Vol 15 No. 1 Winter 2018
Winter 2018
Pharmacy Journal of New England Geriatrics: A HighRisk Population... You Will Eventually Be a Part Of Death with Dignity: Rx and the Law Saving More Money, Now & Later: Financial Forum
Inside: Expanded Features Section
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Vol 15 No. 1 Pharmacy Journal of New England • Winter 2018
of New England
Federal Budgets and the Opioid Crisis Dear Readers, After another brief shutdown of the federal government this winter season, U.S. officials finally approved a long-term spending package that includes major advantages for the healthcare landscape. The budget deal not only includes a four-year extension of funding for the Children’s Health Insurance Program, in addition to the six-year extension that Congress approved in January, but it also includes funding for the opioid crisis and mental health. On a related note, the National Conference of Pharmaceutical Organizations (NCPO), a coalition of organizations that represent more than 300,000 pharmacy professionals, invited the Trump administration to meet to discuss ways of addressing the opioid crisis. We hope this discussion will become a reality, as the pharmacy profession has long-standing contributions in fighting against the opioid epidemic.
Lindsay De Santis Margherita R. Giuliano, R.Ph., CAE
Design & Production Kathy Harvey-Ellis
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. 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.
Sincerely,
Lindsay De Santis Executive Vice President Massachusetts Pharmacists Association
Contents:
Editors
Margherita R. Giuliano, RPh Executive Vice President Connecticut Pharmacists Association
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: PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: lcapobianco@ctpharmacists.org
2 01US News 4 New England States 14 Features: “This Medication is Not for Me!,” Global Initiative for
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Chronic Obstructive Lung Disease, and more Pharmacy Marketing Group: Rx and the Law, Financial Forum From the Colleges
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U.S. News New Study Finds that Patients Like Pharmacies with Preventative Care Services A new survey finds how much people like and trust their pharmacists. Commissioned by the cloud-based services company, PrescribeWellness, the survey finds that nearly half of Americans over the age of 40 would transfer their prescriptions to a pharmacy that provides preventive care services and would prefer to pay cash for those services. They also highly value local pharmacies that give advice about medication interactions and side effects in addition to quick over-the-counter treatments. The “Shortcut to Health” survey polled more than 1,000 adults over age 40 last December, reviewing the 2018 health goals of the respondents and the services they value most from their community pharmacy. According to survey results, 42 percent respondents claimed they are willing to consult their local pharmacist for guidance on losing weight. Although most respondents trusts that their doctor is aware of all medications they are taking, 30% say that they do not discuss possible drug interactions with their physician when they are prescribed a new drug. Meanwhile, 61 percent of respondents say they prefer to discuss new prescriptions with their pharmacists because the pharmacist is better at explaining side effects and has more time to speak with them. http://drugtopics.modernmedicine.com/drug-topics/news/patientspharmacies-give-preventive-care
Justice Department Requests More Information on CVS-Aetna Merger U.S. officials are not yet ready to give the seal of approval to CVS Health’s $69 billion deal to acquire Aetna. On February 1, the Department of Justice asked the firms to provide more information, extending the waiting period on the CVSAetna deal for an additional 30 days. With the merge, CVS aims to create an integrated health system that combines pharmacy and health benefits, and delivers preventive care services through the drugstore 2
chain’s retail clinics. Although this deal would mark a major effort at vertical consolidation in health care, the Trump administration has not yet been receptive to these kinds of deals. Last fall, the justice department moved to block the acquisition deal between AT&T and Time Warner. https://www.cnbc.com/2018/02/01/justice-department-requestsmore-information-on-cvs-aetna-merger.html
Trinity Health Partnership to Form NonProfit Generic Drug Company Trinity Health, whose Connecticut holdings include St. Francis Hospital and Medical Center in Hartford, has partnered with four other health systems to form a not-for-profit generic drug company to improve the availability and decrease the cost of essential generic drugs. Trinity has partnered with Intermountain Health, Ascension and SSM Health as well as the VA health system. All five groups include more than 450 hospitals and more health systems are expected to join soon. The goal is to address the consolidation of generic drugmakers that has caused shortages for more than a decade and allowed some companies to raise prices many times over. The new company will either contract manufacturing to an existing company or get approval from the FDA to make medicines itself. http://www.hartfordbusiness.com/article/20180124/ NEWS/180129961/trinity-health-partnership-to-form-nonprofitgeneric-drug-company
FDA Adds New Compounding Pharmacy Regulations In an effort to clarify existing rules and regulations while creating new ones, the FDA announced its plans and priorities for compounding pharmacy this year. A major priority includes encouraging more compounding pharmacies to register as 340B pharmacies, so-called outsourcing facilities that are able to produce drugs in bulk supply, but are subject to stricter safety standards. Under its new plan, the FDA is seeking to more closely define the necessity of compounded medication for patients whose medical needs cannot be met by an FDA-approved drug. To avoid copying existing medications, the agency will focus on examining whether there is any clinical difference between a compounded drug and a commercially-available drug. The FDA also will
Pharmacy Journal of New England • Winter 2018
review situations it says could impact public health, such as compounding a bulk drug substance instead of diluting a commercially-available drug. Other goals include refining the regulations for communications with states, as the FDA has reportedly received over 3,000 comments related to its relationship with the states. http://drugtopics.modernmedicine.com/drug-topics/news/fda-addsnew-compounding-pharmacy-regulations
New Kiosks Give Arizona Patients a Faster Way to Get Prescriptions A number of kiosks called APMs, or Automated Pharmacy Machines, are popping up around Arizona. These kiosks are designed to make it easier for patients to get their
medications while providing prescriptions at a lower cost. Recently, several APMs were strategically placed at grocery stores and health clinics throughout Arizona. After a doctor calls in a prescription, the patient walks up to the APM and speaks to a real pharmacist through a video conference for a consult. Patients show ID and any insurance, and then receive their medication from the machine minutes later. Each APM can carry more than 500 different prescriptions, which are stocked based on which drugs are most frequently prescribed at each location. http://www.azfamily.com/story/37289487/new-kiosks-allowpatients-to-get-prescription-meds-faster
CPA’s Mid-Winter Conference
CPA’s 2018 Mid-Winter Conference brought a great turnout of engaged pharmacists on February 1 at the Aqua Turf Club in Plantsville, CT.
Above, Dr. Sam Awan presents the “Evolution of Psoriasis,” which will available as an online homestudy program. Awan currently serves as the chief resident of dermatology at the University of Connecticut Department of Dermatology.
At left, CPA President Gillian Kuszewski (right) honors Ellen Zoppo, the former Communications Director of CPA (left) with the Special Recognition Award.
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New England States Connecticut
President’s Message Winter has been quite a busy season for CPA’s pharmacist members and our Executive Vice President Marghie Giuliano, who has been busy at the capital as part of the State of Connecticut Governor’s Healthcare Cabinet. The CPA’s influential spot on the cabinet Gillian Kuszekski, PharmD CPA President, 2017-18 has worked in collaboration with other healthcare representatives to bring attention to the many challenges that pharmacists and their patients face regarding pharmacy benefit managers (PBMs) and drug pricing. This work will set the basis for future legislation that calls for greater transparency in drug pricing. As legislation is introduced, we need the voices of all pharmacists statewide to advocate for what is right for our profession and our patients. When the CPA asks you to contact your state representatives, please do so. We supply talking points; just make them your own. Call. Write. Be proactive. Be involved! It will make change happen. The opioid crisis continues to grip our state and nation. As pharmacists, we are a vital part of the solution to this problem. While the problem is vast and complicated, we must be leaders in working with our patients, providers, and communities to save lives. If you are not trained to prescribe naloxone, do not wait another day. Please become certified and take the time to talk to your patients about risks associated with opioid use. CPA was at the forefront of giving pharmacists the authority to prescribe naloxone and we will continue to work to address this issue and save lives. Meanwhile, our education committee continues to work hard to create meaningful and relevant continuing education programs. As we plan ahead for future CE programs this year, our CE committee recently published an online survey to ask pharmacists for their educational needs. 4
We want to create sessions that are of high value for pharmacists and we need your feedback. Additionally, a new member benefit our committee has produced is an online homestudy CE. We currently have a popular CE program on the new ePrescribing laws, and we have timely topics planned to support the practice of our members. This is just another important reason to support the CPA. I also would like to take moment to thank our education committee for planning a wide range of enticing programs for the 2018 Mid-Winter Conference, which took place on February 1 at the Aqua Turf Club. The full-day event brought nearly 200 pharmacists from throughout Connecticut who had an opportunity to earn up to 8 live credits of CE while networking with their colleagues. From psoriasis to diabetes to fatty liver disease, the event featured a variety of topics that kept all attendees engaged. Attendees also had an opportunity to meet with many exhibitors, including McKesson Drug and AstraZeneca. The CPA is grateful for everyone who was involved in making this event so successful. The Mid-Winter Conference is a highlight of my winter year after year, as it always energizes me to meet with, talk with, and network with my fellow pharmacists. Life is full of challenges. How lucky are we that we have the tools as pharmacists to make such a difference in the lives of others often with greater challenges than our own? I am proud of the work we all do, and I hope that all of our Mid-Winter attendees left feeling proud of the impact they have made on patients and the great potential we all have to do more.
Sincerely, Gillian Kuszekski,, PharmD President, CPA
Pharmacy Journal of New England • Winter 2018
Massachusetts President’s Message Greetings from the Massachusetts Pharmacists Association Board of Directors! We hope that you, your family, and your friends enjoyed the holidays and that the New Year has been
Paul Larochelle Jr., PharmD MPhA President, 2017-18
enjoyable so far. It is once again my pleasure to provide you with some insight on how your Association is working to support all of you in the Profession. This February, the Board of Directors met for its MPhA Strategy Session to review our organization’s previous strategic plan, and set the strategy for future projects, initiatives, and our short and long term goals to continue to build MPhA into a powerful voice for all in our profession. I was encouraged by the enthusiasm of our Board, and especially motivated and inspired by the fresh ideas and perspectives brought by more recent additions to the Board. Following this session we are now focusing on the execution of the plan set forth, and we look forward to sharing more information with you throughout the year. MPhA continues to work to advocate for the profession in legislative activities, and we continue to work towards legislation that will recognize pharmacists as health care providers, legislation that will provide very reasonable standards to ensure independent and small chain pharmacies are treated fairly by the large PBMs, and l egislation that will amend the “Any Willing Provider” law to allow community pharmacies to fill prescriptions for “specialty medications” as long as they can provide the required administrative, handling, and monitoring services required by the drug. As always, we encourage you to be involved in these discussions and efforts. Please consider reaching out to your representatives to discuss the importance of these bills on the profession, and share personal stories that show the impact
that change can make on our service to patients! Part of our way to facilitate change in the profession is through our MPhA Foundation. The Foundation was privileged to provide support to several PharmD Candidates in the form of travel grants to attend a national pharmacy conference. These experiences can really shape a future pharmacist for their career, and your generosity in supporting the Foundation allows us to give back to our future colleagues. Thank you! Providing high-quality continuing education has always been a pillar of MPhA, and we are incredibly excited about the program set for the 2018 MPhA Spring Conference. We have brought back highly requested sessions such as the new drug review, and added new and innovative topics to help you expand and progress your practice through topics on Lean Concepts, Patient Safety Issues for Pharmacy Technicians, and Veterinary Medicine. We’re really excited about these new topics that have been requested in the past from member and attendee surveys. We also invite all of our attendees to avoid the rush hour commute through our Inaugural Beat the Traffic Networking event immediately following the Spring Conference. We look forward to seeing you all there! While on the topic of networking, the Board is now working on several new networking dinner events exclusively for members of MPhA. We believe that the opportunity to meet in a social setting is important to building a sense of community across our members and our profession. These events will be limited in number of attendees, so please keep your eyes on our website for announcements on upcoming dates, times, and locations! As we continue to push forward in 2018, I encourage each of you to reach out to us with your ideas, your concerns, and your willingness to help us serve the community. This organization can only reach its true potential through interactions and collaboration with each of you. I truly believe that through these interactions we can provide additional benefit to our members, our fellow pharmacists, and most importantly, the patients we all serve. I look forward to hearing from you soon, Paul 5
New England States
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Massachusetts Legislative Update Formal sessions for the initial 2017-2018 legislative year ended in November without action on any of our previously submitted bills (see below). As anticipated there was much discussion regarding the rising cost of prescription drugs and the impact on state spending as well as much discussion regarding the opioid drug crisis. In October the senate passed a comprehensive reform measure that contained some language to begin regulating the PBM industry with focus on rebates and drug pricing transparency. The House is likely to take up this same issue in the early spring of 2018 and we hope to incorporate our MAC language into this proposed bill. The MPhA, in collaboration with the Massachusetts Independent Pharmacist Association (MIPA), have sponsored three major pieces of legislation. 1. Senate 583 / House 2185 – An Act to ensure access to generic medications: this bill seeks to address the problems faced with MAC drug lists and rising generic drug costs. Currently in the Joint Financial Services Committee
2. Senate 523 - An Act ensuring access to medications: this bill amends the state existing “Any Willing Provider” law and defines specialty pharmacy and what specialty drugs really are. Currently in the Joint Financial Services Committee 3. Senate 1240/House 1214 – An act recognizing pharmacists as healthcare providers: this bill would finally recognize pharmacists as providers, thus allowing a pathway for payment for clinical services and expand the current Collaborative Drug Therapy law to allow pharmacists to engage in many more disease states including pain management. This bill was reported favorably by the Joint Committee on Public Health and is anticipated to go to the Healthcare Financing Committee as we continue to make progress in the current session. The Massachusetts Attorney General is also currently reviewing possible legislation which would mandate pharmacists review via the Prescription Monitoring Program (PMP) any prescription filled for schedule II & III controlled substances. We will continue to report on this issue as it develops.
MPhA Foundation Wine Tasting Thursday, May 10, 2018 6:00 pm - 8:00 pm Boston Winery 26 Ericsson St, Boston, 02122 Tickets Available at www.masspharmacists.org 6
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Pharmacy Journal of New England • Winter 2018
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New England States
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Rhode Island
President’s Message Hello Members! Happy New Year! We are halfway through our RIPA year and getting ready for our busy Spring! We have a lot of exciting events coming up, with lots of opportunities for you to come out and join your peers for some networking!
Lucrezia Finegan, PharmD RIPA President, 2017-18
April 4th is our annual Face of Pharmacy Legislative Day. Come talk to your legislators about what’s important to you and your profession. We have our regular health fair planned, as well as a short speaking program. If you would like to participate by setting up a demonstration table for the health fair, please email us today – we’re in the planning phase now and would love to show off what pharmacists can do. Our annual Kimberly McDonough Spring Seminar is scheduled for May 9 – we have a full day of learning planned for you, as well as our annual general membership meeting. Remember, that this event is FREE to all active members. If you aren’t a member yet, or your membership has lapsed, please go to our website and renew today to be eligible for the free event. As always, non-members are always welcome and it’s still a great deal for a full day of CE. The RIPA/RIPF Annual Golf Tournament is also in the planning stages and will be held on Monday, June 4. We’ll be back at Potowamut Golf Club again this year and are looking forward to seeing you there for a fun day of golf, raffles, friends, and, of course, raising money for our scholarship funds! We also have set the date for our 2018 President’s Dinner – we’re going to celebrate our incoming and outgoing Council members and officers on September 27 at Quidnessett Country Club. If you weren’t able to make it last year, 8
please join us this year – a great time was had by all! As I said, we’ve got a lot packed into the spring and early summer – there are lots of opportunities to get involved, network with your peers, and have a positive impact on your profession. Please check out our website for the dates/times and registration information for any of these events: www.ripharmacists.org. You can also email us at ripharmacistsassociation@gmail.com if you have any questions. Also, remember that our monthly Council meetings are always open to all members. If you want to get involved but aren’t sure how, come to one of the Council meetings and see what we’re up to. The dates/ times are also on the website. We’re looking forward to a successful rest of the year – I hope to see you at an upcoming event soon! Respectfully, Lucrezia Finegan, RPh, MBA President, Rhode Island Pharmacists Association, 2017-18
Pharmacy Journal of New England • Winter 2018
New Hampshire New Hampshire Pharmacists are Recognized at Holiday Party The annual NH Pharmacy Awards Reception was held on Wednesday, December 13th, 2017 at the Manchester Country Club in Bedford, New Hampshire. The celebration was supported by the NH Pharmacists Association (NHPA), the NH Society of Health-System Pharmacists (NHSHP) and the NH Independent Pharmacy Association (NHiPA) and MCPHS University.
2017 Gold Certificate Awards This year, the NH Board of Pharmacy recognized two New Hampshire pharmacists who have been licensed in the state for 50 continuous years. The ceremony included the presentation of a framed gold certificate. The “Gold Certificate” itself has been around for well over 30 years; the presentation only became formal in the past 8 years. The gold certificate is a replica of the recipient’s license which is engraved with his/her name, as well as a signed citation from the Honorable Governor Chris Sununu. The gold certificates of licensure were presented by Gary Merchant President, NH Board of Pharmacy to the following recipients: Charles Petalas, RPh, NE University ‘64 David Mahon, RPh, MCP ‘67
2017 New Hampshire Pharmacist of the Year Robert Stout is a 1975 graduate of MCPHS University. Bob has provided professional expertise in various practice settings from independent community pharmacy to managerial positions in the chain pharmacy industry. In 2012, Bob was appointed by Governor John Lynch to the NH Board of Pharmacy for a 5-year term. In 2015, he was elected president of the Board of Pharmacy. It was during his tenure on the Board of Pharmacy that Bob dedicated his time and much effort on behalf of the practice of pharmacy in New Hampshire and for the benefit of
From left to right: Katheryn Miller, CPhT, Richard Meinking, PharmD, Charles Petalas, RPh, David McMahon, RPh, Robert Stout, RPh, Ajay Gupta, RPh, Eric Lessard, PharmD, and Hubert Hein, RPh. Absent from photo is William Keefe, RPh.
better patient care. Among Bob’s many achievements are the following, just to name a few: • Chaired a committee to review all NH laws and rules relating to compounding after the NECC compounding disaster in Massachusetts. • Worked with Legislators to craft new laws and totally rewrite the compounding rules for New Hampshire. • Worked with NH Senators and Representative to write a statute requiring that 503B Outsourcing Facilities be required to be licensed in NH and the first in the nation to require that all products produced by these facilities be tested before shipping into the State of New Hampshire. • Worked with Legislators and stakeholders to institute a rule for a mandated 30-minute break for pharmacists working more than an 8-hour shift. This is just a sampling of his numerous accomplishments. All of Bob’s efforts have been directed to patient safety issues and ultimately better patient care.
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New England States
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2017 Distinguished Young Pharmacist Award
other times as homesick healer. As time went on the number of campers increased to 24 and even 37 boys.
This year’s Distinguished Young Pharmacist is Ricky Meinking. Ricky is a graduate of the University of Connecticut, where he received his Doctor of Pharmacy degree in 2007. Following graduation, Ricky began his career as a clinical staff pharmacist at Wentworth-Douglass Hospital. He later returned to school at the University of New England for his Master’s in Public Health, which he earned earlier this year. In July 2016, Ricky was promoted to the Director of Pharmacy position at Wentworth-Douglass. As a result of his dedication to the pharmacy, he was a finalist three times for the hospital’s peer nominated “Leading the Way Award’.
After 22 years of dedicated service to the Boy Scouts, Hubie now spends his spare time as the “Director of the Northern New England Region of the Vintage Chevrolet Club of America” with members from Maine, Vermont, Massachusetts and New Hampshire.
Ricky is a long-standing, active member of the American Society of Health-System Pharmacists (ASHP) and recently joined the Board of Directors for the New Hampshire Society of Health-System Pharmacists (NHSHP). In addition to his work with the PGY1 pharmacy residency program at Wentworth Douglass, Ricky also precepts students from the University of New England and MCPHS University. If that wasn’t enough, Ricky is also involved in the planning committee for a Seacoast Cancer 5K, which speaks to the value he places on community service. It is truly very impressive what he has accomplished thus far.
2017 NH Bowl of Hygeia Award The recipient of the Bowl of Hygeia Award is Hubert Hein. A 1982 graduate of the Massachusetts College of Pharmacy, Hubie started his professional career working at a CVS Pharmacy in Nashua, NH where he remained for 20 years. From there, Hubie worked at Wingate’s Pharmacy in Nashua and then at Rite Aid in Derry, NH. Starting in 1995 to the present, Hubie has provided time and guidance to the scouts as summer camp coordinator, committee member, assistant scoutmaster, high adventure trip meal coordinator, hiking coordinator, health form record keeper and merit badge counselor. Summer camp ranges in attendance from 5 to 18 boys. Some of Hubie’s responsibilities on camp days ranged from tent assignments, activities and sometimes even as referee and at 10
2017 NH Lifetime Achievement Award This year the pharmacy community is honored to recognize William Keefe as the recipient of our 2017 Lifetime Achievement Award. A 1964 graduate of the Massachusetts College of Pharmacy in Boston, Bill was employed at Cate’s Drug in Rochester, NH as a staff pharmacist. In 1967 he purchased Carney Drug, also in Rochester, and continued as an owner until 2005 when he sold the pharmacy and opened Carney Medical Supply. Bill was a founding member of the NH Consultant Pharmacists’ Association and the NH Durable Medical Equipment Association serving as Vice President for both organizations. As well as serving as an officer on the Executive Committee of the NH Pharmacists’ Association for 8 years, Bill was elected Association President in 1980. Additionally, in 1980-81, Bill was one of 8 pharmacists nationally selected to review and set a new mission and goals for (NARD) the National Association of Retail Druggists. Bill is a member of a variety of local service and civic groups, including Kiwanis and Jaycee’s, Bill is a past president of the Rochester Chamber of Commerce and the Downtown Re-development Committee. In 1974, in recognition of his service to the community, Bill was honored as the 1974 recipient of the prestigious Bowl of Hygeia Award.
2017 NH Technician of the Year Award This year’s recipient is Katheryn Miller. Kathy has worked as a pharmacy technician for the last 16 years at a variety of practice settings, including community and hospital
Pharmacy Journal of New England • Winter 2018
pharmacy. She has been a nationally certified technician for the past 12 years. She began working at Wentworth-Douglass Hospital in their retail setting and was quickly promoted to an ambulatory care role. Katie is currently a liaison for off-site physician practices working to ensure a smooth, consistent process for medication supply. She routinely provides recommendations to improve pharmacy operations and streamline workflows. She also provides pharmacy department training on medication safety initiatives for the everchanging Joint Commission accreditation standards and was the recipient of Wentworth-Douglass 2014 Pharmacy Technician of the Year Award.
2017 Cardinal Health Generation Rx Champion Award
2017 NH Excellence Award in Innovation
Integrative Health at Harbor Homes in Nashua, Jay has
This year’s recipient of the Excellence in Innovation Award is Eric Lessard.
heroin addiction. He works to equip these individuals with
A 2008 PharmD graduate of MCPHS in Boston, Eric has acquired extensive pharmacy operations experience in retail and mail-order settings. Following graduation, Eric began his practice with Target Corporation where he was quickly promoted to Senior Manager of Healthcare Operations, Quality and Services. Moving on to greater challenges, Eric went to work for Prime Therapeutics Mail and Specialty Pharmacy, where as Director of Pharmacy Quality he was responsible for the development of strategy, operational excellence and quality outcomes for all Prime Therapeutics locations. Currently practicing at PillPack in Manchester as the Director of Clinical Services and Operations, Eric possesses a rare blend of academic aptitude, ambition and interpersonal skills. Eric leads a team of 75 healthcare professionals, including 23 pharmacists, responsible for clinical services and medication therapy management.
This year’s recipient of the Cardinal Health Generation RX Champions Award is Jay Gupta. Over the past several years, it has become Jay’s personal mission to educate the general public as well as healthcare professionals about the dangers of prescription drug abuse. In addition to addressing the opioid crisis, Jay has dedicated his time to educating people about the abuse and overuse of sleep medications. Another issue Jay has addressed is pain management and opioid abuse. In his role as Director of Pharmacy and conducted education sessions for people in recovery from techniques to better manage anxieties. Jay also spends his time teaching healthcare professionals how to use simple therapeutic yoga techniques (what he calls yoga capsules) to help better manage or alleviate chronic health conditions. In his experience, these easy therapeutic lifestyle changes can lead to a reduction in or elimination of some medications that have the potential for abuse, including benzodiazepines.
Upcoming 2018 Continuing Education Conferences Remember to save the dates for upcoming CE programs in 2018 which are as follows: Saturday, June 9, 2018, Attitash Grand Summit Hotel, Bartlett, NH Sunday, September 16, 2018, Labelle Winery, Bedford, NH Sunday, December 9, 2018, Radisson Hotel, Manchester, NH
Upon joining PillPack, Dr. Lessard quickly identified multiple areas where the process to access patient care and to provide a more personalized service in the delivery of medications could be improved. To achieve overall wellness is what drives Eric’s passion to continually explore and develop new strategies to the benefit of the patients he serves and cares for. 11
New England States
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Vermont
President’s Message The VPA held Pharmacy Day January 26, 2018 at the Statehouse in Montpelier. Our delegation of pharmacists and pharmacy students was recognized before the Joint Assembly, at which time board Jim Godfrey, RPh member Marty Irons spoke of service to his community as exemplified in the life and career of the late Bob Beauchamp of Rutland, a true leader in his community and the profession. At the Senate Health and Welfare committee meeting, we heard testimony from Vermont Retail Druggists on S.140, https://legislature.vermont.gov/assets/Documents/2018/ Docs/BILLS/S-0140/S-0140%20As%20Introduced.pdf, which proposes a single drug wholesaler for Vermont Medicaid to achieve best pricing with full transparency, eliminate the traditional PBM and spread pricing, and maintain full control of all rebates and valuable data. The wholesaler would invoice Vermont Medicaid, instead of the pharmacy, for inventory while the pharmacy would be paid for the service of providing the prescription. Cost savings to Medicaid would be in the millions of dollars. VPA will likely provide testimony as S.140 progresses through the legislative process. VPA has set a priority for the 2018-2019 legislative session to seek a reduction in age for pharmacist-administered immunizations (currently 18 years and older). We welcome your suggestions on age limits for influenza
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and other vaccines, whether through collaborative practice agreement or by prescription order. A breakdown of laws in other states is available at: http://www. pharmacist.com/sites/default/files/files/Pharmacist_IZ_ Authority_1_31_15.pdf . Though the opioid crisis is far from over, it is encouraging that Blue Cross Blue Shield of Vermont reports a 20% decline in opioid prescriptions in the last 6 months of 2017. Insurance opioid limits play a role. More importantly, new rules effective July 1, 2017 provide a framework for responsible prescribing and, when appropriate, referral for pain management or treatment of opioid misuse disorder. Pharmacists can provide help navigating the rules and limits. Moreover, through effective communication with prescriber and patient, we can support the treatment plan and provide input when successful treatment seems at risk. We invite you to participate in the VPA, whose mission is to unite pharmacists and advance the profession by promoting relationships among pharmacists and other healthcare providers, advocating for pharmacy in legislative and rule-making arenas, providing continuing education, and supporting scholarships. Visit our website at http://www.vtpharmacists.com/index.php . Jim Godfrey, RPh President
2017 Recipients of the “Bowl of Hygeia” Award
Larry Presley Alabama
John McGilvray Alaska
Alan Barreuther Arizona
Sue Frank Arkansas
Pierre Del Prato California
Mary Petruzzi Connecticut
Noel Rosas Delaware
Goar Alvarez Florida
Hewitt Ted Matthews Georgia
Ed Cohen Illinois
Ahmed Abdelmageed Indiana
Tim Becker Iowa
Merlin McFarland Kansas
Melody Ryan Kentucky
Gregory Poret Louisiana
Greg Cameron Maine
Cynthia Boyle Maryland
Anita Young Massachusetts
Dennis Princing Michigan
Denise Frank Minnesota
David French Mississippi
David Farris Missouri
Matthew Bowman Montana
Gary Rihanek Nebraska
Mark Decerbo Nevada
Hubert Hein New Hampshire
Thomas F.X. Bender, Jr. New Jersey
David Lansford New Mexico
John T. McDonald III New York
Steve Caiola North Carolina
Tim Weippert North Dakota
Debra Parker Ohio
Ben Allison Oklahoma
Mercy Chipman Oregon
Jerry Musheno Pennsylvania
Marisa Carrasquillo Puerto Rico
Gary Kishfy Rhode Island
Terry Blackmon South Carolina
Tim Tucker Tennessee
Chris Alvarado Texas
Kurt Price Utah
Pat Resto Virginia
The “Bowl of Hygeia”
In Memoriam: Rob Loe South Dakota Keith Campbell Washington Daneka Lucas Washington DC
Kevin Yingling West Virginia
Thad Schumacher Wisconsin
Joe Steiner 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 History Hall located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.
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Features “This Medicine is Not For Me!”: Preventing Medication Errors in Community Pharmacy by Donna M. Horn, MS, RPh, DPh
Abstract The following article contains highlights from the presentation “‘This medicine is not for me!’: Preventing Medication Errors in Community Pharmacy,“ presented during the 2017 New England Pharmacy Conference. Features from the presentation addressed in this article include highlighting three principles all pharmacists can utilize to promote the safe use of medicines, the need for pharmacists to understand how best to engage patients with low health literacy, and the potential future direction of DUR edits to leverage interoperability.
Introduction As a medication expert, the role of the pharmacist is to ensure that patients receive safe and effective medication therapy, get the most benefit from the medication that is prescribed, and achieve optimal outcomes related to their medication therapy. Finding out about an error or adverse event is a challenging and emotional situation. It is common for a pharmacist’s first thought to be, “I hope it wasn’t me who made the mistake.” Concerns for the patient and his family, and the pharmacy and its staff, are also part of the equation. And, of course, determining how and why it happened is an essential step in preventing something similar from happening again. Often, there are multiple underlying system failures that lead to the error or adverse event. The processes associated with prescribing, dispensing, and administering medications that have been involved in serious, preventable adverse drug events should be a primary target for medication safety improvements.
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Key Points Background: • Risk for error is perceived by staff based on their previous situations and outcomes; cannot assume that everyone will “see,” “hear” or “feel” risk in the same way • There is a role for the use of technology in the prevention of dispensing errors • More than 40% of patients with chronic illnesses are functionally illiterate Findings: • Safety steps must be added to ensure dispensing accuracy • Pharmacists have duties with respect to patient counselling • Pharmacists must review DUR alerts for clinical significance and take appropriate action based on the content of these alerts and what they know about the patient Three principles to follow to promote the safe use of medications There are many principles and recommendations available to pharmacy providers to improve safe medication use. In the interest of time and space, this article will concentrate on the following three principles. The first is to reduce or eliminate the possibility of error. One way to achieve this is to create a “fail safe” to a procedure when a risk threshold is reached. For instance, integrate the pharmacy management system to the point of sale system to prevent the clerk from “ringing up” the prescription unless the patient’s date of birth presented at pickup matches the date of birth in the patient profile. Nothing can be sold if there is no matching birth date or if the person picking up the medication does not know the patient’s date of birth. All staff need to be mindful of the risk for wrong-patient errors at the point of sale. The second principle is to make errors visible. For instance, there should be a “hard stop” that alerts the verification pharmacist that during production the bar code process was either bypassed or overridden. For example, if a pharmacy computer generated label indicated metoprolol tartrate 50 mg and the
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production technician pulled metoprolol succinate 50 mg from the shelf, the bar code scan would indicate ‘no match.’ If the technician proceeded to override the system and manually enter the NDC number from the wrong stock bottle, forcing a match, the verification pharmacist would be alerted at verification. The checking process would not be allowed to continue to final check and point of sale without a remedial action from the pharmacist. All staff need to be mindful of the risk for wrong-drug errors when barcode technology is overridden. The third safety principle is to minimize the consequence of error. One way to accomplish this is the practice of post fill audits. The post fill audit is a manual comparison of the actual prescription hard copy or scanned image to the computergenerated label within 24 hours of dispensing. If an error is detected, the patient can be immediately notified, or, if the prescription is still in the will-call bin, it can be removed and corrected before pick patient-up thereby reducing the potential for harm from a wrong-drug or wrong- direction errors. All staff need to be mindful of the risk for data entry errors.
Low health literacy and patient safety The Institute for Medicine estimates that 90 million adults in the United States may have trouble understanding and acting on health information that they receive. Low health literacy is increasingly being viewed as a patient safety issue that may be contributing to medication errors induced by the patient themselves. Patients are asked to comply with their own medication regimens by relying on oral communication from prescribers and pharmacists, as well as the written communication. Written information is comprised of the instructions on patient specific labels attached to vials, including the auxiliary labels, the consumer medication information (patient leaflet), and when required by FDA, the medication guides. With 43% of the adults in the U.S. reading at the lowest levels of reading proficiency , this reliance on the patients, themselves, may be a prescription for medication errors. A study titled “Literacy and Misunderstanding Prescription Drug Labels” reported that although 70% of the patients with low literacy could correctly read the instructions “Take two tablets by mouth twice a day,” only 34.7% could correctly demonstrate the number of
pills to actually take each day. The study included patients aged 18-60 whose first language was English, from three primary care clinics which serve mostly indigent populations. The study evaluated their ability to read, understand and demonstrate instructions on five common prescription medication container labels. The study showed that patients at all literacy levels were more able to read the label instructions than they were able to demonstrate the correct number of tablets to be taken daily. Differences in the ability to read versus the ability to demonstrate use were larger amongst patients with marginal literacy (84.1% read correctly vs. 62.8% demonstrate correctly) and low literacy (70.7% vs. 34.7%). One third of the patients (37.7%) who had adequate literacy skills misunderstood at least one of the label instructions. It is imperative that community and discharge pharmacists engage their patents with active learning, e.g., employ a two-way conversation. To assist patient understanding and prevent communication-related errors, use plain, nonmedical language (instead of ‘inhale’, say ‘breath in’), slow down when speaking and use short sentences. After counselling the patent about the directions for use, side effects, and when to seek additional medical attention, say to the patient, “tell me how you are going to take your medications” or, “tell me what you would do if you forgot to take a dose or if you thought you took a double dose by mistake.” If the directions are ‘two tablets twice a day’, have the patient indicate in their hand, or in the vial cap, how many tablets they will take every day, or, if the directions are ‘give 5 mL everyday’ have them measure out 5 mL in the accompanying liquid measuring device. These practices assist the pharmacist in verifying the patent’s knowledge and understanding. All staff need to be mindful of the risk of error from self-administration of medication by the patent with low heath literacy.
Mindfulness Needed for DUR The other role of the pharmacist that should be noted is drug utilization review (DUR). Pharmacists who actively participate in DUR programs can directly improve the quality of care for patients by striving to prevent the use of unnecessary or inappropriate drug therapy, prevent adverse drug reactions and improve overall drug effectiveness. 15
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A 2017 article in the Chicago Tribune “sting” investigation found that community pharmacies missed potentially dangerous drug-drug interactions despite having active DUR programs. The investigation involved reporters attempting to fill two prescriptions with drug-drug interactions that could cause serious harm to patients if taken together. Of the 255 pharmacies involved in the investigation, 52% of them sold the medications to the ‘patients’ without mentioning the interaction risk. The Tribune concluded that “computer alert systems designed to flag drug interactions either don’t work or are ignored.” While the investigation reinforced the potential risk that undetected medication problems represent to patients, it stopped short of offering a solution beyond encouraging greater diligence by pharmacists. Telling workers to be more careful is a low-level strategy. Pharmacists cannot be expected to compensate for weak systems that allow too many nuisance alerts to be presented during the dispensing process. An overhaul of the DUR process, designed to fix the system, would have a more lasting impact (high-leverage), than suggestions directed at changing human behavior (lowleverage). The article “Improving Clinical Decision Support in Pharmacy: Toward the Perfect DUR Alert” that appeared in the January 2017 issue of the Journal of Managed Care & Specialty Pharmacy proposes possible solutions to address the problems identified by the Tribune’s investigation. Co-authored by Jenna L. Reynolds, BA, BS, and Michael T. Rupp, PhD, of Midwestern University in Glendale, Arizona, the article makes specific recommendations to improve the use of automated clinical decision support tools that community pharmacies use to help pharmacists identify potential drug therapy problems such as drug-drug interactions. High-leverage recommendations made in the article include: improvements to the data-driven drug utilization review (DUR) systems that are used to help pharmacists identify potential problems with a patient’s prescribed medications including (but not limited to) drug interactions; better training of pharmacists to ensure proficiency at using these automated systems; adoption of electronic prescribing to eliminate contributing factors such as illegibility and transcription errors, and; providing more contextual information to pharmacists such as the diagnosis or clinical indication 16
being treated by the prescribed medications. According to the authors, in the ideal pro-DUR system, every alert would be based on patient-specific and order-specific factors. Theoretical “class effect” alerts would be minimized except where they are severe and relatively likely to occur. The perfect DUR alert would be relevant, clinically significant, supported by clinical evidence and prominently displayed to the pharmacist at a point in the dispensing process to allow for full consideration and action by the pharmacist without reworking prescriptions or reversing claims. The authors of the article are calling for an industry wide stakeholders group to develop best-practice recommendations for data-driven DUR alert systems that assist pharmacists and other clinicians to identify potential medication safety problems. At the table, should be clinical knowledge database suppliers, EHR and practice management computer system vendors, clinicians (pharmacists and prescribers), EHR and e-prescribing software vendor certifying organizations (e.g., Surescripts), HIT standards development organizations (e.g., National Council for Prescription Drug Programs), and representatives from the managed care industry, especially PBMs. Considerations for the stakeholder discussion should include: What alerts should we display? Why? What do we want the pharmacist to do with the alert? What alerts can only the pharmacist respond to? What impact will these alerts have on workflow? What look back in time is relevant for DUR? What is an active prescription? Should we consider inactive prescriptions? What are the clinical and legal perspectives?
Conclusion Systematic assessment of error prevention is vital to safety. It is not enough for pharmacy practitioners and operators to strive to prevent error. Regardless of effort, errors will happen. To maximize safety, pharmacists at all levels must also strive to learn from those errors that have occurred. It may be fair to say that the most egregious error made in a pharmacy is one that has been made
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before. All drug dispensing procedures must be examined regularly, and the cause of system breakdowns must be discovered, so that prevention measures can be designed. Pharmacists and pharmacy technicians need to communicate clearly to their pharmacy supervisors what it takes to do the job correctly in terms of personnel, training programs, facilities design, equipment, drug procurement, computer systems and quality assurance programs. An ongoing, proactive program for identifying risks to patient safety and reducing errors should be defined and implemented to decrease patient harm, continue profitability and avoid lawsuits and bad press.
Acknowledgements
Global Initiative for Chronic Obstructive Lung Disease (GOLD): Updates for Pharmacologic Treatment
Emerging evidence and clarification of the COPD assessment tool prompted a major revision of the GOLD report for 2017. Prior to this version, concerns were raised of the assessment tool not performing better than the spirometry grades for prediction of mortality and other health outcomes. In addition, many new medications, such as long-acting muscarinic antagonists and long acting beta agonist combinations, were approved with no real guidance of where to place them in the treatment algorithm for COPD. Now with these major updates and continual annual updates of The Report, we have more comprehensive and current information to better manage COPD with the most effective pharmacologic treatment.
by Tanya Iliadis, PharmD; Associate Director, Clinical Pharmacy Program, Atrius Health The Global Initiative for Chronic Obstructive Lung Disease (GOLD) released its 2017 updates of the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (COPD) Consensus Report. This was a major revision which included changes on how to assess patients with COPD as well as changes to primary treatment recommendations. The Gold Report is updated annually and with its latest revision for 2018 included minor updates with inclusion of newly published literature. The approach to pharmacoligc treatment and recommendations of treatment remain the same and based on the 2017 updates.
Introduction Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease, characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities primarily caused by significant exposure to noxious particles or gases; the most common being tobacco smoking.1 It is the third leading cause of death in the United States, according to most recent data available from 2014. According to the Centers for Disease Control and Prevention, more than 50% of adults with low pulmonary function were not even aware they had COPD.2
Midwestern University press release, Jan. 5, 2017, Michael T. Rupp, PhD., mtrupp@midwestern.edu
Footnotes and References I Institute of Medicine. Health Literacy: A Prescription to End Confusion. In NielsonBohman L, Panzer A, Kindig DA, eds. Washington DC: National Academy Pr;2004. Kutner M, Greenberg E, Baer J. A first Look at the Literacy of America’s Adults in the 21st Century. Washington DC: National Center for Education Statistics, U.S. Department of Education: 2005. Davis T, Wolf M, Bass P, Thompson J,Tilson, H, Neuberger M, Parker R Literacy and Misunderstanding Prescription Drug Labels . Annals of Internal Medicine 2006 J Manag Care Spec Pharm, 2017 Jan;23(1):38-43
Assessment of COPD1 History of exacerbations and symptoms alone now guide the pharmacologic treatment of COPD. History of exacerbations is determined by any exacerbation, whether it required a hospitalization or not, in the past 12 months. Symptoms are determined using a dyspnea scale. GOLD recommends the COPD Assessment Test (CAT) as the more accurate measurement of dyspnea than the Modified British Medical Research Council Dyspnea Scale (mMRC), although either dyspnea scale may be utilized. In the 2017 version of The Report, FEV1 (forced expiratory volume in 1 second) was omitted as a consideration in the treatment algorithm, since it is an unreliable marker of the severity of breathlessness, exercise limitation and health status impairment. FEV1 is better used to stage the disease, predict clinical outcomes, and guide consideration for nondrug therapies such as pulmonary rehabilitation. Once the history of exacerbations and symptoms are assessed, the patient is grouped in the GOLD ABCD 17
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Assessment Tool to better assess and provide the most precise treatment recommendation (figure A). For example, a patient with 1 exacerbation in the past 12 months which was managed in an outpatient setting, who had a CAT score of 12, is labeled as Group B.
At right, Figure A: the ABCD Assessment Tool. Assessment tool simulated from GOLD 2018
Key Points1 • All individuals who smoke should be strongly encouraged and supported to quit. • Spirometry is required to make a clinical diagnosis of COPD, while history of exacerbations and assessment of symptoms guide pharmacologic management of COPD. • Inhaler technique and adherence should be assessed at every visit and before concluding current therapy is insufficient. • Long acting beta agonists (LABAs) and long acting muscarinic antagonists (LAMAs) are preferred over short-acting agents except for patients with only occasional dyspnea. • A LAMA is preferred over a LABA when monotherapy is needed for a patient with exacerbations and less symptoms. • If dual therapy is indicated, LAMA/LABA is preferred over inhaled corticosteroid (ICS)/LABA due to increased risk of pneumonia in COPD with ICS use. • Short-acting bronchodilators may be used for periodic symptoms in Group A patients and is recommended to treat acute exacerbations; however use on a regular basis is not recommended.
Pharmacologic Treatments1 The goal for treatment of COPD is to reduce symptoms and future risk of exacerbations. Management strategies are not limited to pharmacologic treatments, and should be complemented with appropriate non-pharmacologic 18
Exacerbation History >2 or >1 leading to hospital admission 0 or 1 (not leading to hospital admission)
C
D
A
B
CAT <10
CAT >10
mMRC 0-1
mMRC >2
Symptoms interventions, however the scope of non-pharmacologic interventions are beyond this article.
Pharmacologic Treatment Algorithm1 A more personalized approach is encouraged within GOLD by initiating, intensifying, or reducing treatment based on the individual’s symptoms and risk of exacerbations. A pharmacologic treatment algorithm by GOLD Grade was created in the 2017 version of The Report with preferred pathways clearly identified based on most recent literature. Once the ABCD assessment tool is assessed for a patient’s history of exacerbations and symptoms, the patient is grouped in either Group A, B, C or D, which determines the recommended treatment based on the pharmacologic algorithm. Below is a description of the algorithm and the recommended treatment for each group: Group A • All patients should be offered bronchodilator treatment based on their effect on breathlessness. This can be either a short or long acting bronchodilator. If patient has occasional dyspnea, a short acting bronchodilator may be sufficient, however regular use is not recommended and those patients should be on a long acting bronchodilator. Group B • Preferred: Initial therapy should be a long acting bronchodilator. Long acting bronchodilators are superior to short acting bronchodilators when taken as needed and therefore recommended.
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Generic • There is no evidence to prescribe one class of long acting bronchodilator over another for initial relief of symptoms in Group B patients.
Brand and Device
SHORT-ACTING BETA2 AGONISTS (SABA) albuterol
• Use 2 bronchodilators if breathlessness persists on monotherapy. For patients with severe breathlessness, may start with 2 long acting bronchodilators. • If addition of second bronchodilator does not improve symptoms, step back down to one inhaler and evaluate if due to other comorbidities. Group C • Preferred: Initial therapy should be a LAMA since LAMA has shown to be superior to a LABA regarding exacerbation prevention in Group C patients. • If additional therapy is needed for persistent exacerbations, it is recommended to add a LABA (LAMA/LABA combination) versus adding ICS (ICS/LABA) due to increased risk of pneumonia with ICS. Group D • Preferred: Recommend to start with LAMA/LABA combination because this combination showed to be superior to a single agent with patient reported outcomes. LAMA/LABA combination also was superior to ICS/LABA combination in preventing exacerbations and other patient reported outcomes in Group D patients. • Group D patients are at higher risk of developing pneumonia with ICS. • Patients with Asthma-COPD overlap may have ICS/LABA combination as their preferred initial therapy. • Patients who develop further exacerbations may add third agent for triple therapy (LABA/LAMA/ICS). There is no evidence that switching from LAMA/LABA to ICS/LABA results in better exacerbation prevention. • If patient treated with triple therapy has further exacerbations, may consider adding roflumilast, a macrolide,
levalbuterol
Proair HFA Proair Respiclick Proventil HFA Ventolin HFA Xopenex HFA
SHORT-ACTING MUSCARINIC ANTANGONISTS (SAMA) ipratropium
Atrovent HFA
SHORT-ACTING BETA AGONIST/SHORT-ACTING MUSCARINIC ANTAGONIST COMBINATIONS (SABA/ SAMA) ipratropium/albuterol
Combivent Respimat
LONG-ACTING B2 AGONISTS (LABA) indacaterol
Arcapta Neohaler
olodaterol
Striverdi Respimat
salmeterol
Serevent Diskus
LONG-ACTING MUSCARINIC ANTAGONISTS (LAMA) aclidnium bromide
Tudorza Pressair
glycopyrrolate
Seebri Neohaler
tiotropium
Spiriva HandiHaler Spiriva Respimat
umeclidnium
Incruse Ellipta
LONG-ACTING MUSCARINIC ANTAGONISTS/LONGACTING BETA AGONIST COMBINATIONS (LAMA/ LABA) Glycopyrrolate/formoterol
Bevesi Aerosphere
Indacaterol/ glycopyrrolate
Utribron Neohaler
tiotropium/olodaterol
Stioloto Respimat
umeclidinium/vilanterol
Anoro Ellipta
INHALED CORTICOSTEROID/LONG-ACTING BETA AGONIST COMBINATIONS (ICS/LABA) budesonide/formoterol
Symbicort HFA
fluticasone/vilanterol
Breo Ellipta
fluticasone/salmeterol
Advair Diskus
ICS/LAMA/LABA At right, Figure B, inhalers approved for COPD. Does not include nebulizers. HFA = hydrofluoroalkane
Fluticasone furoate/ umeclidnium/vilanterol
Trelegy Ellipta
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and/or stop ICS if with no added benefit to avoid adverse effects.
Conclusion
Choice of Inhaler1
The Global Initiative is dedicated to providing the most current and accurate information to diagnose, manage, and treat COPD. With annual revisions and systematic review of literature included in each revision, there is up to date guidance to best manage these patients.
The choice of inhaler device is dependent on many factors; access, cost, patientâ&#x20AC;&#x2122;s ability and preference. Proper inhalation technique is critical for accurate drug delivery and patients must be provided with instructions and demonstration when prescribing and at every visit. Assess patients on their correct use of their inhaler by demonstration. Prior to any changes in current therapy, inhaler technique and adherence should be assessed.
Understanding Assessment of Risk: Comply with USP <800> by Joseph W. Coyne, RPh USP Chapter <800> is designed to protect healthcare workers, patients, and the enviornemt alike. Understanding USP Chapter <800> and its assessment of risk compent as it relates to the handling and storage of hazardous medications is a vitual to any success. Knowledge that USP Chapter <800> assessment of risk is based on a drugs placement within the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Setting documents is paramount. Conducting a systematic assessment of your organizations risk as it related to hazardous drug handling is the first step to compliance. Understanding the required elements of a proper assessment of risk will aid in the development of an organization plan.
Introduction Presently there are five (5) federal statutory provisions that identify hazardous chemicals for attributes including workpublic exposure, community right-to-know reporting requirements and the Clean Air and Clean Water Act references. The Resource Conservation and Recovery Act (RCRA) is program overseen by the Environmental Protection Agency that specifically address the handling of Hazardous Waste. The United States Department of Transportation addresses hazardous materials, specifically related to transportation safety. The standards put forth by the National Institute of Occupational Safety and Health (NIOSH) and their direct relationship to 20
References 1 GOLD. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonar Disease. 2018. http://goldcopd.org/ 2 Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease (COPD). Retrieved from https://www.cdc.gov/copd/index.html#2 Accessed November 2017.
United States Pharmacopeia Chapter <800> will be the focus here.
Key Points Effective December 1, 2019 USP Chapter <800> will become fully enforceable, which applies to all healthcare personnel handling hazardous drugs regardless of their role within an organization or the practice setting in which the hazardous are being handled. Many of the requirements contained within USP Chapter <800> where initially identified in the 2004 NIOAH Alert Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings and USP Chapter <797>. A hazardous as defined in USP Chapter <800> follows the NIOSH criteria by which a drug is considered hazardous if it meets any one of the six (6) following criteria; carcinogenetic, genotoxic, teratogenic, is a reproductive toxin, caused organ toxicity at low doses, is structurally similar or bears a toxicity profile similar to other drugs classified as hazardous. Based on these six (6) criteria hazardous drugs are classified by NIOSH into three (3) categories; antineoplastic, hazardous non-antineoplastic and reproductive risk only hazardous. These three (3) categories are represented in the NIOSH document in tables. Table 1 as its referred to is all the antineoplastic agents, Table 2 the hazardous non-antineoplastic and Table 3 the reproductive risk only agents. It is these three (3) tables that determine the handling required per USP Chapter
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<800>. USP Chapter <800> requires that all Table 1 medications be stored in compliance with all storage and handling standards within the chapter, with the exception of those Table 1 medications that are in their final dosage forms. The focus of this article is to address those medications that are eligible for exemption from this chapter’s storage and handling requirements, providing a proper assessment of risk is performed and alternative work practices and containment strategies are in place.
Article Text Some drugs defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation (for example, intact medications such as coated tablets or capsules that are administered to patients) and since the operational practice of treating all hazardous medications the same, thus subjecting all hazardous drugs, regardless of their NIOSH listing to the full requirements of Chapter <800>. The stratification via an assessment of risk is the most practical approach. This stratification via assessment of risk requires the identification and use of alternative containment strategies and/or work practices for specific dosage forms, provided the hazardous drugs are not antineoplastic agents requiring manipulation nor are they active pharmaceutical ingredients (API). USP Chapter <800> requires that an assessment of risk address a minimum of the following; drug, dosage form, risk of exposure, packaging, manipulation, documentation of alternative containment strategies and/or work practices, and that it be reviewed at least annually and documented. The development of an assessment of risk begins with obtaining and understanding the current NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016 document and cross referencing it against the formulary utilized at your practice. This comparison will result in a nature formulary division into those hazardous medications which are ineligible to be included in an assessment of risk and those eligible. Those medications that are ineligible for handling via an assessment of risk must be: stored separately from non-hazardous medications, stored under negative pressure (between 0.01” to 0.03” water column) to the adjacent space in a room with at least 12 air
changes per hour (ACPH), that is externally vented, and stored within that room in a manner that prevents contamination and exposure of personnel. Further examination of the eligible list is required to consider dosage (oral solid, solution) form being obtained, the packaging (unit dose, bulk) of each medication and any manipulation being performed (crushing, opening capsules or compounding) to begin to assess the risk for each drug dosage form. When considering a practical alternative containment strategy for personnel, the type of risk must be identified (i.e. ingestion, contact, vapor inhalations). Information related to exposure risk and safe handling may be obtained for Safety Data Sheets, product labelling, the International Agency for Research on Cancer (IARC), and reports published in medical or other professional healthcare journals, as well as other evidence-based recommendations from other organizations Alternative containment strategies may include the use of Closed System Transfer Devices (CSTDs) with non-antineoplastic hazardous medications, the use of gloves meeting ASTM standard D6978 for handling, the purchase of medication in unit-dose or unit-of-use to eliminate the need for manipulation and handling, and the use of dedicated equipment for counting and/or transporting. Consideration must also be given the proper use of Personal Protective Equipment (PPE) based on the function performed. The PPE requirements may well be different for compounding versus administration. Table 5 within the NIOSH List of Hazardous Drugs is as resource for determining appropriate PPE use; however, strict adherence with the recommendations contained within this table is not required for USP Chapter <800> compliance. A standard operating procedure is the foundation for any assessment of risk, as it is this SOP that will determine how and by whom these assessment of risks are conducted. This SOP will also determine what staff training is necessary and subsequently which skills must be assessed as part of personnel’s annual competency assessments. Documentation of the resultant assessment of risk is not only required for compliance but is vital for adoption by all person21
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nel to ensure their safety. Numerous methods may be utilized to accomplish this requirement, but consideration must be given to how this information is to be communicated to personnel. Whichever method is selected within the organization it must be available and clearly understood by every employee from the moment the hazardous medication is received within the facility through the administration to a patient.
that handles hazardous medications must determine which approach is most suited for their organization and implement the appropriate requirements for compliance.
Acknowledgements The author would like to recognize Clinical IQ, LLC and Critical Point, LLC for their contributions to this article.
Conclusions Hazardous medications, as defined by the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings document, must be handled by either complying with all requirements defined with USP Chapter <800> or by utilizing an assessment of risk approach. Hazardous medications eligibility for handling via an assessment of risk is clearly defined within the chapter as are the required elements for said assessment of risk. Each organization
Geriatrics: A High-Risk Population ...You Will Eventually Be a Part Of by Stephanie Tsouvalas Hernandez, PharmD, BCGP, FASCP The purpose of this article is to identify the age related changes that place the geriatric population into a “high risk” category, with a special focus on end stage renal disease (ESRD). Understanding the systems and organs most affected by aging enables pharmacists and other members of the healthcare team to have a greater impact on reducing risks in the geriatric population.
Introduction Aging leads to an overall decline in body system function that everyone will eventually experience. Organs and systems may demonstrate variability in the rate of decline, which will manifest with differing clinical presentations and symptoms. Aging most profoundly affects the cardiovascular system, pulmonary system, central nervous system (CNS), gastrointestinal system (GI), immune system, endocrine system, liver, renal system and kidneys. Additionally, pharmacokinetic and pharmacodynamic effects influence pharmacological interventions in these body systems and organs. 22
Notes and References 1 Kienle P and Douglass K. Perform an Assessment of Risk to Comply with USP <800>. Pharmacy Purchasing & Products. 2017. 14(3). Retrieved on 3/29/2017 from https://www.pppmag.com/article/2012 2 USP Convention, Inc. <800> Hazardous Drugs-Handling in Health care Settings. USP 40-National Formulary 35. 1st supp. Rockville, MD: USP Convention, Inc , 2017. 3 Connor TH, MacKenzie BA, DeBord DG, et al. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings, 2016. DHHS (NIOSH) Publication Number 2016-161 (Supersedes 2014-138). http://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf
In 1991, Dr. Mark Beers and colleagues published a list of medications considered to be potentially inappropriate for long term care (LTC) facility residents. The “BEERS Criteria” is a set of guidelines for healthcare professionals set forth to improve the safety of prescribing medications for older adults. The list is in its fifth permutation with the most recent revision completed in 2015 by the American Geriatric Society. The most recent addition to the criteria are the list of drugs that should be avoided, or dose adjusted based on kidney function and documented drug-drug interactions. According to the Centers for Disease Control and Prevention (CDC), approximately 30 million people or 15% of U.S. adults are estimated to have Chronic Kidney Disease (CKD) and more than 1 in 7 people have some degree of CKD. After age 40, kidney filtration begins to fall by approximately 1% per year. Pharmacists play a critical role within the multidisciplinary collaborative healthcare team in reducing the incidence of CKD and mitigating risk of kidney failure, as well as preventing overall unnecessary medication-induced complications.
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Key Points Background • Age-related physiological changes place the geriatric population into a “high risk” category. • Some medications are considered “high risk” in the geriatric populations. Findings • Pharmacists play a critical role in minimizing risk. • Pharmacist intervention can have a profound impact on patient safety.
Presentaton The purpose of this presentation was to provide an understanding of the biological health challenges facing the aging geriatric population with an emphasis on the impact pharmacist can have. It is critical for the healthcare team to understand the systems and organs most affected by aging in order to provide optimal care. Beginning with the cardiovascular system, the size of the heart may be slightly larger and the heart walls thicken with age. Diastolic filling rate decreases and the systolic blood pressure increases at rest. Peripheral circulation changes include a decrease in maximal oxygen consumption and a decrease in beta-adrenergic modulation. There is an increase in stroke volume, counteracting a decreased heart rate. Next, the pulmonary system undergoes a gradual increase in size of the trachea and central airways resulting in more anatomic dead space and decreased lung weight. The chest walls thickens, which causes a loss of elastic recoil in the lung, increased closing volume and decreased maximum expiratory volume, thus positioning the patient at risk for respiratory failure. The CNS and brain are subject to reduced blood flow causing a number of potential complications including: decreased coordination, prolonged reaction time, impairment of shortterm memory, decreased sensory conduction time and a
more permeable blood-brain barrier. Additionally, the serotonin system changes affect neuronal function in the areas of pain, feeding, sleep, cardiac regulation and cognition. GI system changes begin at the oral cavity where patients are prone to traumatic oral lesions and xerostomia. In the stomach there is gastric muscular atrophy, gastric mucosa thinning, increase in gastric pH, decrease in gastric acid secretion and a decrease in both GI blood flow and overall gastric motility. In the small intestine and colon, there is a decrease in nutritional absorption, and many patients experience constipation and fecal incontinence. The immune system undergoes changes with aging which includes a decrease in cell-mediated responses and humoral responses, decrease in thymus size, altered T-cell function and a decrease in antibody production by the B-cells. The aging endocrine system results in deteriorated regulatory and feedback mechanisms, as well as decreased binding affinities and receptors, decreased glucose tolerance and decreased production of sex hormone. Changes in the liver are defined in two categories: physiological and pharmacokinetic. The physiological changes associated with aging are: decreased liver size and hepatic blood flow, as well as a decrease in cytochrome P450 content. Pharmacokinetic changes associated with aging are: decreased first pass metabolism, which may increase medication bioavailability, phase 1 metabolism may be impaired; however phase 2 metabolism is least affected. Further considerations are focused on dosage adjustments where drugs with a high hepatic extraction or drugs metabolized by oxidation both require a decrease in dose. Conversely, drugs metabolized by conjugation do not require a dosage adjustment. Lastly, changes in the renal system and the kidneys are presented in two categories: anatomic and functional. Anatomic changes associated with aging include decreased kidney size and number of glomeruli, renal tubule changes and renal vascular changes. Functional changes associated with aging include decreased renal blood flow, decreased glomerular filtration rate (GFR) and decreased mean creatinine clearance 23
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(CrCl). Conservation of sodium is reduced due to lower plasma rennin activity and urinary aldosterone secretion. The overall biological deterioration and change of body composition can significantly alter pharmacokinetic and pharmacodynamics. As the body ages, total body water and lean muscle decreases; but adipose tissue increases, thus altering pharmacokinetic effects. Impact of the changes on drug distribution depends on the physiochemical properties of the drug. Fat soluble drug will have a lower bioavailability, potentially mitigating its therapeutic effect; where a water soluble drug will have a higher bioavailability and a potentially higher incidence of adverse reactions. Guidelines for healthcare professionals known as the BEERS List have been set to help improve the safety of prescribing medications for older adults and specifically recognize the ramifications of age-related changes in this population subset. The BEERS list includes classes of medications that are considered â&#x20AC;&#x153;potentially inappropriateâ&#x20AC;? in the older adults. Among many diseases that affect our aging population, one of the most common is CKD. The natural aging kidneys and increase prevalence of comorbidities such as diabetes, hypertension and cardiovascular disease damage the kidney. The National Kidney Foundation and Kidney Disease Outcomes Quality Initiatives (NFK KDOQI) have established clinical practice guidelines of CKD which classify kidney disease into 5 stages. Acute Renal Failure (ARF) and Chronic Kidney Disease (CKD) are the two classification of renal disease. ARF is characterized by a sudden decline in renal function and an abrupt decrease in glomerular filtration rate (GFR). The three main categories which are named for their location within the kidney system: prerenal ARF, intrarenal ARF and postrenal ARF. In contrast CKD is characterized by abnormalities in the kidney structure and/or function present for 3 months or longer, resulting in a range of health issues. Two mechanisms of damage leading to CKD are: an initiating mechanism related to underlying etiology and the progressive mechanism. Progression of CKD to end stage renal disease (ESRD) is often observed through a sequence of events. First, azotemia occur which is an abnormally high level of nitrogen (BUN) waste products, then a compensatory glomerular filtration leads to glomerular 24
sclerosis resulting in uremia, an excess of urea and creatinine in the blood that would normally be excreted in urine. This process ultimately leads to kidney failure and ESRD. Understanding the pharmacokinetic alterations in ESRD are critical when selecting medication therapy. In ESRD, there is a decrease in bioavailability of oral drugs and an increase in the apparent volume of distribution for volume overload patients and a decrease for muscle wasted patients. Impaired renal elimination prolongs medication half lives. Additionally, basic drugs will bind more readily, low albumin will result in decreased binding, and acidic drugs will exist more in the unbound state. Understanding the pharmacokinetics is essential in the optimal selection and dosage of both prescription and over the counter (OTC) medications, as many medications must be avoided or used with caution in patients with ESRD. Pharmacists play a key role in assisting prescribers and patients choose both prescription and OTC medications across all care settings. Simple recommendations and interventions about OTC choices including pain relievers, decongestants and antacids are just a few examples of how a pharmacist can guide a patient to the safest choice in the presence of CKD. For patients on dialysis, medication considerations must be made based on molecular weight, protein binding, volume of distribution, plasma clearance and dialysis flow rate. Dialysis enhances the plasma clearance by 30% or more of numerous medications such as acetaminophen, aspirin, atenolol, gabapentin, lisinopril, melatonin, metformin and many more. Simple adjustments in the dose or the time of dosing can have a major impact on the medication effects and, ultimately, the safety to the patient.
Conclusions Preventing CKD and mitigating the risk of kidney failure are areas a pharmacist can significantly influence. Hypertension and diabetes are the greatest risk factors for the development of CKD, therefore screening for these patients for kidney disease is crucial. Education around lifestyle changes focused on prevention, utilizing medication to slow CKD progression and addressing conditions or exposures to
Pharmacy Journal of New England • Winter 2018
avoid that can harm the kidney or cause acute kidney injury are essential. Pharmacists advising on potentially modifiable risk factors such as smoking cessation, lipid control, reduced dietary sodium and glucose control can have a great impact on disease prevention. Additionally, pharmacists can educate patients on the importance of disease state screening and monitoring, medication adherence, proper medication dosing or medications to avoid can reduce a patient’s risk of CKD. Continued emphasis should be placed on the pharmacist’s role in overall patient healthcare since the pharmacist is the liaison between the prescriber and the patient, thus always involved in the final steps of the transaction to the ultimate user, the patient.
Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015 Oct 8. doi: 10.1111/jgs.13702. [Epub ahead of print].
Acknowledgements
8. Munar, M., & Singh, H. (2007). Drug Dosing Adjustments in Patients With Chronic Kidney Disease . American Family Physician , 15(75), 10th ser., 1487-1496. Retrieved June 26, 2017, http://www.aafp.org/afp/2007/0515/p1487.html
The author would like to express sincerest gratitude to Jamin Reda, K. Cynthia Stamatopulos, Paula Tsouvalas Ellison, PharmD, and David Hernandez for the invaluable support throughout the preparation and presentation process.
9. Drug Dosing in Special Populations: Renal and Hepatic Disease, Dialysis, Heart Failure, Obesity, and Drug Interactions. In: Bauer LA. eds. Applied Clinical Pharmacokinetics, 3e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical. com.ezproxymcp.flo.org/content.aspx?bookid=1374&sectionid=74719619. Accessed July 07, 2017.
Notes and References 1. https://guideline.gov/summaries/summary/49933/American-Geriatrics-Society2015-updated-Beers-Criteria-for-potentially-inappropriate-medication-use-in-olderadults
3. Halilovic J, Dager W. Acute Kidney Injury. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 10e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com.ezproxymcp.flo.org/ content.aspx?bookid=1861&sectionid=134127206. Accessed June 29, 2017. 4. ASN dialysis curriculum. (2017). ASN Dialysis Advisory Group. [online] Available at: https://www.asn-online.org/education/distancelearning/curricula/dialysis/ DrugDosingInrig.pdf [Accessed 6 Jul. 2017]. 5. https://nccd.cdc.gov/CKD/FactorsOfInterest.aspx?type=Age 6. Perlman RL, Heung M, Ix JH. Renal Disease. In: Hammer GD, McPhee SJ. eds. Pathophysiology of Disease: An Introduction to Clinical Medicine, Seventh Edition New York, NY: McGraw-Hill; 2013. http://accessmedicine.mhmedical.com.ezproxymcp.flo. org/content.aspx?bookid=961&sectionid=53555697. Accessed June 29, 2017. 7. José António Lopes, Sofia Jorge; The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J 2013; 6 (1): 8-14. doi: 10.1093/ ckj/sfs160
10. https://www.intechopen.com/books/senescence-and-senescence-related-disorders/endothelium-aging-and-vascular-diseases 11. Renal dosing - database. GlobalRPh. globalrph.com/index_renal.htm. Accessed August 13, 2017. 12. https://medlineplus.gov/ency/article/004006.htm
2. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American
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Pharmacy Marketing Group
Rx and the Law By: Don R. McGuire Jr., R.Ph, JD
Death with Dignity Death with Dignity. Physician-assisted Suicide. Aid in Dying. Nomenclature has evolved in the twenty years since Oregon passed the first Physician-assisted Suicide legislation in the United States. There are now a total of six states1 plus the District of Columbia that allow the practice. Three of those six states passed their legislation during the last two years. That’s not much data on which to base a trend, but it does raise questions for pharmacists participating in the practice. Each state is different in detail, but the high level procedures are similar. The patient must make a request for medication with which to end their life. This request may be oral and sometimes requires a second request following a mandatory waiting period. Eventually this request is documented on a state-created form and the patient’s signature is witnessed by at least one disinterested witness. Typically the patient must have been diagnosed with a terminal illness and facing death within a relatively short time, such as six months. The attending physician then has to certify a number of items in order to be compliant with the law. These include the terminal nature of the patient’s condition, an assessment of their mental state, that there doesn’t appear to be any coercive force being exerted on the patient and that the patient has been counseled on risks, benefits and alternatives. This completed form is then forwarded to the appropriate state agency, many times the Department of Health.
Once the attending physician has certified the patient meets the criteria of the law, many times the patient is required to meet with a second, consulting physician. This physician then documents their assessment of the patient’s condition on the state form. Finally, the form must be submitted to the state, either directly and/or through the attending physician. Either the attending or consulting physician can refer the patient for a psychiatric/psychological examination. This exam is also documented on a state form and submitted as above. If the patient has successfully passed these hurdles and waited for the requisite waiting periods, their physician is ready to dispense the needed medications(s) or write prescriptions for them. Now it is time for the pharmacist to get involved. The first decision by a pharmacist may not be a legal one, but a moral one. How does the pharmacist feel personally about dispensing these medication(s)? Does it feel wrong or run counter to what their career goal has been? These are not questions that can be answered by anyone but the pharmacist involved. One thing to consider is that by the time the patient gets to this point in the process, it is as a result of careful consideration.
Endnote 1 - Montana’s authority is based on a decision by the Montana Supreme Court rather than by legislation.
Did You Know? That the Connecticut Pharmacists Association offers a 2-Week Online Course for CT Law? www.ctpharmacists.org 26
Pharmacy Journal of New England â&#x20AC;˘ Winter 2018
Financial Forum
How would you like to save hundreds of dollars per month in retirement? By saving and investing for Saving More Money, Now & Later retirement using a Roth IRA, that is essentially the potential You could save today & tomorrow, often without that penny you give yourself. Roth IRAs are the inverse of traditional IRAs: the dollars you direct into them are not tax deductible, -pinching feeling, but the withdrawals are tax free in retirement (assuming you Directly & indirectly, you might be able to save more per abide by I.R.S. rules). Imagine being able to receive month than you think. Hidden paths to greater savings can retirement income for 20 or 30 years without paying a penny be found at home and at work, and their potential might of federal income taxes on it in the years you receive it. Now surprise you. imagine how sizable that income stream might be after decades of compounding and equity investment for that Little everyday things may be costing you dollars you IRA.4 could keep. Simply paying cash instead of using a credit card could save you four figures annually. An average U.S. Many of us can find more money to save, today & tomorhousehold carries $9,000 in revolving debt; as credit cards row. Sometimes the saving possibilities are right in front of currently have a 13% average annual interest rate, that us. Other times, they may come to us in the future because average household pays more than $1,000 in finance charges a year.1 The typical bank customer makes four $60 of present-day financial decisions. We can potentially realize some savings by changes in our financial behavior or withdrawals from ATMs a month â&#x20AC;&#x201C; given that two or three our choice of investing vehicles, without resorting to are probably away from the host bank, that means $5-12 austerity. a month lost to ATM fees, or about $60-100 a year. A common household gets about 15 hard-copy bills a month and spends roughly $80 a year on stamps to mail them â&#x20AC;&#x201C; why not pay bills online? Automating payments also rescues you from late fees.1 A household that runs full loads in washing machines and dishwashers, washes cars primarily with water from a bucket, and turns off the tap while shaving or brushing teeth may save $100 (or more) in annual water costs.1
Citations. 1 - realsimple.com/work-life/money/saving/money-saving-secrets [7/13/17] 2 - investopedia.com/articles/stocks/11/intro-tax-efficient-investing.asp [8/5/16] 3 - blog.turbotax.intuit.com/tax-deductions-and-credits-2/can-you-deduct-401k-savings-from-your-taxes-7169/ [2/7/17] 4 - cnbc.com/2017/05/15/personal-finance-expert-do-these-6-things-to-save-an-extra700-per-month.html [5/15/17]
Then, there are the big things you could do. If you are saving and investing for the future in a regular, taxable brokerage account, that account has a drawback: you must pay taxes on your investment income in the year it is received. So, you are really losing X% of your return to the tax man (the percentage will reflect your income tax rate).2 In traditional IRAs and many workplace retirement plans, you save for retirement using pre-tax dollars. None of the dollars you invest in those plans count in your taxable income, and the invested assets can grow and compound in the account without being taxed. This year and in years to follow, this means significant tax savings for you. The earnings of these accounts are only taxed when withdrawn.2,3 27
From the Colleges
University of Connecticut School of Pharmacy School of Pharmacy Student Tyler Ackley ‘19 (PharmD) Earns One of UConn’s Top Academic Honors Tyler Ackley ’19 (Pharm.D.) has been named a 2018 University Scholar. He is one of just 25 students to receive this distinction, one that is among the top academic honors bestowed by the University. Being named a University Scholar allows highly motivated students to design and create in-depth Tyler Ackley, ‘19 research, creative projects, and individualized plans of study that support their academic and intellectual interests during their final three undergraduate semesters. When asked to describe Ackley, his Honors Advisor in the School of Pharmacy, Brian Aneskievich, said without hesitation, ‘translational.’ “Tyler is very interested in basic science research but in a way that can be applied in clinical settings,” Aneskievich says. “He has an intense interest in translating basic research into applications that will be important in treating real human conditions. He has demonstrate this in his work on rheumatoid arthritis in professor Caroline Dealy’s lab.” Dealy, an associate professor of reconstructive sciences, is chair of Ackley’s University Scholar Advisory Committee. Aneskievich and Andrea Hubbard, both faculty in Pharmaceutical Sciences, also serve on his committee. Ackley first began working with Dealy when he participated in the 2016 Technology Incubation Program (TIP) summer program. His project was titled “Soluble Epidermal Growth Factor Receptor Isoforms: Functional Roles and Potential Therapeutic Application in Rheumatoid Arthritis.” Looking to further his investigational efforts in the summer of 2017, he applied for competitive project funding and earned
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the Karl A. Nieforth Pharmacy Student Research Award, one of the School’s highest honors. The ultimate goal of Ackley’s research is to provide a way of managing the effects of Rheumatoid Arthritis using a targeted approach that does not rely on the powerful immunosuppressant medications that are currently prescribed. Ackley earned his BS in Pharmacy Studies magna cum laude and a BS in Molecular and Cellular Biology (MCB) summa cum laude in the spring of 2017. With his MCB degree, he also completed a research project as an Honors Scholar, titled: “Investigation of Genomic Imprinting in the X-linked Lymphocyte Regulated 3b (Xlr3b) Locus and its implications in Cognition” with professor Michael O’Neill. In fact, Ackley is quick to credit the professors he has worked with at UConn for the majority of his success. He says, “My plan is to get a Ph.D. in immunology or biochemistry and to eventually have a career in education where I can both teach and do research. I couldn’t have accomplished what I have so far without the support of a series of great professors here at UConn.” He adds that his original undergraduate thesis, his work in the TIP Summer Program, and now his University Scholar project have prepared him well for his future graduate studies and, ultimately, a career in academia. Aneskievich says that Ackley is invested in the School of Pharmacy and the success of his fellow students as demonstrated by his tutoring efforts with Rho Chi, the pharmacy honors society of which he is a member. “I respect and appreciate the amount of work Tyler has done academically and the progress he has made in his research, but also his willingness to give back to his fellow students is really impressive.” For his part, Ackley says the best thing about being part of the School of Pharmacy is the friendships he has made due to the closeness of his class. “We take courses together, we study together. I even live with five of my classmates. I couldn’t do this without their support.” Ackley joins a cohort of three other University Scholars in the School of Pharmacy. Kelly Chan and Minji Choi will graduate
Pharmacy Journal of New England • Winter 2018
in the Pharm.D. Class of 2018. Sagune Sakya, another Pharm.D. Class of ’18 candidate, completed her University Scholar requirements when she was earning her BS in Pharmacy Studies in 2016.
American Geriatrics Society, which regularly compiles a list of medications that should be used with caution in older patients. Some of the most commonly prescribed antidepressants are on this list which leaves clinicians having to decide which of the therapies may be safest in their patient.
UConn Pharmacy Practice Professors to Study Medication Effectiveness
Drs. Baker and Sobieraj hope that as a result of this research, clinicians will have an evidence-based source of comparative data to inform clinical practice decisions when prescribing antidepressants to older patients. The research will also summarize what is currently known about the efficacy of antidepressants in older patients with MDD.
Two University of Connecticut pharmacy practice professors have been awarded $380,000 from the Department of Health and Human Services and the Agency for Healthcare Research Quality to assemble and work with a diverse panel of experts to study the treatment of depression for older adults. Dr. William Baker Jr. and Dr. Diana Sobieraj’s team will evaluate the evidence for the harms and effectiveness of medications for the treatment of older adults with major depressive disorder, as the field currently faces numerous challenges and discrepancies that limit its usefulness for practicing clinicians. Major depressive disorder (MDD) affects 4.8 percent of adults over the age of 50, according to the National Institute of Mental Health, but studying and treating this population is challenging due to the lack of comprehensive and uniform literature. The focus of this project is to quantify the harms associated with first-line antidepressants for the treatment of MDD in older patients. The project is in partnership with the
The PIs will work with a team of experts with various perspectives on the field. Dr. Craig Coleman, Dr. Adrian Hernandez and Dr. C. Michael White, all from the UConn School of Pharmacy, will provide methodical and administrative support. Dr. David Steffans, a practicing psychiatrist and expert in geriatric depression research from UConn Health, Dr. Karina Berg, a practicing geriatrician at UConn Health and Dr. Joseph Ross, a practicing physician with a background in drug-related harm from Yale University are also part of the research team. Dr. Baker received his Pharm.D. from UConn and Dr. Sobieraj received her Pharm.D. from the University of Rhode Island. Their research focuses on systematic review and metaanalysis associated with the treatment of cardiovascular diseases and internal medicine. This project is DHHS/AHRQ number HHSA290201500012I.
SAVE THE DATE Pharmacy Day at the Capital March 22, 2018 Connecticut State House, Hartford
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From the Colleges
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Massachusetts College of Pharmacy and Health Sciences – Boston Dear Colleagues, I hope the 2018 finds you well. The academic year has been moving at a rapid rate and our faculty and students have already accomplished a significant amount of work. I would also like to pass along the news that Dr. Caroline Zeind, who has been an integral member of MCPHS University for many years, was recently appointed as Interim Provost and Vice President of Academic Affairs. Enjoy the following highlights from the School of Pharmacy-Boston; I wish you all a productive spring semester, and President Monahan sends his best wishes to all of you. Best Wishes, Paul DiFrancesco Dean and Associate Professor
Faculty-Student Collaborations Members of the MCPHS University Office of Experiential Education (Catherine Basile BS, PharmD, Kara Bonaceto, PharmD, Nicole Carace, PharmD, and Gretchen Jehle, PharmD) developed a poster for presentation at the ASHP Midyear meeting held in Orlando, Florida this past December. The poster, “Implementation of an Interprofessional Education (IPE) Assessment Tool During Introductory Pharmacy Practice Experiences (IPPEs),” describes the assessment tool used by IPPE students to document interactions with other healthcare professionals and students of healthcare disciplines. Students reflected upon the Interprofessional Education Collaborative (IPEC) core competencies: values and ethics, roles and responsibilities, teams and team work, and interprofessional communication. Use of the assessment tool confirms that Introductory Pharmacy Practice Experience students participate in numerous interprofessional interactions in both community and institutional settings. The majority of interprofessional 30
interactions in both settings were between prescribers and student prescribers, and the most common non-prescriber interaction was with nurses.
Student Updates On January 24, Phi Lambda Sigma inducted ten new members during a ceremony at the Hampshire House in Boston. PLS is a national society focused on the development of leadership qualities among pharmacy students. As a complementary organization to Rho Chi, PLS honors leadership with member selection based on peer recognition. Recognition is designed to instill and enhance self-confidence, and to promote the advancement of pharmacy. PLS welcomed seven new student initiates, each recognized for their exemplary actions and leadership. Sierra Ferreira, Sydney Graboyes, Emily Mai, Christine Marotta, Leisl Reyes, Amanda Robinson, and Nguyen (Anh) Vu were all honored as new student initiates. Dr. Mary Amato, Professor of Pharmacy Practice, Francis Melaragni, Assistant Professor of Social and Administrative Sciences, and Executive Vice President Richard Lessard, COO and CFO, were recognized and inducted for their leadership and contributions to the profession as distinguished faculty and administrators. Robert O’Connell, an MCPHS alumnus,
Above, Nicole Carace PharmD and Kara Bonaceto display their poster at the ASHP Midyear meeting.
Pharmacy Journal of New England • Winter 2018
delivered an inspiring keynote address to our newly inducted leaders. Chapter President Nataly Estrin (PharmD 2019) and Vice President Madeline Acquilano (PharmD 2019) presided over the induction ceremony.
Summer Undergraduate Research Fellowship The 2017 Summer Undergraduate Research Fellowship (SURF) program concluded on October 26 with a research poster session and awards banquet. SURF is a competitive, application-based program that pairs undergraduates with faculty mentors for an intensive 10-week research experience. Nicholas Jakowenko, Thomas Lavoie, Brenna McKaig, Isabella Newbury, Stephanie Scalia, Siphra Tampubolon, Karin Tenglin, Phong Tran, and Phuong Tran successfully completed the program as Research Scholars, under the mentorship of eight faculty members and the supervision of the SURF Advisory Board (Drs. Ned Barden, Stephen Kerr, Timothy Maher, Michelle Ceresia, and Hongwei Zhang, and Prof. Steven Crosby). The Research Scholars completed projects in the disciplines of pharmacology, pharmaceutics, medical humanities, biomedical informatics, behavioral neuroscience, public health, and critical care pharmacotherapeutics. Brenna McKaig, Isabella Newbury, and Stephanie Scalia were selected as Research Scholar awardees for this program cycle. Dr. Alejandro Pino, Associate Professor of Pharmaceutical Sciences, received the 2017 SURF Program Research Mentor Award.
Faculty Updates Caroline S. Zeind, PharmD, Interim Vice President and Provost for Academic Affairs, and Michael G. Carvalho, PharmD, Assistant Dean of Interprofessional Education, Professor and Chair of Pharmacy Practice, Boston Campus, served as chief co-editors of the 11th Edition of Applied Therapeutics: The Clinical Use of Drugs (formerly known as Koda-Kimble and Young’s Applied Therapeutics) published by Wolters Kluwer in December 2017. Assisting Drs. Zeind and Carvalho were many members of the School of Pharmacy-Boston faculty who contributed as section editors, chapter authors and co-authors, and
Above, members pictured at the Phi Lambda Sigma ceremony.
interprofessional case authors and co-authors. Among these were Michael C. Angelini, Associate Professor of Pharmacy Practice; Mary G. Amato, Professor of Pharmacy Practice, Program Director of MS Clinical Research, and Fellowship Coordinator, Brigham & Women’s Hospital/MCPHS University Fellowship; Snehal H. Bhatt, Associate Professor of Pharmacy Practice; Judy W. Cheng, Professor of Pharmacy Practice; Michelle Ceresia, Associate Professor of Pharmacy Practice; R. Rebecca Couris, Professor of Nutrition Science and Pharmacy; Steven J. Crosby, Assistant Dean of Student Engagement & Success and Associate Professor of Pharmacy Practice; Suzanne Dinsmore, Assistant Professor of Pharmacy Practice; Erika Felix-Getzik, Associate Professor of Pharmacy Practice; Joseph W. Ferullo, Associate Professor of Pharmacy Practice; Jennifer Goldman, Professor of Pharmacy Practice; MaryKathleen Grams, Director of the Post BS Pharmacy PharmD Pathway; Philip Grgurich, Assistant Professor of Pharmacy Practice; Christy S. Harris, Associate Professor of Pharmacy Practice; Timothy R. Hudd, Associate Professor of Pharmacy Practice; Susan Jacobson, Associate Professor of Pharmacy Practice; Maria D. Kostka-Rokosz, Assistant Dean of Academic Affairs and Professor of Pharmacy Practice; Susan A. Krikorian, Professor of Pharmacy Practice; Trisha LaPointe, Associate Professor of Pharmacy Practice; Matthew Machado, Associate Professor of Pharmacy Practice; Michele Matthews, Associate Professor of Pharmacy Practice; William McCloskey, Professor and Vice-Chair of Pharmacy Practice; Amee Mistry, Associate Professor of Pharmacy Practice; Oussayma Moukhachen, Assistant Professor of Pharmacy Practice; Yulia 31
From the Colleges
continued
Murray, Assistant Professor of Pharmacy Practice; Stefanie C. Nigro, Assistant Professor of Pharmacy Practice; Phung On, Assistant Professor of Pharmacy Practice; Dhiren K. Patel, Associate Professor of Pharmacy Practice; Dorothea C. Rudorf, Professor of Pharmacy Practice; David Schnee,
Associate Professor of Pharmacy Practice; Richard J. Silvia, Associate Professor of Pharmacy Practice; Loriel Solodokin, Assistant Professor of Pharmacy Practice; and Kathy Zaiken, Professor of Pharmacy Practice.
Massachusetts College of Pharmacy and Health Sciences – Worcester/ Manchester Dear Colleagues, After a successful fall 2017 semester, our spring 2018 semester is well underway. As the P1 students begin exploring the opportunities offered by the pharmacy profession, the P2 students tackle Pharmacotherapeutics and Pharmacology and look forward to choosing their APPE sites for the next academic year. The P3 students, now halfway through their APPE rotations, are exploring residency, fellowship and employment options following graduation in May. But as you can see from the updates below, our faculty have been keeping just as busy as our dedicated, enthusiastic students! Enjoy the updates, and I wish you all a successful spring semester. Anna K. Morin, PharmD Dean and Professor of Pharmacy Practice
Faculty Grants
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Terrick Andey
Terrick Andey, Assistant Professor of Pharmaceutical Sciences, has received funding from the 2017-2018 AACP New Investigator Award for his proposal titled “Nanoparticle Delivery Platform for Dual Targeting
of Triple Negative Breast Cancer.” The award process involves a highly competitive peer-reviewed process; Dr. Andey is one of only sixteen research projects nationwide to receive funding for 2018.
ASHP Midyear Clinical Meeting Presentations Faculty and students from the class of 2018 collaborated to present twenty-nine posters at the 2017 ASHP Midyear Clinical Meeting that took place in Orlando, Florida on December 3-7. The posters covered a wide variety of topics; below are some exemplary titles: Audrey A. Abelleira, PharmD Candidate; Amanda M. Morrill, PharmD, BCPS Assistant Professor of Pharmacy Practice; Cheryl Abel, PharmD, Associate Professor of Pharmacy Practice; Carroll-Ann Goldsmith, DSc, Professor of Pharmaceutical Sciences. Demographic differences in perception and utilization of tobacco cigarette smoking cessation methods: a pilot study. Khadija T Kubra, PharmD Candidate; Kimberly Hor, PharmD Candidate; Zi Yang He, PharmD Candidate; Katherine Carey, PharmD, BCACP, Associate Professor of Pharmacy Practice. Vitamin D deficiency and statin-induced myopathy-a review of the evidence. Kimmi Cheung, PharmD Candidate, Regina Cabrera, PharmD Candidate, Evan R. Horton, PharmD, BCPPS, Associate Professor of Pharmacy Practice. Using modern technology to tackle the opioid epidemic: a review of mobile apps as accessible self-help resources. Abubker Omaer, PharmD Candidate; Ali Alqarni, PharmD candidate; Carlos X Randulfe Batista, PharmD Candidate;
Pharmacy Journal of New England • Winter 2018
Robert B Campbell, PhD, Associate Professor of Pharmaceutical Sciences. Drug resistance in prostate cancer treatment: Best practices to overcome the barrier function.
Interprofessional Education Highlight The following faculty were highlighted in the AACP Pharmacy Practice Section Newsletter for “IPE Initiatives to Enhance Student Participation for Introductory Pharmacy Practice Experiences”: Karyn Sullivan, Gretchen Jehle, Nicole Carace, Cheryl Abel, Amanda Morrill and Kaelen Dunican.
Faculty Presentations George Acquaah-Mensah. Continuing Education Presentations to the Antigua and Barbuda Pharmaceutical Society and the Antigua and Barbuda Medical Association. November 2017 (Antigua): •
2 Fill or Not 2 Fill: A Painful Dilemma
•
Advances in Pain Management
Linda Spooner, Martin MM, Deming P. Ready or not, here it comes: Updates for management of hepatitis C virus across practice settings. Continuing Education Presentation. ASHP Midyear Clinical Meeting. December 2017. Timothy Aungst. What you need to know: Medical apps in the inpatient setting. Platform Presentation.ASHP Midyear Clinical Meeting. December 2017 (Orlando, FL) Paul Kaplita, Alok Sharma. Virtual experimental pharmacology elective course in a pharmacy school program. Poster Presentation. Magna Teaching with Technology Conference. October 2017 (Baltimore, MD)
Faculty Publications
Students Michael Seigars and Zu Yang He present at the ASHP Midyear Clinical Meeting.
Aungst TD, Smith C. Using mobile tools to improve pharmacy productivity. ASHP. eBook 2018. 978-1-5828-571-6. Deming P, Spooner LM. Specialty considerations in management of hepatitis C. Pharm Today 2017;23(11):55-64. Durand C, Bylo M, Howard B, Belliveau P. Vancomycin dosing in obese patients: special considerations and novel dosing strategies. Ann Pharmacother 2017; Published online December 21, 2017. Massey C, Aungst TD, Evans P, Bartlett D, Silva MA. Cost savings impact of a pharmacist-initiated teleservice program for Medicare Part D reviews. J Am Pharm Assoc 2017;58(1): 56-60. Morrill AM, Abel CA, Januszewski M, Chamberlain B. Community education by advanced pharmacy practice experience students: increasing electronic cigarette awareness amongst teens. Currents in Pharmacy Teaching and Learning 2017;9(6):1147-1150.
Abraham GM, Spooner LM. Citrus, altius, fortius: the new paradigm in the treatment of chronic hepatitis C disease. Clin Infect Dis 2018;66(3):464-474. Adabor ES, Acquaah-Mensah GK. Machine learning approaches to decipher hormone- and HER2-receptor status phenotypes in breast cancer. Briefings in Bioinformatics 2017; doi:10.1093/bib/bbx138.
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From the Colleges
continued
University of New England UNE’s Rachel Naida Gives Diabetes Management Tips in Journal Tribune Rachel Naida, Pharm.D. ‘13, assistant clinical professor in the College of Pharmacy, has been published in the October 29 issue of the Journal Tribune. In the piece, Naida outlines strategies for diabetes management during the winter and holiday season.
“A 10.5 percent failure rate on medical products is unacceptable anywhere in the world. And that threat is growing, not diminishing, because it is a huge underground industry, a very profitable criminal industry that is even threatening our secure drug supply chain in the United States,” McCall said. Rachel Naida, PharmD.
“Multiple studies have demonstrated a relationship between the change in seasons and an effect on blood sugar control in both type 1 and type 2 diabetes, in all age groups, sexes and races,” wrote Naida. “These studies most strongly demonstrate that the results of patients’ hemoglobin A1C (HgA1C), a test that measures how well controlled your sugars are over a three-month time period, are the highest in the winter and the lowest in the warmer months.” This research supports the idea that people with diabetes experience less control of their blood sugars in the winter months. To maintain control of diabetes during the winter, Naida recommends keeping up with exercise, eating a balanced diet and consistently testing blood sugar.
UNE’s Kenneth McCall Interviewed for NPR Article on Falsfied Medications In a report released November 28, 2017, the World Health Organization revealed that an estimated “1 in 10 medical products circulating in low- and middleincome countries is Kenneth McCall, PharmD. either substandard or falsified.” Furthermore, the findings detailed that there is an estimated 34
10.5% failure rate in all medical products used in low- and middle-income countries. Kenneth McCall, BSPharm, Pharm.D., CGP, associate professor for the Department of Pharmacy Practice, weighed in as an expert on the topic, discussing the implications of this failure rate with NPR.
McCall, who is on the board of directors for the Partnership for Safe Medicines (PSM), works with the organization to protect consumers against counterfeit, substandard or otherwise unsafe medicines. Recently, the group connected dangerous counterfeit pain medications laced with fentanyl, which is 50 times more powerful than heroin, to deaths in 12 U.S. states. “We know that it’s contributing to the opioid crisis in the United States,” says McCall.
UNE Pharmacy Students Advance to Final Round of Clinical Skills Competition Class of ’18 pharmacy students Kayla Harris and Shea Ryan placed sixth in the 75th American Kayla Harris and Shea Ryan Society of Health-System Pharmacists’ (ASHP) Midyear Clinical Skills Competition, held December 3-7 in Orlando, Florida. This marked the first time that the UNE team reached the final round of competition. The clinical skills competition (CSC) encourages and recognizes excellence in clinical skill development. It entails analysis of a case study, where pairs of pharmacy students demonstrate their ability to provide direct patient care in a collaborative practice alongside physicians.
Pharmacy Journal of New England • Winter 2018
The 2017 case study required students to develop a care plan for the treatment of Community Acquired Pneumonia (CAP) in a patient with severe Chronic Obstructive Pulmonary Disease (COPD). They were expected to address the primary cause of the patient’s admission, as well as provide a treatment plan for all additional health concerns that should be addressed. “The most difficult aspect was the two-hour time constraint,” said Harris and Ryan. “We worked as quickly as possible, trying to swiftly reach consensus about treatment, use resources for aspects of care we were uncertain about and compose our plan as neatly and thoroughly as possible.” In the final round, teams presented a two-minute proposal of care before the judging panel. Judges then had time to ask questions about the case and the team’s specific care plan.
metabolic side effects of atypical antipsychotic medications: Central vs. direct effects,” Houseknecht’s talk focused on her groundbreaking research of antipsychotic medications. Atypical antipsychotic (AA) drugs, including risperidone (RIS), are used to treat schizophrenia and bipolar disorder, and some are approved to treat irritability associated with autism in children. Although AA drugs were initially developed to minimize neurological side effects caused by typical antipsychotic drugs, AA drugs have been found to have significant side effects. Houseknecht and her team are the first to have published a study focusing on risperidone’s impact on bone cells and skeletal changes.
UNE’s Lauren Payne Published in Critical Care
“The competition was challenging, requiring us to dig deep into our therapeutic knowledge, manage time effectively, work together seamlessly and provide a succinct, compelling argument for our decisions,” Harris and Ryan said. “This was a fantastic opportunity to work as a team, cultivating skills that will benefit our future careers in pharmacy.”
UNE’s Karen Houseknecht Gives Keynote Speech at International Pharmacology Conference On December 14, 2017, Karen Houseknecht, Ph.D., professor of pharmacology in the University of New England College of Osteopathic Karen Houseknect, PhD Medicine and interim dean of the University of New England College of Pharmacy, presented the keynote address at the International Conference on Toxicology and Pharmacology. Held in Rome, Italy, the conference brought together leading principle investigators, pharmacologists, toxicologists, clinicians, CRO’s, biotech and pharmaceutical industry professionals to discuss the evolution of the health care, medicinal and clinical trials.
Lauren Payne, PharmD.
Lauren Payne, Pharm.D. ’14, assistant clinical professor in the University of New England Department of Pharmacy Practice, has been published in Critical Care, an international, peer-reviewed clinical medical journal.
The journal aims to improve the care of critically ill patients and provide a comprehensive overview of the field. Payne’s manuscript, titled “Cefepime-induced neurotoxicity: a systematic review,” outlines her team’s research of Cefepime, a widely used antibiotic. This antibiotic has been shown to have neurotoxic effects, attributed to its ability to cross the blood–brain barrier. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, seizures and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Through their research, Payne and her collaborators aimed to to characterize the clinical course of cefepime neurotoxicity and response to interventions. Payne served as the corresponding author of this publication, which was written in collaboration with individuals from Maine Medical Center/ Maine Medical Partners Neurology.
Titled “Mechanisms underlying adverse endocrine and 35
From the Colleges
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Study by UNE’s Edward Li Published in Leading Specialty Pharmacy Journal The Journal of Managed Care and Specialty Pharmacy has published research by Edward Li, M.P.H., BCOP, professor in the College of Pharmacy. Ernesto Lobaina (COP, ’19) served as a co-author of the study.
Edward Li, MPh, BCOP
Their study is titled “Application of the FDA biosimilar extrapolation framework to make off-label determinations.” Through the FDA’s extrapolation framework, a biosimilar can obtain licensure for indications not explicitly studied in the context of a clinical trial. This structure enables conclusions from studies in one population to make inferences in other populations. In their manuscript, Li and Lobaina describe the FDA extrapolation framework for evaluating whether there are any differences in the mechanism of action, pharmacokinetics/ biosdistribution, immunogenicity and toxicity between on-label and off-label indications. They conclude that in some cases, the use of biosimilars for off-label indications can be scientifically justified.
UNE’s Daniel Brazeau Receives Lecture Award from International Academic Honor Society Chapter
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Founded in 1922, Rho Chi is an international honor society for pharmaceutical sciences. Its mission is to encourage high scholastic achievement and fellowship among pharmacy students and to promote the pharmaceutical sciences. Each year, Creighton University’s Rho Chi chapter identifies a nationally recognized leader working to advance the mission and goals of the profession of pharmacy to receive this prestigious award. Brazeau was selected for his work in bringing pharmacogenomics into the curriculum of pharmacy schools. As a member of the Department of Pharmaceutical Sciences at the University at Buffalo, he was asked to design and implement a new required pharmacogenetics course for the pharmacy school. His class subsequently became the first pharmacogenetics course to be offered in any school of pharmacy. Today, UNE is among the few schools in the nation to offer a comprehensive, required course in pharmacogenomics among schools of pharmacy. In addition to his work in pharmacogenetics, Brazeau was a co-founder and chair of the Pharmacogenetics Special Interest Group in the American Association of Colleges of Pharmacy (AACP). He currently serves as chair-elect on the AACP Council of Faculties and is on the board of directors. Brazeau was presented with the honor February 16. He gave a talk before faculty and students and participated in the induction celebration for new members of Rho Chi.
UNE’s Srinidi Mohan Publishes Manuscript in ‘Amino Acids’
Read the study
Daniel Brazeau, PhD
Professions Rho Chi Lecture Award.
Daniel Brazeau, Ph.D., director of genomics research core, research associate professor in the College of Pharmacy and College of Osteopathic Medicine, has received the Creighton University School of Pharmacy and Health
Srinidi Mohan, Ph.D., assistant professor in the University of New England College of Pharmacy, has been published in Amino Acids for his breast cancer research. Mohan has received a provisional patent for his innovation, which uses a marker in the blood to detect the presence of highly aggressive tumors and to help track cancer growth. Discovered while studying nutritional supplements, Mohan found that the marker Nw-hydroxy-L-Arginine (NOHA) was both a sensitive and reliable indicator for estrogen receptornegative (ER–) tumors, found in the most aggressive types of breast cancer.
Pharmacy Journal of New England • Winter 2018
Currently, no reliable blood-based marker exists for estrogennegative breast tumor prognosis and/or disease monitoring. In his ongoing study, Mohan will focus on developing NOHA as a less-invasive, blood-based indicator for sensitive estrogennegative breast tumor prognosis in racially distinctive populations. It will be used for early detection, screening and tumor management. Mohan’s UNE research team includes Class of ’18 pharmacy students Ian Greenstein, Cathy Ng, Kelly Frazier and Giang Nguyen, with technicians Lisa Harding, B.S., and David Barlow, B.E.
Srinidi Mohan, PhD
Read the manuscript in Amino Acids
UNE Pharmacy Students Partner with Apothecary by Design for Independent Service Project Students in the Health Care Quality and Safety in Pharmacy Practice course have completed the final phase of their independent study: creating an updated patient satisfaction survey for Apothecary By Design (ABD). Led by faculty advisor Leslie Ochs, Pharm.D., Ph.D., MSPH, assistant professor in the College of Pharmacy, Class of ’19 pharmacy students A.J. Golash, Huong Nhan and Sara Stafford gained an in-depth understanding of the importance of healthcare quality and safety in pharmacy practice.
researched literature to determine appropriate survey response scales and questions, as well as healthcare industry standards for patient satisfaction surveys and ways to improve response rates. They also worked to incorporate the Net Promoter Score, a cross-industry standard, into the updated survey. Once approved, the survey was mailed to over 6,000 ABD patients. The pharmacy will now be implementing this updated version as a way to gauge patient satisfaction and improve quality of care. Members of the ABD project team included Kirsten Burell, Pharm.D., clinical pharmacist; Cidnee Carrigan, Pharm.D., PGY1 pharmacy resident; Kyra Chamberlin, M.S., RN, vice president of Clinical Operations; Khaly Huynh, CPhT, data analyst and Cherie Wiley, director of Quality Management.
Pictured at left: Leslie Ochs, A.J.. Golash, Sara Stafford, Huong Nhan worked on an independent study.
Working with a team of ABD healthcare professionals, Golash, Nhan and Stafford formulated a plan to update the pharmacy’s patient satisfaction survey. The students
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University of St. Joseph Message from the Dean Dear Colleagues: Greetings to All! We at University of Saint Joseph School of Pharmacy welcome 2018 with an even stronger sense of community. The collaborative efforts from faculty, staff, and many wonderful supporters are timely and unwavering. Let us continue our pursuit of promoting “best practices” while molding the next generation of influential pharmacy leaders! Happy New Year! Joseph Ofosu Founding Dean and Professor
for a new PGY-1 Residency at HOCC and was chosen as the engagement ambassador for his department. He received his Doctor of Pharmacy from the University “I am grateful for the opportunity to be a preceptor. I am thankful for the recognition for the work we put in and know that each and every preceptor is truly deserving. I consider it an honor to walk into my hospital and have the chance to help students develop clinical judgment and shape the way they practice Pharmacy,” said Blazawski. Masood-Sidebottom was awarded the Community Preceptor of the Year. She is currently a pharmacist for CVS Health and began working there as an intern in 2013. Over the last 4 years
News
she has progressed to the role of pharmacy manager. Masood-
The University of Saint Joseph (USJ) School of Pharmacy
is well respected, outgoing, and praised for her positive rela-
hosted its annual Preceptor of the Year Award Ceremony on Oct. 5, honoring Jon Blazawski, PharmD., and Kristen MasoodSidebottom, Pharm.D. As experiential education professionals, pharmacist preceptors teach students practice-related skills necessary to provide quality pharmacist care. In addition to serving as teachers, pharmacist preceptors mentor student
Sidebottom was a member of the inaugural class of 2014. She tionships with co-workers, customers, medical professionals, pharmaceutical representatives, and insurance providers. “I love teaching students and was always so amazing during my rotations how much my preceptors knew and were able to teach me and I’m glad I can return the favor. I also like being
pharmacists, promoting personal and professional growth.
able to tell my students I went to USJ and know what they are
“The Preceptor of the Year Continuing Education Event and
Mater for my dedication to the future pharmacists from USJ,”
Awards Program is one of my favorite nights of the academic year. It allows the School of Pharmacy the opportunity to
going through! I’m honored to be recognized from my Alma said Masood-Sidebottom.
personally thank the many preceptors who take the time to give back to the profession and educate the next generation of pharmacists,” said Jennifer Luciano, Pharm.D., director of Experiential Education. “This year’s recipients have continuously been strong supporters of the school and have supported both our introductory and advanced pharmacy practice experience students.” Blazawski was awarded the Institutional Preceptor of the Year. He is currently a pharmacist at the Hospital of Central Connecticut (HOCC) as both a clinical and oncology specialist. He received his Doctor of Pharmacy from the University of Connecticut and completed his PGY-1 Residency at Tripler Army Medical Center in Honolulu, HI. As a preceptor, he mentors and encourages students to reach their full potential. In the near future, he will be the oncology residency preceptor
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Above, pictured L to R: R Dean Joseph Ofosu, Dr. Kristin Masood-Sidebottom, Dr. Jon Blazawski, Dr. Jennifer Luciano, Dr. James G. Henkel, Associate Dean
Pharmacy Journal of New England • Winter 2018
Two of our P3 students, Adeel Kadeer and Paola Sandoval, did an amazing job presenting about the opioid epidemic and information on Narcan at the Midstate Medical Center for pharmacy week 2017!
Publications Banka SS, Thachil R, Levine AR, Lin H, Kaafarani H, Lee J. Randomized controlled trial of different aspirin regimens for reduction of niacin-induced flushing. Am J Health-Syst Pharm. 2017; 74:898-903 Cardinale M, Malm T, Owusu K. Blood Components, Plasma,
Above, pictured L to R: Adeel Kadeer and Paola Sandoval
and Plasma Products. Side Effects of Drugs (SEDA). 2017. DiPaula BA, Mohammad RA, Ayers P, Basalyga V, Burton A, Bush C, Farthing K, Marshal VD, Shah BM. Residents as preceptors and educators: What we can learn from a national survey to improve our residency programs. Currents in
Nounou MI, Ko Y, Helal NA and Boltz J; Adulteration and counterfeiting of online nutraceutical formulations in the US: Time for intervention?; Journal of Dietary Supplements, Oct 11 2017; PP. 1-16.
Pharmacy Teaching and Learning. 2018; 21-27.
Posters and Presentations
Manoukian O.S., Arul M.R., Sardashti N, Stedman T., James R,
Garcia-Colon Y, Blanck J, Podoloff J. Designing a pharmacist-
Rudraiah S., Kumbar S.G. Biodegradable polymeric inject-
led medication education discharge program in a neonatal
able implants for long-term delivery of contraceptive drugs.
intensive care unit (NICU). CSHP Annual Catch the Wave
Journal of Applied Polymer Science. 18 November 2017, DOI:
Conference. Cromwell, CT. November 2017.
10.1002/app.46068, pages 1-9.
Vulaj K, Riggott R, Falcetti T, Levine AR. Utilization of procal-
Stratton S., Manoukian O.S., Patel R., Wentworth A., Rudraiah
citonin to improve antimicrobial stewardship in pneumonia.
S., Kumbar S. G. Polymeric 3D printed structures for
ASHP Midyear Clinical Meeting. Orlando, FL. December 2017
soft-tissue engineering. Journal of Applied Polymer Science, 12 July 2017, DOI: 10.1002/app.45569, pages 1-13.
Donato J, Davies E, Levine AR. The impact of early initiation of clonidine on duration of dexmetomidine in patients with
Nounou MI, ElAmrawy F, El-Haddad G, ElGaddar O, ElYazbi
severe alcohol withdrawal syndrome. ASHP Midyear Clinical
A and Eshra A; “‘Comparative randomized crossover clinical
Meeting. Orlando, FL. December 2017.
study for the evaluation of erectile dysfunction medications via novel pentagon system.”; Current Drug Safety, 2018, Accepted, Under production. Abou-Taleb BA, Bondok M, Nounou MI, Khalafallah N and Khalil S; Are multisource levothyroxine sodium tablets marketed in Egypt interchangeable?; Annales d’Endocrinologie; December 2017.
Shin, Falcetti T, Levine AR. Patient characteristics associated with choice of oral anticoagulation in acute pulmonary embolism. ASHP Midyear Clinical Meeting. Orlando, FL. December 2017. Zeiner A, Burak M, Laskey D. Effect of Connecticut law requiring prescription drug monitoring program use on emergency department opioid prescribing habits: a single center
Helal N, Osami A, Helmy A, McDonald T, Shaaban L and
retrospective analysis. ASHP Midyear Clinical Meeting.
Nounou MI; Non-Viral Gene Delivery Systems: Hurdles for
Orlando, FL. December 2017.
Bench-to-Bedside Transformation; Die Pharmazie; Volume 72, Number 11 (November), 2017, pp. 627-693.
Weiner N, Burak M, Laskey D. Perception and practices of medication disposal among emergency department
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From the Colleges
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waiting room patients at a large urban academic center. ASHP Midyear Clinical Meeting. Orlando, FL. December 2017.
Invited Oral Presentations
Professional Accomplishments Dr. Andrea Leschak has been elected as president-elect of the Connecticut Chapter of the American Society of
Malm, T. Emerge from the Crowd: Interview Questions:
Consultant Pharmacists (CT-ASCP).
The good, the bad, the ugly. American College of Clinical
Dr. Andrea Leschak successfully completed the requirements
Pharmacy Annual Meeting, October 2017: Phoenix, AZ
to become a Board Certified Geriatric Pharmacist (BCGP).
Malm T, Falcetti T. Making the Perfect Poster and How to Tell People About It. Catch the Wave Greg Gousse Conference. Rocky Hill, CT November 2017
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