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  • 1. Spring 2012 / Volume 55, No. 2Scholarship ScrambleAugust 26, 2012Willows Run Golf Course, Redmond, WA Pg. 28 Special Features Member Northwest Pharmacy New Requirement for Highlight Convention CE Partcipants See page 8 See page 6 See page 27
  • 2. It’s your business. Only better.Understanding your business, and how every Leader® services and offerings help retail independent pharmacies:inch of your pharmacy makes money is • Improve reimbursementsessential during this critical time in our industry. • Streamline operations • Create alternate revenue streamsWith Leader®, our market-leading offering, we • Increase market shareare partnering with retail independents tohelp them be more successful now and into Seattle Distribution Center located at: the future. 801 C Street NW Auburn, WA 98001Become a partner today. Salt Lake City Distribution Center located at: 955 West 3100 South Salt Lake City, UT 84119 © 2009 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. Lit. No. 1LDR1280 (0409)
  • 3. WSPA Board of Directors President Julie Akers President-elect Brian Beach Immediate Past President Ron Williams Spring 2012/Volume 55, No. 2 Secretary/Treasurer Steve Singer Features board members Beth Arnold mEMBERSHIP 4 Kurt Bowen (Student) Why you should renew your membership Brenda Bray Northwest Pharmacy Convention 6 Jill Carrier (Technician) Don Downing member highlight 8 Shaelah Easterday (Student) Heather Ferguson Legislative and Regulatory Affairs Council News 10 Christopher Foley (Student) Legislative Update Melissa Hansen Andrew Heinz (Student) School News 12 Kirk Heinz Get the Latest WSU/UW Information Anne Henriksen Paul M. Iseminger (Technician) Greg Matsuura Amanda Norman (Student) departments and specials Mary Slate Williams (Student) Cindy Wilson Continuing Education 19 Roger Woolf Health Information Exchange 15 managing editor Rx and the Law 31 Kathleen Goodner Upcoming Events 32 Publisher The Washington Pharmacy is owned and published advertisers by the Washington State Pharmacy Association to provide information, news and trends in the profession of pharmacy. Opinions expressed by the Agility Recovery 31 contributors, whether signed or otherwise, do not Bi-Mart 30necessarily reflect the attitudes of the publishers nor Cardinal Health 2 are they responsible for them. Subscription rate is $24 per year domestic / $59 foreign (including first Good Neighbor Pharmacy 16 class postage.) McKesson 17 Per copy rate is $6. Pace Alliance 18 Washington Pharmacy ISSN (1539-1469) is published quarterly for $24 per year domestic / $59 Pharmacists Mutual 27 foreign including first class postage by Washington RxRelief 30 State Pharmacy Association at 411 Williams Ave. S, Renton, WA 98057. PERIODICALS Postage paid at Renton, WA and at additional mailing offices. Staff POSTMASTER Please send address changes to: Jenny Arnold, Director of Pharmacy Practice Development Washington State Pharmacy Association 411 Williams Avenue S Kathleen Goodner, PR & Communications Manager Renton, WA 98057 Danyal Henderson, Administrative Coordinator MISSION STATement The Washington State Pharmacy Association exists Dedi Hitchens, Director of Government Affairs to advocate on behalf of its members to ensure Maria Lieggi, Membership & Education Administrator pharmacy professionals are recognized, engaged and valued as essential to the health care team. Jeff Rochon, Chief Executive Officer Visit wspa’s website at www.wsparx.org
  • 4. Why you Should renew today! IT’S YOUR FUTURE STRENGTHEN YOUR SKILLS Health care is in a dynamic state of Opportunities abound for you as a WSPA change. Decisions impacting pharmacy member. Participate in quality conferences, are made all the time. As the adage goes, seminars, and workshops that will contribute “If you are not at the table, you are on the to your continuing education and professional menu.” The WSPA is your invite to the table. development. Attending WSPA events helps Since health care reform is implemented to build your network and meet key players at a state level, it is crucial that you are in pharmacy, while learning about new and engaged and involved in those decisions. upcoming therapies, products, services, issues and developments. The WSPA is your voice to advocate for advancing the profession and protecting Whether you are looking for high-quality, timely your livelihood. CE that is relevant to your practice, or you want to learn about best practices from experts in AMPLIFYING YOUR VOICE your specialty, the WSPA has something for you. WSPA advocates for the profession on MAKE CONNECTIONS numerous levels to: strengthen and expand our role in patient care; protect WSPA provides opportunities to meet and access to pharmacy-provided services network with people in the pharmacy and products; and reinforce the value of profession. When you join the WSPA, you have pharmacies in ensuring patient safety and the opportunity to join one or more practicemember only information quality health outcomes. academies to connect with professionals from similar practice settings that allows you to: WSPA works within multidisciplinary • Solve problemsWSPA is the source for news and information about committees, patient advocacy groups, • Share ideasthe pharmacy profession and the members it serves, regulatory agencies, public health • Move your practice forwardand routinely provides members with relevant, jurisdictions, other professionalvaluable and timely information on the latest safety, associations, health insurance payers and WSPA academies include:regulatory and legislative news. Members receive: employers. • Ambulatory/Community Practice • Health Systems• Access to “Members Only” online Resource On a legislative level, WSPA works within • Independent Pharmacy Centers for Audit Avoidance & Protection, LRAC to ensure lawmakers understand the • Long Term Care Handling of Hazardous Drugs, Billing for Patient pharmacy profession. • Students Care Services, Compliance and Regulations, • Technicians Medication Safety, Medicaid, Medicare, Labor and Industries Resource Centers, Pharmacy Security, Whatever your practice setting or background, Non-English Communication Tools and much WSPA offers plenty of resources to build a more powerful network of professionals in pharmacy• Timely and valuable information via email alerts who can serve as mentors and support. and Washington Pharmacy, the association’s quarterly magazine The Washington State Pharmacy Association• WSPA Career Center and Salary Survey offers a comprehensive suite of benefits and• Quality On Demand Online CE services that give members of all practice• If you are Washington State Legislative and settings and career levels the tools they need Regulatory Affairs Council (LRAC) member, to succeed. Take a look at all WSPA has to offer you will also receive LRAC updates. It’s easy to and join your colleagues who are dedicated to become a member! Just mark the LRAC box on pharmacy. Become a member today! the membership form Together we are stronger! Washington State Pharmacy Association 411 Williams Avenue SouthFollow the WSPA on Facebook, Twitter, and LinkedIn! Renton, WA 98057 425-228-7171 Fax 425-277-3897 4 Washington Pharmacy www.wsparx.org
  • 5. Washington Pharmacy 5
  • 6. NW Pharmacy ConventionThank You Convention Exhibitors and AttendeesT hank you to all who came to this year’s convention. We had nearly 500 participants! In addition to great weather, the weekend was filled with energized conversations, networking, CE opportunities, and of course, golf! A special thank you to our sponsors - AmerisourceBergen, Cardinal Health, and McKesson for their support. Also a big thank you to the nearly 60 exhibitors who participated.Mark your calendars for the 2013 convention - May 30 - June 2, 2013! You won’t want to miss it!Thank You 2012 Convention ExhibitorsAbbott Diabetes Care Rexam Prescription ProductsAHRQ Roche DiagnosticsAmerican Associated Pharmacies RX ReliefAmerican Regent Inc. RX Systems IncAmeridose RxPlus PharmaciesAmerisourceBergen ScriptProAmerisourceBergen Technology Smart FillAmylin Teva NeuroscienceBoehringer-Ingelheim, GmbH University of Florida OnlineCardinal Health Master of Science in PharmacyCareer Staff RX WalgreensCodonicsCP AdvantageCSL BehringCubist PharmaceuticalsDesigner GreetingsFred Meyer PharmacyGenelex - You ScriptHealth Engineering SystemsICU Medical, Inc.Idaho State Pharmacy AssociationIndependent Pharmacy CooperativeJanssen Pharmaceutical Companies of Johnson &JohnsonKirby LesterLegally MineLilly USA, LLCMcKessonMerck VaccinesMTS Medication TechnologiesNephron Pharmaceutical CorpNiproOmnicellOregon State University Management & HR Skills forPharmacists OnlineP.C.C.A.ParataPBA HealthPharmacists MutualPharmacy Software ReviewsPharMEDium Services, LLCPioneerRXQS/1Qualis Health 6 Washington Pharmacy
  • 7. Community PharmacyContributed by: National Community Pharmacists AssociationThe Adherence Challenge pharmacy. Maybe you think your patients are perfectly adherent and do not need any assistance. Try the following experiment— it won’t takeA dherence seems to be the buzzword these days, from think tanks long. such as the New England Healthcare Institute to our own shop here at NCPA. During his address at last year’s annual convention, Research tells us that the greatest opportunity to improve medicationthen-NCPA Executive Vice President and CEO Bruce T. Roberts, RPh, is- adherence is with patients who have diabetes, hypertension, depression,sued an adherence challenge to the profession. He said that as one of its hyperlipidemia, and asthma. We’ve chosen the top two prescribed medi-most crucial and basic functions, community pharmacists must advo- cations for each disease state and listed them in the box at right. Selectcate and promote to patients the importance of taking their medication one to three of the medications listed and check your pharmacy’s da-as prescribed. tabase or dispensing report to see how many patients are refilling their medications every 30 days, or as regularly as the prescription indicates.You might be thinking, “What’s in it for me?” or “Why should I careabout improving patient adherence?” As a society, we’re all affected by How did your experiment turn out? As you expected? Better or worse?non-adherence. The costs associated with non-adherence are stagger- Do you see potential for additional refills and improving your patients’ing, with our health care system being “taxed” $290 billion in avoidable health? Now would be a perfect opportunity to take note of a fewmedical spending every year when patients don’t take their medications names on the non-adherent list. The next time you see these patients,as prescribed. emphasize how important it is to take their medications regularly as prescribed and refill them on time. Try to find out if there is a larger issue.The health consequences of non- adherence are alarming as well. Areported 125,000 patients die annually of cardiovascular disease alone Alternatively, you could give these patients a call right now. As phar-as a result of non-adherence to prescribed medication. macists, it is our duty to promote the adherence that helps our patientsIt’s a perplexing and huge puzzle to grapple with and it won’t be solved maintain or improve their health. Your patients will respect and appreci-overnight, but we must recognize the critical role pharmacists play in ate the personal interest you show in their well-being.improving medication adherence and the beneficial opportunities thatfollow. Think about it: we are the medication experts and the most ac- Over the course of the next month, conduct this experiment with allcessible health care providers in the community. We serve as key touch medications on the list and see if you can practice at least two adher-points for patients and can effectively monitor their medication use as ence interventions a day. We think you’ll be impressed with the results.they move through the health care system. Do you have an adherence idea, tip, or program that is working in yourNCPA believes that attention to patient adherence must become the pharmacy? Let us know. Send an e-mail to adherence@ncpanet.org, orstandard of practice for pharmacists in the future, and we are working call 800–544–7447.toward achieving a goal we have set for our profession. It is our associa-tion’s vision that in five years the actions taken by community pharma- Diabetescists will result in measurable improvement in patient adherence. Glucophage (metformin) Actos (pioglitazone)So in every corner of the association, from student affairs to the govern-ment and legislative department, NCPA is taking strides to ensure that Hypertensionmedication adherence becomes a consistent practice for every pharma- Prinivil (lisinopril)cist. Lopressor (metoprolol)NCPA is committed to sharing clinical pearls, best practices, communica- Depressiontion tips, and the business case behind improving patient medication Lexapro (escitalopram)adherence. We’ll show you how adherence only takes a minute. Zoloft (sertraline)Take care of your patients and the rest will follow. It’s a win-win. HyperlipidemiaReprinted with permission from National Community Pharmacists Asso- Zocor (simvastatin)ciation in the July 2010 issue of America’s Pharmacist. For more informa- Lipitor (atorvastatin)tion about NCPA, visit www.ncpanet.org. AsthmaQuick Adherence Experiment Proventil-HFA (albuterol) Singulair (montelukast)E veryday medication adherence practices can take just a few min- utes, yet reap rewards for you and your patients. Reprinted with permission from National Community Pharmacists As- sociation in the August 2010 issue of America’s Pharmacist. For moreYou may wonder how to start addressing the adherence topic in your information about NCPA, visit www.ncpanet.org. Washington Pharmacy 7
  • 8. WSPA Member Highlight W SPA member, Dr. Nancy Hecox has been highlighted in 2012 by APhA as an Honorable Mention as an Immunization Champion and by the Washington State Public Health Association as a Health Champion for her outstanding work around immunizations. Nancy works at Tieton Village Drug who has partnered with Yakima Health District to provide free vaccines to children and adults in conjunction with the Yakima Health District. Tieton Village Drug, an independently owned pharmacy, was the first pharmacy in the state to become a Vaccine for Children then a Washington Vaccine Association provider. Nancy and Tieton Village Drug created the Vaccine for Adults program to provide free vaccine to uninsured and underinsured adults. Vaccines are administered on site and also through off site immunization clinics in businesses, schools, impromptu clinics, the local Mission, day care centers, senior citizen centers, long term care facilities, state fairs, boardrooms, treatment centers and nursing homes. This program protects community health by ensuring the uninsured and underinsured in the Yakima Valley have free access to an important service. When asked about her pharmacy service Nancy says “I am trying to provide a new delivery model, as most of these citizens can’t take time off of work to make a doctor’s appointment, pay for childcare and miss work for the most vital of all preventative healthcare. That is vaccines.” Nancy’s dedication to improving health goes beyond both immunizations and her community alone. She has published an article in the Journal of the American Pharmacists Association titled “Tuberculin skin testing by pharmacists in a grocery store setting.” Nancy has taken her experience providing TB testing to other pharma- cies to expand the number of pharmacists providing this service to their patients. This is a clear example of Nancy’s interest in better serving her patients by identifying needs, and overcoming barriers to solving prob- lems.Nancy is an Associate Professor of Pharmacology at Pacific Northwest University of Health Sciences College of Osteopathic Medicine. Nancy has been mar-ried to Ray Hecox for 32 years, who is willing to be her with vaccine clinics when necessary. Together they have a passion for serving their community. CALL FOR AWARD NOMINATIONS “Dont worry when you are not recognized, but strive to be worthy of recognition.” -Abraham Lincoln T he Washington State Pharmacy Association annually honors the accomplishments of deserving pharmacy professionals. The 2012 Award winners will be recognized at the Distinguished Awards Banquet during the WSPA Annual Meeting November 2-4, 2012 at the Great Wolf Lodge in Centralia, WA. We urge you to take a moment and nominate a colleague that you believe deserves to be recognized for their accomplishments. Awards include: • Bowl of Hygeia • Washington State Pharmacist of the Year • Washington State Health System Pharmacist of the Year Award Sponsored by Pfizer • Washington State Pharmacy Student of the Year • Washington State Pharmacy Technician of the Year • Washington State Distinguished Young Pharmacist of the Year Sponsored by Pharmacist Mutual • Bill Mueller Outstanding Mentor Award • David Almquist Award • Distinguished Leadership Service Award • Innovative Pharmacy Practice Award • Rodney D. Shafer Achievement Award • Cardinal Health Generation RX Champions Award For a list of previous award winners and award descriptions, please go to www.wsparx.org and click on “About WSPA” and “Awards”. Please complete the 2012 Award Nominations form and submit by August 27, 2012. We look forward to hearing from you! 8 Washington Pharmacy
  • 9. National News Contributed by: APhAHealth care teams with pharmacists best for The Community Preventive Services Task Force described the compo-hypertension nents involved in TBC as adding new staff or changing the roles of existing staff; forming teams that included the patient, the primary care provider,C ommunity Preventive Services Task Force gives team-based care for and other health professionals; and having the team support and share patients with high blood pressure its highest recommendation based responsibilities for hypertension care. Team activities included facilitating on reviews of nearly 80 studies. communication and coordination of care; enhancing use of evidence-based guidelines; establishing regular, structured ways to monitor patient prog-Pharmacists on patient care teams dealing with hypertension received a ress and schedule additional visits; and engaging patients actively in theirmajor boost recently when the Community Preventive Services Task Force own care with education, support, and other tools and resources.endorsed team-based care (TBC) including pharmacists to improve bloodpressure control. The task force, an independent, nonfederal, uncompen- Based on these findings, the task force called for "health care and publicsated group of public health and prevention experts appointed by the CDC health organizations [to] consider implementing a multidisciplinary team-director, gave the evidence supporting TBC its highest recommendation. based approach to improve the effectiveness of hypertension care for patients." The task force added that the benefits of TBC could also apply to"APhA and Americas pharmacists applaud the findings of the Community other heart disease risk factors, such as high cholesterol and diabetes.Preventive Services Task Force," said APhA Executive Vice President and CEOThomas Menighan, BSPharm, MBA, ScD (Hon), FAPhA. "Patients need all In addition, the Community Preventive Services Task Force credited theof us in health care to work together as a team focused on helping them CDC/CMS-led Million Hearts initiative, which incorporates TBC as a centralachieve the goals they set with their physicians and other providers on the component in preventing 1 million heart attacks and strokes by 2017. Theteam." task force noted that blood pressure control is one of the four health behav- iors targeted by the initiative using the acronym ABCS, along with aspirinBased on a review of nearly 50 studies conducted between 2003 and 2012 use, cholesterol management, and smoking cessation.as well as a systematic review of nearly 30 studies published in 2006, theCommunity Preventive Services Task Force concluded that TBC for patients "We celebrate CDCs support and the Community Preventive Services Taskwith high blood pressure increased the proportion of patients with con- Forces recommendations to use team-based care to improve blood pres-trolled blood pressure, decreased systolic and diastolic blood pressure, and sure control," said Rebecca Snead, BSPharm, Executive Vice President andimproved patient outcomes for diabetes and blood lipid levels. CEO of the National Alliance of State Pharmacy Executives. "Pharmacists are strong supporters of the Million Hearts initiative to achieve the goal ofThe teams investigated in these studies included a patient and a primary preventing 1 million heart attacks and strokes by 2017, and the task forcescare provider, with most adding a pharmacist, a nurse, or both. Only four recommendations will maximize the team-based care necessary to achievestudies did not incorporate a pharmacist or nurse. Pharmacists and nurses this goal."improved both systolic and diastolic blood pressure comparably, whilestudies including pharmacists significantly increased the proportion of "The affirmation that team-based care clearly improves patient outcomespatients who were able to control their blood pressure. makes our work to accelerate expansion of interprofessional education across all health professions even more timely and important," said Lucinda"Pharmacists have been building the capacity to provide enhanced care for Maine, PhD, BSPharm, Executive Vice President and CEO of the Americandecades while the system catches up," Menighan noted. "We have been Association of Colleges of Pharmacy (AACP). "AACP is pleased to providegratified by the mounting evidence and public notice that shows that when leadership to such initiatives."pharmacists get involved in medication use, costs go down and patientcare quality goes up. Today, we are eager to work with our colleagues in Reprinted with permission from the May 22, 2012 issue of APhA’s FocusXtramedicine and nursing to build the kinds of collaborative practices that most and Alex Egervary. For more information about APhA, visit their web site atbenefit our patients." http://www.pharmacist.com” Washington Pharmacy 9
  • 10. LRAC News By Dedi Hitchens, Director of Government Affairs T he Washington State Legislature has spent a great deal of time pharmacy and she is up for re-election. If you live in the Eatonville, Ort- trying to come to an agreement on how to balance the biennial ing, Rainier or Yelm area, please consider giving her you support. budget. Over the last two years, the Governor has called three special sessions resulting in the addition of three months to the legisla- Preparing for 2013 tive session. Here’s how it works: Washington State’s legislative cycle is LRAC has already begun the interim work to prepare for the 2013 Legis- two years long. Regular sessions begin the second Monday in January lative session. Issues of importance include Pharmacy Benefit Manager and alternate between 105 day and 60 day sessions. Special sessions are Transparency/Audit, anti-mail mandatory mail order legislation, includ- called by the Governor to address specific issues, usually the budget. ing pharmacists in the Legend Drug Act, allowing electronic prescribing There can be any number of special sessions within the two-year cycle, of controlled substances, and increasing penalties for crimes against and they can last no more than 30 days. pharmacies. Of the major budget issues that faced legislators, several were perti- To see my end of session bill report and my budget report on the nent to health care and impacted pharmacy. Considerations included 2011-13 Supplemental Operating Budget Washington State Lawmakers elimination of Medicaid prescription coverage for adults, implementing passed during Special Session, you can go to the WSPA website at www. prescription drug co-payments, and the elimination of the Basic Health wsparx.org. Plan. The Washington State Pharmacy Legislative and Regulatory Affairs Council (LRAC) successfully fought off those proposed cuts. If you have additional issues, please contact us. All issues will be consid- ered by the LRAC Steering Committee and the bills will be reviewed and During the 2012 Legislative Session, LRAC defended the profession approved by the LRAC Legislative Review Committee. against numerous bills and budget proposals that would have negative- ly impacted pharmacy. A bill introduced by the Department of Health November Elections (DOH) to increase your license fee by $25 annually to fund the Prescrip- This year we have the opportunity to vote in several elections. At a state tion Monitoring Program was introduced. While the WSPA has sup- level, we will be electing a new Governor. In addition, the entire Wash- ported the PMP and has helped to find other funding mechanisms, LRAC ington State House of Representatives and half of the State Senators are opposes this funding approach and was successful in getting the issue up for re-election. Federally, we have a Presidential election. tabled until next year. A budget proviso authorizing the Health Care Authority (HCA) to implement a competitive bidding process for generic We have had a few state legislators who stood out this year. Senator drugs was inserted in the House budget which potentially could have Mike Carroll, Republican from the Lakewood area (28th district), who sits led to HCA selecting one preferred generic drug for Medicaid clients for on the Senate Health and Long Term Care and Senate Judiciary com- specific diseases. Lawmakers didn’t get the opportunity to hear concerns mittees is a supporter of pharmacy bills. He sponsored our Pharmacy from stakeholders. This quickly became a priority during the Special Robbery bill and was instrumental in moving the bill out of the Senate. Session. When the final version of Washington State’s Operating Budget He has a tight race. Pharmacy needs “champions” in the legislature and was released, the competitive bidding provision was included in the Senator Carroll was our champion on our Pharmacy Robbery legislation. budget. LRAC switched gears and fired up our grassroots efforts. LRAC, WSPA, and NACDS sent out Action Alerts to members to urge Governor Representative Kirk Pearson, a Republican in the Monroe area (39th Gregoire to veto the provision in the budget. After weeks of meetings district), is running for a Senate seat. He sponsored our Pharmacy Benefit with the Governor’s staff, Fiscal Policy staff, and various legislators, the Manager (PBM) Transparency legislation and would be a great pharmacy Governor vetoed the generic competitive bidding process provision and supporter in the Senate. He said he is willing to continue to work on PBM signed the budget into law. This was a huge success for pharmacy. Thank transparency legislation. you to each of you who took the time to contact the Governor office! Lt. Governor Brad Owen has been an avid supporter of pharmacy issues. In addition to defensive efforts, LRAC saw an opportunity to work on He is a regular speaker at Pharmacy Day on the Hill in Olympia every advancing the recognition of pharmacists as care providers through year. He is approachable and his office is always open to LRAC. Please a bill requiring all Medicaid Managed Care plans to abide by certain give him your vote and a campaign contribution if you can. provisions including paying for certain chronically ill patients to receive a comprehensive medication review by a primary care provider. Work- A list of lawmakers who have gone above and beyond for Pharmacy is ing in conjunction with the Washington State Hospital Association, the available in the Advocate section of the WSPA website at www.wsparx. Washington State Medical Association, and a pharmaceutical manu- org. If you have any questions about your local legislator or where they facturer, LRAC respectfully asked the sponsor of the bill, Senator Randi stand on pharmacy issues, please do not hesitate to call me. I am more Becker, Republican from the 2nd District and Ranking Minority for the the happy to answer any questions. Senate Health Care Committee, if we could amend her bill to include Washington pharmacists. We shared the recent Report to the US Sur- LRAC is making great strides in Olympia. Please continue to support our geon General with Senator Becker highlighting the value of pharmacists efforts by maintaining your membership. If you haven’t joined, please do provided care services. She agreed to the amendment. This was a big so today. A lot of changes are going on with Health Care and you can bet step for pharmacists- gaining consensus with stakeholders on the role of there will be more to come. Get involved, support LRAC. pharmacists in patient care and chronic therapy management. Unfor- tunately, the Health Care Authority applied a substantial fiscal note and Thank you to all of you who have given your continued support to the killed the bill in committee. Senator Becker proved to be supportive of Washington State Pharmacy Legislative and Regulatory Affairs Council . 10 Washington Pharmacy
  • 11. School News personnel at a firefighter training center in Spokane. The first respond- T he College held its first ers training simulated a hospital wing collapsing due to heavy snow stand-alone commence- on roof and multiple injuries resulting. Faculty members Brenda Bray ment ceremony on May and Colleen Terriff teach emergency preparedness and response 4 at the Masonic Center in to third-year pharmacy students and emphasize the importance of Spokane. More than 1,000 pharmacists being involved in community-wide disaster planning and students, their families and exercises. A third faculty member – Megan Willson – helped stage a College faculty and staff were there. For the past decade, WSPA Member Greg Gibbons Named WSU WSU pharmacy graduates have 2011 Outstanding Alum by WSU College of attended the WSU Spokane ceremony and prior to that, the Pharmacy WSU Pullman ceremony. Both ceremonies are still options for those G graduates, but the College also created its own ceremony this year to be able to focus more attention on its students and pharmacy. WSPA reg Gibbons, Class of 1982, was recently named “Outstanding CEO Jeff Rochon and WSPA President Julie Akers administered the Alumnus of the Year” by the WSU College of Pharmacy. Greg Oath of a Pharmacist to the PharmD graduates near the end of the received the award in April at the WSU College of Pharmacy’s ceremony. annual “Donor Appreciation and Awards Night” held in Spokane. The Alumni of the Year Award was established to recognize a WSU Pharmacy alumnus whose contributions to the community and the health care A web cam has been set up for viewing the construction underway profession have brought distinction to the WSU College of Pharmacy. on the College’s new building in Spokane, which began last August. The web cam can be accessed from this page on the College’s web Greg is the owner of Gibbon’s Pharmacy site: www.pharmacy.wsu.edu/information/ in Toppenish, Washington, and is part of a newbuilding.html The College is on track multi-generational pharmacy family. His to move its Pullman facilities to Spokane father, Everett Gibbons, is a 1956 WSU by the end of the summer of 2014. pharmacy graduate. In 1982, after gradu- ation from the WSU College of Pharmacy, The College created a new position of Greg returned to Toppenish to work in his “Ombudsman for Students” and Associate dad’s pharmacy. He also worked at other Professor Mark W. Garrison was appoint- pharmacies in the area including the ed. Garrison will serve as an additional Indian Health Clinic and at a local hospital resource for students, allowing the College pharmacy. He was always working hard to to separate student support on admin- expand his base of knowledge about his istrative issues from student support on profession. academic issues, such as advising. Garrison has been a pharmacy faculty member For the past three decades, Greg has been since 1989 and recently finished a term as very involved in his community. He is a assistant dean for student services. He has member of the Yakima Valley Pharmacy received a “teacher of the year” award six Association, was named the Washington State Pharmacist of the Year in times, including the past four years. His appointment as ombudsman 2008, and is a member of the Cardinal Health Northwest Retail Advisory is effective through June 30, 2013. Committee. Greg has served as a member of the WSU College of Phar- College Dean Gary M. Pollack, who is also the vice provost for WSU macy Dean’s Advisory Council, and has played an instrumental role in ef- Health Sciences, was awarded $1.8 million in grants for recruitment forts to increase scholarship support for students. He and his family have of two new faculty researchers and for two pieces of critically needed been long time supporters of the College, and have recently established laboratory equipment from the Health Sciences and Services Author- an endowed scholarship for future pharmacy students. ity of Spokane County. Dr. K. Michael Gibson is one of the researchers and will be joining the College on July 1 from Michigan Technological For more information about the WSU College of Pharmacy, please con- University. Negotiations are underway with the second researcher. tact Communications Director Lorraine Nelson at lanelson@wsu.edu. Pharmacy students and faculty participated in a disaster training exercise in April with firefighters, paramedics, and search and rescue Washington Pharmacy 11
  • 12. School News At the UW School of Pharmacy graduation in June, Karen Craddick received the Alumni Professional Excellence Award. Stephanie Friedman received the Faculty Excellence Award. Pharmacy student Denise Ngo, ’14, and Associate Dean Nanci MurphySchool/Faculty News have received a Project CHANCE award from the American Pharmacists Association - Academy of Student Pharmacists and the Health ResourcesImpel Neurophama, a company started by Professor of Pharmaceu- and Services Administration. The $10,000 funding from the award willtics Rodney Ho, John Hoekman, PhD, ‘10, and a UW business school go to create a cardiovascular disease prevention project at Communityalumnus, was recently showcased in a ‘Pacific Northwest’ magazine Health Care in Lakewood, Wash.article about Seattle’s booming invention market. Impel is developing atechnology platform for nose-to-brain drug delivery. Graduate Student NewsIn June, Professor of Pharmaceutical Outcomes Research and Policy LouGarrison moderated a plenary session at the 17th International Meeting Medicinal chemistry grad student Jean Dinh and pharmaceutics gradfor the International Society for Pharmacoeconomics Outcomes and students Diana Shuster and Jenna Voellinger received Institute ofResearch (ISPOR) in Washington, D.C. The session focused on best prac- Translational Health Sciences TL1 Multidisciplinary Predoctoral Clinicaltices for the design, implementation and evaluation of performance- Research Training Awards.based risk-sharing arrangements. Medicinal chemistry grad student Shannon Kruse has been awardedClinical Professor of Pharmacy Micki Kedzierski and her students were an NIH National Institute of General Medical Sciences T32 Predoctoralprofiled on the magazine-style TV show ‘UW360’ for their work with Molecular Biophysics Training Grant.chemically dependent populations. The episode aired on UWTV andKOMO4 throughout the month of May. Medicinal Chemistry grad student Eri Nakatani received a prestigious University of Washington Magnuson Scholarship.Kelly Lee, Assistant Professor of Medicinal Chemistry, has been awarded PORPP grad student Heidi Wirtz received a two-year postdoctoral fellow-a five-year, $1.45 million grant from the NIH to study influenza virus ship in health outcomes from the PhRMA Foundation.membrane fusion. Amy Cizik, graduate student in the Pharmaceutical Outcomes ResearchThe UW/Hearthstone Pharmacy Education and Service Program (origi- & Policy Program, has received a UW Thomas Francis, Jr. Global Healthnally co-founded by Professor Emeritus of Pharmacy Joy Plein) will re- Travel Fellowship. Cizik will travel to Tanzania this summer to pilot test aceive the Leading Edge Care and Services Award from Aging Services of mobile phone application for surgical follow-up with surgeons from theWashington. The UW/Hearthstone service program is one in which UW Muhimbili Orthopaedic Institute.pharmacy faculty and students provide education and care to residentsof Seattle’s Hearthstone Continuing Care Community. WSPA Member Awarded UW 2011Sean D. Sullivan, Director of the School’s Pharmaceutical OutcomesResearch & Policy Program, has been named the Stergachis Family Distinguished Alumnus Award in PharmacyEndowed Professor and Director. The Stergachis Family Endowmentwas established in January 2012 and is named after Andy Stergachis, PracticeProfessor of Epidemiology and Global Health and Adjunct Professor of TPharmacy and his wife, JoAnn Stergachis. he School of Pharmacy’s 2011 Distinguished Alumnus Award inProfessor of Pharmaceutics Jashvant Unadkat has started a new venture Pharmacy Practice will go to a young pharmacist who has alreadyat the UW School of Pharmacy — the UW Research Affiliates Program made significant contributions to pharmacy technology, clinicalon Transporters. It is a cooperative effort between the school and phar- pharmacy and pharmaceutical outcomes research. Ryan Hansen is themaceutical research companies AstraZeneca, Genentech and Merck. vice president and director of technology at Kelley-Ross Pharmacy, theResearchers across the four institutions are collaborating on research president of a clinical pharmacy consulting business, and has recentlythat will facilitate drug development. completed his PhD in the School of Pharmacy’s Pharmaceutical Out- comes Research & Policy Program (PORPP).Pharmacy Student News “I am very humbled and honored to receive this recognition,” said Han-The UW student chapter of the American Pharmacists Association - sen. “I have so many colleagues who are also very worthy of this award.Academy of Student Pharmacists (APhA-ASP) won the Chapter Achieve- Joining this list of esteemed colleagues and alumni offers a welcomement Award in the AAA Division at the March APhA meeting in New challenge to my career.”Orleans. Hansen received his Doctor of Pharmacy degree in 2003. Prior to that, he graduated cum laude with a Bachelor of Arts in chemistry and phi-12 Washington Pharmacy
  • 13. School News losophy from Carroll College in Montana. He will graduate from PORPP increased care for patients. this spring with his dissertation investigating the association between sedative hypnotic insomnia treatments and motor vehicle crashes. “Since joining Kelley-Ross as an intern in 2000, Ryan Hansen has fundamentally changed our practice for the better,” said Ryan Oftebro, Hansen has played a key role in helping Kelley-Ross Pharmacy gain president and principal of Kelley-Ross. “His grasp of technology in recognition for its innovative pharmacy practice models. The phar- healthcare, business acumen and leadership have enabled Kelley-Ross macy operates one of the few community pharmacy-centered mail to grow and thrive. Ryans dedication and service to the profession service businesses in the country. This business allows Kelley-Ross sets an example for us all.” to compete directly with national mail service corporations in order to preserve the integrity of regional community pharmacy practice. As a consultant, Hansen is working with other pharmacies to help The result is a thriving business that serves local and regional clients them enhance their own technology initiatives. He also helps them interested in mail services. They have also created a practice model develop models and evaluations for improving cost effectiveness. that other community pharmacies can follow. Hansen works with UW pharmacy students at Kelley-Ross locations Hansen, who was named a 2010 Next Generation Pharmacist Technol- who are interested in applying and evaluating new technologies in ogy Innovator of the Year Finalist, led the implementation of robotic their practice settings. In addition, he teaches the material related to technology within Kelley-Ross. At its long-term care location, Kelley- pharmacy pricing and reimbursement in “Pharmacy, Health Care and Ross uses two robots that automate much of the dispensing services. Society,” a core PharmD course. This is not only making mail service pharmacy more cost efficient for clients; it is also giving pharmacists greater opportunity to provide Hansen has worked for many years in support of the technology initia- tives of the School of Pharmacy’s Bracken Pharmaceutical Care Learn- ing Center (PCLC). In this role, he works to enhance students’ access to state-of-the-art pharmacy technology. This past year, when the PCLC received new computers, he volunteered his time to help update the pharmacy management system’s computer network. Hansen and his wife, Keli, have also endowed a scholarship for incom- ing PharmD students. The Hansens are also long-time School of Phar- macy Dean’s Club members. In his role as a PhD candidate in PORPP, Hansen’s research interests in- cluded investigating the economic cost of opioid prescription misuse, evaluating pharmacotherapy options for treating epilepsy and model- ing treatments for chronic respiratory diseases. He has presented at conferences for the International Society for Pharmacoeconomics and Outcomes Research and the Agency for Healthcare Research and Quality, among others. He has been published in multiple journals, including the Clinical Journal of Pain and the American Journal of Health-System Pharmacy. “I have worked with countless pharmacists and students over my 30- plus years as a pharmacist and academic,” said Professor of Pharmacy and PORPP Director Sean Sullivan. “I have witnessed firsthand a variety of styles of work ethic, attitude, commitment and demeanor. Ryan exhibits the very best of all these attributes, and at such a young age. He embodies everything we should value and acknowledge in a distinguished alumni.” He will be presented with the Distinguished Alumnus Award by the School of Pharmacy and the Pharmacy Alumni Association at the Dean’s Recognition Reception on April 5 at the Museum of Flight in Seattle. Washington Pharmacy 13
  • 14. Grow your business, secure your future Why have nearly 2,900 independent pharmacies joined Health Mart? Because only Health Mart provides the managed care representation, branding, in-store programs, specialized Diabetes Life Center, national and local advertising support, and collective strength you need to: • Attract new customers • Maximize your relationships with existing customers • Enhance business efficiency WASHINGTON HEALTH MART LOCATIONS: Aberdeen DuPont Medical Lake St. John Aberdeen Health Mart DuPont Health Mart Medical Lake Owl Health Mart St. John Health Mart Bellevue Duvall Moses Lake Seattle Pharmacy Plus Health Mart Duvall Family Health Mart Southgate Pharmacy Health Mart Luke’s Health Mart TLC Integrative Health Mart East Wenatchee Newport Meridian Health Mart Eastmont Health Mart Seeber’s Drug Health Mart Brewster White Center Health Mart Brewster Health Mart Ellensburg Nine Mile Falls Downtown Health Mart Lake Spokane Health Mart Spokane Bridgeport Hart & Dilatush Health Mart Gross Drug Health Mart Elma Odessa Lidgerwood Owl Health Mart Elma Health Mart Odessa Drugs Health Mart Cashmere Spokane Valley Doanes Valley Health Mart Fairfield Olympia Halpin’s Health Mart Fairfield Owl Health Mart Medical Center Health Mart Cheney Tonasket Cheney Owl Health Mart Freeland Yauger Park Health Mart Roy’s Health Mart Lind’s Health Mart ©2011 Health Mart Systems Inc. All rights reserved. RTL-05726-12-11 Chewelah Port Angeles Twisp Valley Drug Health Mart Hoquiam Jim’s Health Mart Ulrich’s Valley Health Mart Crown Drug Health Mart Cle Elum Quincy Wenatchee Cle Elum Health Mart Kenmore Heartland Health Mart Wenatchee Clinic Health Mart Ostrom’s Drugs Health Mart Colfax Republic Woodinville Tick Klock Drug Health Mart Kettle Falls Republic Drug Store Health Woodinville Health Mart Kettle Falls Health Mart Mart Coupeville Yakima Lind’s Health Mart Leavenworth Richland Terrace Heights Health Mart Village Health Mart Malley’s Health Mart Davenport Tieton Village Health Mart Lincoln County Health Mart Join Health Mart today! 855.HLTH.MRT | www.healthmart.com14 Washington Pharmacy
  • 15. Health Information Exchange (HIE)Q&A on HIE prescriber New Possibilities for Health Information • Sending a current medication profile to a hospital admitting a patient Exchange (HIE), E-Prescribing and Beyond • Reporting immunizations to the Washington State immunization registry Contributed by Susan Teil Boyer, MS, RPh, HIE Consultant • Checking the immunization registry for a patient history of immunizations reported O ver the past two months WSPA and OneHealthPort, the state’s Health Information Exchange, gathered feedback during conversations with pharmacists around the state. As stated above, pharmacists who are part of the HIE can receive We talked with pharmacists about opportunities to use the HIE to Continuity of Care Document (CCD) for their patients. The Continuity improve quality of care and reduce administrative cost. Our primary of Care Document is the new standard for exchanging a patient record focus has been promoting e-prescribing to pharmacies in the state summary. It is designed to simplify what physicians share on a patient that have not yet adopted it. The HIE’s federal partner, the Office referral or other care transition. of the National Coordinator (ONC), has challenged us to improve Information contained in the CCD includes: e-prescribing participation to 97% of pharmacies throughout the • Basic Patient information nation in 2012. • Patient problems • Medications In the course of our conversations we found that pharmacists • Immunizations who are not e-prescribing have a number of concerns. Among • Alerts the top concerns are transaction costs, vendor costs to connect, • Vital signs completeness of the information, and lack of interest among the • Functional statistics pharmacies’ local prescribers. WSPA and OneHealthPort will be • Results working together to try and identify solutions for these concerns • Plan of Care and move forward on electronic prescription transmission. While e-prescribing is a key focus of our outreach effort, it is not the only reason for pharmacists to adopt HIE. As streamlined patient care becomes increasingly important and care teams, including pharmacists, become more prominent, the The HIE is a flexible and robust communication channel for HIE Community Referral and Consult Report offers an intriguing pharmacists to exchange clinical and business messages with other opportunity to package and share clinical information with your healthcare providers. Through the use of HIE, pharmacists are able prescriber colleagues. For example, you may report adverse effects of to quickly obtain information and improve the quality of patient care. a drug back to the prescriber, and the prescriber may refer a patient Examples of transactions that a pharmacy participating in HIE could for immunizations or blood pressure monitoring to you. The referral send and receive include: and consult tool is very flexible. Matched with the CCD and other information described above, this tool and the HIE have great potential • Receiving lab results to support the ongoing integration of pharmacists with their broader • Receiving Continuity of Care Document (CCD) with clinical community care teams. information • Receiving admission and discharge information from the For more information on these possibilities and opportunities you can nursing home for long term care pharmacies. contact us at OneHealthPort. • Community referral form, for the physician to request monitoring by the pharmacist http://www.onehealthport.com/HIE/index.php • Consult form, for the pharmacist to report back monitoring results, issues, concerns • Sending a consult report or continuity of care document to a Washington Pharmacy 15
  • 16. 16
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  • 19. continuing education for pharmacists Volume XXX, No. 4FDA Safety Warnings and Prescribing Updates: Simvastatin,Acetaminophen, Ondansetron, and DronedaroneMona T. Thompson, R.Ph., containing entity labeling has to muscle injury.PharmD always carried a risk of muscle Furthermore, 22 patients injury (myopathy), FDA issued a (0.4 percent) in the 80mg groupDr. Thompson has no relevant financial drug safety communication in June versus zero patients in the 20mgrelationships to disclose. 2011 making several restrictions, group developed rhabdomyolysis. contraindications, and dose limita- Rhabdomyolysis was defined as tions for simvastatin to reduce the unexplained muscle weakness orGoal. The goal of this lesson is to risk of muscle injury based on the pain with serum CK >40 times theprovide a review of significant U.S. agency’s ongoing safety review of upper normal limit. This adverseFood and Drug Administration therapy with high-dose simvasta- event can range in severity from(FDA) safety warnings and associ- tin. These recommendations are asymptomatic elevation of muscleated prescribing updates that were currently reflected in the updated enzymes to life threatening electro-recently issued regarding simvas- product information leaflets for all lyte imbalances, acute renal fail-tatin, acetaminophen, ondansetron, products. ure, multi-organ failure syndrome,and dronedarone. In 2010 nearly 30 million and death. prescriptions of simvastatin were The greatest risk of develop-Objectives. At the completion of dispensed from one generic manu- ing myopathy was observed in thethis activity, the participant will be facturer alone, ranking it 7th among first year of simvastatin 80mg dailyable to: the Top 200 medications dispensed. therapy. In addition, an increased 1. demonstrate an understand- It addition, in 2010 it was esti- risk of myopathy was seen in pa-ing of the safety warnings and mated that more than two million tients taking simvastatin 80mg inassociated prescribing changes, if Americans were prescribed what is combination with amiodarone.applicable, issued for each of the now considered an unsafe dose of Secondary to SEARCH and oth-entities discussed; simvastatin. er safety data, the revised recom- 2. determine the patient popu- Among the studies that led to mendation states that the previouslation at risk for adverse events in the new FDA recommendations highest approved dose of simvas-relation to the safety warnings for was the Study of the Effectiveness tatin 80mg should only be used ineach of the entities discussed; and of Additional Reductions in Choles- patients who have been taking this 3. identify fundamental patient terol and Homocysteine (SEARCH). dose for 12 months or more withoutcounseling points secondary to the The study was a seven-year, evidence of myopathy. Patientssafety warnings and associated randomized, double-blind clinical already taking lower dosages ofprescribing changes, if applicable, trial that compared the efficacy the drug should not be titrated tofor the entities discussed. and safety of simvastatin 80mg to the 80mg dose. If additional LDL simvastatin 20mg, with or without reduction is necessary, alternateSimvastatin vitamin B12 and folate in patients therapy is recommended.Simvastatin is an HMG-CoA who had survived a myocardial in- Atorvastatin 40mg and rosuva-reductase inhibitor (“statin”) that farction. In SEARCH, 53 patients statin 10mg are effective in reduc-was initially approved in 1991 as (1 percent) in the 80mg group ing LDL levels by 45 to 50 percentan adjunct to diet to reduce the lev- versus two (0.03 percent) in the which is comparable to simvastatinels of low-density lipoprotein (LDL) 20mg group developed myopathy, 80mg. Table 1 compares the rela-or “bad” cholesterol. It is marketed which was defined as unexplained tive LDL-lowering efficacy of avail-as Zocor® or in combination with muscle weakness or pain with a able statin agents at all doses.ezetimibe as Vytorin® by Merck. serum creatine kinase (CK) greater Myopathy is often the resultAbbott markets Simcor® which than 10 times the upper normal of simvastatin used in combina-contains simvastatin and extended limit. CK is a muscle enzyme tion with certain drugs includingrelease niacin. While simvastatin- which becomes elevated secondary CYP3A4 inhibitors. Therefore, Washington Pharmacy 19
  • 20. Table 1 Relative LDL-lowering efficacy of statin agents** Atorvastatin Fluvastatin Pitavastatin Lovastatin Pravastatin Rosuvastatin Simvastatin % LDL-C Reduction 40 mg 1 mg 20 mg 20 mg 10 mg -30% 10 mg 80 mg 2 mg 40 mg 40 mg 20 mg -38% 20 mg 4 mg 80 mg 80 mg 5 mg 40 mg -41% 40 mg 10 mg 80 mg -47% 80 mg 20 mg -55% 40 mg -63% **Adapted from FDA drug safety communication last updated December 15, 2011 the second part of the FDA safety tiazem, while the 20mg dose should crease the risk of adverse skeletal communication resulted in a not be exceeded with amlodipine, muscle effects. Lastly, simvastatin new simvastatin label with more amiodarone, or ranolazine. prolongs INR when used in com- stringent drug interaction and Also, large quantities of grape- bination with warfarin, rendering drug-drug dosing limits. Simvas- fruit juice should be avoided (>1 frequent INR monitoring when tatin is now contraindicated with quart per day). It is important to initiating or altering therapy. The itraconazole, ketoconazole, posa- note that several of these medica- most common adverse events re- conazole, erythromycin, clarithro- tions are prescribed together for lated to therapy are: upper respira- mycin, telithromycin, HIV protease the treatment of various cardiovas- tory infections, headache, abdomi- inhibitors, nefazodone, gemfibrozil, cular-related diseases, and health- nal pain, constipation, and nausea. cyclosporine, and danazol. The care providers may need to adjust Table 2 includes safety infor- 10mg dose should not be exceeded therapy to avoid drug interactions. mation for simvastatin to convey to in patients taking verapamil or dil- Merck launched a new website, patients. www.simvastatininfocenter.com, with information for patients about Acetaminophen Table 2 these changes. Acetaminophen or paracetamol Simvastatin Patient The simvastatin label contin- (N-acetyl-p-aminophenol or APAP) Safety Counseling Points ues to issue other contraindica- is the most widely used analge- tions, warnings, precautions, and sic and antipyretic agent in the • All patients starting simvastatin- monitoring recommendations that United States and the world. It is containing entities should be advised remain consistent and are worthy available over-the-counter (OTC) of the risk of myopathy, and should of review. Simvastatin is contrain- as a 325mg and 500mg immedi- be told to report promptly any unex- dicated in patients with active liver ate release tablet, and as a 650mg plained muscle pain, tenderness, or disease (or persistent unexplained extended release preparation mar- weakness. elevated hepatic transaminase keted for the treatment of arthri- • Patients using the 80mg dose levels), women who are pregnant tis. It is also available in several should be informed of the greater risk of myopathy. or may become pregnant (category infant and children’s formulations • Patients should be informed that X), and nursing mothers. Other consisting of chewable tablets, oral there are certain types of medications predisposing factors for skeletal suspension and elixir, as well as a that should not be taken in combina- muscle effects (myopathy and rhab- component of many OTC and pre- tion with simvastatin, and urged to domyolysis) include advanced age scription cold and analgesic combi- inform providers when a new medica- (>65), female gender, renal impair- nation products. tion is prescribed or when the dose of ment, and uncontrolled hypothy- Unfortunately, its commonality an existing medication is increased. roidism. Liver function tests (liver and comfort with use may have led • Patients should be advised to report enzymes) should be obtained prior to presumed safety among Ameri- any symptoms that may indicate liver injury such as fatigue, anorexia, right to initiation of therapy and semi- cans who are either not aware of upper abdominal discomfort, dark annually for the first year. More the maximum safety dose or who urine, or jaundice. frequent monitoring is warranted do not fully comprehend the extent • Women of childbearing age must for patients with elevated transam- of harm that is associated with use an effective method of birth inase levels until normalization oc- exceeding the safe dose. Therefore, control to prevent pregnancy while curs. Discontinuation should occur unintentional overdosing may oc- using simvastatin. If they become if ALT/AST is persistently >3 times cur in patients who are ingesting pregnant, simvastatin therapy should the ULN (upper limit of normal). multiple acetaminophen-containing be discontinued immediately. Women In addition to the drug interac- products. who are breastfeeding should not take simvastatin. tions listed above, fibrate products Acetaminophen is not always and niacin (>1gm/day) may in- clearly labeled as an ingredient20 Washington Pharmacy
  • 21. and the abbreviation “APAP” is with fulminant hepatic failure. new boxed warning on the risk ofsometimes used on prescription NAC may be administered orally severe liver injury be added to alllabels for medications that contain or intravenously. Among its sev- prescription products that containa narcotic and acetaminophen. eral protective mechanisms, it is a acetaminophen. Boxed warningsIn addition, there are various precursor of glutathione and, thus, are FDA’s most serious warn-strengths and concentrations of ac- increases the concentration of glu- ings. Drug companies were givenetaminophen formulations that are tathione available for the conjuga- three years, (until January 2014)marketed for infants and children tion of NAPQI. to make the necessary changes towhich may lead to dosing errors. In both 2009 and 2011, FDA limit the amount of acetaminophen The American Association of announced required labeling to 325mg per dosage unit. Alterna-Poison Control Centers reports that changes for acetaminophen-con- tively, they may choose to with-acetaminophen is one of the most taining products in an attempt to draw the product from the market.common pharmaceuticals associ- reduce the number of misadven- However, because several ofated with both unintentional and tures associated with its use. In these products are already avail-intentional poisoning and toxicity. April of 2009, FDA announced that able in multiple strengths, includ-In the United States, acetamino- it would require that by April 2010, ing 325mg, FDA is not anticipatingphen toxicity is the most common the ingredient “acetaminophen” that this requirement will affectcause of acute hepatic failure, and must be clearly identifiable on the patient care or the options avail-is the second most common cause packaging so that consumers can able for pain management.of liver failure requiring transplan- easily recognize the active ingredi- In addition, FDA is askingtation. ent for all OTC preparations. companies to add a new warning The pathophysiology of hepato- Second, all OTC labels now regarding severe allergic reactions,cellular damage as a result of acet- contain warnings that highlight including anaphylaxis. While rare,aminophen toxicity is based on the the potential for liver toxicity and swelling of the face, mouth andproduction of the toxic metabolite warn consumers against using throat, difficulty breathing, itching,of acetaminophen called N-acetyl- more than the recommended dose and rash have been reported withp-benzoquinone imine (NAPQI). of acetaminophen, using multiple APAP use.NAPQI has a short half-life and, products that contain acetamino- It is important to note thatonce it’s conjugated with glutathi- phen, and for consuming moder- at the time of writing this lesson,one, is renally excreted. However, ate amounts of alcohol along with FDA had not made any additionalunder conditions of an acute acet- acetaminophen. changes to the dosing of OTCaminophen overdose or when the In January 2011, FDA an- acetaminophen products. How-maximum dose is exceeded over a nounced that it was asking manu- ever in the fall of 2011, McNeilprolonged period of time, NAPQI is facturers of oral prescription acet- Consumer Healthcare (the manu-produced in excess of the available aminophen combination products facturer of Tylenol®) revised theglutathione levels. Hence, NAPQI (not intravenous) to limit the maxi- Extra Strength Tylenol® label. Itcovalently binds to hepatocellular mum amount of acetaminophen in now contains new dosing instruc-proteins initiating a cascade of these products to 325mg per tablet, tions lowering the maximum dailyoxidative damage, mitochondrial capsule, or other dosage unit. FDA dose for the single-ingredient paindysfunction, hepatocellular injury, provides the rationale that by lim- reliever from eight tablets per dayand liver necrosis. iting the amount of acetaminophen (4,000mg) to six tablets per day Toxicity is associated with a in oral prescription products per (3,000mg). The dosing intervalsingle ingested dose of 150mg/kg dosage unit, patients will be less has also changed from two tab-or approximately 7 to 10 grams likely to overdose if they mistak- lets every four to six hours, to twoAPAP in adults. Toxicity may occur enly ingest too many doses. tablets every six hours. The lowerat lower doses in circumstances Because all oral prescription maximum dose is expected to be onof chronic alcohol use, diminished products containing acetaminophen the labeling of Regular Strengthnutritional status, and viral illness also contain an additional anal- Tylenol® sometime in 2012. Thewith dehydration. gesic (most often an opioid) and company also states that they are When dosing recommendations because there are no data to indi- working closely with other manu-are adhered to, the risk of hepato- cate that taking more than 325mg facturers of acetaminophen prod-toxicity is extremely small. For- of APAP per dosage unit provides ucts to help ensure consistency intunately, N-acetylcysteine (NAC) more pain relief, this change is not dosing instructions.is an available antidote. While expected to greatly reduce the pain There are significant changesit is maximally hepatoprotective management effectiveness of these to liquid acetaminophen marketedwhen given within eight hours of drugs. The dosage limit will not for infants which were announcedan acute APAP ingestion, it has affect the dosing directions for the by FDA in December 2011. An ad-been shown to decrease mortality same products. ditional concentration (160mg/5ml)rates in late-presenting patients FDA is also requiring that a is now available made to coincide Washington Pharmacy 21
  • 22. made in an effort to reduce the be associated with abnormal heart Table 3 risk of accidental acetaminophen rhythms. This was issued second- Acetaminophen Patient overdosing. The document can be ary to ongoing safety reviews and Safety Counseling Points found at: www.fda.gov/downloads/ has led to interim changes to the ForConsumers/ConsumerUpdates/ drug label. • Advise patients to continue tak- UCM239891.pdf. Patient safety In addition, GlaxoSmithKline ing their prescription pain medicine information is included in Table 3. is being required to conduct a thor- as directed. There is no immediate ough QT study to assess the poten- danger to patients who take oral Ondansetron (Zofran) tial for the drug to prolong the QT prescriptions containing greater than Ondansetron was developed and interval. These results are expected 325mg of acetaminophen. marketed by GlaxoSmithKline in the summer of 2012 and may re- • Counsel patients who have multiple acetaminophen-containing prescrip- under the trade name Zofran®, and sult in additional labeling changes. tions about the risk of severe liver was initially approved by FDA in A long QT interval results when injury associated with toxicity. 1991. It is an antiemetic agent myocardial repolarization does not • Inform patients of the new dos- in the selective 5-HT3 receptor work normally. It is defined as a ing instructions for Extra Strength antagonist class which works by QT interval >470ms for postpuber- Tylenol®. blocking the action of serotonin, a tal males and >480ms for postpu- • The 160mg/5ml liquid acetamino- natural substance that is linked bertal females. The syndrome can phen marketed for infants may with nausea and vomiting. be congenital or acquired (e.g., side be packaged with an oral syringe Current FDA-approved indica- effect of medication, hypokalemia, instead of a dropper. Parents and caregivers should only use the device tions include prevention of nausea hypomagnesemia). provided with the product to measure and vomiting associated with mod- Patients with a prolonged QT the dose. Do not mix and match dos- erately to highly emetogenic cancer interval are at risk for an arrhyth- ing devices. chemotherapy, radiotherapy, mia called Torsades de pointes • Advise patients that although rare, prevention of postoperative nausea which can cause cardiac arrest. there have been reports of severe al- and vomiting (PONV), and treat- This is a rare arrhythmia that lergic reactions with acetaminophen ment of PONV if no prophylactic occurs more often in hospitalized including swelling of the face, mouth dose of ondansetron was received. patients who have other risk fac- and throat, difficulty breathing, itch- It is commonly used off-label for tors discussed in this lesson. ing, or rash. the treatment of hyperemesis The Zofran® label already gravidarum and nausea and vomit- contains information about the ing associated with pregnancy. It potential for QT prolongation, butwith the concentration found in is also used off-label for treatment this revision represents a strongerChildren’s Tylenol®. This repre- of nausea and vomiting associated warning. The new warning statessents another effort to minimize with chemotherapy, gastroenteri- that ondansetron should be avoideddosing errors for parents and tis, and other disorders associated in patients with congenital QTcaregivers. The previous infant with nausea and vomiting. prolongation since these patientsconcentrations of 80mg/ml and Zofran® is widely used because are at risk for developing Torsades80mg/0.8ml will continue to be it has been found to be effective in de pointes. In addition, it is nowavailable until supplies are de- comparative studies, is available in recommended to conduct electro-pleted. several different formulations (tab- cardiogram (ECG) monitoring in The new 160mg/5ml infant let, oral disintegrating tablet, oral patients with electrolyte abnor-acetaminophen may be pack- solution, and injection), is labeled malities (hypokalemia or hypomag-aged with an oral syringe versus as pregnancy risk factor B, and has nesemia), congestive heart failure,a dropper. Therefore, healthcare a low incidence of drowsiness and bradyarrhythmias, or in patientsproviders must advise parents and sedation. These advantages make taking other medications that cancaregivers to only use the device it ideal for outpatient use. It can lead to QT prolongation. Accordingprovided with the product pur- be prescribed safely in children to FDA guidelines, drug-inducedchased. It is important not to mix with viral gastroenteritis while prolongation of more than 10msand match measuring devices from phenothiazines (i.e., promethazine, suggests potential for clinicallyprevious bottles. Finally, dosing prochlorperazine) are contrain- significant prolongation.instructions for children as young dicated in children less than two Various studies have beenas six months will now be included years of age. Ondansetron has also conducted which examine the effecton the label of Infants’ Tylenol® become more commonly used since of ondansetron on the QT interval.and Children’s Tylenol®. coming off patent due to increased All three studies cited by FDA in FDA has drafted a download- affordability. the safety announcement are as-able PDF that may be printed and In September 2011, FDA issued sociated with intravenous admin-distributed to the lay public detail- a drug safety communication for istration of ondansetron. In 2008,ing some of the recent changes ondansetron indicating that it may Charbit et al conducted a study22 Washington Pharmacy
  • 23. due to lower body temperature and cal cardioversion to restore sinus Table 4 administration of anesthesia, both rhythm. Dronedarone is prescribed Ondansetron Patient droperidol and ondansetron were for rhythm control (versus rate Safety Counseling Points associated with similar clinically control) with a goal of reducing relevant QT interval prolongation. symptoms by decreasing frequency • Advise patients to contact a health- Caution should be taken when on- and duration of episodes, as well as care provider if they experience signs dansetron is administered to treat the symptoms during recurrences. and symptoms of an abnormal heart rate or rhythm, such as shortness of PONV. Since its launch in July 2009 by breath, dizziness, or fainting. Another study conducted by Sanofi Aventis and through Octo- • Patients with the greatest risk for Haferman et al found that when ber 2011, over 1.3 million prescrip- developing arrhythmias associated ondansetron was used in patients tions for Multaq® were dispensed with ondansetron use include those with cardiovascular disease with to approximately 278,000 patients. with congenital long QT syndrome; one or more risk factors for Tor- Dronedarone is an analogue of those taking diuretics which may sades de pointes, ondansetron amiodarone (Cordarone®) that predispose them to hypokalemia or did significantly increase the QT lacks the iodine moiety. It was de- hypomagnesemia; and those taking interval for up to 120 minutes veloped in hopes of better tolerabil- other medications that lead to QT prolongation. after administration. The authors ity and fewer long term side effects concluded that patients at high in comparison to amiodarone. Thus risk for Torsades de pointes should far, studies have confirmed that it receive telemetry (cardiac monitor- does have a safer extracardiac side-with 16 healthy volunteers who ing) while on ondansetron. effect profile and less cumulativereceived 1mg of droperidol, 4mg of Alternative antiemetics that toxicity, but it is also less effectiveondansetron, 1mg droperidol plus can be used to reduce the risk of in maintaining sinus rhythm (DIO-4mg ondansetron, or placebo intra- QT prolongation include the selec- NYSOS clinical trial). In addition,venously in a crossover design. tive 5-HT3 receptor antagonist, dronedarone carries its own set of Droperidol is another effective palonosetron (marketed as Aloxi®), limitations and contraindications.antiemetic that earned a black boxwarning in 2001 for its potential which has similar indications, or In January 2011, FDA issuedfor proarrhythmic events related to prochlorperazine, a phenothiazine, a safety announcement regardingQT prolongation. Compared with used for the general treatment of severe liver injury associated withplacebo, both droperidol and on- nausea and vomiting. the use of dronedarone second-dansetron significantly prolonged Zofran® is dosed according to ary to voluntary post-marketingthe QT interval. The difference was weight in children up to 4mg per reports. The case reports included25 +/- 8ms after droperidol which dose. Children 12 years of age hepatocellular liver injury, he-was significantly greater than 17 and older are dosed as adults. The patic failure, and two cases of liver+/- 10ms which was measured adult dose is most commonly 4 to transplantation.after ondansetron. The authors 8mg, but varies according to the The current Multaq® labelconcluded that both droperidol indication. The most commonly states that it is contraindicated inand ondansetron either alone or in reported side effects are headache, patients with liver toxicity relatedcombination induced significantly constipation, dizziness, malaise, or to previous use of amiodarone andmarked QT interval prolongation fatigue. in patients with severe hepaticwhen administered at usual doses. Counseling information is in- impairment. Patients are advisedThe authors also noted that none of cluded in Table 4. to report symptoms suggestingthe participants had QT exceeding hepatic injury such as anorexia,the threshold known to increase Dronedarone (Multaq) nausea, vomiting, fever, malaise, Dronedarone (Multaq®) is an fatigue, right upper quadrant pain,an individual’s risk of Torsades antiarrhythmic agent approved to jaundice, dark urine, or itching.de pointes. However, this study reduce the risk of hospitalization Healthcare professionals shouldwas conducted in healthy volun- related to atrial fibrillation (AF) also consider periodic laboratoryteers with no other risk factors for in patients in sinus rhythm with a monitoring of hepatic enzymes, es-prolongation as there otherwise history of paroxysmal or persistent pecially during the first six monthswould be in postoperative patients. AF. Paroxysmal AF is defined as of therapy.Although ondansetron appears to two or more recurrent AF episodes In July 2011 and again inbe less toxic than droperidol based that terminate spontaneously in December 2011, FDA issued a drugon this study, it should still be ad- less than seven days, and usually safety communication regardingministered with caution in patients in less than 24 hours. Persistent dronedarone and an increased riskwith a prolonged QT interval. AF is defined as AF that fails to of serious cardiovascular adverse However, a study conducted self-terminate within seven days. effects when studied in patientsin 2005 concluded that in the Episodes of persistent AF often with permanent AF. Permanentpostoperative setting, a situation require pharmacologic or electri- AF is defined as AF that lasts forknown to prolong the QT interval Washington Pharmacy 23
  • 24. more than one year, and cardiover- should not be administered to pa- Table 5 sion either has not been attempted tients with class IV heart failure or Dronedarone (Multaq ® ) or has failed. The safety announce- patients who have had an episodePatient Safety Counseling ments are based on data from two of decompensated heart failure in Points clinical trials, the PALLAS trial the past four weeks, especially if and the ATHENA trial. In PAL- they have depressed left ventricu-• Multaq® is not for persons with LAS, dronedarone was evaluated lar function (left ventricular ejec-heart failure with symptoms which for its effectiveness in patients tion fraction <35 percent).have recently worsened, or forpersons with severe heart failure. with permanent AF. The trial Multaq® is an option if a patientPatients should call their doctor if was terminated early because of a cannot tolerate amiodarone, orthey have signs or symptoms of heart significantly higher number of car- for patients who have an underly-failure including: shortness of breath diovascular events comprised of 43 ing condition such as pulmonaryor wheezing at rest; wheezing, chest hospitalizations for heart failure, or thyroid disease which is atightness or coughing up frothy spu- 23 strokes, and 13 cases of sudden contraindication for amiodaronetum at rest, nighttime or after minor death. These events resulted in 25 use. It may also be considered inexercise; trouble sleeping or waking deaths, which was double the rate younger patients due to the con-up at night due to breathing prob- compared to the placebo group. cern about the cumulative effects oflems; using more pillows to prop selfup at night in order to breathe more These results were then com- amiodarone taken over a lifetime.easily; gaining more than 5 pounds pared to the ATHENA trial to Currently, there is not enough evi-quickly; or increasing swelling of feet confirm that when used according dence to determine if it is effectiveor legs. to the label (non-permanent AF), in patients with resistant atrial• Multaq® is not for persons with patients did not have an increased fibrillation where multiple antiar-permanent AF. Patients should call risk of cardiovascular death, rhythmics have failed to maintaintheir doctor if they notice their pulse stroke, or heart failure. sinus rhythm.is irregular. Thus the Multaq® label has Multaq®’s approved dosage is• Advise patients to tell their doctor been revised in accordance with the 400mg twice daily with meals. Inif they have signs or symptoms ofliver problems: loss of appetite, nau- FDA safety communication which addition to the previous warningssea, vomiting; fever, feeling unwell, includes the following key points: and contraindications discussed,unusual tiredness; itching; yellow- dronedarone is contraindicated in dronedarone should not be givening of the skin or the whites of eyes; patients with permanent AF; car- with other class I or class III an-darkening of urine; or right upper diac rhythm should be monitored tiarrhythmic drugs (amiodarone,quadrant stomach pain or discomfort. every three months and if a patient flecainide, propafenone, quinidine,Patients who had liver problems after is found to be in AF, dronedarone disopyramide, dofetilide, or sotolol)taking amiodarone should also avoid should be stopped or the patient or strong inhibitors of CYP3A (ke-dronedarone. should be cardioverted if clinically toconazole, itraconazole, voricon-• Patients who are pregnant orbreastfeeding should not take Mul- indicated; dronedarone should azole, cyclosporine, telithromycin,taq®. Patients who plan to become only be prescribed according to its clarithromycin, nefazodone, andpregnant should talk to their physi- indication; and patients prescribed ritonavir). Concomitant use withcian and use effective birth control. dronedarone should receive appro- other drugs and herbals that pro-• Warn patients about certain priate antithrombotic therapy. long the QT interval and increasedrugs that are contraindicated with Dronedarone’s role in treat- the risk of Torsades de pointes aredronedarone: nefazodone, ritonavir, ing atrial fibrillation is still yet to also contraindicated.ketoconazole, itraconazole, voricon- be fully understood. In the 2011 Dronedarone should also beazole, telithromycin, clarithromycin, updated guidelines for the manage- avoided in patients with secondand cyclosporine. Also advise patientsof the risk of a dangerous abnormal ment of atrial fibrillation jointly or third degree atrioventricularheart rhythm (Torsades de pointes) issued by the American College (AV) block or sick sinus syndromethat can occur when taken with of Cardiology Foundation and without a functioning pacemaker,phenothiazines, tricyclic antidepres- American Heart Association, the bradycardia (<50bpm), QTc Bazettsants, and class I or class III antiar- following recommendation was interval >500ms or PR intervalrhythmics. made: (Class IIa) Dronedarone is >280ms, liver toxicity related to• Advise patients to avoid grapefruit reasonable to decrease the need for previous use of amiodarone, preg-juice. hospitalization for cardiovascular nancy (category X), and nursing• Emphasize to patients that it is events in patients with paroxysmal mothers. When used in combina-important to continue antithrombotictreatment as prescribed by their phy- AF or after conversion of persistent tion with potassium depletingsician while taking dronedarone. AF. Dronedarone can be initiated diuretics, monitoring of potassium during outpatient therapy. and magnesium levels is necessary A second recommendation was to ensure that levels remain within also published stating the follow- the normal range throughout the ing: (Class III-Harm) Dronedarone durations of therapy with Multaq®.24 Washington Pharmacy
  • 25. The most common adverse reac- tions associated with therapy in- NEW Requirement for The author, the Ohio Pharmacists Founda- tion and the Ohio Pharmacists Association clude diarrhea, nausea, abdominal pain, vomiting and asthenia. CE Participants: CPE Monitor disclaim any liability to you or your patients resulting from reliance solely upon the infor- mation contained herein. Bibliography for Patient safety counseling additional reading and inquiry is available points are included in Table 5. Do you have your NABP eProfile ID number? upon request. C Summary PE Monitor is a national, collaborative effort by NABP and the Accreditation Council This lesson serves as a summary of This lessonfor Pharmacy Education (ACPE) to provide an electronic system for pharmacists and is a knowledge-based CE activity and is targeted to pharmaciststheir completed continuing pharmacy education recent significant FDA safety an- pharmacy technicians to track in all (CPE) credits. It will also offer state boards of pharmacy the opportunity to electronically practice settings. nouncements that were issued for authenticate the CPE units completed by their licensees, rather than requiring pharma- simvastatin, acetaminophen, on- cists and technicians to submit their proof of completion statements upon request or for dansetron, and dronedarone along random audits. This initiative will streamline processes for pharmacy practitioners to ensure with relevant prescribing changes they are maintaining professional competency requirements. CPE Monitor is expected to that a healthcare provider should save pharmacists, pharmacy technicians, state boards of pharmacy, and CPE providers time be aware of. These medications can and money. continue to be safely prescribed and dispensed according to the Pharmacists and pharmacy technicians will receive a unique ID after setting up their Program 0129-0000-12-004-H05-P revised labeling. e-Profile with date: 4-15-12 Release NABP. As ACPE-accredited providers begin transitioning their systems to It is vital that pharmacists are CPE Monitor throughout 2012, pharmacists and pharmacy technicians will need to begin Expiration date: 4-15-15 providing their NABP e-Profile ID and date of birth to the provider when they register for aware of these safety announce- CE or submit1.5 (0.15for credit. The system will then direct electronic data from ACPE- Hours: a request CEU) CPE ments and apply them when indi- accredited providers to ACPE and then to NABP, ensuring that CPE credit is officially verified cated. Providers are encouraged to by the providers. Once information is received by NABP, pharmacists and pharmacy techni- read the full revised product leaflet The Ohio Pharmacists Foundation Inc. is cians will be able to log in to access information about their completed CPE activities. After accredited by the Accreditation Council for full prescribing information, as for Pharmacy Education as a ACPE-accredited CPE providers will no longer be required to distribute a transition period, provider of well as the clinical trials referred continuing pharmacy education. statements of credit. to in this lesson. In addition, boards of pharmacy will be able to request reports on their licensees, elimi- - nating the need for pharmacists and technicians to send paper copies of CPE statements The author, the Ohio Pharmacists Founda-n- tion and the Ohio Pharmacists Association of credit. Instead, records kept in CPE Monitor will be sent to the boards for CPE activities nal disclaim any liability to you or your patients taken from ACPE-accredited providers. resulting from reliance solely upon the infor- mation contained herein. Bibliography for In Phase 2 of the CPE Monitor initiative, CPE Monitor will add a function to record CPE from additional reading and inquiry is available providers not accredited by ACPE in addition to CPE activities from ACPE-accredited provid- upon request. ers. Until Phase 2 is completed, pharmacists and technicians will need to submit proof of completion of CPE from providers not accredited by ACPE directly to the board of phar- macy when required to do so. y of This lesson is a knowledge-based CE activity and is targeted to pharmacistsn- To prepare for the new process, pharmacists and technicians are encouraged to obtain in all practice settings.for their NABP e-Profile ID now to ensure their e-Profile is properly setup. Many ACPE-accredit-n- ed CPE providers are now requiring pharmacists and pharmacy technicians to submit their e-Profile ID and date of birth to receive credit for completed CPE.ongges To get you NABP e-Profile ID number, go to www.nabp.net. ld can Once you obtain your NABP e-profile ID number, don’t forget to log in and update your WSPA profile at www.wsparx.org. Program 0129-0000-12-004-H05-P Release date: 4-15-12are Expiration date: 4-15-15- CE Hours: 1.5 (0.15 CEU)di-d toaflet The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council as for Pharmacy Education as a provider ofed continuing pharmacy education. Washington Pharmacy 25
  • 26. continuing education quiz Please print. Program 0129-0000-12-004-H05-P 0.15 CEU Name________________________________________________FDA Safety Warnings and Prescribing Updates: Address_____________________________________________Simvastatin, Acetaminophen, Ondansetron, and City, State, Zip______________________________________Dronedarone Email_______________________________________________ NABP e-Profile ID*__________________________________1. In the SEARCH study, the greatest risk of developing *Obtain NABP e-Profile number at www.MyCPEmonitor.net.myopathy with 80mg daily therapy of simvastatin was: a. immediate. c. in the third year. Birthdate____________ b. in the first year. d. beyond the fourth year. (MMDD) Return quiz and payment (check or money order) to2. All of the following are contraindicated with simvastatin Correspondence Course, OPA,EXCEPT: 2674 Federated Blvd, Columbus, OH 43235-4990 a. ketoconazole. c. gemfibrozil. b. clarithromycin. d. amiodarone. 8. Healthcare providers must advise parents and caregivers3. The dose of simvastatin not to be exceeded when taken with administering liquid acetaminophen products to infants to use:amlodipine is: a. the same household teaspoon with each dose. a. 5mg. c. 20mg. b. an infant dropper. b. 10mg. d. 40mg. c. an oral syringe. d. the device provided with the product.4. Patients taking simvastatin should be advised to report all ofthe following symptoms of liver injury EXCEPT: 9. Ondansetron is labeled as pregnancy risk factor: a. dizziness. c. anorexia. a. A. c. C. b. fatigue. d. dark urine. b. B. d. X.5. In the U.S., acetaminophen toxicity is the most common 10. Torsades de pointes is a type of arrhythmia associated with:cause of acute: a. a long QT interval. b. a short QT interval. a. heart failure. c. hepatic failure. b. respiratory failure. d. renal failure. 11. Patients at greatest risk for developing arrhythmias associ- ated with ondansetron use include those with all of the follow-6. To decrease the potential for overdose, FDA asked manufac- ing EXCEPT:turers of oral prescription acetaminophen combination products a. taking diuretics predisposing to hypokalemia.to limit the amount of acetaminophen per tablet to: b. taking diuretics predisposing to hypomagnesemia. a. 325mg. b. 500mg. c. taking medications leading to QT prolongation. d. a congenital short QT interval.7. How many years has FDA given acetaminophen productmanufacturers to add a box warning on prescription product 12. Dronedarone is approved for use in patients with a historylabeling concerning the risk of severe liver injury? of paroxysmal or persistent atrial fibrillation. a. 6 months c. 2 years a. True b. False b. 1 year d. 3 years 13. Compared to amiodarone, dronedarone has been shown to have all of the following properties EXCEPT: a. safer extracardiac side effects.Completely fill in the lettered box corresponding to b. less cumulative toxicity.your answer. c. increased effectiveness in maintaining sinus rhythm.1. [a] [b] [c] [d] 6. [a] [b] 11. [a] [b] [c] [d]2. [a] [b] [c] [d] 7. [a] [b] [c] [d] 12. [a] [b] 14. All of the following drugs are contraindicated with drone-3. [a] [b] [c] [d] 8. [a] [b] [c] [d] 13. [a] [b] [c] darone EXCEPT:4. [a] [b] [c] [d] 9. [a] [b] [c] [d] 14. [a] [b] [c] [d] a. ritonavir. c. ketoconazole.5. [a] [b] [c] [d] 10. [a] [b] 15. [a] [b] [c] b. azithromycin. d. cyclosporine. I am enclosing $10 (member); $15 (nonmember) for 15. In accordance with the FDA safety communication forthis month’s quiz made payable to: Ohio Pharmacists dronedarone,:Association. a. it is contraindicated in patients with paroxysmal AF.1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor) b. patients in AF should be monitored for cardiac arrhythmia2. Did it meet each of its objectives?  yes  no every six months. If no, list any unmet_______________________________ c. patients should be receiving appropriate antithrombotic3. Was the content balanced and without commercial bias? therapy.  yes  no4. Did the program meet your educational/practice needs?  yes  no5. How long did it take you to read this lesson and complete the To receive CE credit, your quiz must be postmarked no later than quiz? ________________ April 15, 2015. A passing grade of 80% must be attained. All quizzes6. Comments/future topics welcome. received after July 1, 2012 will be uploaded to the CPE Monitor and a statement of credit will not be mailed. Send inquiries to opa@ohiop- harmacists.org. April 2012
  • 27. Endorsed by:**Guarantee a better Quality of Life for your family. Life Insurance can provide for your loved ones by: • Providing coverage for final medical and funeral expenses • Paying outstanding debts • Creating an estate for those you care about • Providing college fundingLife insurance solutions from The Pharmacists LifeInsurance Company. For more information, contact your local representative: Anne Kelley, AAI Kim Dornbier, CISR, CIC 800.247.5930 ext. 7147 800.247.5930 ext. 7441 425.501.1428 515.320.1214 www.phmic.com * * This is not a claims reporting site. You cannot electronically report a claim to us. To report a claim, call 800.247.5930. ** Compensated endorsement. Not all products available in every state. The Pharmacists Life is licensed in the District of Columbia and all states except AK, FL, HI, MA, ME, NH, NJ, NY and VT. Check with yourPO Box 370 • Algona Iowa 50511 representative or the company for details on coverages and carriers.
  • 28. 2012 Scholarship ScrambleDear Friends:We are excited to announce that the annual Scholarship Scramble, hosted by the Washington State Pharmacy Foundation, will be held onAugust 26, 2012 at Willows Run Golf Course in Redmond, WA. All proceeds from the Golf Scramble will go towards the Foundation’s missionto provide scholarships for pharmacy students at Washington State University and University of Washington.Student pharmacists continue to see steep increases in the cost of tuition. Those attending school in 2012-2013 face double – digit tuitionincreases and will be paying over $20,000 for the school year. Top this with living expenses, books, computers and necessary technology,the investment to become a pharmacist is significant. The WSPF Student Scholarships make a difference in student’s lives. Some could notafford to pursue their education if it wasn’t for scholarships such as these. These students need our help more than ever.Please join us for a day of golf, games and dinner! Everyone is invited to participate in this event. Bring your family, friends, neighbors, co-workers – the more players, the more support for students! We need 144 players to make this event a smashing success. This year, we hopeto raise $12,000 so we can give eight scholarships to deserving student pharmacists. We need YOU to help us reach our goal!Don’t golf or can’t make it? There are other ways to help:• Donate - if you would like to make a cash donation, contact the WSPF at 425-228-7171. The Washington State Pharmacy Foundation (WSPF) is a non-profit 501(c)(3), charitable organization. Our tax ID number is 91-0996629. Contributions to the Washington State Phar- macy Foundation can be tax deductible.• Socialize - there are plenty of non-golfing events taking place after golf including dinner, a raffle and fun games such as the very popu- lar Wine-O Ring Toss. Join us for dinner and catch up with friends and colleagues and support a great cause!• Advertise – take advantage of the exposure and sponsor a hole. It will make you visible to hundreds of people in attendance.• Spread the word - add the event to your Facebook, Twitter, and Linkedin profile, make copies to hand out or mail to your friends and associates, pick up the phone and invite a friend. The possibilities are endless!The Washington State Pharmacy Foundation (WSPF) Student Scholarship Fund has been in existence since 1958. For more than 50 years,WSPF has been providing scholarships to pharmacy students to help meet their rising cost of education. The WSPF is proud of its studentscholarship history and plans to continue it for future generations of pharmacy students.To register or for more information including sponsorship opportunities, please visit the Washington State Pharmacy Association’s websiteat www.wsparx.org or call WSPA at 425-228-7171.Sincerely, John Oftebro, R.Ph. Jeff Rochon, Pharm.D WSPF President WSPA Chief Executive Officer 28 Washington Pharmacy
  • 29. Pharmacy For Sale pharmacist Tired of working Sundays, holidays, and late nights? If you are interested in having a life outside of work and working Eastern Washington , Colombia basin for a Northwest based and employee owned company that 4500 sq.ft. This is not a small store. offers great schedules, excellent benefits, wages and working Store 85% Rx 15% front end conditions, Bi-Mart is looking for you! We are seeking a 150 scripts daily staff Pharmacist for our Oregon locations in Lincoln City, For questions or more information, call Hermiston, Winston, and Klamath Falls. Apply by calling 1-800-456-0681 ext. 308 or email: RxCareer@bimart.com. 509 -659- 0250 or email Ritzdrug@gmail.com Check our web site at www.ritzvilledrug.com30 Washington Pharmacy
  • 30. Rx and The LawBy Don McGuire, R.Ph., J.D. E-prescribing and E-errors they should interact with the patient to make sure that the patient does. If the pharmacist is still uncertain after talking with the patient, a E -prescribing is here to stay, but it is not the cure-all for call to the prescriber is warranted. prescription errors that some people think. Through my years of handling pharmacy professional liability claims, physicians’ Technology can fix many problems, but it can’t fix every problem. handwriting is much less of an issue than most pharmacists would E-prescribing shouldn’t cause pharmacists to let their guard down. believe. More often than not, illegible prescriptions result in a It remains for the pharmacist to be diligent and make sure that the phone call for clarification, not an error. While not a significant patient leaves with the correct medication and knows how to use it. cause of errors, illegible prescriptions definitely impact the __________________________________________________________ pharmacy’s workflow and efficiency. © Don R. McGuire Jr., R.Ph., J.D., is General Counsel at Pharmacists E-prescribing is going to take care of all of the prescription errors, Mutual Insurance Company. right? Consider the following prescription: Erythromycin ointment, 1 tube, apply UD. The pharmacy filled the prescription with a 25 This article discusses general principles of law and risk management. It gram tube of topical erythromycin ointment. The problem was that the physician meant to prescribe a 3.5 gram tube of erythromycin is not intended as legal advice. Pharmacists should consult their own ophthalmic ointment. So the pharmacy had a perfectly legible, attorneys and insurance companies for specific advice. Pharmacists incomplete prescription. What can a pharmacist do in this should be familiar with policies and procedures of their employers and situation? insurance companies, and act accordingly. Patient counseling is the solution! The patient was not counseled with this prescription. However, a few simple questions would have uncovered this error. “What did the doctor tell you this was for?” and “How did the doctor tell you to use this?” The answer to either of these questions would have indicated the ophthalmic route that was not found on the prescription. Patient counseling provides many benefits for both the patient and the pharmacist. First, patient counseling, or at least an offer to counsel, is required by law or regulation. This alone makes patient counseling a good risk management tool. But the real benefit for you and your patients is found when you practice up from this baseline. Counseling allows Agility is in the business of saving the pharmacist to detect hidden errors in prescriptions prior to the patients taking them home. Experience shows that many patients businesses. We bring together will take or use whatever is dispensed to them. Verifying the intent innovative products, affordable of the prescription and what is being treated is vital to know prior to services and, most important, great dispensing. people – experts with the know-how Also, patient counseling educates the patient about the proper and passion to help you plan and use and storage of their prescription drug. A proper counseling recover from disasters. Agility is the session will allow you to assess the patient’s health literacy and difference between giving in to a provide the proper information to improve their outcomes. Many crisis and surviving one. times pharmacists assume that patients know more about their medications than they really do. This assumption leads to a poor, or even non-existent, patient counseling interaction. Patients do not always ask good questions because of the fear of embarrassment or because they simply don’t know what to ask. It is up to the pharmacist to take charge of this interaction and make sure that the POWER TECHNOLOGY SPACE CONNECTIVITY patients know what they need to know about their medications. When the answers provided during the counseling session don’t match what the pharmacist or patient expected, then it is time to call the prescriber. This method is much more efficient than calling to verify every e-prescription received. Vague terms in a Agility Recovery is the endorsed provider of disaster recovery prescription such as 1 bottle, 1 tube or directions as UD should services to the Washington State Pharmacy Association. For more be red flags to a pharmacist. If the pharmacist can’t discern the information call 720.490.4572 or visit www.agilityrecovery.com. quantity, directions or the indication from the prescription, then Washington Pharmacy 31
  • 31. UPCOMING EVENTSImmunization PracticumJuly 19, 2012 | WSPA Office | Renton, WAThis program is designed specifically to train pharmacists and pharmacy students to participate in an Immunization program foradults and adolescents. The content derived from the CDC program “Epidemiology & Prevention of Vaccine-Preventable Diseases”and adapted to Washington State specific pharmacy law and practice. By completing this course, pharmacists can earn 15 hours ofcontinuing education credit while becoming certified to administer adult and adolescent vaccines.WSPF Scholarship ScrambleAugust 26, 2012 | Willows Run | Redmond, WAThe Washington State Pharmacy Foundation is proud to announce this year’s WSPF Scholarship Scramble will be held on August 26,2012 at Willows Run Golf Course. All proceeds from the Golf Scramble will go towards the Foundation’s mission to provide scholarshipsfor pharmacy students at Washington State University and University of Washington. SAVE THE DATE! 2012 WSPA Annual Meeting - November 2-4, 2012Join us at the Great Wolf Lodge in Centralia, WA for the WSPA’s2012 Annual Meeting, November 2-4!This year’s meeting will offer a unique blend of professionaldevelopment and family engagement. From the moment youenter the soaring Great Wolf Lodge lobby and find yourselfsurrounded in the north woods theme, you will know that thismeeting will be anything but ordinary.This is an “Everything Under One Roof” destination. You can parkyour car and never need it again until it is time to go home.We were able to negotiate an incredible deal! Great Wolf Lodgerooms are available at the WSPA Annual Meeting rate of $149/night for a family suite November 1-4, 2012 if reserved by Oc-tober 5th. Please refer to code “1210WAST” when making yourreservations. To make reserve your room, please call 800-640-WOLF (9653). For more information about the hotel visit theirwebsite - Great Wolf Lodge. Register with the WSPA by October5th for the meeting to get the early bird registration!Registration will be available soon! Keep eye out for registrationforms coming via email and in the next edition ofWashington Pharmacy!