Vol 12 No. 4 Fall 2015
Fall 2015
Pharmacy Journal of New England
Important Updates for Influenza Vaccine: 2015-16 Delivering the Prescription Rx and the Law 2015: A Time for Patience Financial Forum
New England Pharmacists Convention 2015 Photos & Award Winners Inside
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Pharmacy Journal
Vol 12 No. 4 Pharmacy Journal of New England • Fall 2015
of New England It’s Time to Be Thankful Dear Readers,
Editors
David Johnson Margherita R. Giuliano, R.Ph., CAE
Managing Editor
The Connecticut and Massachusetts Pharmacists Foundations would like to remind pharmacists that the Foundations accept tax-deductible donations all year. As many of us begin to think about holiday charitable giving, please consider contributing to the future of pharmacy, and helping the Foundation continue to distribute student scholarships each year, at a time when the cost of higher education becomes an increasing challenge. We would also like to take this time to thank all of our board members, foundation members, committee members, and those who support their state associations throughout the year. We appreciate all you do. Donations may be sent to the Connecticut Pharmacists Foundation at 35 Cold Spring Road, Suite 121, Rocky Hill, CT 06067 and to the Massachusetts Pharmacists Foundation at 500 W. Cummings Park, Suite 3475, Woburn MA, 01801. Include a tribute to a former professor, colleague or mentor, and we will publish them in a future Pharmacy Journal! Sincerely,
Ellen Zoppo CPA
Design & Production Kathy Harvey-Ellis The Pharmacy Journal of New England is owned and published by the Massachusetts Pharmacists Association and the Connecticut Pharmacists Association. Opinions expressed by those of the editorial staff and/or contributors do not necessarily reflect the views or policies of the publisher. Readers are invited to submit their comments and opinions for publication. Letters should be addressed to the Editor and must be signed with a return address. For rates and deadlines, contact the Journal at (860) 563-4619. Pharmacy Journal of New England 35 Cold Spring Road, Suite 121 Rocky Hill, CT 06067-3167 members@ctpharmacists.org
Submitting Articles to the Pharmacy Journal of New England™ Margherita R. Giuliano, RPh Executive Vice President Connecticut Pharmacists Association
David Johnson Executive Vice President Massachusetts Pharmacists Association
The Pharmacy Journal of New England™ is the product of a partnership between the Connecticut Pharmacists Association and the Massachusetts Pharmacists Association. The Journal is a quarterly publication. All submitted articles are subject to peer review. In order to maintain confidentiality, authors’ names are removed during the review process. Article requirements must conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1982;96 (1part1):766-71). We strongly encourage electronic submissions. PJNE does not assume any responsibility for statements made by authors.
Please submit manuscripts to: PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: ezoppo@ctpharmacists.org
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US News New England States New England Pharmacists Convention 2015: Complete Coverage Feature: Important Updates for Influenza Vaccine 2015-16 Pharmacy Marketing Group: Rx and the Law, Financial Forum From the Colleges Continuing Education for Pharmacists
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U.S. News Drugmaker offers $1 Alternative to Medicine that Skyrocted 1000%
Two Abbvie Hepatitis C Drugs Can Cause Injury, FDA Warns
A San Diego-based pharmaceutical company says it will offer a low-cost alternative to Daraprim, a drug used by cancer and AIDS patients that recently skyrocketed from $13.50 to $750 a pill.
Federal health officials are warning doctors and patients that two hepatitis C drugs from AbbVie can cause life-threatening liver injury in patients with advanced forms of the disease. The Food and Drug Administration said on Thursday that it would require AbbVie to add new warnings to the drugs, Viekira Pak and Technivie, about their risks for patients who already have advanced liver damage caused by hepatitis C. The warning could reshape the growing field of high-priced drugs to treat the virus, which also includes Gilead Sciences’ blockbuster medications Sovaldi and Harvoni. Brian Abrahams, a Jefferies analyst, wrote in an investment note that the warning was a “moderate positive” for Gilead Sciences. But he added that AbbVie’s Viekira Pak was already expected to be “displaced” by a similar drug from Merck next year. The F.D.A. said in an online posting that AbbVie’s drugs had been linked to multiple cases of severe liver damage — some of them fatal — in patients who already had liver cirrhosis.
Imprimis Pharmaceuticals says the substitute drug will be priced as low as $99 for a 100-capsule bottle. Daraprim is produced by Turing Pharmaceuticals, which came under intense fire in recent weeks after chief executive Martin Shkreli raised the price of the drug by 5,000%. Imprimis (IMMY) said its substitute drug is a customized formulation that can be used to treat toxoplasmosis, the ailment that AIDS patients previously relied on Daraprim to control. “While we respect Turing’s right to charge patients and insurance companies whatever it believes is appropriate, there may be more cost-effective compounded options for medications, such as Daraprim, for patients, physicians, insurance companies and pharmacy benefit managers to consider,” Imprimis CEO Mark Baum said in a statement. In September, Turing’s price increase caught the eye of presidential candidate Hillary Clinton, who tweeted that she wanted to put an end to drug “price gouging.” Clinton wrote to the Food and Drug Administration and Federal Trade Commission asking that they look at Turing Pharmaceutical’s pricing of Daraprim. Clinton also asked the FDA to allow importation of low-price versions of the drug from the U.K. and Canada. “Patients who rely on this treatment should not have their health and lives put at risk because of an unnecessary anticompetitive market, and the FDA should act through all of its available authorities to remedy this situation as soon as feasible,” she wrote in the FDA letter, which was first reported by Reuters. http://money.cnn.com/2015/10/23/news/companies/imprimisdaraprim-turing-martin-shkreli/
TB Now Kills as Many as AIDS, New Report Finds The number of tuberculosis cases has fallen by 18 percent since 2000, but the completely curable infection now kills as least as many every year as the AIDS virus, the World Health Organization said Wednesday. It’s because countries are not spending enough money to treat people infected with the highly infectious disease, which takes weeks or months of daily antibiotics to eradicate. TB killed 1.5 million people in 2014, WHO said — about the same as in 2013. “HIV’s total death toll in 2014 was estimated at 1.2 million, which included the 400,000 TB deaths among HIV-positive people.” So the estimates for deaths from HIV and TB both include the same 400,000 people, making it difficult to say which infection killed more people. AIDS is caused by the human immunodeficiency virus (HIV), which damages the immune system, making people more susceptible to TB. “We are still facing a burden of 4,400 people dying every day, which is unacceptable in an era when you can
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diagnose and cure nearly every person with TB,” said Dr. Mario Raviglione, director of WHO’s Global TB Program.
Walgreens agreed to pay $9 a share in cash for Rite Aid, offering a 48% premium to Rite Aid’s closing price Monday.
More people are infected with TB than anyone knew, WHO said.
The deal, which would unite two of the country’s three biggest drugstore owners, would be likely to draw scrutiny from antitrust regulators, who could demand divestitures in exchange for their approval.
“This year’s report describes higher global totals for new TB cases (9.6. million) than in previous years,” WHO said in a statement. “However, these figures reflect increased and improved national data and in-depth studies rather than any increase in the spread of the disease. More than half of the world’s TB cases (54 percent) occurred in China, India, Indonesia, Nigeria and Pakistan. Among new cases, an estimated 3.3 percent have multidrug-resistant TB (MDR-TB), a level that has remained unchanged in recent years.” HIV cannot be cured, but a careful regimen of antibiotics can cure all but the most extensively drug-resistant strain of tuberculosis. “Effective diagnosis and treatment saved 43 million lives between 2000 and 2015,” WHO said. “Worldwide, TB incidence has fallen 1.5 percent per year since 2000, for a total reduction of 18 percent.”
It also adds to a blockbuster year for health-care mergers and acquisitions, helping to put 2015 on track to be the busiest year ever for M&A. Including assumed debt, the transaction is valued at $17.2 billion. Rite Aid’s debt totaled $7.4 billion in August. Drug makers, hospital chains, health insurers and others have already struck some $427 billion of merger deals in the U.S. this year, according to Dealogic, as the Affordable Care Act and other factors spur them to seek more leverage with their suppliers and cut costs. By combining their drugstore networks, which together include roughly 13,000 U.S. stores, Walgreens and Rite Aid, which have both been pinched by drug-price inflation, could reap considerable savings.
The U.S. has just 9,400 active cases.
Rite Aid, based in Camp Hill, Pa., has about 4,600 drugstores in 31 states. Walgreens has roughly 8,200 U.S. stores, while CVS Health Corp. has more than 7,800.
WHO says $1.3 billion is needed for research on new tests, drugs and vaccines against TB, and $1.4 billion is needed for existing drugs and treatments.
Both Rite Aid and Walgreens have a major presence in states like California, New York and Massachusetts, while in others, including Florida, Texas and Illinois, there isn’t any overlap.
“A primary reason for detection and treatment gaps is a major shortfall in funding,” said Dr. Winnie Mpanju-Shumbusho, WHO Assistant Director-General for HIV, TB, Malaria and Neglected Tropical Diseases.
And Walgreens and Rite Aid would be likely to argue to regulators that they compete not just with other traditional drugstore chains, but also with companies such as groceries and club stores.
http://www.nbcnews.com/health/health-news/tb-now-kills-many-aids-new-reportfinds-n453041
In terms of market value, Rite Aid is much smaller than Walgreens and CVS, which both have a market capitalizations of more than $100 billion. Rite Aid had revenue of $26.5 billion in the fiscal year ended in February. In the fiscal year ended in August 2014, Walgreens had revenue of $76.4 billion. CVS had 2014 sales of $139.4 billion.
Walgreens, Rite Aid Unite to Create Drugstore Giant Walgreens Boots Alliance Inc. agreed to buy Rite Aid Corp. for about $9.4 billion, in a move that would create a drugstore giant as companies across the U.S. health-care industry look for ways to bulk up.
Rite Aid, like its rivals, has sought to broaden its business lines to boost sales amid increased competition. The company has expanded its RediClinics, walk-in centers that can give flu shots and tend to ailments. It also has built a portfolio of 3
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1,859 wellness stores, which offer organic food and natural personal-care products and feature consultation rooms for discussions with pharmacists. This year Rite Aid bought pharmacy-benefit manager Envision Pharmaceutical Services, or EnvisionRx, for about $2 billion. Pharmacy-benefit managers process prescriptions for the groups that pay for drugs, usually insurance companies or corporations, and use their size to negotiate better deals with drug makers and pharmacies. They often also operate mail-order pharmacies. In September, Rite Aid cut its earnings outlook in part because of costs associated with the EnvisionRx deal. That had contributed to a nearly 20% reduction in Rite Aid’s share price this year before news of the Walgreens talks leaked. That decline might help explain the above-average share-price premium Walgreens is paying. Walgreens, which is to report its results Wednesday, is the product of acquisitions, giving it more than 13,200 stores in 11 countries. The company, based in Deerfield, Ill., operates under the Walgreens and Duane Reade banners, and in the U.K. and elsewhere as Boots. It also has one of the largest pharmaceutical wholesale and distribution networks in the world. Walgreens was founded in 1901 when Charles R. Walgreen Sr. purchased the Chicago drugstore where he had worked as a pharmacist.
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Last year, Walgreens acquired the part of European drugstore chain Alliance Boots GmbH that it didn’t already own. Under pressure from shareholders, including activist investor Jana Partners LLC, Walgreens considered using the acquisition to relocate overseas in a so-called “tax inversion”—a type of deal that is used to make a U.S. company more tax-efficient. Walgreens ultimately decided against relocating. The company’s chief executive is Stefano Pessina, a septuagenarian Italian billionairewho took the role on a permanent basis in July and served as executive chairman of Alliance Boots before the merger with Walgreens. Mr. Pessina hasn’t been shy about his desire to do big deals. “We can clearly see the need or the opportunity for horizontal and vertical consolidation in our industry,” he said on a conference call in July. Mr. Pessina transformed a small family business into Alliance Boots, a European drug retailing and wholesaling powerhouse, through a series of takeovers. In 2007, he took the company private in an $18.5 billion leveraged buyout with KKR & Co. At year-end, KKR still owned about 4.6% of Walgreens stock. http://www.wsj.com/articles/walgreens-boots-alliance-nears-deal-to-buy-riteaid-1445964090
New England States Connecticut
President’s Message Thank you for your confidence in me, electing me as president. It is a privilege to serve in this capacity, and holds great tradition. I am humbled to follow in the our past presidents’ footsteps. Two and a half years ago, the then board held a retreat to determine the direction of the CPA for the next 3-5 years. We developed Jacqui Murphy a comprehensive strategic CPA President, 2015-16 plan to advance pharmacy in Connecticut. We defined three areas to focus on and developed core values for each. These areas are Development of the Pharmacy Profession, Promote the Value of Pharmacists and CPA, and CPA is a Relevant Organization for Pharmacists and the Community. We are at the halfway point of this strategic plan and I can tell you that we have made significant inroads in all three core values. We have a greater presence in social media, a new incentive for student loan refinancing for CPA members, a YouTube video produced by the students from the Universities of Connecticut and St. Joseph’s. We are looking at new ways to encourage our younger pharmacists to join and be active. As you read your Fast 5 on Fridays, you see our progress. Still there is much to be done. Here is how you can help advance the CPA strategic plan and as a result, advance the practice of pharmacy in CT. First, follow what is happening in the state and federal legislatures. There are several bills that will impact the practice of pharmacy on all levels. Reading the Fast 5 will give you the basics, and during session, the office sends out talking points to pass on to your legislators. After spending the day on the Capitol in DC last spring, I know that first hand personal experience makes a big difference on whether the legislators listen to you. Please contact your elected officials when we
Pharmacy Journal of New England • Fall 2015
ask and cite personal examples of how the bill will affect your patients and your practice. Second, help us to promote our services, our knowledge, and our profession. The board has been working to improve our visibility on social media and you can help. I’m sure many of you are on Facebook. Are you “friends” with the CPA? Do you repost what the CPA puts out there? If not, please “friend” CPA today and repost pertinent posts. We have also done a lot of outreach this year, attending many events and speaking to groups. Recently one of our board members presented to a group of seniors in Madison on OTC medications, talking about duplicate ingredients, alcohol content, and other information they need to know to make smart selections. I’ve done traditional brown bag events at three senior centers in New Haven for the past three years. I’m sure many of you have done similar events. If so, the CPA would like to know. If you know of a group that would like a speaker, let us know. If you are uncomfortable speaking we will find someone. We are working on a brochure to hand out at events listing potential topics that we already have prepared presentations. Lastly, a word about the state of our Association. We have a lack of involvement among pharmacists in the state. I know two things for sure. 1. We all have many other commitments outside of work that keep us super busy! And 2. I am preaching to the choir, as an old boss was fond of saying. So I am challenging all members of the Association to do something about this. I am asking every member to recruit one pharmacist and one technician to join the CPA this year. And then I want you to encourage these 2 individuals to get involved – serve on a committee, attend public events like the NBC Wellness Weekend, etc. If you are an employer, you can go one step further by arranging their schedules so they can be involved. We need members to take on leadership roles. By getting people involved we have a broader resource group to draw from. To sum it up: 1. Contact your legislators asking for support on bills that matter to pharmacy. 2. Let the CPA office know what you are doing to promote pharmacy, and friend and repost CPA Facebook postings, and 3. Help bring more pharmacists on board and get them involved in our organization. I look forward to a very productive year! 5
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Massachusetts President’s Message Keeping Pharmacists Safe -- and Making Ours Voices Heard It’s exciting to embark upon another new year with the Massachusetts Pharmacists Association. I would like to tell you a little bit about my plan for the upcoming year. As I am sure that you are all aware we have an opioid crisis in Massachusetts, regionally, and Karen Horbowicz across the nation. It is believed MPhA President, 2015-16 that most heroin users begin with prescription opioids. According to the Department of Public Health, confirmed unintentional opioid deaths skyrocketed to over 1000 last year with another 250 estimated but not yet confirmed. That’s the highest it has been in Massachusetts history. According to preliminary data from earlier this year we are on pace to match and likely exceed that number by year’s end. Those are some staggering statistics. Many people have been touched by this crisis in one way or another, and I am included in that group. In 2012, I was held up at gunpoint while working in the evening. A masked man came into my store when it was still light outside, on a busy street with many people looking on. He left with several thousand dosage forms of opioids, stimulants, and benzodiazepines. He was in and out in less than 90 seconds, and he was never caught. Unfortunately, this story is not unique to me. I have had many conversations with other pharmacy colleagues and their concern is palpable. If you have not been robbed then you know someone who has. We have also had the misfortune of having a trusted employee steal narcotics from us as well. So while I have not had to suffer through the heartache of a family member or friend’s addiction, I have been touched by this epidemic and it is tragic. But I believe it is not insolvable. I would like to share 6
with you a framework that I plan to use over the next year. First, pharmacy safety is my top priority. As pharmacists, we serve as the last line of defense in protecting our patients. As such it is not uncommon to find ourselves in a compromising and potentially dangerous situation behind the counter. But a pharmacist should not fear for her safety or that of her staff. The solution is complex, multifaceted, and requires a balance between pharmacy safety and the delivery of patient care. But we have to get this right. Without a safe work environment we will be unable to perform the duties entrusted to us. I believe that one of the ways we can make our environments safer is to share our experiences and learn from each other. Whether that is done via work groups, continuing education sessions, or informal meetings, I want open lines of communication amongst our membership. Second, I would like to be more proactive in our approach to addressing the prevention of prescription drug abuse. One of the solutions to preventing unintended opioid related overdose deaths has been the use of intranasal naloxone kits. Increasing their availability to those who need it has provided a number of individuals with a second chance as well as an opportunity to seek out the help that they need. While this has assuredly saved lives and serves as a great example of the role pharmacists can play, it is not enough. Whether it is individual counseling, community outreach, or other innovative solutions we have not yet thought about we need to employ an all of the above approach. I would like to urge our membership to get more actively involved in their communities. To this day the general public is relatively uninformed or under-informed about the dangers associated with prescription drugs, specifically their potential for abuse. In certain instances, patients do not have realistic expectations for what their medications are capable of doing. The CDC is in the process of drafting guidelines for the prescribing of opioids in a primary care setting, focusing on a stepwise approach to pain relief where opioids are not first line. We are in a great position to join the conversation. Finally, I want the voice of pharmacists to be heard and I want our story to be told. Every day brings a new story about the opioid epidemic. This coverage has done wonders for elevating the profile of this important issue. But whose
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perspective has been missing in these stories? The pharmacist. I want this to change. We have a strong voice, we have a compelling story, and we need to be heard. In summary, the framework I would like to use to guide our work over the next year includes three elements: safety, prevention, and advocacy. I am certain that additional goals and ideas will come to light as we journey through the next year together. I look forward to both the challenges and the opportunities that the year holds.
MPhA Award Winners 2015 From a young age, Paul Jeffrey, PharmD, heard his father, a prominent pharmacist, assert “service to humanity is the best work of life.” Taking these inspiring words to heart, Paul has dedicated himself to a live of service and giving — also, coincidentally, as a pharmacist — and was named the Bowl of Hygeia receipient for 2015. Currently Director of Pharmacy for MassHealth, Paul leads a team that establishes policies and procedures for administering the pharmacy benefits for Medicaid recipients. This group manages a network of pharmacies, clinical initiatives, and an intricate claims processing system. Prior to this role, Paul worked as the Director of Pharmacy for Boston Medical Center (originally Boston University Medical Center). He oversaw the operation of both the inpatient and outpatient pharmacies there. Earlier in his career, Paul held several roles at the University of Maryland Medical System,
including Associate Director of Pharmacy, and also taught as a Clinical Associate Professor of Clinical Pharmacy. Paul combined his love of service into his career when he became the Residency Program Director at the University of Maryland. “I’ve always had an interest in mentoring younger pharmacists,” he explained. Paul’s involvement in pharmacy associations, however, started much earlier; he first served as the student delegate for the American Society of Health-System Pharmacists’ (ASHP) House of Delegates while attending MCPHS as an undergraduate. This passion for helping his profession followed him to the University of Maryland, where he participated in the Maryland Society of Hospital Pharmacists (MSHP), eventually becoming its president. While employed at Boston Medical Center, Paul also was installed as the president of the Massachusetts Society of Health System Pharmacists (MSHP), where he helped to organize educational seminars and advocate for policy initiatives. In Paul’s current function in the Medicaid arena, he volunteers as the chairperson for the Eastern Medicaid Pharmacy Administrators Association, where he helps convene an annual educational and networking meeting. A resident of Hingham, MA, Paul has devoted years of service to the Hingham Congregational Church. He has been active in organizing and participating in youth mission trips for the church for over 14 years. He traveled to Appalachia and many other locales to make home repairs for the needy, including constructing decks, adding wheelchair ramps, and painting. It’s a busy life, but Paul wouldn’t have it any other way. “I’m grateful for my life circumstances,” he said. “I thank God, family, my colleagues, and friends who have provided the circumstances for me to be successful professionally and given me the support to keep a focus on serving others.”
Save the Date! Massachusetts Pharmacists Association Spring Conference April 29, 2016 Four Points by Sheraton, Norwood 7
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Alexandria (Alex) Dunleavy, PharmD, takes pride in the positive impact she has on her patients daily as a Staff Pharmacist at Walmart. Her steadfast dedication to her profession earned her the title of Pharmacist of the Year, presented at MPhA’s Installation & Awards Banquet on September 24. As a clinically-focused pharmacist, Alex administers vaccines and performs Medication Therapy Management (MTM) services. She meets with each patient to discuss any new prescriptions. “I really enjoy it,” says Alex. “It keeps me on my toes and brings new challenges. I appreciate that Walmart focuses on impacting one patient at a time.“ After graduating from the University of Connecticut School of Pharmacy, Alex completed a one-year Pharmacotherap residency with the University of Texas in San Antonio. She then attended a Primary Care residency at the VA Medical Center in San Antonio. After residency training, she accepted a clinical adjunct faculty position with Northeastern University. Later, Alex decided to apply her skills as a clinically-trained pharmacist to the community setting. She has worked for Walmart for nearly 15 years. She also teaches the MTM curriculum to certify other pharmacists in this skill set, after becoming certified to teach herself through the American Pharmacists Association (APhA) program. While pleased with her award, Alex sees herself as merely one example of a profession on the forefront of change. “I accepted the award on behalf of all community pharmacists who are embracing the changes in the profession and assuming the role of patient care.” Matthew (Matt) Machado, PharmD, has led the charge for significant state legislative changes benefitting pharmacists over the past 10 years, working closely with MPhA Executive Vice President David Johnson. At the MPhA Awards & Installation Banquet on September 24, it was only fitting that Dave presented Matt with the Nathan Goldberg award, given 8
to an MPhA member who has excelled in legislative efforts. Matt has helped to move pharmacists ahead for nearly 15 years. He has presented testimony at the State House on numerous occasions, including advocating for multiple bills allowing pharmacists and pharmacy interns to administer immunizations to adults in Massachusetts. He participated in the influenza immunization pilot program, later publishing the data in the Pharmacy Journal of New England and presenting it to the Department of Public Health (DPH). This work helped compel the DPH to permit pharmacists to administer adult immunizations for a variety of conditions. Matt also gave strong backing to the CDTM (Collaborative Drug Therapy Management) bill, which now allows pharmacists to manage a patient’s drug regime in partnership with a physician under the CDTM protocol. He participated in the CDTM state task force, gave presentations to the legislature several times, and later attended the bill’s signing as the president of MPhA. Reflecting on the current climate, Matt believes the healthcare provider bill is the most crucial piece of current legislation for pharmacists. “This bill will create a better, more collaborative healthcare system,” says Matt. After graduating from MCPHS in 2001, Matt completed a residency with Walgreens and MCPHS University - Boston. In 2003, he became an MCPHS faculty member, a position he holds today. He instructs aspiring pharmacists in the classroom and also directs the Walgreens/ MCPHS University – Boston residency program. Matt trains students in a community pharmacy practice setting at Walgreens, working with them one-on-one. Matt anticipates staying involved in issues impacting pharmacists. “I am truly honored and moved by being named recipient of the 2015 Nathan Goldberg award,” said Matt. “I fully intend to continue to try and impact the profession of pharmacy in a positive way and encourage and inspire my colleagues and students to follow my lead.”
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MPhA honored Barbara Miller Perry, PharmD, MPH as its 2015 Pharmacy Industry Award winner. With her work at Pfizer as well as several years of involvement with MPhA, Barbara is a natural choice for this award. As a Medical Outcomes Specialist at Pfizer for the past 12 years, Barbara facilitates quality improvement projects for healthcare delivery systems. She captures and analyzes quality measure data for cardiovascular disease, pain management, and other conditions at partner organizations, then helps to identify a quality strategy to improve patient care and outcomes. Prior to her tenure at Pfizer, Barbara was the Chief Operating Officer for Quality Partners of Rhode Island, an organization that augments the quality of care for Medicare beneficiaries. She earned a PharmD from Shenandoah University and a Master’s in Public Health from Boston University. “It’s a great privilege to serve the association, and to be recognized by my peers is an honor,” said Barbara. Barbara’s contribution to MPhA started in 2007, when she was approached by the- Executive Director to serve on the Board as an industry representative. Over the past eight years, she has held a variety of leadership roles for the association, most notably President. Arriving full circle, Barbara currently serves as the Governor of the Academy of Industry. Barbara believes industry pharmacists can share their extensive expertise on the science and development of new drugs and the need for new treatment options. “They (industry pharmacists) have a wide variety of skills they can contribute to the association in fulfilling its mission,” she said. With all of the devastating consequences of the opioid epidemic, a pharmacist might be tempted to think twice about filling that prescription for pain medication. But what about the patients who suffer from pain that cannot be treated any other way, especially someone with complex medical issues? As an Advanced Practice Pharmacist
in Pain Management, it is these very challenging patients whom Michele Matthews, PharmD, CPE, BCACP treats — and a role she excels in. Michele was honored with the Upsher Smith Excellence in Innovation recipient. At Brigham & Women’s Hospital, Michele works with anesthesiologists, primary care providers, and psychologists to manage complex patients with chronic pain under collaborative drug therapy management. It is unique for the hospital to offer this type of pharmacist-run clinic to patients within primary care, says Michele. “It’s innovative not only for pain management, but for healthcare within Massachusetts.” Many of the patients there also have chronic pain co-occurring with challenging medical issues such as substance abuse and mental illness. Michele graduated from MCPHS University in 2002. She completed a PGY-1 Residency at the Robert Wood Johnson University Hospital in New Jersey. Michele started her career as an Assistant Professor of Pharmacy Practice at MCPHS-Worcester campus and maintained a practice in an urban family medicine clinic, where she saw a high prevalence of undertreated chronic pain and overuse of high risk medications such as opioids. She has now been working with patients suffering from chronic pain for more than 10 years. In her current position as Associate Professor of Pharmacy Practice at the MCPHS – Boston, she educates her students on the safe and effective use of analgesics and reinforces the importance of demonstrating empathy and compassion, maintaining objectivity, avoiding judgement, and listening to patients. She feels that these principles help patients have an improved quality of life. With the prescription drug abuse crisis continuing to worsen, pharmacists are in a prime position to help. A few pharmacists have been working to combat the epidemic for a long time, and Todd Brown is one of them. For his efforts, Todd was awarded the 2015 Cardinal Health Rx Champion Award.
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Todd has participated in drug abuse efforts and educated others at the federal, state, and local levels. He has shared expertise with the Washington DC-based Center for Lawful Access and Abuse Deterrence (CLADD), taken part in the organization’s annual policy meeting, and participated in congressional briefings on “The Role of the Pharmacist in Preventing Prescription Drug Abuse.” Todd has also helped to shape drug abuse efforts in Massachusetts. In 2013, he was appointed by the state’s Department of Public Health to the Medical Marijuana Dispensary Committee. As part of this group, he reviewed medical marijuana dispensary applications, balancing patient needs with safety concerns. Todd has also developed public service announcements about safe medication use and drug prevention in conjunction with the Plymouth County District Attorney’s office. No less involved in his own backyard, Todd is a member of Organized Against Substance Abuse in Stoughton (OASIS), where he has participated in drug takeback events, educated pharmacists on naloxone, and taught seniors about safe medication use. He has also helped lead the organization as a member of its Steering Committee. “I am honored to receive the Cardinal Health Generation Rx Champions Award and join the past recipients,” said Todd. “It is especially gratifying to receive this award in a time when the drug abuse epidemic is so prevalent and when such initiatives are so important. I hope this will stimulate other pharmacists to become involved in their local drug abuse coalitions.” Todd is the Vice Chair of the Department of Pharmacy and Health System Sciences at Northeastern University, where he has worked for 26 years. He also leads his colleagues as the Executive Director of the Massachusetts Independent Pharmacists Association (MIPA). Prior to these roles, Todd practiced at several independent community pharmacies. 10
By 2012, Elicia Fauvel DeParolesa was a successful pharmacy manager for CVS Health. She refused to become complacent in this role, and looked for ways to improve her patients’ quality of life. The steps she took attracted the attention of MPhA’s awards committee, and Elicia was named the 2015 Distinguished Young Pharmacist. To provide better care to patients, Elicia began holding a monthly presentation on a health topic at her CVS store. She also started spending more time training newly minted pharmacists — those who were no longer interns but who did not yet have experience practicing. Elicia also began teaching a pharmacy practice lab at MCPHSBoston, her alma mater, and still does this today. She also traveled to Washington DC to lobby in support of opioid abuse prevention and Medicare Part B. Currently, Elicia works at a Foxboro CVS, but also travels South Yarmouth, Orleans, and Hyannis stores to mentor the pharmacists there. She believes it is critical for new pharmacists to combine clinical knowledge with business management skills. “A lot of pharmacy graduates get thrown into being a manager, so how can we have them balance running a business with keeping people healthy for the rest of their lives?” Elicia holds a certificate in diabetes education. She earned her PharmD and a bachelor’s degree in Pharmaceutical Marketing and Management from MCPHS-Boston. Elicia has also furthered her profession through volunteer efforts. For 15 years, she has been a member of Lambda Kappa Sigma (LKS), a women’s pharmacy fraternity. Elicia sits on the organization’s Trust Liaison Committee or scholarship committee. Coincidentally, she was also named LKS’ Distinguished Young Pharmacist for 2015. Elicia hopes to continue teaching and intends to remain a community pharmacy practitioner. “I am very humbled by this award,” said Elicia. “ I love community pharmacy and will always be a community pharmacy advocate.”
Pharmacy Journal of New England • Fall 2015
New Hampshire Legislative Update Collaborative Practice A bill requested by pharmacists, HB 190, establishing a statutory commission to study the standards for collaborative pharmacy practice, was signed into law on July 6, 2015. The Commission has completed its work, and legislation has been drafted for this legislative session to expand access to collaborative practice pharmacy services to New Hampshire citizens in order to provide greater access to cost-effective care. Naloxone HB 271 - Relative to possession and administration of an opioid antagonist for opioid-related overdoses - was signed into law on June 2, 2015. The bill is in response to the heroin epidemic in New Hampshire. There were 326 confirmed drug overdose deaths in the State last year and the numbers are significantly rising this year. The Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention, and Treatment assigned a task force to work on the implementation of this bill, and it cumulated with a press conference at the Governor’s office on September 29th. At that time, the Department of Health and Human Services unveiled their initiative, Anyone Anytime Campaign, www.anyoneanytimenh.org. The Governor asked the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery, the Department of Health and Human Services, the Board of Pharmacy, and the New Hampshire Medical Society to work with physicians, providers, pharmacists and family members to successfully and promptly make naloxone (Narcan) more available to those at risk of an opioid overdose. Included in the Governor’s recommendations, primary care and other providers are encouraged to offer naloxone prescriptions to persons at risk of opioid overdose and concerned family and friends of those at risk. She encouraged pharmacies to prepare to stock Narcan in both intramuscular and intra-nasal form and to respond to any increased demand for naloxone. It is
important to note that a doctor-patient relationship is not required to receive a prescription for naloxone. And, once the standing order at a pharmacy is complete, a person can go to the pharmacy and purchase it through the standing order. WorkLoad Issues Another bill, requested by the NH Pharmacists Association, was House Bill 141, Relative to rulemaking authority concerning practice standards and safe and secure operation of pharmacies. The bill passed the House and is being held in the Senate Executive Departments and Administration Committee for further study. This bill would give the Board of Pharmacy rulemaking authority to adopt rules around workload issues. New legislation for the 2016 session Relative to mandatory vaccines Relative to prescriptions under the telemedicine act Relative to access to investigational drugs, biological products, and devices Relative to sales by pharmacists under the controlled drug act Establishing a commission to study health care for all in New Hampshire Requiring the board of pharmacy to adopt protocols governing the dispensing of naloxone hydrochloride Relative to the controlled drug prescription health and safety program Relative to drug take-back programs Relative to pharmacy benefit managers
RxRelax with Yoga by Jay Gupta, RPh, MTM specialist When people hear that I have combined my pharmacist background with a yoga therapy practice, reactions often range from being amused to confused. How can someone who dispenses medications all day possibly look to something like yoga for health problems; and conversely, how can someone who embraces yoga possibly look to chemicals for relief? The 11
New England States
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answer, in my experience, is that both may be effective when used properly.
includes physical movements, breath- and mindfulness-based practices and very deep relaxation.
My story as a teenager in India with unmanaged asthma (and other conditions) did not find relief in a doctor’s office or at a pharmacy counter. As a last resort, my parents sent me to a yoga school. Within three months, it felt and looked like I developed a new healthy body. I was grateful, amazed and at the same time incredibly curious about what the mechanism of action of this powerful medicine might be. I immersed deeper into the study and practice of yoga.
Over the years, we’ve brought YogaCaps’ free therapeutic yoga service to hospitals, including a VA medical center, pain clinic, and many community settings, including a major mental health center. 100% powered by volunteers, YogaCaps currently serves patients at / from 10 hospitals and is the largest program of its kind throughout New England.
Intrigued also by the molecules behind the medicines, I jumped into pharmacy school and then pursued an international career in marketing of pharmaceuticals and Ayurvedic products. After coming to the USA, I worked for many years as a community pharmacist. I was surprised to see that much of yoga in the USA at the time was a mix of gymnastics and fashion. Demographics showed that those who practiced yoga tended to be healthy mid- to upper-income Caucasian women. I began to teach free yoga sessions for all abilities and ages in the New England area. In 2006, my wife and I incorporated a 501c(3) non-profit called YogaCaps, with a mission to bring yoga to people with chronic physical and mental health conditions. I am often asked what ‘YogaCaps’ means. ‘Caps’ is short for “capsules.” I wanted to explore yoga as a medication. I knew it would need to be safer, easier to do and effective; so I worked to develop a seated, therapeutic formulation. It
12
While intellectually I knew that yoga and mindfulness could change the chemistry of the body and have many positive effects on the musculoskeletal system, I didn’t expect some of the major improvements in participants’ health that we have seen. People experienced a reduction in pain, depression, anxiety, insomnia, cholesterol, A1C and blood pressure. People successfully managed some of the side effects of cancer treatments with their yoga routines. We included family members in the classes and saw successful lifestyle changes take root. We heard from a physician about her patient who lost 35 pounds of weight, and reduced tremors and Sinemet for Parkinson’s. We heard from a mental health professional about her patient with PTSD who reduced auditory hallucinations after her very first class. As requests for YogaCaps continue to grow, we have started to train healthcare professionals how to teach this seated, therapeutic and trauma-sensitive yoga. This 100-hour training has a self-care component and we call it “RxRelax.” It provides
Pharmacy Journal of New England • Fall 2015
insight, and decisiveness, as well as, need and scholastic ability. This year the foundation awarded two outstanding students. The recipients will be honored at the New Hampshire Pharmacy Awards banquet in December. The first 2015 scholarship recipient is Morgan Ratte, a 2016 PharmD Candidate, currently studying at University of Rhode Island’s College of Pharmacy. 30.0 AMA PRA category 1 live CMEs and CEs for nurses, pharmacists and other healthcare professionals. As we try to put the pieces of our healthcare system together in new and more meaningful ways, integrative health practices like yoga hold a great deal of promise. The NIH supports the integration of yoga into medical treatment. Research shows that yoga can be effective for over 75 health conditions and now we have a potential blockbuster medication on hand. With the leadership of Dr. Carroll-Ann Goldsmith and Dr. Maryann Cooper at MCPHS, a pilot study for insomnia in patients who are actively being treated for cancer is using RxRelax therapeutic yoga as an intervention. My hope is that this article has made you curious about exploring yoga for your own use and perhaps for patient referrals as appropriate. Jay Gupta is an “Excellence in Innovation” award winner registered pharmacist in NH, MTM specialist and master yoga teacher. He travels nationally sharing yoga with people on wheelchairs, while teaching free weekly sessions at local hospitals, including a VA hospital. On the forefront of making integrative health practices more accessible, he regularly partners with hospitals and healthcare systems. Jay is an invited speaker and presenter at numerous health-related conferences and community events across the country for for: Massachusetts Hospital Association, MGH, Dana Farber Cancer Institute, Catholic Medical Center, Elliot Hospital (conference and CME Grand Rounds presentation), Dartmouth Hitchcock Medical Center, Veterans Administration Medical Center, Harvard Pilgrim Health Care, United Healthcare, Christopher and Dana Reeve Foundation, Indian Medical Association of New England, International Association of Yoga Therapists, Greater Nashua Mental Health Center, Abilities.com, Nesbitt College of Pharmacy and Nursing at Wilkes University and more.
New Hampshire Pharmacists Association Scholarship Foundation 2015 Scholarship Recipients Each year the New Hampshire Pharmacists Association (NHPA) Scholarship Foundation provides student pharmacists of NH an opportunity to receive scholarship funds. The scholarship committee places high value on students with the right balance of professionalism, initiative, leadership, Morgan is a member of the University’s Rho Chi Honor Society, Phi Lambda Sigma Pharmacy Leadership Society and America’s Senior Care Pharmacists. Morgan has also participated in the College’s mission trip to an orphanage in Jamaica where students of pharmacy provide education to the caregivers about medication adherence and dosing. Morgan is leading the 2016 mission trip. The second scholarship recipient is a MCPHS University 2018 PharmD Candidate, Joanna Nichols. Joanna is the Vice President of the University’s Health and Wellness Club, serves a member of the National Technical Honor Society and APhAASP. She has also worked as a volunteer swim coach for the Special Olympics. We wish the 2015 scholarship recipients continued success in their education and pharmacy careers. For information about the NHPA Scholarship Foundation scholarship program, please visit our website at www.nhpharmacists.net.
Upcoming CE Conference: Save the Date—Last Chance CE –Sunday, December 6, SERESC Conference Center, 29 Commerce Drive, Bedford, NH Visit www.nhpharmacists.net for additional details. 13
New England States
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Maine MPA Recognizes Individuals for their Contributions to the Profession of Pharmacy The MPA celebrated the contributions of pharmacists, technicians, and students at the 2015 Fall Convention in Bangor, Maine. The award ceremony recognized pharmacists for national and local awards. The recipients are:: Bowl of Hygeia Award: Kenneth “Mac” McCall Distinguished Young Pharmacist Award: Jason Berube Cardinal Health Generation Rx Champions Award: Heather Stewart Upsher-Smith Excellence in Innovation Award: Penobscot Community Health Center Maine Technician of the Year: Jessica Stoup A highlight of the night was the MPA membership awarding $4,000 in scholarships to four outstanding students from Maine or attending the Maine pharmacy schools of Husson University and the University of New England. The deserving recipients were Kayla Harris (UNE), Katelyn Bernard (UNE), Thomas Ventrella (Husson), and Bennett Doughty (UConn) .
MPA President, Gregory Cameron presents the Bowl of Hygeia Award to Dr. Kenneth “Mac” McCall
MPA Appoints New Members to the Board of Directors and re-elects Treasurer MPA welcomes Diane Blanchette as Technician Representative to the Board of Directors. Diane has 30+ years of technician experience to share with the board. Also, Amelia Arnold has been selected as an at-large representative to the board. Amelia brings legislative and retail perspective to the board. A big thank you goes out to Eric Jarvi for serving another term as Treasurer of the Association. He was unanimously elected by the membership. Eric has done an outstanding job maintaining the association’s strong financial health for the past four years. MPA appreciates his current support and continued involvement in the organization.
MPA Spring 2016 Convention and Trade Show
Members of Pharmacy Fraternities posed for the camera at the annual awards ceremony.
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The MPA Spring Convention and Trade Show is April 1-3, 2016 at the Freeport, ME, Hilton Garden Inn. The education committee is lining up outstanding speakers to educate our pharmacy community on topics relevant to the profession. The programming will include CPR certification as a continuing education option. Need Immunization training? We are determining a need for an immunization certification track at the convention. If you are interesting in this training, please send an email to the MPA office at MPARXinfo@gmail.com to be added to the list. As details are finalized, please visit MPARX.com.
Pharmacy Journal of New England • Fall 2015
Rhode Island Hello fellow Rhode Island Pharmacists Association Members! Congratulations to the 2015 RIPA award recipients! Each of these talented individuals was honored at our 141st RIPA President’s Dinner and Awards Ceremony, which was held on September 24th. • RIPA Presidential Leadership: Anita N. Jackson, PharmD
article, visit the APhA web site at https://www.pharmacist. com/pharmacist-services-acos-improve-outcomes-matter
Sunset at Sea View: A night of Wine and Fellowship by the Bay On October 3rd, RIPA teamed up with the APhA Foundation to host a great evening of networking, fun, and fundraising to advance pharmacy. Ted Doyle, RIPA member and APhA Foundation supporter, opened his historic Rhode Island oceanfront home for a night of wine and appetizers to benefit the APhA and RI Pharmacy Foundations.
• NCPA Pharmacy Leadership: Lynn M. Pezzullo, RPh, CPEHR • McKesson Incoming President: Lynn M. Pezzullo, RPh, CPEHR • Bowl of Hygeia: Deborah S. Newell, RPh, CDOE, CVDOE • Distinguished Young Pharmacist: Christopher L. Federico, PharmD, CDOE, CDE, BCACP • Excellence in Innovation: Stephen J. Kogut, PhD, MBA, RPh • Guido L Pettinichio: Tara Higgins, PharmD • Cardinal Health Generation Rx: Jeffrey Bratberg, PharmD • RIPA Pharmacist Service: Lucrezia Finegan, RPh, MBA • RIPA Professional Service: Denise Gorenski, M.Ed. • RIPA Student Service: Patricia Buderwitz, PharmD Candidate • Charles Hachadorian, Jr. Award: Paul George, MD
RIPA Member in the News RIPA’s President-Elect, Sarah Thompson, PharmD, CDOE is paving the way for pharmacists, as featured by APhA in their article, Pharmacist Services in ACOs Improve Outcomes that Matter. Under Sarah’s leadership and management at Coastal Medical, population health pharmacists run many of the central clinical initiatives. Within these initiatives, pharmacists participate on multidisciplinary teams to identify and prioritize patients’ medication management needs. Pharmacists on Sarah’s team also support refill and prior authorization needs, medication reconciliation, MTM consults, collaborative disease state management, cardiac risk reduction, and medication conversion. To access the full
Above, left to right: Ted Doyle, PharmD (APhA member and donor), Heather Larch, RPh (President, RIPF), Lynn Pezzullo, RPh (President, RIPA), Kelly Valente, PharmD (APhA Foundation, Board of Directors member), Ryan Burke, PharmD (APhA, Associate Director, Practice Initiatives)
Kelly Valente, APhA Foundation Board of Directors member, and Ryan Burke, Associate Director, Practice Initiatives at APhA, represented the national organization at the event. Corporate sponsors included Corner Bakery, Mattingly Management, Party Plus Taylor Rentals, Middletown Mutt Mansion, and Lazy Man and Monkey.
Above, left to right: PharmD Candidates, URI College of Pharmacy, Class of 2017, Julie Kelly, Amanda Ryle, and Alicia Palombo, Karen Ryle, RPh (President, NABP), Donna Horn, RPh (Director, Patient Safety Community Pharmacy, ISMP)
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New England Pharmacists Convention 2015
Above, L to R: CPA President-Elect Bahar Matusik, James Henkel from University of Saint Joseph School of Pharmacy, and CPA Treasurer Peter Tyczkowski.
MPhA Vice President Paul Larochelle presents the Pharmacy Industry Award to Barbara Perry.
At left, from L to R: Christine Perry and Secretary Joanne Doyle Petrongolo from MPhA, and Meghan Wilkosz of CPA
Presenter Sarah Thompson visits with CPA Past President Philip Hritcko.
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MPhA Pharmacist of the Year Alex Dunleavy, MPhA Chairman and Susan Holden and Board Member Kerry McGee.
Pharmacy Journal of New England • Fall 2015
UConn Takes the Pepto Bowl The Pepto Bowl was held on September 25 at the New England Pharmacists Convention at Gillette Stadium. Eight out of the ten New England schools of pharmacy participated this year. The competing teams were: UConn, URI, University of New England, Northeastern, MCPHS University – Boston, MCPHS University - Worcester/ Manchester, Western New England University, and University of Saint Joseph’s The four teams that scored highest on the pre-test and moved on to the live competition were: URI, UConn, MCPHS University - Boston, and MCPHS University- Worcester/Manche UConn prevailed in the live competition. The scores were as follows: o o o o
UCONN 32,399 MCPHS University – Worcester/ Manchester 29,700 MCPHS University - Boston 13,300 URI 12,800
Above, left to right: CPA Past President Phil Hritko, the winning UConn team of Nibal Fadhil and Sarah Chambers, and CPA Treasurer Peter Tyczkowski.
See you at the 2016 Pepto Bowl!
Pictured clockwise, the teams from MCPHS-Worcester/Manchester, URI, and MPCHS-Boston.
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New England Pharmacists Convention Poster Competition Title of Poster: Interprofessional Rounds for Clinical Pharmacy and Physician Assistant Students. Author: Yulia A. Murray, PharmD, BCPS; Beth Buyea, MHS, PA-C, MCPHS University. Category: Successful Integration of Pharmacy Students in a Practice Setting Purpose: Health care professionals work collaboratively in a team-based approach to provide patient-centered care. A review of the literature shows a trend in this interprofessional education style in medical and nursing schools. There is a lack of literature demonstrating the effects of interprofessional education for other health care professions, such as pharmacy and physician assistant students. The goal of this project is to evaluate the pharmacy and physician assistant student perceptions of interacting with students from other disciplines and to work together as an interprofessional team to create a care plan for a specific patient. Methods: Pharmacy and physician assistant students on rotation in internal medicine at Newton-Wellesley Hospital were paired to participate in one session of interprofessional student rounds. These rounds were facilitated by a faculty member from the School of Pharmacy and the School of Physician Assistant Studies. Paired students were first asked to obtain a history and perform a focused physical exam on a preselected patient. Working collaboratively, they next created a diagnosis and treatment plan. The second part of the activity required the team to present the patient to the facilitators with a discussion of how they arrived at the diagnosis and plan. The student perceptions were evaluated with a pre- and post- modified Readiness for Interprofessional Learning Scale (RIPLS) Questionnaire. Results: Analysis of the pre- and post- survey data revealed increased positive thinking about other healthcare professionals, better understanding of the roles of other professionals, improved communication, and a better understanding of the importance of team skills for future practice. This activity demonstrated that integrating students from different health care disciplines into an interprofessional activity has a positive outcome, with students benefiting from 18
the activity. The limitations of this study include the activity was done once in a 6 week block and there was a small cohort sampled. Title: Impact of pharmacist-led education on insulin administration technique. Authors: Corinn Martineau, PharmD, CDOE, Virginia Lemay, PharmD, CDOE, CVDOE, and Lisa Cohen, PharmD, CDE, CDOE, University of Rhode Island, College of Pharmacy. Category: Innovation in Pharmacy Practice Purpose: A prospective study evaluating the impact of pharmacist-led education on insulin administration technique and patient confidence surrounding self-management of diabetes. Methods: A single location, pre- and post-evaluation of an intervention conducted between January and March 2015. Participants were identified for inclusion at one Rite Aid Pharmacy location while picking up a prescription refill for insulin. Patients eligible for inclusion were > 18 years old, currently prescribed any type of insulin (e.g. short-acting, long-acting, etc.) and were using either vial-and-syringe or a pen device for administration. Interactions with the pharmacist included an initial, face-to-face evaluation and one telephone encounter 4 weeks following the initial encounter. Study outcomes included pre- and post-intervention checklist scores, as well as improvement from baseline to follow-up in patient confidence survey scores. Results: Nine patients were enrolled in the study. Both vial-and-syringe and pen device checklist scores demonstrated improvement from baseline to follow-up. The paired t-test analysis demonstrated a statistically significant difference of 1.67 (95% CI, 0.23 – 3.10; p=0.04) in the vial-andsyringe users and a difference of 1.43 (95% CI, 0.70 – 2.16; p=0.003) in the pen device users. The greatest improvement in the confidence questionnaire was seen in the final question, with a mean score of 5.6 ± 1.0 at baseline and 6.2 ± 0.4 at follow-up. This project demonstrates the need for periodic reassessment of patients’ injection technique, as well as the role for community pharmacist-led patient education surrounding insulin injection technique in order to improve patients’ administration performance and confidence level.
Feature
Pharmacy Journal of New England • Fall 2015
Important Updates for Influenza Vaccine 2015-16 by Karl Granskog, PharmD and Jennifer Girotto, PharmD The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) updated its recommendations for the 2015-2016 influenza season on August 7, 2015.1 This article will summarize those pertinent updates. Influenza vaccination should begin by October, if possible, to best ensure that patients are vaccinated before the onset of influenza-like illness in the community. Both trivalent and quadrivalent vaccines will again be available this season, and vaccine products are summarized in Table 1. All vaccines will be comprised of hemagglutinin from an A/California/7/2009 (H1N1)-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like (Yamagata lineage) virus. The quadrivalent vaccine products will contain the additional B/Brisbane/60/2008-like (Victoria lineage) virus. These vaccines represent a change in the influenza A (H3N2) strain and influenza B (Yamagata lineage) strains from last year’s vaccines. In addition to the currently approved influenza vaccine products, in September 2015 the Vaccines and Related Biological Products Advisory Committee of the FDA voted to recommend, by accelerated approval, the licensure of a new influenza vaccine, Fluad, by NVS Influenza Vaccines for patients over 65 years. This candidate vaccine, Fluad® is the first adjuvanted seasonal influenza vaccine in the United States to be recommended for approval. This adjuvanted vaccine, is currently approved in over 30 countries with approximately 76 million doses distributed.2 A Phase III clinical trial comparing immunogenicity and safety with a U.S. licensed, non-adjuvanted trivalent influenza vaccine showed that this candidate vaccine demonstrated non-inferiority for seroconversion rates and geometric mean titers, with significantly higher influenza antibody titers for all three vaccine strains in patients ≥ 65 years of age3.
There are special considerations for vaccination of patients with a history of allergic reaction. First, any person with a history of severe allergic reaction after influenza vaccine administration should not be re-vaccinated, regardless of the suspected cause or responsible influenza vaccine component. As in previous years, ACIP has also set forth recommendations for patients who have an egg allergy. Severe allergic reactions may occur in these patients after the administration of various influenza vaccines, but it should be noted that such reactions are rare. Most of the currently available influenza vaccines are prepared via propagation of the influenza virus using embryonated eggs. Exceptions to this method are the egg-free recombinant influenza vaccine (RIV3, Flublok) and the cell-culture based inactivated influenza vaccine (ccIIV3, Flucelvax)1, but only the Flublok vaccine is considered completely egg-free. While neither of these products is licensed for use in patients < 18 years of age, the RIV3 vaccine (Flublok) recently gained approval for all patients ≥ 18 years of age, and is no longer restricted to an upper age limit of < 65 years. All patients who have experienced only hives after egg exposure should be vaccinated with either the IIV or RIV3 vaccine1. However, if IIV is used (either egg or cell culture-based), the vaccine should be administered by a healthcare provider who is familiar with egg allergy manifestations and the patient should be observed for at least 30 minutes after vaccine administration. For those patients with a more severe reaction to egg products (angioedema, respiratory distress, lightheadedness, recurrent emesis or who required epinephrine or emergency medical intervention after exposure), RIV3 may be administered. If RIV3 is not available, the patient is not ≥ 18 years of age, or there is any contraindication to 19
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administration, IIV may be administered by a physician with experience in recognition of severe allergy manifestations1.
Since the influenza A(H1N1) 2009 pandemic virus strain has been included in all influenza vaccines since the 2010-2011 season, ACIP no longer recommends separate consideration of receipt of vaccine doses containing this strain in children aged 6 months to 8 years. Rather, the process for determining the appropriate number of influenza vaccine doses for this age group has been simplified. Children in this age group should receive 2 doses of influenza vaccine (at least 4 weeks apart) if they have not received a total of ≥ 2 doses of influenza vaccine prior to July 1, 2015. It is important to note that the 2 doses did not have to occur in successive years. All children 6 months to 8 years who have received at least 2 influenza vaccines prior to July 1, 2015 will only require one vaccine dose in 2015-2016. For some patients, more than one influenza vaccine product may be appropriately indicated. ACIP does not express a preference among vaccine products, but rather highlights the importance of timely vaccine administration to prevent influenza-related illness. This differs from last year’s recommendation, in which ACIP expressed a preference for the use of the live attenuate influenza vaccine (LAIV) over the inactivated influenza vaccine (IIV) in healthy children aged 2 through 8 years. The use of either LAIV or IIV is an acceptable option for this age group, as recent data has not shown a consistent relative benefit with the use of the LAIV. References: 1. Grohskopf LA et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR. Center for Disease Control and Prevention. 7 August 2015. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm. 2. Ernst, Diana. FDA Committee Votes Yes on New Flu Vaccine for Elderly. MPR. 15 September 2015. http://www.empr.com/news/fda-committee-votes-yes-on-new-fluvaccine-for-elderly/article/438730/. 3. Tsai TF. Fluad®-MF59®-adjuvanted influenza vaccine in older adults. Infect and Chemother. June 2013;45(2):159-74.
Vaccine Category
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Brand Name (Manufacturer)
Recommended Ages
Dose
IIV3, instramuscular
Afluria (bioCSL)
> 9 years
0.5 mL
IIV3, instramuscular
Fluvirin (Novartis vaccines)
> 4 years
0.5 mL
IIV3, instramuscular
Fluzone (Sanofi Pasteur)
6 - 35 months
0.25 mL
IIV3, instramuscular
Fluzone (Sanofi Pasteur)
> 36 months
0.5 mL
IIV3, instramuscular
Fluzone High-Dose (Sanofi Pasteur)
> 65 years
0.5 mL
IIV3, instramuscular
Flucelvax (Novartis vaccines)
> 18 years
0.5 mL
RIV3, intramuscular
Flublok (Protein Sciences)
> 18 years
0.5 mL
II4, intramuscular
Fluarix Quadrivalent (GlaxoSmithKline)
> 3 years
0.5 mL
II4, intramuscular
FluLaval (ID Biomedical Corp. of Quebec)
> 3 years
0.5 mL
II4, intramuscular
Fluzone Quadrivalent (Sanofi Pasteur)
6 - 35 months
0.25 mL
II4, intramuscular
Fluzone Quadrivalent (Sanofi Pasteur)
> 36 months
0.5 mL
II4, intradermal
Fluzone Intradermal Quadrivalent (Sanofi Pasteur)
18 years - 64 years
.1 mL
LAIV4, intranasal
FluMist Quadrivalent (MedImmune)
2 years - 49 years
0.1 mL in each nostril
Pharmacy Marketing Group
Rx and the Law By: Don R. McGuire Jr., R.Ph, JD This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.
Delivering the Prescription A lot has been written about quality processes in the dispensing function and many good ideas are out there; the Two Dosage Unit rule, shelf talkers, NDC checks, etc. But one thing that isn’t often talked about is getting the right prescription to the right patient. All of the safety and quality processes go for naught if the prescription is given to the incorrect patient. Consider these two examples. Tom Smith comes into Anytown Pharmacy to pick up his wife’s prescription. In the will-call bin with her prescription was also one for Ron Smith. The technician thought Tom had said Ron and assumed that the second prescription was his. She gave Tom both prescriptions. The error was discovered when Tom returned home. Paul was making a delivery for City Pharmacy one afternoon and pulled into a driveway shared by 101 and 103 Main Street. Mary was standing in the driveway. “You got here just in time; I’m headed out for my doctor’s appointment.” Paul ignored his normal protocol at the insistence of the patient. He gave the prescriptions to Mary who left for her appointment. Paul discovered later that the prescriptions were for a patient who lived at 103, but Mary lived at 101. Many times pharmacists don’t think about the actual hand-off to patients. They would be surprised to learn what happens at the delivery point. For example; patients step forward when someone else’s name is called, patients or staff hear names incorrectly, patients with the same or similar names appear at the pharmacy at the same time, or patients in the same extended family with the same name utilize the same pharmacy. Unfortunately, claims history tells us that these patients are very likely to take the medications that they go home with or get
Pharmacy Journal of New England • Fall 2015
delivered to them. This occurs even when their name isn’t on the label, they have never heard of the drug or their own doctor’s name is not on the prescription. Also unfortunately, juries are less inclined to place blame on the patient for these sorts of mishaps. Fair or not, the responsibility falls on the pharmacy to get the right medication to the right patient. A number of solutions are available. Previous articles have extolled the value, to both the patient and the pharmacist, of patient counseling. This article won’t repeat all of those benefits, but patient counseling is an effective tool to discover errors at the time of delivery. But patient counseling is not always needed or required, so we need other tools. Asking the patient to produce identification and requiring the staff to review prior to handing over the medications is one method. Others have asked the patient for a second identifier to differentiate patients with similar names; address, phone number or social security number. This has to be done as discreetly as possible to protect the patient’s privacy. It is also helpful to ask additional questions of persons picking up others’ prescriptions; what is their relationship to the patient or ask some of the secondary identifiers above. Delivery drivers should never deviate from their protocols and should verify the address and identity of the patient when delivering medications. Date, time and to whom the medications were delivered should all be documented. Most of the time, delivery to the patient is not a problem, so little attention is paid to it. But, ignoring this step of the dispensing process creates a weak point in the pharmacy’s overall quality initiative. History shows us that patients will take whatever medication is given to them, even when it makes no rational sense to do so. It is essential that this final step in the dispensing process gets the same attention as other steps in the process. Once the medication is in the wrong hands, it is impossible to predict the outcome.
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Financial Forum 2015: A Time for Patience Don’t let the market’s jumps rattle your commitment to staying invested. What the market does today, it may not do tomorrow. That may seem elementary, but there are days, weeks, months, and even years when that investing lesson is ignored. Wall Street started 2015 with pronounced volatility, and in the opening six weeks of the year, investors were again reminded why patience is so important. What did investors do in January? Sell. The S&P 500 lost 3.10%. Discouraging news items bred pessimism: deflation was coming to Europe, world demand for oil had peaked and prices would never come near $100 again, the slowdown in Europe and Asia would soon unravel America’s economic comeback. An old market belief dictates that the opening month of a year sets the tone for the rest of the year. Clear implication: 2015 equals bad market year. Sell, sell before it is too late.1 What did investors do at the start of February? Buy. The S&P 500 gained 3.03% in the first trading week of the month (and it had advanced 2.64% in the 30 days ending February 6). Encouraging news items bred optimism: the European Central Bank unveiled an asset-purchase program extending into 2016 to fight deflation with a scope matching QE3, oil prices began to rebound sharply, assorted earnings pleased Wall Street. Clear implication: 2015 might not be so bad. Buy the dip.2,3 What’s the takeaway here? Don’t panic. Don’t let a down January lead you to put off your annual IRA contribution or trim your per-paycheck retirement plan deferrals. What ground stocks lose, they may quickly regain. For the record, 2014 provided the same lesson in patience. January 2014 saw the S&P 500 fall 3.56%. February 2014 brought a 4.31% gain. The S&P went on to go +11.39% for the year. Perhaps its 2015 performance will mimic this.1,3 History is no barometer of future stock market 22
performance, but it can be illuminating with regard to how stocks have overcome the “January effect” – a bad January does not necessarily lead to a lousy year. In fact, here is the real eye-opener: during 1989-2014, the S&P finished up for the year 75% of the time after a loss of 2% or greater in January, with an average annual gain of nearly 8% in those market years. In fact, only twice in the past quarter-century has a bad January presaged a bad year for the index (2000, 2008). In 2009, it lost 8.57% in January and went +35.02% for the rest of the year. In 2003, it gave up 2.74% for January, then went +29.94% across the next 11 months. This illustrates that on Wall Street, anything can happen – and that includes good things.4 Stay patient & stay invested. The last couple of years have been notably placid for U.S. stocks. Entering February, the S&P had gone more than 1,200 days without a correction. That lulled some investors into a comfort zone, to the point where they overreacted to significant (but in no way aberrant) stock market fluctuations.5 Patience is a virtue for the long-term investor trying to build wealth for retirement and other future objectives. Already, this stock market year has highlighted its value. The Federal Reserve may elect to raise interest rates and the strong dollar may persist for some time, but those factors may not hold back the bulls in 2015 any more than many others have since 2009.
Citations. 1. ycharts.com/indicators/sp_500_monthly_return [2/9/15] 2. markets.on.nytimes.com/research/markets/usmarkets/ usmarkets.asp [2/6/15] 3. online.wsj.com/mdc/public/page/2_3022-quarterly_gblstkidx.html [12/31/14] 4. nvesting.com/analysis/75-of-the-time,-%27down%27-january-good-for-s-p-500%27s-yearly-close-240337 [1/31/15] 5. tinyurl.com/kw8ue3b [1/31/15]
From the Colleges
Pharmacy Journal of New England • Fall 2015
University of Connecticut School of Pharmacy As we continue the celebration of our 90 years of excellence in pharmacy education, we looked at our alumni who have chosen nontraditional career paths as well as those who have excelled in providing care at community pharmacies and hospitals across the state and nation. One such woman was Anna Houston Lane Petry ’31. Lane, an early graduate of the school, hailed from a family of trailblazers. Her mother’s sister, Anna Louise James, is recognized as the first African-American woman registered as a pharmacist in the State of Connecticut and ran a store in Old Saybrook, Connecticut. Her father, Peter, was also a pharmacist and her mother a chiropodist. Lane worked in the family-owned store before marrying George Petry in 1938. Rather than continue behind the pharmacy counter, Ann Petry, as she was then known, turned her attention to writing. She became an editor and reporter for a weekly newspaper, the People’s Voice. Her writing flourished and she published several novels, including The Street, which was nominated for the 2015-2016 UConn Reads program. Throughout her life she continued to write trying her hand at children’s literature, short stories, and poetry. Petry received honorary degrees from Suffolk University, Mt. Holyoke College, and, in 1988, an honorary Doctor of Letters from UConn. Petry is only one of our alumni with a pioneering spirit. Angelo DeFazio ‘85 Angelo DeFazio’s parents were Italian immigrants who instilled their son with a work ethic and drive to succeed. A self-proclaimed member of “skid row,” DeFazio’s classmates would never have guessed his entrepreneurial spirit and compassion for others. Buying his first pharmacy at age 26, DeFazio now owns four pharmacies in Hartford, manages the pharmacy for Charter Oak Clinic, and owns one of only six medical
marijuana dispensaries in the state. He is active in many professional organizations and was named 2012 Pharmacist of the Year by the National Community Pharmacists Association. DeFazio serves on the Connecticut Pharmacy Commission, is an emeritus member of the School of Pharmacy Advisory Board, and is active on a national level. He precepts UConn pharmacy students on rotation, has partnered with the school on medication management research, and is always on the leading edge of new practice models. William (’65) and Adam (’93) Hait Adam Hait had an idea. When he approached his dad in 1994 requesting seed money for a nationwide retail distribution drug business, Bill had to think twice. The Hait family had built a good life around the traditional community pharmacy they owned and operated in northern New Jersey. In fact, Bill pointed out that the majority of the clientele serviced came from less than a mile in any direction. After graduation in 1965, Bill went into retail pharmacy with his own father at the family’s community pharmacy. Together they doubled the size of the store and made it one of William Hait ‘65 the best single store pharmacies in New Jersey. Adam joined his father and grandfather in the family business, but the pioneering spirit called him. Adam recognized the need for a discreet market for infertility drugs supported by highly trained professionals. In 1994, the concept of niche marketing in pharmacy was in its infancy. Although it was Adam’s entrepreneurial spark that launched the idea, it was the entire family that built the business into the second largest retail distributor of fertility drugs in the U.S. Barbara Deptula ’78 Barbara Deptula is currently a director of AMAG Pharmaceuticals. In 2012, she retired from her position as executive vice president and chief corporate development 23
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officer at Shire Pharmaceuticals, where she was responsible for leading the strategic business development, planning, and execution for this global specialty biopharmaceutical company. Prior to joining Shire, Deptula served as president of biotechnology at Sicor Pharmaceuticals, leading the merger with Teva. At Coley Pharmaceuticals (Pfizer), Deptula was senior vice president of commercial and product development, an executive team member that built the core commercial and development operations. Over her 35-year career, she is recognized for her role in several major mergers and acquisitions, both buying and selling products and companies. Her industry experience included positions in marketing and product development, as well as international operations. Her career has been with both biotech startups as well as with multinational pharmaceutical companies including the Genetics Institute (Glaxo), Schering Plough (Merck), and U.S. Bioscience (Medimmune/Astra Zeneca). In 2007, Deptula was named by Governor Edward Rendell as one of “Pennsylvania’s 50 Best Women in Business,” was featured as one of the “100 Most Inspiring Professionals in Life Sciences” by PharmaVOICE magazine, and was recognized as one of the Top 100 women to watch on the FTSE 100 for 2011 and 2012. Deptula began her career as a retail and hospital pharmacist and as a drug control agent with the State of Connecticut before completing her MBA at the University of Chicago. Joseph C. Papa, Jr. ’78, ’12 Joe Papa serves as Perrigo’s president and chief executive officer and as a member of the Board of Directors. He was elected chairman of the board in October 2007. The Perrigo Company is the world’s largest manufacturer of over-thecounter pharmaceutical and nutritional products for the store brand market. The company also develops, manufactures and markets topical OTC pharmaceuticals, prescription generic drugs, active pharmaceutical ingredients and consumer products, and operates manufacturing and logistics 24
facilities in the United States, Australia, Israel, United Kingdom, Mexico, and Germany. Papa previously served as chairman and CEO of Cardinal Health’s Pharmaceutical Technologies and Services business unit, president and COO for Watson Pharmaceuticals, president Global Country Operations for Pharmacia’s North American business, and president of Searle’s U.S. Operations. Papa also served in a variety of general management, sales, marketing and R&D positions during his 15-year career at Novartis Pharmaceuticals. During his pharmaceutical industry career Papa led the teams that successfully launched several block buster pharmaceutical products including Lotrel, Diovan and Celebrex; and is the patent holder for a cardiovascular combination treatment containing Amlodipine and Benazepril. In addition to a Bachelor of Science in Pharmacy from UConn, Papa earned an MBA from Northwestern’s Kellogg Graduate School of Management and received a Doctor of Science honoris causa from UConn. He is a member of the Board of Trustees for the University of Sciences in Philadelphia and the Board of Directors from Smith & Nephew, a U.K. based medical device company. He was the founding chair of the University of Connecticut School of Pharmacy Advisory Board. In 2012, Barrons named him as one of the 30 “World’s Best CEOs” and in 2014, the Harvard Business Review ranked him among the “Best-Performing CEOs in the World” at number 47 and at number 10 in the biotech and pharma industries. Edward ’49 and David ’59 Silver Silver’s Drug Shop was established in 1919 in West Haven, Connecticut by 21 year-old William H. Silver when he purchased Woods Drug Store. Silver sent two of his three sons, Edward ’49 and David ’59 to the UConn School of Pharmacy. Together, the Silvers’ built the business into an iconic fixture in the West Haven community. The Silver
Pharmacy Journal of New England • Fall 2015
brothers have been providing scholarship support to several generations of UConn Pharmacy students. Joe Papa ’78 ’12, chairman, president, and CEO of Perrigo credits the scholarship named in honor of William H. Silver as providing him with much needed support during his undergraduate studies. Darlene Able ’80 Darlene Able is a passionate advocate for independent community pharmacy and enjoys mentoring young pharmacists interested in pharmacy ownership. She serves on the Board of Directors for the Northeast Pharmacy Services Corporation and the Cardinal Health Home Health Care Advisory Board. In 2007, she won Pharmacy Development Services peer-voted “Walk the Talk” contest in acknowledgement of her development and implementation of patient centric pharmacy programs. Before retiring, she was an active preceptor for the UConn School of Pharmacy and a member of both the School of Pharmacy Advisory Board and the school’s Experiential Education Advisory Board. Able provided special services for patients such as blister packaging, health resources, medical
supplies, and access to compounded medications. Ralph Frank ’75, ’90 Ralph Frank is currently the director of substance abuse testing for Connecticut Pharmacists Concerned for Pharmacists and an assistant adjunct professor of pharmacy practice at the University of Connecticut. He recently retired from his position as pharmacy manager at Hartford Hospital. Prior to joining Hartford Hospital, Frank practiced at Bristol Hospital for 27 years, serving as a clinical pharmacist, director of occupational medicine and ultimately director of pharmacy. He served as an assistant adjunct clinical professor at the University of Connecticut and mentored Introductory Pharmacy Practice Experience students, Advanced Pharmacy Practice Experience students, and residency candidates at Hartford Hospital. Frank maintains a keen interest in current issues in substance abuse, as well as epidemiological trends of poisoning and overdose events. He serves as a consultant to government, industry and the court system regarding substance abuse and forensic drug testing. He is a past president of the Connecticut Society of Health System Pharmacists and is active in both this and the American Society of Health Systems Pharmacists. Know an UConn alum who is doing great things? Drop us a line at: pharmacy@uconn.edu
Did You Know? That the Connecticut Pharmacists Association offers a 2-Week Online Course for CT Law? www.ctpharmacists.org
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Massachusetts College of Pharmacy and Health Sciences – Boston Dear Colleagues, On behalf of President Monahan and Provost Pisano, I bring you greetings from the School of Pharmacy Boston at MCPHS University. The new academic year is well on its way and our many highly motivated students, both new and returning, have again populated the bustling Longwood Medical Area. The faculty was quite busy this past summer offering summer courses, providing clinical rotations, speaking at CE programs, and of course preparing their coursework for the new academic year. I would like to update you about some of the changes and accomplishments that have occurred. I would also like to extend my congratulations to Eleni Peterson, PharmD class of 2017 who was one of 25 students selected nationwide to receive the Presidential Scholarship Award at this year’s National Community Pharmacists Association’s (NCPA) annual conference which was held on October 10-14 in the Washington DC area. Eleni was recognized for her hard work as past president of our NCPA student chapter and for her overall commitment to MCPHS University and to our profession. In closing, thanks to all of our faculty, preceptors, and students for your dedication and hard work on behalf of our Profession. Paul DiFrancesco, EdD, MPA, RPh Dean and Associate Professor MCPHS School of Pharmacy Boston
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New Faculty Dr. Lynn M. Squillace has joined us as an Assistant Professor and Director of the Regulatory Affairs and Health Policy Master’s Program at the Boston campus. She is also an attorney who most recently served as the Associate General Counsel to the Massachusetts Group Insurance Commission where her practice included a focus on Affordable Care Act implementation, pharmacy policy, mental health parity, health insurance regulation and alternative payment models. She received her law degree from Suffolk University and was the Health Law and Bioethics Fellow at Boston University School of Public Health while earning her Master of Public Health degree. Dr. Squillace also holds teaching appointments at the Boston University School of Public Health and Providence College.
Faculty Appointment Dr. Kathy Zaiken was named as the new Governor of Ambulatory Care Pharmacy for the MPhA Board of Directors at the MPhA Installation & Awards banquet on September 24.
Community Engagement MCPHS University was once again invited for the sixth consecutive year by the Board of Directors of the Topsfield Fair (America’s Oldest Fair founded in 1818) to participate in a health and safety service event on Wednesday, October 7 and Thursday, October 8 2015. Dr. Rebecca Couris and her students, who were on their Ambulatory Care rotation, presented on several topics using posters and handouts including proper medication disposal (Medication Return Policies) from surrounding communities in concert with local police departments. Other topics covered included Lyme disease and Environmental Safety. This event has allowed us to identify many potential students interested in the various degree programs offered at MCPHS University and has also led to the awarding of scholarships by the Board of Directors at the Topsfield Fair to deserving MCPHS students.
Pharmacy Journal of New England â&#x20AC;˘ Fall 2015
Pharmacy Preceptor Appreciation With more than 200 preceptors in attendance, the MCPHS University Preceptor Appreciation Seminar was held September 10 at the Doubletree Hotel in Westborough. The program, which provided five hours of Continuing Education credit for attendees, was developed in response to preceptor requests on topics that included MTM and Transitions of Care. Both areas were covered with an expert panel consisting of four preceptors for the MTM session and three preceptors for the Transitions of Care session. The program also featured an update from the Pharmacy Experiential team on pharmacy education accreditation and a review of legal issues. Also at this event the Preceptor of the Year awards were presented to the following preceptors:
Mary Jane Estrada, RN, MSN, ANP-BC Effi Papatsoris, PharmD, RPh Jeanne Anderson, PharmD, RPh
MCPHS Continuing Education: Your Connection to Lifelong Learning The MCPHS CE Department offers a variety of ACPEaccredited live and online activities throughout the year. Check out www.alumni.mcphs.edu/CE for complete information. Stay engaged and become a lifelong learner! Upcoming live activities include Sterile Compounding Practices (December 4, Worcester campus), Pharmaceutical Care Days (December 5-6, Worcester campus), and 76th Annual Reed Conference (March 10, Gillette Stadium in Foxborough). The online library currently features 17 sessions on a variety of topics.
Massachusetts College of Pharmacy and Health Sciences â&#x20AC;&#x201C; Worcester/Manchester Dear Colleagues,
Awards
I hope everyone had an enjoyable and productive summer. We were very busy over the summer as we were in full swing educating and mentoring all our students during our summer semester. We had another successful commencement ceremony at Gillette Stadium and have followed that up by bringing in the largest class yet for this Fall. I wish you all the best in your academic year.
Linda Spooner received the 2015 ACCP Adult Medicine PRN Mentoring Award at the October 2015 ACCP Annual Meeting in San Francisco. The Adult Medicine PRN Mentoring Award honors an Adult Medicine PRN member whose outstanding teaching and guidance inspires students, residents, fellows, and others in the profession of pharmacy in a way that significantly impacts the careers of the mentees.
All the best, Michael J. Malloy, PharmD, Dean and Professor
Grants Pervanas, HC and Towle, J. New Hampshire Screening, Brief Intervention, and Referral to Treatment (SBIRT) InterProfessional Education (IPE) Training Collaborative. The grant is being funded for the next three years by the United States Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) and facilitated through the Dartmouth Institute for Health Policy and Clinical Practice. This grant will be used to train healthcare professional students to provide the necessary 27
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skills to screen, provide brief intervention techniques and referral to treatment for individuals with substance abuse concerns. Amount funded $15,000.00.
University and compete in the national competition at the Midyear Clinical Meeting in December which will be held in New Orleans, LA.
Fellowship: Linda Spooner was among thirty-five pharmacists to receive Fellowship in the American Society of HealthSystem Pharmacists (ASHP) in recognition of the excellence they have achieved in pharmacy practice. The 2015 Fellows were honored on Tuesday, June 9, 2015, during the ASHP Summer Meetings and Exhibition in Denver.
Presentation at National Meeting: Sullivan K, Oslenski L, Milligan P. Accelerating Change to Improve Outcomes. Platform presentation at the American Society of HealthSystem Pharmacists Annual Medication Safety Collaborative Meeting. Denver, CO. 2015 June.
ASHP Clinical Skills Competition: Congratulations to Christopher Rochon and Meghan Amaral who won the ASHP Clinical Skills competition! Nine teams of students from Worcester and Manchester entered the competition which was held September 21. The ASHP Clinical Skills competition (CSC) is an interactive, team-based analysis of clinical scenarios for hospital/health-system pharmacists. It provides pharmacy students the opportunity to enhance their skills in collaborative practice with physicians in providing direct patient care. Chris and Meghan will now represent MCPHS
Mukherjee M, will be presenting a session titled Late Breakers in Endocrinology/Metabolism discussing new and emerging clinical data affecting endocrinology pharmacotherapy at ACCP in San Francisco. Poster Presentation: Blanchard G, Sullivan K, Nemeth CA, Nguyen H, Pariseau J. Back to the back rub: an interdisciplinary inpatient sleep protocol for older adults. Poster presented during the Presidential Poster Session at the Annual Scientific Meeting of the American Geriatrics Society, National Harbor, MD. May 2015.
CPA Schedules its Mid-Winter Conference Pharmacists from across New England will gather on Thursday, February 4th as a means to earn 8 CE credits at the CPA’s annual Mid-Winter Conference in Southington. Last year, over 250 pharmacists spent the day earning CE credits, mingling with friends and meeting new acquaintances, as well as visiting a variety of vendor booths. “The Mid-Winter is a great venue to mix with industry vendors, get a jump-start on CE credits, and understand what is happening in the industry,” stated Marghie Giuliano, Executive Vice President of CPA. Programs for the 2016 conference will include the traditional “New Drugs of 2015” morning session, presented by Dr. Dan Hussar of the Philadelphia College of Pharmacy. Other topics to be covered include COPD, Connecticut Law and more. This year, the CPA will again be incorporating a passport for those in attendance to use while visiting the Exhibit booths. Those with stamps from the majority of the booths will be entered into a contest to win a new iPad Mini. The CPA will also run a membership drive at the Mid-Winter Conference, offering a $50 discount to any new member. “It is important for pharmacists to realize that CPA is the voice of the profession,” stated Jacqui Murphy, President of the CPA. “There is strength in numbers, and whether you work retail, in a hospital, or in research, the actions of the Legislature affect all of us. Membership is a vital way to ensure that your voice as a pharmacist is heard.” For more information or to register for this ACPE accredited conference, please visit the CPA website at www.ctpharmacists.org. 28
Pharmacy Journal of New England • Fall 2015
Northeastern University Message from the Dean Greetings from Northeastern! We’ve had an exciting summer, highlighted by a number of outstanding achievements by our students and faculty. Please take a few minutes to learn about what’s taking place on campus. We have many events taking place at the school this fall, highlighted by the accreditation of our Doctor of Pharmacy and Continuing Education programs. Stay tuned this winter when we share news of these and other events. David P. Zgarrick, PhD, FAPhA Acting Dean and Professor
Distinguished Professor and Director Vladimir P. Torchilin to Receive EJPB Best Paper Award Dr. Vladimir P. Torchilin, Ph.D., D.Sc, Distinguished Professor and Director of the Center for Biotechnology and Nanomedicine, was recently selected for the 2014 European Journal of Pharmaceutics and Biopharmaceutics Best Paper Award. Along with his colleagues, Giorgia D’Arrigo, Gemma Navarro, Chiara Di Meo, and Pietro Matricardi, Dr. Torchilin received recognition for the manuscript entitled, Gellan gum nanohydrogel containing anti-inflammatory and anti-cancer drugs: a multi-drug delivery system for a combination therapy in cancer treatment. Volume 87, Issue 1, 208–216 (2014). The award will be presented in 2016 at the 10th World Meeting on Pharmaceutics, Biopharmaceutics and Pharmaceutical Technology that will be held in Glasgow, Scotland, from April 4-7.
Dr. Jane Saczynski is Principal Investigator for Recently Awarded NIH Study Dr. Jane S. Saczynski, Ph.D., is Principal Investigator of a new R21 grant funded by the National Institute of Health (National Institute on Aging). The study, entitled Screening Elderly for Delirium in the Emergency Department (SCREENED-ED), will develop and pilot test an intervention, “Delirium Screening (D-SCREEN) in the ED”, involving 300 older patients. The study includes 150 newly enrolled intervention participants, 150 historical controls (comparison group) that have 4 key components: systematic screening for delirium using the CAM; informing providers of the screening result; a checklist protocol for initial delirium management based on clinical guidelines; and documentation of the diagnosis of delirium in the Electronic Health Record (EHR). Congratulations to Dr. Saczynski on her awarded grant and in providing further eminent research on the topic.
Northeastern University Alumni Represented at AACB/NABPD Annual Meeting On September 24-26th, Alumni Liz (Fang) Wade and Gary Merchant attended the AACP/ National Association of Boards of Pharmacy District I/II meeting at the Sheraton Portsmouth Harborside Hotel in Portsmouth, NH. Liz Wade was a presenter at the annual event, which was hosted by the Northeastern University Office of Continuing Pharmacy Education. The meetings address both present and future professional and educational impacts in pharmacy practice. Both board members
Pictured, from left to right: John Reynolds, Liz Wade, Gary Merchant and David Zgarrick
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and faculty members from Schools of Pharmacy alike meet each year to discuss related issues on a regional and national scale.
Makriyannis Receives 2015 AAPS Distinguished Pharmaceutical Scientist Award Alexandros Makriyannis, PhD, Professor and Behrakis Trustee Chair in Pharmaceutical Biotechnology and Director of the Center for Drug Discovery at Northeastern University, was given the 2015 American Association of Pharmaceutical Scientists (AAPS) Distinguished Pharmaceutical Scientist Award. The award, sponsored by Astra Zeneca Pharmaceuticals, recognizes the outstanding accomplishments of an individual in the pharmaceutical sciences, regulatory and/or technology fields whose work has moved the frontier of the field significantly and has stimulated research investigations by others. For more information about Dr. Makriyannis’ research, visit the Center for Drug Discovery website at http://www.cdd.neu.edu/.
Recent Hires and Promotions: Dr. Jeanne Madden, Associate Professor, Pharmacy and Health Systems Sciences Jeanne Madden joined Northeastern University this year as an Associate Professor in the Department of Pharmacy and Health Systems Sciences. She received her BA in History from Brown University, her SM in Population and International Health from the Harvard School of Public Health, and her PhD in Health Policy from Harvard University. Jeanne’s main research interests are in public and private insurance coverage, vulnerable populations, mental health, and study design. Dr. Jessica Moreno, Assistant Clinical Professor, Pharmacy and Health Systems Sciences Jessica Moreno earned both her Bachelor of Science in
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Chemical Engineering and Doctor of Pharmacy from University of Michigan. Prior to coming to Northeastern, she completed a post-doctoral industry fellowship at MCPHS/Cubist Pharmaceuticals, a first-year pharmacy residency at the VA Ann Arbor Healthcare System, and a second-year psychiatric pharmacy residency at the William S. Middleton Memorial VA Hospital. Jessica’s research interests are in the fields of addictions medicine and posttraumatic stress disorder. Dr. Tayla Rose, Assistant Clinical Professor, Pharmacy and Health Systems Sciences Tayla Rose is joining the college as an Assistant Clinical Professor in the Department of Pharmacy and Health Systems Sciences after serving as a Visiting Assistant Clinical Professor in 2014-2015. She completed a Post-Graduate Year 1 (PGY1) Pharmacy Residency with a focus in Ambulatory Care at Northeastern University and Federally Qualified Health Centers (FQHCs)/Program of All-Inclusive Care for the Elderly (PACE). Tayla received her BS in Pharmacy Studies and Doctor of Pharmacy (PharmD) from the University of Connecticut. Dr. Jane Saczynski, Associate Professor, Pharmacy and Health Systems Sciences Jane Saczynski is an Epidemiologist and Associate Professor of Pharmacy and Health Systems Sciences. Prior to coming to Northeastern she was an Associate Professor of Medicine and Quantitative Health Sciences at the University of Massachusetts Medical School. Dr. Saczynski received her PhD in Human Development and Family Studies from the Pennsylvania State University and did two post-doctoral training fellowships in Epidemiology. The first was in Psychiatric Epidemiology
Pharmacy Journal of New England • Fall 2015
Epidemiology at the Johns Hopkins Bloomberg School of Public Health and the second in Neuro-Epidemiology at the National Institute on Aging. Her research focus is cognitive function, dementia and delirium, with a focus in how cognitive status impacts chronic disease management. She has funding for this work form the National Institute on Aging, the Heart Lung and Blood Institute and the National Science Foundation. Stephanie Sibicky received her Doctor of Pharmacy degree from the University of Rhode Island and completed an ASHPaccredited pharmacy practice residency at the Hospital of Saint Raphael in New Haven, CT. She has worked in hospital and long-term care pharmacy after completion of her residency and began her career in academia at the University of Saint Joseph School of Pharmacy in Hartford, CT and joined the faculty at Northeastern University in 2015. She obtained her Certification in Geriatric Pharmacy in 2011 and became a Board Certified Pharmacotherapy Specialist in 2013. Dr. Sibicky is dedicated to enhancing pharmacy education in the area of geriatrics and internal medicine. She has focused her practice and research on patient-centeredcare in the elderly by addressing inappropriate medication use and improving transitions of care. By her membership in Lambda Kappa Sigma pharmacy fraternity, the American Association of Colleges of Pharmacy, and involvement with the American Society of Consultant Pharmacists on a local and national level, Dr. Sibicky promotes the importance of advocacy for the profession of pharmacy to her students and peers. She also enjoys volunteering for and participating in events to raise awareness for conditions that impact older adults.
School of Pharmacy Student Organizations Recognized The Alpha Rho Chapter of Lambda Kappa Sigma at Northeastern University was recognized as the “2015
Northern New England Region Collegiate Chapter of the Year.” This award is presented to chapters who have exemplified the core values of the pharmacy professional fraternity by demonstrating professionalism, leadership, and service in pharmacy. The Beta Chi chapter of Phi Delta Chi Professional Pharmacy Fraternity was recently awarded 4th place in the nation for the Thurston Grand President's Award, which recognizes excellence in the areas of scholarship, leadership, brotherhood, professional/service, and chapter publication. The chapter scored in 2nd place for their leadership, and 3rd place for professional/service projects. Each October, the Beta Chi chapter sponsors the Bouvé College Health Fair, offering a free flu clinic, health screenings and a blood drive on campus.
Northeastern Students Volunteer at the Avon Walk to End Breast Cancer The Northeastern University Student Health Plan (NUHSP) student chapter volunteered and participated in the Avon Walk to End Breast Cancer on October 4, 2015. A group of seven NUSHP officers and student members walked alongside 789 teams and 6,274 other participants in this annual walk event sponsored by the American Cancer Society.
Northeastern University School of Pharmacy Alumni and Friends Reception We are looking forward to seeing you and providing updates on the exciting changes and events happening at the school. Please join us at the Hilton New Orleans Riverside on Monday, December 7th, 2015 in the River Room from 5:30-7:00 pm.
New Fellowship Program with Alnylam Pharmacy graduates interested in a career in the biopharmaceutical industry often look towards Industry Fellowships to gain practical experience and a better understanding of potential career opportunities. Recently, Alnylam Pharmaceuticals partnered with Northeastern University and established a Medical Affairs focused, PostDoctoral PharmD Industry Fellowship program within the 31
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Boston/Cambridge area. Alnylam Pharmaceuticals, a small biopharmaceutical company based in Cambridge, is leading the translation of RNA interference (RNAi) as a new class of innovative medicines, with a core focus on RNAi therapeutics toward genetically defined targets for the treatment of serious, life-threatening diseases. Under the mentorship of Alnylam Fellowship Director and Director of Medical Communications and Publications, Annie Partisano, PharmD, MS, fellows will have the opportunity to gain experience through a variety of rotations within the Medical Affairs department, including, but not limited to, Publications, Scientific Communications, Patient Advocacy, Health Economics and Outcomes Research, and Field Medical. The fellow will also have the opportunity for rotations with other departments within Alnylam including, but not limited to: Regulatory, Clinical Operations, Commercial, Drug Safety and Pharmacovigilance, and Clinical Development. These elective rotations will allow the fellow to gain insight into the integral and strategic roles of various functions within Alnylam throughout a productâ&#x20AC;&#x2122;s life cycle. Along with the opportunities at Alnylam, the fellowship will maintain a robust academic component through its partnership with Northeastern University. The fellow will receive an adjunct clinical faculty appointment at the University and through the leadership of the Northeastern Fellowship Director and Associate Clinical Professor, Mark Douglass, PharmD, will be engaged in various teaching experiences. The fellow will
precept Doctor of Pharmacy students and collaborate with other faculty members on elective courses and lectures as a core function and expectation of this program. Participation in continuing education seminars and planning meetings designed to create a sense of community among the Alnylam/Northeastern University Fellowship community will also be part of the training. Furthermore, the fellow will have the opportunity to participate in a teaching certificate program offered by Northeastern University. This past July, Alex Wei, PharmD, a 2015 graduate of Rutgers University, became the first Medical Affairs Fellow within this program. Within just a few short months, Alex has gained a greater appreciation for both industry and academia and has highlighted the importance of the fellowship program within Alnylam and Northeastern. As such, the program will be expanding and is in the process of recruiting applications for the 2016-2018 Medical Affairs Fellowship program. If you know of any interested applicants please have them visit the Northeastern University website for more information (http://www. northeastern.edu/bouve/pharmacy/fellowships/) or email fellowship@alnylam.com
Please let us know if you have news or a feature article to submit for a future issue of the
Pharmacy Journal of New England Contact: kellis@masspharmacists.org
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Pharmacy Journal of New England • Fall 2015
University of New England UNE College of Pharmacy Students and Alumni Awarded Honors at Maine Pharmacy Association Fall Convention Two students from UNE’s College of Pharmacy and one alumna were recognized at the Maine Pharmacy Association (MPA) Fall Convention Awards Banquet in Bangor, Maine on September 12, 2015: • Kaitlyn Bernard ’17, and Kayla Harris ‘18, each received scholarships from MPA • Heather Stewart, Pharm.D. ’14, is the 2015 recipient of the Cardinal Health Generation Rx Award MPA awards up to seven scholarships annually to students who demonstrate superior academic achievement and service to the community. Bernard and Harris were selected based on their professionalism and integrity. Stewart, a pharmacist at Walgreens, is an active advocate for prescription drug abuse education and prevention. As a student at UNE, she coordinated four drug take-back events with local police and drug enforcement officials, and provided education about prescription drug abuse at schools and MPA legislative events. After graduating, Stewart continued this work, coordinating a drug take-back event with the local police department at her Walgreens location. She was also the lead author of “Inside Maine’s Medicine Cabinet: Findings from DEA Medication Take-Back Events,” published in the American Journal of Public Health.
UNE Brings Together Community Experts to Advance Veterinary Pharmacy Knowledge in Maine On August 12, 60 students from the UNE College of Pharmacy (COP) were joined by former students, area pharmacists and local veterinarians for a Veterinary Pharmacy Compounding Laboratory Day, where they learned how to formulate custom medications for pets. This event was part of an elective course that aims to educate its students in veterinary pharmacy—a specialty that only ¼ of U.S. pharmacy schools offer. Students worked in UNE’s Hannaford Pharmacy Practice
Lab, working with specialized equipment and materials to gain experience creating custom formulated medications for small animals. Specialty pharmacists from Apothecary By Design and PetScripts joined students and community veterinarians in discussing the interconnectivity of their professions and how they can best serve animal patients. “An increasing number of pet owners are seeking prescriptions for their pets from large retail pharmacies. This course provides students with the skills they need to communicate with veterinarians, review medications and counsel pet owners on the administration of veterinary medications,” says Cory Theberge, Ph.D., assistant professor in the College of Pharmacy, coordinator of the veterinary pharmacy elective course. “Teaching students how to custom formulate drugs is also important because approximately 80% of the time the veterinarian is prescribing a human drug that has been reformulated or flavored for veterinary use.” Although the majority of Pharm.D. graduates obtain jobs in retail settings where they will likely encounter veterinary prescriptions for cats and dogs, the veterinary pharmacy skill set is not assessed in pharmacy licensure exams. This compounding lab and elective course, led by Theberge, aims to provide UNE graduates with a skill set that not only distinguishes them from other job candidates, but also serves the interests of millions of pets and their owners across the country. “This elective provided me with insight into the small, but important, area of veterinary pharmacy,” said Shannon Grady, UNE College of Pharmacy Class of 2016. “It gave me the knowledge to effectively provide recommendations on medications for animals, the confidence to interact with veterinarians and the resources to look up veterinary pharmacy information.” 33
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UNE welcomes Pharmacy Students from the University of Granada The University of New England College of Pharmacy is pleased to welcome five students who have traveled from the University of Granada (UGR) in Granada, Spain to UNE’s Portland Campus to learn and share culture with UNE pharmacy students. The UGR pharmacy students are enrolled in a Vaccine Preventable Diseases course, and they will also participate in site visits to hospitals, community pharmacies, long-term care pharmacies, specialty pharmacies and biotechnology companies to better understand the healthcare system in the United States. “The exchange program between UNE and UGR creates a valuable cultural and academic learning experience for our students, says Gayle Brazeau, Ph.D., dean of UNE’s College of Pharmacy. “It allows students to share ideas about healthcare systems, public health and the profession of pharmacy from the unique perspective of each country.”
Steven Carroll receives Indian Health Service Scholarship Steven Carroll, a second year student in the College of Pharmacy, is the recipient of a competitive Indian Health Service (IHS) scholarship. The IHS Scholarship Program provides financial support to qualified American Indian and Alaska Native students pursuing careers in the health professions. “Growing up, I was able to spend many summers in my mother’s hometown of Nome Alaska. It was there that I first saw the strong sense of community that exists in the Alaska Native and American Indian communities,” explained Carroll. “It was an atmosphere in which we all felt a sense of responsibility for each other. A patient centered care pharmacy practice would be a natural fit and benefit to these communities.” 34
The scholarship is awarded in exchange for service with the IHS in a full-time clinical practice setting after graduation. Carroll plans to work as a pharmacist in an IHS or tribal health center. “The IHS scholarship is the beginning of a professional relationship that will continue after graduation,” Carroll commented. “I see this as an opportunity to practice the patient-centered care that is the focus of UNE’s Pharmacy program.”
Stephanie Lewis joins the UNE College of Pharmacy as a PGY1 resident and clinical instructor The UNE College of Pharmacy welcomes Stephanie Lewis as a Post-Graduate Year One (PGY1) resident and clinical instructor as part of a UNE-Hannaford Pharmacy-Martin’s Point Healthcare Community Residency Program. Lewis is a Class of 2015 graduate from the Massachusetts College Pharmacy and Health Sciences Doctor of Pharmacy (MCPHS) program. Her outstanding academic record at MCPHS included being a member of the Rho Chi honor society, taking classes in the Doctor of Pharmacy Honors Program and making the dean’s list for 10 semesters.
of
While at MCPHS, Lewis’ leadership was exemplary. She was the 2012–2014 chapter president of the American Pharmacists Association Academy of Student Pharmacists (APhA-ASP), Rho Chi chapter secretary 2013–2014, inducted into Phi Lambda Sigma in 2013 and served as part of the Boston Medical Reserve Corps. Lewis has received several awards recognizing her professional contributions including: • University Citizenship Award — MCPHS • Massachusetts Pharmacists Association Foundation Scholarship
Pharmacy Journal of New England • Fall 2015
• National Association of Chain Drug Stores Scholarship and Emerging Leader Award— MCPHS The Community Pharmacy Residency Expansion Program is funded by a grant from the National Association of Chain Drug Stores Foundation. It provides opportunities for residents to continue their education and develop their clinical and pharmacy administration skills through direct patient care.
Ron Hills Receives National Science Foundation Grant for New Research Project Ronald D. Hills Jr, Ph.D., UNE assistant professor of medicinal chemistry, was recently awarded a $375,000 grant from the National Science Foundation’s Research in Undergraduate Institutions (RUI) program to fund a new research project. With this three-year grant, Hills will work to develop new modeling methods that will help examine ABC transporters, a protein superfamily known to prevent antibiotics and anticancer drugs from entering cells. This research will eventually aid researchers in identifying how to stop or delay the development of treatment drug resistance. Hills will collaborate on this project with Olgun Guvench, Ph.D., assistant professor in UNE’s Department of Pharmaceutical Sciences, and Andrew Ward, Ph.D., associate professor in the Department of Integrative Structural and Computational Biology at the Scripps Research Institute in La Jolla, California. The project will also serve as a way to promote student interest in scientific research through an annual outreach program. The program will offer three unique opportunities: • Students will have the chance to participate in a week-long computer modeling workshop. • Two UNE undergraduate students will earn a $5,000 stipend for completing research that help to advance this projects’ aims
• A biochemistry course for Pharmacy students will integrate process oriented guided inquiry learning (POGIL) that will help them develop higher-order cognitive learning skills. Facilitating Research at Primarily Undergraduate Institutions: Research in Undergraduate Institutions (RUI) is a program at the National Science Foundation that supports faculty at institutions awarding 20 or fewer Ph.D. degrees in all NSFsupported fields in the past two years.
UNE College of Pharmacy Featured on ‘WMTW’ Segment UNE’s College of Pharmacy (COP) was highlighted on a WMTW news segment for its growing partnership with Apothecary By Design (ABD). The segment discussed how UNE students are gaining hands-on experience by doing rotations at ABD throughout their time in school, working side-by-side with specialty pharmacists in a variety of different areas including compounding and nutraceuticals. UNE P2 student Kayla Harris was interviewed for the piece, speaking about how the program has benefitted her as well as many of her peers. “It’s a way for students to look into these aspects of pharmacy that aren’t what they’d normally hear about in their regular education, and to see the role that they can play both in a setting like Apothecary and how that can translate into the community setting.” The partnership has proven to be mutually beneficial, as ABD has hired a total of five UNE students upon their graduation over the past three years. Watch the clip online
UNE College of Pharmacy Promotes George P. Allen to Chair of the Department of Pharmacy Practice The University of New England College of Pharmacy is pleased to announce that George P. Allen, Pharm.D., has assumed the role of chair of the Department of Pharmacy Practice. Allen joined the College as an associate professor in 2010. He was appointed vice chair of the Department in 2012, and interim chair on January 1, 2014. A native of Rhode Island, Allen received a B.S. in molecular, 35
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in infectious diseases pharmacotherapy at Wayne State University in Detroit, Michigan. Before joining UNE in 2010, Allen served as a member of the faculty at the Oregon State University College of Pharmacy in Portland, Oregon. His teaching responsibilities included didactic instruction pertaining to the pharmacology of antimicrobials and management of infectious diseases. Allen performs laboratorybased studies of antimicrobial resistance, and his professional service activities have included leadership roles within the Society of Infectious Diseases Pharmacists.
UNE began its Continuing Education program in 2011, issuing 1,100 CECs to participants. This year, that number has risen to more than 9,000 CECs, and UNE is now the leading universityaffiliated provider of live continuing education events in Maine, New Hampshire and Massachusetts. UNE also provides CEC opportunities for pharmacy technicians -- professionals who assist licensed pharmacists with the distribution of medication, communication with patients, and other pharmacy-related responsibilities.
In addition to his leadership within the Department of Pharmacy Practice, Allen has served as a member of UNE’s College of Pharmacy Executive Committee, the University Faculty Assembly Executive Committee, and the College of Pharmacy faculty vice chair and chair. Allen was one of 30 faculty members nationwide who was selected to complete the 2014– 2015 American Association of Colleges of Pharmacy Academic Leadership Fellows Program.
“More and more, pharmacists are being delegated to perform clinical tasks, such as immunizations or cholesterol testing,” explained Dan Mickool, director of Continuing Education in UNE’s College of Pharmacy. “We want to increase the scope of continuing education credits for those pharmacists as their level of responsibilities increase, so they can communicate effectively with physicians and make proper treatment recommendations.”
He recently presented two abstracts at the Interscience Conference on Antimicrobial Agents and Chemotherapy/ International Congress of Chemotherapy and Infection (ICAAC/ICC) in San Diego, California.
Brian Wells Recognized in Gold-Standard Pharmacotherapy Text
UNE Propels Pharmacy Practice Forward through Continuing Education credits in New England UNE is working to advance the future of pharmacy practice by serving as the exclusive Accreditation Council for Pharmacy Education (ACPE) provider for pharmacy continuing education credits (CEC) in northern New England. Each year, practicing pharmacists and pharmacy technicians must complete 15 to 20 CECs to maintain their licensure. These credits, earned through attending seminars and symposiums held by pharmacy experts, help enhance the quality of professional development and advance the field 36
of pharmacy. UNE, in accordance with its mission to promote lifelong learning, is an ACPE accredited institution that provides these credit opportunities for the Maine Pharmacy Association, Maine Society of Health Systems Pharmacists, New Hampshire Pharmacy Association, New Hampshire Health System Pharmacists and Massachusetts Health Systems Pharmacists.
Brian Wells, Pharmacy ’16, will be formally recognized in Pharmacotherapy: A Pathophysiologic Approach, for his intellectual contributions to the book’s chapter on Major Depressive Disorder (MDD), written by Christian Teter, Pharm.D., BCPP, associate professor of Psychopharmacology at UNE. Wells is the first student to be approved for formal written acknowledgement. During his Advanced Pharmacy Practice Experience rotation with Teter, Wells was encouraged to identify something of clinical significance that was absent from the MDD chapter in the book. His contribution discussed the key factors involved with determining a patient’s antidepressant regimen, noting the importance of understanding whether an individual requires medication with sedating properties or activating effects.
Pharmacy Journal of New England • Fall 2015
University of St. Joseph School of Pharmacy Message from the Dean Greetings to All! We opened the academic year welcoming University of Saint Joseph’s Ninth President, Dr. Rhona Free. University of Saint Joseph School of Pharmacy’s fall semester began with another enthusiastic class of Pharm.D. students. Eighty-six women and men matriculated into the University of Saint Joseph School of Pharmacy Class of 2018. They represent 14 states (including Puerto Rico), and 14 countries. The faculty and staff, as always, welcome their eager spirits and look forward to a healthy and happy academic year. We thank you and welcome your ideas, collaboration, support and well wishes in preparing these new students for this wonderful Pharmacy profession.
demographics, as well as the development of pharmacy leadership at both a local and national level. Alexander R. Levine, Pharm.D., BCPS, Assistant Professor, Department of Pharmacy Practice and Administration Dr. Alexander Levine joins the University of Saint Joseph School of Pharmacy as an Assistant Professor in the Department of Pharmacy Practice and Administration. Prior to coming to USJ, he was a critical care pharmacist in the Surgical Intensive Care Unit at Massachusetts General Hospital, Boston, Massachusetts. Dr. Levine received his Doctorate in Pharmacy from the University of Connecticut, Storrs, Connecticut and completed a PGY-1 residency at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
Best, Joseph Ofosu Dean and Professor, University of Saint Joseph School of Pharmacy
Dr. Levine will be teaching in the infectious diseases and immunology therapeutics courses. His primary research interests are antimicrobial pharmacokinetics, sedation and analgesia, and anticoagulation in critically ill patients. Dr. Levine will establish a clinical practice in the Medical/Surgical Step-Down Unit at Saint Francis Hospital and Medical Center in Hartford, Connecticut.
New Appointments
News
Tamara Malm, Pharm.D., MPH, BCPS, Assistant Professor, Department of Pharmacy Practice and Administration
Class of 2018: University of Saint Joseph’s five-day Orientation culminated on August 14, 2015 with the White Coat Ceremony at Hoffman Auditorium on the West Hartford Campus. Our featured speaker was Mr. Thomas Menighan, Executive Vice President and Chief Executive Officer of the American Pharmacists Association (APhA). He delivered a wonderful talk on Leadership and Professionalism.
As always, we thank you for your continued support.
Dr. Malm joins the University of Saint Joseph School of Pharmacy as an Assistant Professor in the Department of Pharmacy Practice and Administration. Prior to coming to USJ, she completed her PGY2 in Health System Pharmacy Administration at Yale-New Haven Hospital, New Haven, Connecticut and PGY1 at Vidant Medical Center in Greenville, North Carolina. She completed her Doctorate in Pharmacy and Master of Public Health with a concentration in Epidemiology at the University of Kentucky. Dr. Malm will be precepting final year pharmacy students on their Ambulatory Care APPE rotation at Yale-New Haven Hospital. She will also be lecturing in the Pharmacotherapy of Respiratory Disorders and Self-Care courses over the upcoming year. Her primary research interests are in the effects of hospitalization on the public health of differing
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CPA Award Recipients University of Saint Joseph students received four of the 5 Connecticut Pharmacists Association awards at the New England Pharmacist’s Convention in Foxborough, Massachusetts September 25, 2015.
The recipients from left to right are: Meredith Gilbert – Murray Abraman Memorial Scholarship, Katherine Roper – Steven J. Kruzshak Memorial Scholarship, Amanda Branda – Henry A. Palmer Memorial Scholarship and Lydia Tran – Milton S. Camilleri Memorial Scholarship.
Posters and Presentations Edafiogho IO, Ghoneim OM, Sweezy MA, Howard HR. “Synthesis and Evaluation of Imidooxy Compounds as Potential Anticancer Agents”. Presented as Poster at the American Association of Colleges of Pharmacy (AACP) Annual Meeting, National Harbor, Washington DC, July 11-15, 2015. Ghoneim OM, Dhuguru J, Soldato DE, Edafiogho IO. “Structure Activity Relationship of Novel Piperazino Enaminones as Potential Anti-inflammatory Agents”. Presented as Poster at the American Association of Colleges of Pharmacy (AACP) Annual Meeting, National Harbor, Washington DC, July 11-15. . Soldato DE, Luciano J, and Laskey DA. “Assessing Critical Thinking through Writing in a Three Calendar-Year Pharmacy Curriculum.” Presented at the American Association of Colleges of Pharmacy (AACP) Annual Meeting, National Harbor, Washington DC, July 11-15, 2015. Keefe D, Goldstein S, Khalil A, Ghoneim OM. “Modulation of Repetitive Behaviors in Autism Spectrum Disorder: Design, Synthesis and Biological Evaluation of a Potent and Selective Serotonin Autoreceptor Antagonist” presented at the American Chemical Society 250th National Meeting, Boston, MA, August 16-20, 2015. Edgren B, Summit on Developing Sustainable Reimbursement Models for Pharmacist Practitioners, University of New Mexico, Albuquerque, NM August 9-11, 2015. Matusik B. “Precepting the millennial generation: what every preceptor should consider”; National Preceptor’s Conference, Washington DC, August 20-22, 2015. 38
Farrokh S and Matusik B. “Training pharmacy students to become residents through a specialty elective course”; National Preceptor’s Conference, Wash DC, August 20-22,. 5. Kohn CG, Freemantle N, Coleman C. “Ranolazine added to standard-of-care treatment in the management of stable angina: cost-effectiveness analysis from the United Kingdom perspective.” European Society of Cardiology Conference, London, England, September 4-6, 2015. Snyder DJ, Matusik B. “Rivaroxaban-induced serum sickness after total knee arthroplasty.” American Journal of HealthSystem Pharmacy 72:1567-1571; doi:10.2146/ajhp140549 September 15, 2015 Ewing C. “Pneumococcal Update”. CT Immunization Coalition Influenza Conference, Branford, CT September 17, 2015. Malm T. “Interdisciplinary Teamwork in a Transitional Primary Care Clinic.” Tri-State Health System Pharmacy Summit, Tarrytown, NY September 18, 2015 Dr. Richard Alper presented a talk on the “Endocannabinoid system of Medical Marijuana” at the student track at the New England Pharmacists Convention (NEPC) on September 25, 2015 at Gillette Stadium in Foxborough, MA. Dr. David Slomski, a 2014 graduate of the USJ School of Pharmacy, presented “Medical Marijuana in Connecticut: The Role of the Dispensary Pharmacist” at the student track at the New England Pharmacists Convention (NEPC) on September 25, 2015 at Gillette Stadium in Foxborough, MA.
Continuing Education
Pharmacy Journal of New England â&#x20AC;˘ Fall 2015
Pediatric Over-the-Counter Medication Refresher for Pharmacists By: Ashley S. Crumby, PharmD, Assistant, Clinical Professor, Purdue University, and Clinical Pharmacist, PediatricInfectious Disease, Riley Hospital forChildren at IU Health (Indianapolis); Rachel E. Bohard, 2013 PharmD Candidate, Purdue University; and Andrea J. Bittner, 2013 PharmDCandidate, Purdue University. # 0106-9999-15-066-H04-P (1.5 CEUs); expires 11/5/2018
Learning Objectives At the conclusion of this lesson, successful participants should be able to: 1. Identify challenges associated with over-the-counter (OTC) medication use in children. 2. Identify situations in which physician referral is appropriate for pediatric patients with cough/cold and fever symptoms. 3. Design a treatment plan, including specific counseling points for parents, for a pediatric patient with cough/cold symptoms and/or fever.
Introduction Many over-the-counter (OTC) cough and cold product labels may contain complex instructions and misleading graphics, which may guide caregivers toward administration of inappropriate products to children. Due to low literary or numeracy skills, some caregivers are at increased risk for inappropriate administration of pediatric OTC products. A recent study showed 85% of parents in the United States treat their children with OTC medications prior to seeking professional care. This makes addressing situations in which physician referral is necessary an important role of the pharmacist..1 Misuse of OTC products can be the direct result of incorrect indication, selection of an inappropriate product, or incorrect dosing. Although rare, an estimated 85% of pediatric fatalities caused by OTC medications involved inappropriately dosed cough and/or cold products.2 Factors leading to overdose of these products included administration of more than two medications containing the same ingredients, inappropriate utilization of measuring devices, use of adult products in situations where pediatric products were indicated,selection of a product which was not indicated, and involvement of more
than two caregivers in the treatment or selection of the OTC product..2 Pharmacists can play an important role in the selection of appropriate OTC products (non-pharmacologic and pharmacologic) as well as during the provision of counseling regarding dosing, adverse effects, and administration techniques. It is essential for pharmacists to be aware of current OTC product labeling as well as recommendations in order to assist caregivers with the selection and use of OTC medications in children.
The Common Cold: A Brief Overview The common cold is typically a self-limited viral infection which can be caused by more than 200 viruses. The most common virus seen in children is rhinovirus. On average, most children will experience between six and eight colds per year, each lasting between ten and fourteen days per episode..3 Following onset, cold symptoms tend to peak around day three or four and begin to diminish on or after day seven.3 These symptoms may include stuffy or runny nose, frequent sneezing, accumulation of mucus in the back of the throat (often referred to as postnasal drip), sore throat, cough, and water eyes. Other symptoms such as low-grade fever, decreased appetite, and mild head or body aches can also occur.4,5 Mucus production during a cold is common and can be clear, white, yellow, or even green in color.4 Historically, caregivers thought the color of the mucus was an indicator of illness severity, but it has been shown that the colors merely represent the bodyâ&#x20AC;&#x2122;s production of antibodies and have no significance in determining whether antibiotic therapy is indicated.4 Because the majority of cold cases are viral in nature, antibiotics are often unnecessary and should generally be 39
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avoided. Communicating this to caregivers is important and can often prevent unnecessary physician visits. An important rule of thumb to remember is “green snot doesn’t mean squat.” Rest, increased fluid intake, and the use of non-pharmacologic as well as pharmacologic therapy can be used for symptomatic relief during episodes of the common cold.6 These methods will help to alleviate the cold symptoms, but will not shorten the length of illness.6 Although the common cold is typically a self-limiting and mild viral infection, it can sometimes lead to more serious complications including secondary bacterial infections.7 In some instances, physician referral of seriously ill infants and children is necessary, and pharmacists can play a vital role in this referral process due to their increased accessibility and contact with caregivers.
Non Pharmacologic Therapy Non-pharmacologic therapy can include a variety of approaches and should generally be considered “first-line” for symptom relief as well as immune system support during the common cold. Some recommendations include the use of humidifiers to improve the environment as well as increasing fluid intake to keep the body well hydrated. Below you will find specific instructions regarding a variety of nonpharmacologic options. Symptomatic relief: 6,8 Humidifiers or cool mist vapors. In general, cold air humidifiers are recommended when compared to warm air humidifiers due to safety concerns with regard to children. Also, regular cleaning of humidifiers and other treatment products is recommended due to the increased risk of bacterial growth and mold which may occur. If these instruments are not cleaned regularly, they may emit microorganisms into the environment and cause serious illness due to pathogen inhalation.8 Bulb syringe with or without saline nasal drops. This approach is considered the treatment of choice for nasal symptoms in infants. Nasal bulb syringes can be used to clear the nose 40
every 3-4 hours. 6 Head elevation. Elevating the head of the bed can promote better drainage of the sinus and nasal passages. A large, wedge-shaped pillow that raises the upper body by 6 to 8 inches is best if the patient is experiencing significant drainage.9, 10 Increased water ingestion. Water is considered the best expectorant for children. Proper hydration thins the mucus, which can ease the child’s efforts to expel it and prevent dehydration. Immune System Support5 The common cold is caused by a viral infection and requires the body’s immune system for proper eradication. General ways to promote immune system function include: Avoiding secondhand smoke or other air pollutants5 Avoiding unnecessary antibiotics5 Antibiotics can breed resistance, thus increasing the chance of becoming ill with antibiotic-resistant infections. Breastfeeding5. Breast milk contains antibodies which can be passed from mother to child. These antibiodies can provide protection against infection even after breastfeeding is stopped. Increasing fluid intake Drinking plenty of fluids during the common cold is important. Healthcare providers should always recommend pediatric-specific fluids such as Pedialyte® because these products contain the proper amount of fluid and electrolytes and can help prevent electrolyte imbalances. Eating yogurt. Active cultures present in certain yogurts and probiotics contain beneficial bacteria which can aid in preventing colds.5 Yogurts and probiotics containing Lactobacillus acidophilus with Bifidobacterium animales were shown to reduce both the incidence and duration of rhinorrhea, cough, and fever symptoms in children 3-5 years old.11 Although sufficient efficacy evidence is lacking, the CDC considers Lactobacillus safe for use in children and infants but does caution regarding the use of probiotics in patients on concomitant immunosuppressive therapy.12
Pharmacy Journal of New England • Fall 2015
Yogurts containing live active cultures include (but are not limited to): Yoplait YoPlus, Stonyfield, Dannon Activia13, Check labeling on individual products for specificinformation Receiving adequate amounts of sleep. Adequate sleep promotes immune system function 14 . Younger children require more sleep than older children but in general, “adequate sleep””includes at least 10- 12 hours.14
Pharmacologic Therapy Although not always recommended in pediatric patients, various pharmacologic agents can be used to treat the symptoms of the common cold. In general, these options include antihistamines, nasal decongestants, antitussives, expectorants, and analgesics. Other therapeutic options include complementary or alternative medicine such as chicken soup, vitamin C, zinc, Echinacea, Airborne Jr®, and honey. Below are recommendations for the use of these products in pediatric patients. Antihistamines. Antihistamines competitively bind, but do not activate the H1 receptor and prevent histamine from binding.15 First generation antihistamines are considered nonselective and provide mostly sedative effects. This class of antihistamines includes diphenhydramine, clemastine, and chlorpheniramine.15 Second generation antihistamines are peripherally selective and therefore provide less sedation due to an inability to cross the blood brain barrier.15 Second generation oral OTC antihistamines include loratidine, fexofenadine, and cetirizine.15 First generation antihistamines are often utilized during the common cold because they are associated with anticholinergic properties such as drying of mucus membranes. This association results in a reduction of nasal, lacrimal gland, and salivary hypersecretion, thus decreasing the amount of mucus and drainage present.15 When compared to first generation antihistamines, the second generation products are not considered to be as beneficial due to reduced anticholinergic properties. A Cochrane systematic review evaluating the use of antihistamines either alone or in combination with a decongestant concluded antihistamine use as monotherapy did not provide any clinically significant effects on general recovery in the course of the common cold in either children or adults.16 First generation antihistamines were associated with a small decrease in sneezing and rhinorrhea, but were also associated
with a significantly higher incidence of side effects such as sedation.16 Many caregivers expect antihistamines to decrease nasal symptoms because they provide this effect in the setting of allergic rhinitis. The general population does not understand the pathophysiology of allergic rhinitis and the common cold differ greatly. 16, 17 During allergic rhinitis, large amounts of histamine are released in response to an allergen while a common cold uses bradykinin as the major cytokine mediator.16,17 Bradykinin can induce vasodilation and lead to congestion, but this mechanism is unaffected by antihistamines. Sedation of a sick child is the most likely benefit seen with the use of antihistamines although the use of these products for sedative effects alone is not currently recommended.18 Although safety and efficacy data regarding antihistamine use in pediatric patients is sparse and somewhat conflicting, the general consensus is that antihistamine use as monotherapy provides no real benefit in terms of nasal symptom relief and should be avoided in pediatric patients. 3, 16, 19 Combination therapy including antihistamines and decongestants has been shown to be ineffective in small children, but may provide limited benefit in older children and adults by relieving nasal symptoms such as runny nose and post-nasal drip. 3, 16, 17, 19 Nasal decongestants. Topical and systemic decongestants produce vasoconstriction in the nasal mucosa, therefore reducing inflammation and swelling while improving ventilation.15 OTC decongestants for oral use can be found in a variety of products and include pseudoephedrine (immediate and sustained release) as well as phenylephrine.15 These oral options have a slower onset of action when compared to topical decongestants, but are often associated with longer decongestive effects and less local irritation.15 Of the oral options, pseudoephedrine is the most frequently used oral decongestant, and although considered safe, has been associated with the potential for increased blood pressure and heart rate.15 Additionally, use of pseudoephedrine in patients with a history of hypertension, vasospasm, and/or cardiovascular disease should be avoided due to increased risk for stroke or heart attack.15 Use of pseudoephedrine should also be avoided in the treatment of patients taking monoamine oxidase inhibitors such as linezolid due to the risk of severe hypertensive reactions. 41
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At this time, insufficient data exist to support the safety and efficacy of phenylephrine as an oral decongestant in any age. However, it is suggested that phenylephrine has minimal effect on blood pressure even when taken at higher than recommended doses, making it seem like a safer alternative to pseudoephedrine.20 Although data is conflicting, phenylephrine is “generally recognized as safe” and may be an appropriate alternative for patients unable to tolerate the adverse effects associated with pseudoephedrine.20 Topical OTC nasal decongestants are an option in patients unable to take oral medications and include phenylephrine, naphazoline, tetrahydrozoline, oxymetazoline, and xylometazoline.15 These topical products are extremely effective at relieving nasal congestion and produce less systemic adverse effects than oral decongestants, but may produce burning, sneezing, stinging, and dryness of the nasal mucosa.15 Additionally, prolonged use (>3-5 days) can result in severe rebound congestion.15 Patients should be counseled to discontinue the use of topical decongestants after three days and to contact his/her doctor. At this time, studies evaluating the safety and/or efficacy of nasal decongestants in pediatric patients have not been completed, making the use of these agents inappropriate in children due to lack of sufficient data. 16, 19 Some studies have shown potential benefit, including relief from nasal congestion, from oral or topical nasal decongestants in the adolescent and adult populations, making recommendations for these groups more appropriate.16, 19 Antitussives. Cough is one of the most common and troublesome presenting symptoms in children.21 This symptom is not only troublesome for the child, it can also be one of the most intolerable symptoms for caregivers because it often prevents sick children from getting enough sleep at night.21 The Slone Survey identified that in any given week, about 1 in 10 children in the U.S. receives some form of cough and/or cold products.22 With these results, it is important to address the high prevalence of medication use in children, especially given the lack of efficacy data and potential for adverse effects.22 Various review articles have helped to characterize the use of cough and/or cold products in children, but evidence to support the effectiveness of the agents in the pediatric population remains inconclusive.23 42
One agent utilized in the treatment of cough is dextromethorphan. This cough suppressant is used to depress the cough center activity in the medulla and inhibits the reuptake of serotonin in the presynaptic cleft.24 This suppressive action can be harmful because it puts the patient at potential risk for severe respiratory depression and serotonin syndrome.24 These risks are especially dangerous in the pediatric population due to a lack of sufficient data, thus making the use of dextromethorphan for treatment of acute cough an inappropriate recommendation in children.3, 23 Topical antitussive options are also available for use in children to treat the symptoms commonly associated with cough and cold. These products use medicated vapors to relieve symptoms such as cough without causing the systemic side effects (i.e. drowsiness or jittery feelings) that have been associated with other cough and cold relief products.25 One of the most commonly used topical antitussives is Vicks VapoRub® which includes camphor, eucalyptus oil, and menthol. Vicks VapoRub® is approved for use in children 2 years of age and older and can be applied to the neck and chest up to three times per day.26,27 This product is not intended for use in children less than 2 years old due to the camphor component, and should also not be applied in the nostrils or under the nose.25-27 Side effects associ VapoRub® include increased mucus production, obstruction of small airways, and rebound congestion.26,27 Another formulation, Vicks BabyRub®, does not include camphor and is regarded as safe for children less than 2 years old when used as directed.28 This product is a combination of petrolatum, aloe extract, eucalyptus oil, lavender oil, and rosemary oil. Because it is marketed as “unmedicated,” very little safety and efficacy data is available regarding its use in the pediatric population.26,27 Expectorants. Expectorants, specifically guaifenesin,are used to reduce the viscosity of respiratory tract fluid secretions and increase sputum volume.29 These actions are thought to improve the efficacy of the cough reflex as well as the action of the ciliary in the trachea and bronchi, making it easier for patients to expel bronchial drainage.29 However, like other cough and cold products, limited evidence is available to support the efficacy of guaifenesin for acute cough and upper respiratory tract infections.19
Pharmacy Journal of New England • Fall 2015
Water is considered the safest and most efficacious expectorant for children with an acute cough.30, 31 Little data supports the use of mucolytics or pharmacological expectorants, but it is clearly understood that ample water intake will promote thinning and loosening of the mucus and promote coughing.30, 31
Complimentary and Alternative Medicine (CAM) All use of herbal supplementation in children under the age of 2, as well as in pregnancy and lactation, should be done with extreme caution.32 Many CAM therapies are associated with little clinical data regarding efficacy and safety, especially in the pediatric population. Non-pharmacologic therapy is the safest way to manage symptoms of the common cold in pediatric patients, and should be used prior to pharmacologic therapy and CAM. Vitamin C – Vitamin C is the most commonly used CAM product associated with the common cold. 3 Vitamin C should not be used for treatment, but limited evidence suggests that prophylactic use may decrease the severity and duration of symptoms.3 However, excessively high doses of vitamin C should be avoided as they have been correlated with adverse effects including headaches, intestinal and urinary complications, kidney stones, and significant interactions with anticoagulants.3 Oral Zinc: 33 Oral zinc formulations have demonstrated a dose-related reduction in the duration of the common cold in adults, however studies in children did not reveal the same reduction when compared to placebo. This lack of reduction could be attributed to differences in formulation, dosing, and frequency ofadministration. Differences in host inflammatory responses, virus etiology and susceptibility, and even the lack of reliable third-party symptom reporting could also account for the lack of evidence. If oral zinc therapy is used in the pediatric population, it is important to use a recommended dose and to counsel patients regarding common side effects such as nausea or bad (metallic)taste.
ria, fungi, and viruses.32 Root preparations may be effective in lessening the severity of cold symptoms, but clinical data is inconclusive. 5,34 The use of echinacea can also trigger allergic reactions and should be avoided in patients with allergies to ragweed, daisy, aster, and chrysanthemum. 5, 34 Also, many tinctures have high alcohol concentrations (15-90%), which should be considered when evaluating the use of echinacea in pediatric patients.32 Use for greater than 10 days in any population is not recommended.32 Airborne Jr®35,36 This product is marketed for children ages 4-10 as an herbal supplement designed to “boost your immune system to help your body combat germs.”35 The primary ingredients listed are vitamin C (835% of the daily recommended value), vitamin E, zinc, and manganese.35 This product has not been evaluated by the FDA and has not been proven to be clinically effective for the prevention or treatment of cough or cold.35 Airborne Jr® is classified as an herbal supplement, holding a similar place in therapy to vitamins with the same ingredients.36 Honey37- Data supporting the effectiveness of honey for the treatment of acute cough in children due to upper respiratory infections is limited.37 A review of two trials containing a total of 268 patients, ages 2-18, showed treatment with honey to be potentially superior to treatment with diphenhydramine but these results were consistent with “low to moderate quality evidence.”37 Chicken Soup – Limited clinically significant data is available with relation to the use of chicken soup for the common cold.3,30 Some individuals believe the hot steam from the soup may help relieve sinus pressure and inflammatory symptoms. This action is similar to the moistening of oral and nasal passage seen with other hot beverages or warm air humidifiers.3, 30 Individuals also like the use of chicken soup during the common cold because it is one of the few nonpharmacologic options that is safe for the pediatric population and is not associated with adverse effects.
Echinacea:5, 32, 34 This product is believed to act as a nonspecific immune stimulant and is used to stimulate white blood cell function and cell-mediated immunity. It is also reported to have broad-spectrum antimicrobial activity against bacte 43
Continuing Education
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Prevention of the Common Cold: Disinfection and Hand Washing In general, viruses often spread via hand-to-hand contact as well as through large particle aerosolization.34 Avoiding close contact with people who have colds or other upper respiratory tract infections (URTIs) can help prevent viral exposure.4 Infected persons are most contagious during the first three days of symptom onset and will likely no longer be contagious by about day seven of illness.5 Routine disinfection of commonly touched surfaces such as door knobs, sink handles, and light switches can decrease the risk of viral spreading.39 This disinfection should be done using an EPA-approved product such as Lysol® to ensure appropriate killing of the virus.39 Proper hand hygiene in both children and adults may also prove beneficial in preventing illness and stopping the spread of the virus.4 Intermittent and frequent hand washing is recommended for all ages and should be done using antibacterial soap or hand sanitizers containing organic acids such as salicyclic acid. Recent studies have demonstrated increased efficacy at prevention of rhinovirus infection when using organic acid-based when compared to ethanol-based hand sanitizers. This difference is thought to be the product of extended residual activity against rhinovirus seen with organic acid products.39-41 These products can be found over-the-counter and are generally considered safe for use in children.40
Pain and Fever Relief One of the leading causes of parental concern with regard to symptoms of illness is fever.38 The common belief children must maintain a “normal” temperature leads to the misuse of antipyretics on a daily basis.38 Many parents are not aware of the beneficial effects associated with fever including slowing of bacterial and viral growth which in turn helps the body recover more quickly from an infection.38 Due to this beneficial effect, the primary treatment goal for a febrile child should not be normalization of body temperature but should actually include improvement of the child’s general wellbeing including adequate fluid intake nd prevention of more serious symptoms.38 Another common misconception in the pediatric population is with regard to the treatment of pain. In previous decades, 44
pain management for infants and children was not considered a significant priority due to the assumption that these patients did not experience pain due to an “inadequately developed neuroendocrine system and nerve pathways.”10 However, many clinical studies have since proven the pediatric population may actually be more sensitive and potentially experience more intense pain than adults.10 As a result, effective practices to appropriately manage pain in children have become standard in the clinical setting, including using pain assessment as the fifth vital sign.10 Like adults, children can experience pain in a variety of situations including immunizations, acute illness (i.e. otitis media), chronic disease, injury, and medical procedures, thus making pain management an important part of treatment in this population.10,32 Treatment of both fever and pain contain both non-pharmacologic and pharmacologic options. Safe and effective OTC medication options for the treatment of pain and/or fever include ibuprofen and acetaminophen.42,43 Either choice, when used in appropriate doses, may be considered first line therapy when the patient requires an analgesic or antipyretic.42,43
Non-Pharmacologic Therapy Fever10, 42 Environmental Control - Adjust room temperature to avoid extremes in heat or cold - Remove excess clothing and/or use lightweight clothing -Sponge baths with lukewarm water - Do not use cold water which can induce shivering thus further increasing body temperature - Do not use rubbing alcohol which can be systematically absorbed and cause fume inhalation, both of which have hazardous CNS side effects (i.e. increased heart rate, headaches, dizziness, and nausea) Pain4, 23 Hot/Cold Packs - Use cold packs if pain is associated with inflammation and swelling
Pharmacy Journal of New England • Fall 2015
- Use heating pad if patient is experiencing stiffness or chronic pain Distraction - Consider using an enjoyable activity or item such as TV, board games, ice cream, etc. as a distraction for children in pain Massage/physical therapy - Make the child more comfortable and relaxed to positively contribute to general well-being and allow the body to naturally overcome the acute situation
Pharmacologic Therapy Acetaminophen. The current recommendation for pharmacologic treatment of fever and pain in children is the use of acetaminophen. In the past, recommendations included the use of aspirin in these situations, but due to a confirmed association between salicylates and Reyes syndrome in children, aspirin is no longer considered a treatment option for this population.42,43 The recommended dose of acetaminophen in children is 10-15 mg/kg/day every 4-6 hours with a maximum dose of 75 mg/kg/day (or 5 doses in 24 hours.42,43 OTC acetaminophen formulations for children include a standard liquid concentration of 160mg/5mL as well as chewable tablets and Meltaways®.42-44 The generally acceptable safe and effective duration of OTC use is 5 days or less.42,43 Hepatotoxicity is a severe adverse reaction of acetaminophen use and is seen in situations of supratherapeutic dosing (greater than 15 mg/ kg/dose) or in prolonged overdose situations in which appropriate single doses were given at intervals shorter than four hours.42 Ibuprofen. Ibuprofen is another option for fever and pain in the pediatric population and has been associated with a faster onset and duration of action than acetaminophen. However, data do not currently support a significant difference in safety or effectiveness between the two agents, making them both appropriate options in children. 42 Dosing recommendations in children are different for the treatment of fever versus pain. For children greater than 6 months of age, the dose for treatment of fever is 7.5 mg/kg/dose given every 6 hours with a maximum dose of 30 mg/kg/day. This is slightly different
than the dose for treatment of pain which is 5-10 mg/kg/dose given every 6-8 hours with a maximum dose of 4 doses in 24 hours.42,43 Dosage forms for ibuprofen in children include liquid preparations in concentrations of 40 mg/mL as well as 100 mg/5 mL.42 The variety of concentrations makes selection of the appropriate product even more important due to the risk of overdose if the wrong product is used. Ibuprofen is also available as a chewable tablet .45 One critically important point to remember in this population is the maintenance of adequate hydration while taking ibuprofen or other non-steroidal anti-inflammatory agents.42 Although only limited case reports exist, renal insufficiency has been directly correlated with the use of ibuprofen as a result of prostaglandin inhibition that ultimately disrupts renal blood flow.42 It is recommended to avoid the use of ibuprofen in children who are dehydrated, have a history of cardiovascular disease, have preexisting renal disease, or are also using other nephrotoxic agents.42
When to Refer 10, 19, 43, 46, 47 In general, non-pharmacologic therapy should be considered first line for treatment of cough and cold in pediatric patients. If pharmacologic therapy is used to alleviate symptoms, it is important for the caregiver to use OTC medications only for the amount of time recommended.47 If symptoms persist beyond the recommended amount of time, the caregiver should be instructed to follow-up with the primary care physician. Here are some general situations in which physician referral is recommended: Cough/cold symptoms6, 10, 31 • Persistent cough >4 weeks31
• Children <2 years old with cough31 • Cough indicative of another disease state such as pertussis, croup, bronchiolitis, asthma, GERD10,31 • Symptoms lasting > 10 days6
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Pain symptoms10, 43 • Swelling or erythema at the site of pain • No relief, no improvement, or worsening of pain despite adequate treatment Fever10, 42, 43 • Age > 6 months and temperature ≥103oF • Age > 2 months and rectal temperature ≥100.2oF • Age 3-6 months and temperature ≥101oF • No fever relief or improvement despite adequate treatment • Development of seizures or unusual drowsiness in addition to looking more “ill” • Development of additional symptoms such as stiff neck, inconsolable irritability, vomiting/diarrhea, rash, headache or severe pain in throat or ear • Fever in an immunocompromised child such as one with cancer, HIV, or history of transplant
Barriers to Appropriate OTC Use in Children Inappropriate dosing is one of the most important barriers to proper OTC use in children and plays a significant role in OTC-associated fatalities in this population.2 Dosing instructions on these products are often confusing and result in both overdosing and underdosing situations. Because pharmacists are such an accessible healthcare provider, it is important they feel comfortable providing dosing recommendations with regard to use of these products in children. Another barrier to appropriate OTC use in children is the selection of combination products containing the same active ingredients. Many caregivers unknowingly administer 2-3 times the daily recommended amount of medications such as acetaminophen because they are not aware of its inclusion in multiple products used in cough and cold. For this reason, single ingredient products should be recommended in order to avoid an unintentional overdose of any one ingredient.2 Selection of an inappropriate product is also a common barrier to proper OTC use in pediatric patients.2 In some 46
instances, caregivers may select products not indicated for a child’s symptoms or even substitute adult products when pediatric formulations are indicated.2 Finally improper utilization of measuring devices also contributes to inappropriate OTC use.2 Although many caregivers are tempted to use household teaspoons and tablespoons for medication dosing, these devices are not considered appropriate because the amount of medication delivered can vary greatly. In these situations, pharmacists should offer to explain how to use the devices appropriately or provide measuring tools which will provide the recommended dose of medication with less difficulty.2
Putting it all Together Medication adherence is an important part of medication use in children and can be negatively impacted by a variety of factors including:10 • Poor communication between the provider and the caregiver and/or patient • Lack of understanding regarding the severity of the illness • Lack of interest regarding taking medication (especially in adolescents) • Poor taste of drug formulations • Uncertainty or anxiety regarding potential medication related adverse effects • Inconvenient dosage forms and dosing schedules (i.e. administration three or more times daily) • Failure of the caregiver to remember to administer the drugs Medication safety is another very important part of mediation use. Administration errors may result from the following scenarios:10 • Incorrect or inappropriate medication • Incorrect or inappropriate dose • Inappropriate medication administration technique
Pharmacy Journal of New England • Fall 2015
• Inappropriate dosing instrument2 • Administration of more than two medications containing the same ingredients2 • Two or more caregivers contributing to the treatment and selection of the OTC product2 To avoid life-threatening events, pharmacists can remind caregivers to keep all medications (OTC and prescription) out of the reach of children. They should also keep all medications in the original bottles or containers with the lids tightly sealed.6
5. Currently, nasal decongestants are not recommended in children due to limited safety and efficacy data. This drug class should be reserved for adolescent and adult populations.16,19 6. Dextromethorphan is not an appropriate treatment for cough in pediatric children.3 7. Ibuprofen is an appropriate analgesic and/or antipyretic for children greater than 6 months old.6, 42, 43 8. Aspirin should NEVER be given to children due to the rare, but very serious, risk of Reyes syndrome. 6, 42, 43
Recognizing and understanding common flaws in the medication-use process can help providers, caregivers, and patients create strategies to prevent problems before they arise.10
9. Avoid cough and cold medications with multiple active ingredients. Use single ingredient products to reduce the risk of overdose.48
Clinical Pearls for Pharmacists
10.Pharmacists are the most accessible healthcare professionals: it is critical to select the appropriate products based on the individual pediatric patient, screen each patient for potential drug-drug interactions or contraindications, and thoroughly educate caregivers about proper dosing and administration.
1. Not all OTC products are approved for use in children. The FDA recommends against the use of cough and cold products, such as pseudoephedrine, phenylephrine, diphenhydramine, brompheniramine, and chlorpheniramine, in children younger than 2 years of age. 57 Additionally, manufacturers of these products voluntarily changed their labels to state: “do not use in children under 4 years of age.” 57 Paying close attention to product labeling, ingredients, and instructions for use allows pharmacists to provide appropriate recommendations and guidance for patients.6 2. FDA recommends against the use of cough and cold products (decongestants, ephedrine, pseudoephedrine, or phenylephrine, and the antihistamines diphenhydramine, brompheniramine, or chlorpheniramine) in children <2 years old, but the manufacturers voluntarily changed their labels to state: “do not use in children under 4 years of age.” Although vitamin C is often used in the adult population for prophylaxis of the common cold, it should not be used as active treatment in adults or children.3 3. Antibiotic therapy is not appropriate for treatment of the common cold in adults and children. Therapy directed toward symptom relief is a more appropriate recommendation.3 4. Antihistamines should not be recommended for the treatment of nasal symptom relief in children.3,16,19
References 1. OTC Medicines/Dietary Facts and Figures. Consumer Healthcare Products Association. Available at: http://www.chpainfo. org/pressroom/OTC_FactsFigures. aspx. Accessed June 10, 2012. 2. Dart RC, Paul IM, Bond GR, et al. Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications. Ann Emerg Med. 2009; 53(4)411-7. 3. Simasek M, Blandino DA. Treatment of the Common Cold. Am Fam Physician. 2007; 75(4):515-520. 4. Centers for Disease Control and Prevention. Get Smart: Know When Antibiotics Work: Common Cold and Runny Nose. Available at http://www.cdc.gov/getsmart/ antibioticuse/ URI/colds.html. Accessed May 14, 2012. 5. National Institutes of Health. MedlinePlus. Common cold. Available at http://www. nlm.nih.gov/medlineplus/enc y/article/000678.htm. Accessed May 14, 2012. 6. Centers for Disease Control and Prevention. Get Smart: Know When Antibiotics Work: Symptom Relief. Available at http://www.cdc.gov/getsmart/antibioticuse/ symptom-relief.html. 7. Aguilera L. Pediatric OTC Cough and Cold Product Safety. US Pharm. 2009;34(7):3941. 8. Humidifier Health. What is the Source of the problem? Available at http://www. humidifierhealth.org/?go=health. Accessed May 14, 2012. 9. Smith SM, Schroeder K, Fahey T. Overthe-counter medications for acute coughin children and adults in ambulatorysettings. Cochrane Database ofSystematic Reviews 2008; 1 :CD001831. 10. Nahata MC, Taketomo C. Pediatrics. In: Pharmacotherapy: A Pathophysiologic Approach. 7th ed. DiPiro JT, Talbert RL, Yee GC, et al., eds. New York, NY: McGraw-Hill; 2008. 11. Lever GJ, Li S, Mubasher ME, et al. Probiotic effects on cold and influenzalike symptom incidence and duration in children. Pediatrics. 2009 Aug;124(2):e172-9.
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12. National Institutes of Health. MedlinePlus Supplements. Lactobacillus. Available athttp://www.nlm.nih.gov/medlineplus/dru ginfo/natural/790.html. Accessed July 8, 2012. 13. Tyson A. Yogurt Brands Containing Probiotics. LiveStrong. Available at http://www. livestrong.com/article/281319 -yogurt-brands-containing-probiotics/.Accessed July 8, 2012. 14. Sleep for Kids. Children’s Sleep Sheet. Available at http://www.sleepforkids.org/ html/sheet.ht ml. Accessed July 8, 2012. 15. May JR, Smith PH. Allergic Rhinitis. In:Pharmacotherapy: A Pathophysiological Approach. 7th edition. Dipiro JT, Talber RL, Yee GC, eds. New York, NY: McGraw-Hill; 2008. 16. Sutter AI, Lemiengre M, Campbell H, et al. Antihistamines for the common cold. Cochrane Database Syst Rev. 2003;(3):CD001267. 17. What is the Common Cold? New-Medical. Available at http://www.newsmedical. net/health/What-is-the-Common-Cold.aspx. Accessed May 14, 2012. 18. Consumer Healthcare Products Association. Statement from CHPA on the voluntary label updates to oral OTC children’s cough and cold medicines. www.chpainfo. org/10_07_08_PedCC.aspx. Accessed July 8, 2012. 19. Isbister GK, Prior F, Kilham HA. Restricting cough and cold medicines in children. J Paediatr Child Health. 2012; 48(2): 91-8. 20. Harron RC, Winderstein AG, AmKelvey RP, et al. Efficacy and safety of oral phenylephrine: systematic review and meta-analysis. Ann Pharmacother. 2007;41:381-90. 21. Paul, Ian M. Therapeutic Options for Acute Cough Due to Upper Respiratory Infections in Children. Lung 2012; 19: 41-44. 22. Vernacchio L, Kelly JP, Kaufman DW, et al. Cough and Cold Medication Use by US Children, 1999-2006: Results from the Slone Survey. Pediatrics 2008; 122: e323-e329. 23. Smith SM, Schroeder K, Fahey T. Overthe- counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database of Systematic Reviews 2008; 1 :CD001831. 24. Dextromethorphan. Respiratory Agents. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. St. Louis, MO. Available at: http://factsandcomparisons.com. Accessed June 7, 2012. 25. VICKS®. VapoRub® Topical Ointment. Available at: http://www.vicks.com/products/ vapofamily/ vaporub-topical-ointment. Accessed October 2012. 26. OTC cough and cold medication: keeping children safe. Pharmacist’s Letter/ Prescriber’s Letter 2011;27(1):270105. 27. Vicks Vapo-Rub – How dangerous for children? Child Health Alert. 2009 Feb;27:2. 28. VICKS®. BabyRub® Soothing Ointment Available at: http://www.vicks.com/products/childrensmedicine/ babyrub-ointment. Accessed October 2012. 29. Guaifenesin. Respiratory Agents. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. St. Louis, MO. Available at: http://factsandcomparisons.com. Accessed June 7, 2012. 30. Aguilera L. Pediatric OTC Cough and Cold Product Safety. US Pharm. 2009; 34(7):39-41. 31. Cold medicines for kids: What’s the risk? Children’s Health. MayoClinic. Available at: http://www.mayoclinic.com/health/coldmedicines/ CC00083. Accessed on: July 2012. 32. Echinacea (Echinacea purpurea, Echinacea angustifolia). Natural Products Database. Lexi-Comp Online. Lexi- Comp, Inc. Hudson, OH. Available at: http://online. lexi.com/crlonline. Accessed May 15, 2012. 33. Science M, Johnstone J, Roth DE, et al. Zinc for the treatment of the CMAJ. 2012. Available at www.cmaj.ca. Accessed May 14, 2012. 34. Woelkart K, Linde K, Bauer R. Echinacea for Preventing and Treating the Common Cold. Planta Med. 2008; 74(6):633-7.
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35. Airborne. Product Information. Airborne, Inc. Minneapolis, MN. Available at: http:// www.airbornehealth.com/productinformation. Accessed on July 2012. 36. Airborne Jr. Effervescent Health Formula Grape. Dietary Supplements Labels Database. United States National Library of Medicine. Available at: http://dietarysupplements.nlm.nih.gov. Accessed July 2012. 37. Oduwole O, Meremikwu MM, Oyo-Ita A, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2012;3:CD007094. 38. Gwaltney JM Jr, Moskalski PB, Hendley JO. Hand-to-hand transmission of rhinovirus colds. Ann Intern Med. 1978; 88:463-7. 39. Turner RB, Hendley JO. Virucidal hand treatments for prevention of rhinovirus infection. Antimicrob Agents Chemother. 2005; 56(5): 805-7. 40. Turner RB, Biedermann KA, Morgan JM, et al. Efficacy of Organic Acids in Hand Cleansers for Prevention of Rhinovirus Infections. Antimicrob Agents Chemother. 2004; 48: 2595-8. 41. Turner RB, Fuls JL, Rodgers ND. Effectiveness of hand sanitizers with and without organic acids for removal of rhinovirus from hands. Antimicrob Agents Chemother. 2012; 54(3): 1363-4. 42. Sullivan JE, Farrar HC. Clinical report – fever and antipyretic use in children. Pediatrics 2011; 127:580-587. 43. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. NEJM 2002;(347) 14:1094-1103. 44. Smith SM, Schroeder K, Fahey T. Overthe- counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database of Systematic Reviews 2008; 1 :CD001831. 45. Motrin®. McNeil Consumer Healthcare Division. Available at: http://www.motrin. com. Accessed on July 2012. 46. Chang AB, Glomb WB. Guidelines for Evaluating Chronic Cough in Pediatrics: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2006; 129: 260S-283S. 47. Chang AB, Landau LI, Van Asperen PP, et al. Cough in children: definitions and clinical evaluation. MJA 2006; 184: 398- 403. 48. U.S. Food and Drug Administration. FDA Statement Following CHPA’s Announcement on Nonprescription Overthe- Counter Cough and Cold Medicines in Children. Available at: http://www.fda.gov/NewsEvents/Newsroom/ PressAnnouncements/2008/ucm1169 64.htm. Accessed on: July 2012. 49. Diphenhydramine. Lexi-Drugs Online. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed July 2012. 50. Pseudoephedrine. Lexi-Drugs Online. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed May 14, 2012. 51. Pseudoephedrine. Pediatric and Neonatal Lexi-Drugs Online. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed May 14, 2012. 52. Dextromethorphan. Lexi-Drugs Online. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed June 7, 2012. 53. Guaifenesin. Lexi-Drugs Online. Lexi- Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed June 7, 2012. 54. Aspirin. Lexi-Drugs Online. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed July 2012. 55. Acetaminophen. Lexi-Drugs Online. Lexi-Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed July 2012. 56. Ibuprofen. Lexi-Drugs Online. Lexi- Comp Online. Lexi-Comp, Inc. Hudson, OH. Available at: http://online.lexi.com/crlonline. Accessed July 2012. 57. An Important FDA Reminder for Parents: Do Not Give Infants Cough and Cold Products Designed for Older Children. U.S. Food and Drug Administration. Accessed 17 October 2012. Available at: http://www.fda.gov/Drugs/ResourcesFor You/ SpecialFeatures/ucm263948.htm
Continuing Education Quiz Pediatric Over-the Counter Medication 1. Which non-pharmacologic treatment is NOT RECOMMENDED in a pediatric patient with a cough or cold? A) Increasing fluid intake with water B) Receiving at least 10 hours of sleep C) Using a warm air humidifier D) Use of nasal bulb syringes in infants with congestion 2. NK is a 12 year old boy who presents to clinic with a runny nose, cough, and nasal congestion. NK states that he has felt “really bad all over” for the past 2 days and hasn’t been able to sleep well because he can’t breathe through his nose. He has not had a fever. NK is not taking any other medications, has NKDA and no significant PMH. Mom has not tried any form of therapy for his cold symptoms, but states she would like to get something to help him beathe at night so he can sleep. What would be the appropriate recommendation for NK? A) Pseudoephedrine 30 mg q 4-6 hours; max 240 mg; appropriate counseling on all potential adverse effects
4. A mom comes to your pharmacy with her 8 month old daughter, ML. She states ML has had a deep, nonproductive cough for the last 5 days which is very bothersome and is even preventing her from getting enough sleep at night. Mom thinks it may be from something she picked up from her new daycare, especially because she knows other kids have been sick recently. Mom wasn’t sure how she should treat the cough but states she was told to pick up some Children’s Tylenol Plus Cough and Sore Throat® (acetaminophen and dextromethorphan) by the mom of another kid. She has the product in her hand but wants to know what you would recommend for her daughter before she buys it. What would be your recommendation? A) Nonpharmacologic therapy with increased fluid intake using Pedialyte®, adequate sleep, and use of cold air humidifier B) Children’s Tylenol Plus Cough and Sore Throat®(acetaminophen 160 mg/5mL and dextromethorphan 5mg/mL); 5 mL q 4-6 h C) Children’s Delsym® (dextromethorphan 30mg/5mL); 0.2 mL q 6-8 hours
C) Use of medications containing ≥2 active ingredients D) Use of an inappropriate measuring device
B) Drinking 8-10 glasses of water throughout the day C) Guaifenesin 50mg every 4 hours D) Dextromethorphan 10mg every 8 hours 8. NM is a 5 month old WM who just received three immunizations. He is restless and will not stop crying. His mother suspects NM is experiencing lingering pain at the injection site. What is the best analgesic for NM at this time?
B) Ibuprofen 10mg/kg/dose x 1 dose
B) Avoiding exposure to persons with cold symptoms and proper hand hygiene may help prevent the common cold
B) Inappropriate dosing
A) Acetaminophen 15mg/kg/dose every 4-6 hours as needed for cough
5. Which of the following statements is NOT true?
C) Phenylephrine 5-10 mg q 12 hours instead of pseudoephedrine; appropriate counseling on all potential adverse effects
A) Administration by a single caregiver
She says she has had the cough for about 24 hours without relief. JS confirms she does not have a history of allergies or sinus congestion. What is the best recommendation for JS with regard to an expectorant?
A) Neonates do not experience pain. No treatment recommended.
A) Green mucous typically indicates a bacterial infection, and most often requires physician referral
3. Which is NOT a challenge associated with over-the-counter medication use in children?
7. JS is a 7 year old little girl who is complaining of a headache, cough, and lots of “drainage in her throat.”
D) Refer to physician
B) Diphenhydramine 12.5 mg q 4 hours; max 75 mg/day; appropriate counseling on all potential adverse effects
D) Nonpharmacologic therapy including a cold air humidifier, head elevation, and increased fluid intake
D) Ibuprofen 10mg/kg/dose every 4 hours as needed for cough
C) Nonpharmacologic therapy should always be considered as first line therapy in pediatric patients with mild cough/cold symptoms D) Products including vitamin C or yogurt with active cultures can reduce the severity and duration of the common cold in children 6. What is the MOST appropriate treatment for cough in a 10 year old boy with a sore throat and persistent, productive cough? A) Dextromethorphan 30mg every 4 hours as needed for cough
C) Acetaminophen 15mg/kg/dose x 1 dose D) Aspirin 10mg/kg/dose x 1 dose 9. MR is a 4 month old female brought to your community pharmacy by her mother. MR is febrile with a temperature of 101.2oF. Her mother is very concerned and asks you for the “quickest thing” to bring her daughter’s fever down. What is your recommendation? A) MR should call her pediatrician or go to the emergency room right away. B) Acetaminophen 30mg/kg as an initial loading dose, followed by 10mg/kg/dose every 4-6 hours thereafter until afebrile C) Ibuprofen 10mg/kg/dose every 6 hours until afebrile D) No pharmacological therapy required. MR should be taken home and given an ice bath
B) Increased water intake and elevation of the head of the bed C) Guaifenesin 400mg every 4 hours as needed for cough
(see next sheet)
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10. Which is a common factor that positively affects pediatric medication adherence? A) A poorly tasting liquid formulation that does NOT include a sweetener or flavoring to mask the bitter taste B) A dosing schedule that requires administration every 6 hours C) A caregiver who doesn’t believe their child’s symptoms or illness requires treatment D) Open and clear communication between the provider and the caregiver
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