance

Question 2 of 19

6 . Which of the following is NOT an acceptable COPD medication regimen for a patient in treatment Group D (high risk, more symptoms)?

2. Using the scenario outlined in Question #1, which of the following treatment regimens would be appropriate for RS based on the treatment group in which he is currently classified? A) Short-acting β-2 agonist B) Long-acting anticholinergic + shortacting β-2 agonist C) Inhaled corticosteroid + long-acting anticholinergic + short-acting β-2 agonist D) Long-acting β-2 agonist + PDE-4 inhibitor + short-acting β-2 agonist 3. MK is a 70YOF with COPD. She has been using albuterol HFA 2 puffs 4 times/day as needed. Her symptoms have worsened gradually during the past few months, and now she has persistent symptoms and shortness of breath. Her spirometry revealed an FEV1 55% of predicted and an FEV1/FVC of 60%. Her current mMRC score is 3. Which of the following medications is best to initiate? A) Tiotropium B) Mometasone C) Fluticasone/salmeterol D) Roflumilast

A) Inhaled corticosteroid + long-acting anticholinergic + short-acting beta-2 agonist B) Inhaled corticosteroid + long-acting beta-2 agonist + short-acting beta-2 agonist C) Inhaled corticosteroid + long-acting anticholinergic + long-acting beta-2 agonist + short-acting beta-2 agonist D) Inhaled corticosteroid + longacting anticholinergic + short-acting anticholinergic + short-acting beta-agonist

8. The primary reason for transition from Combivent® aerosolized solution to Combivent Respimat® inhalers is which of the following? A) The FDA mandated the change in accordance with the Clean Air Act B) There was a need for easier administration methods C) The previous aerosolized solution was not efficacious D) The previous aerosolized solution required too many puffs per dose 9 . Which of the following long-acting beta agonists is available as a once daily inhalation? A) Salmeterol B) Formoterol C) Arformoterol D) Indacaterol 10 . For which two of the following medications should the patient be counseled not to swallow the medication containing capsule? A) Fluticasone and arformoterol B) Arformoterol and tiotropium C) Indacaterol and tiotropium D) Fluticasone and indacaterol 11. Did the article help you achieve EACH of the stated objectives? If not, describe in the comment box at the end of this section. Refer to the article for the list of learning objectives. A) Yes B) No 12. Overall evaluation of this article? A) Very Good

7. Which of the following is true regarding COPD?

B) Good

A) Airflow limitation is reversible with proper treatment

D) Poor

B) Medications used in the management of COPD are curative in intent

C) Neutral E) Very Poor 13. Quality of the written material/content?

C) COPD symptoms are progressive in nature rather than fluctuating

A) Very Good Quality

D) COPD is largely a genetic disease and has little to do with environmental risk factors

C) Neutral

B) Good Quality D) Poor Quality E) Very Poor Quality

Pharmacy Journal of New England • Summer 2014

14. How much time was required to complete this article?

17. The author(s) did NOT appear to be promoting a product or company? Please use COMMENT box at end of evaluation to explain or provide comment.

A) 0.5 hours B) 1.0 hours

A) Strongly Agree

C) 1.5 hours

B) Agree

D) 2.0 hours

C) Neutral

E) 2.5 hours

D) Disagree

15 . The learning activities (e.g. case studies, quiz) were effective?

E) Strongly Disagree 18. Author(s) communicated material clearly?

A) Strongly Agree

B) Agree

C) Neutral

D) Disagree

E) Strongly Disagree 16. The information in this article will help assist and reinforce my practice/treatment habits? A) Strongly Agree

E) Strongly Disagree 19. Comments. Please use this space to provide comments related to any of the above questions.

B) Agree C) Neutral D) Disagree E) Strongly Disagree

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Expiration Date 8/8/2017 Summer-2014 (1.5 hours - 0.15 CEUs) ACPE Program No. 0106-9999-14-022-H01-P Type of Activity: Knowledge

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Email__________________________________________________________________________ NABP No._____________________________________Birthdate (MM/DD)____________________ • A grade of 70% or greater is required for credit. • Re-examination will be permitted upon failure. • Credits will be uploaded to your NABP e-profile account upon passing this course. • Evaluation must be completed to receive credit. Evaluation Did the article achieve the stated objective? Completely 5 4 3 2 1 Not at all Overall evaluation of the article? Excellent 5 4 3 2 1 Poor The information presented was relevant to your practice? Yes 5 4 3 2 1 No How many minutes did it take you to read course and complete exam?_____________________ Please attach any comments or suggestions.

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