CT-ASCP's

SenioRx Care Perspective

Inside: What’s New with COPD? Pages 2-4 Influenza Vaccinations in Patients with a Page 5 History of Egg-Allergy SAVE THE DATE— Schwarting Senior Symposium 2015 Page 6 Notes ‘n Votes— September 2014 Page 7

Fall 2014 Volume VIII No. 3

UCONN ASCP Student Chapter Update Andrew Barna, Student Chapter President

1 | Fall 2014 CT-ASCP Chapter Newsletter

Who We Are

The UCONN chapter of ASCP currently consists of 33 members ranging from

P3 to Pre-Pharm, with new members always welcome to join. We currently

meet bi-weekly on Wednesdays from 3-4pm in the School of Pharmacy. Our

E-Board consists of 6 members: President- Andrew Barna (P3), Vice President

- Heather Jones (P3), Secretary- Alexa Sanna (P3), Treasurer- Alyssa Weers

(P3), PSG Representative- Robert Ambrose (P3), and Historian- Matthew

Merola (P2). Our breakdown of members by year is: P3- (15), P2- (9), P1- (5),

and Pre-Pharm- (4).

As we begin the new school year, the UCONN chapter of ASCP is excited to

learn about how the field of geriatric pharmacy is changing and evolving. This

year our members are trying to take a more active role in experiencing geriatric

pharmacy, as well as spreading awareness and adherence to the elderly

community.

Our chapter kicked off the new semester by having an ice cream social for new

and returning members. At the meeting, we informed new members about

ASCP’s role in the school and community, shared our ideas for the upcoming

semester, and encouraged new members to take an active role in the

experience.

What We Have Done

On September 21, 2014, 13 of our chapter members volunteered for the Walk

to End Alzheimer’s Disease at Bushnell Park in Hartford, CT. Our members

helped with setting up for the event, as well as, spreading Alzheimer awareness

and increasing advocacy.

We are also selling UCONN School of Pharmacy sweatpants and draw-string

bags to fundraise for various events. If you would like to purchase one of these

items, please let us know.

Our Ideas for the Future

This year, our chapter is really trying to take a more active role in

understanding what geriatric pharmacy is and what it has to offer. We are

currently sending 11 members of the UCONN Chapter to attend the 2014

ASCP Annual Meeting and Exhibition from November 5-7, at the Gaylord

Palms Resort and Convention Center in Orlando, Florida. Our members are

looking to gain knowledge from and network with established health care

professionals who specialize in this field, while also representing UCONN

School of Pharmacy.

Along with attending the ASCP Annual Meeting, our chapter really wants to

meet and learn from past ASCP alumni and current chapter members. We are

also trying to have Guest Speakers who specialize in geriatric pharmacy, to

share about the field and possible job and shadowing opportunities. We would

love to host the guest speakers here at the UCONN School of Pharmacy or

through Zoom, a website where you can easily host webinars. This would

allow us to conveniently broadcast to our student members.

With the insight and experience we gain from the various health care

professionals we meet, our chapter wants to get more involved in the

community. Our members are looking to volunteer at nursing homes and

assisted living centers. We are trying to set up informational sessions on

constipation, the importance of vaccines in the elderly, and fall prevention.

We are truly looking forward to this year as members of ASCP. If there are

any opportunities to shadow at various sites, participate in brown bag events,

or volunteer for events that would allow us to further our education into

geriatric pharmacy, we would greatly appreciate it.

If any ASCP members or alumni would like to have students shadow at their

site, volunteer to be a guest speaker, or help in fundraising for events like An-

nual. Please email our chapter President, Andrew Barna, at

ascp.uconn@gmail.com.

2 | Fall 2014 CT-ASCP Chapter Newsletter

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recently published updated guidelines for the care of

patients with Chronic Obstructive Pulmonary Disease (COPD) including an update on the Global Strategy for Diagnosis,

Management, and Prevention of COPD in January of 2014. These guidelines provide the most up-to-date, evidence-based

recommendations for the overall care of patients with COPD and outline the diagnosis, classification, and selection of

appropriate drug therapy.

COPD is characterized by symptoms of dyspnea, chronic cough, and chronic sputum production. A definitive diagnosis can

be made using spirometry; when the ratio of a patient’s forced expiratory volume in one second (FEV1) to forced vital

capacity (FVC) is less than 0.7. FEV1 is the amount of air a patient can expel in one second, compared to FVC, which is the

total volume a patient can expel after a full exhale. The severity of COPD is determined using a combined assessment of

ndependent factors of COPD: symptoms, degree of airflow limitation (e.g., FEV1), risk of exacerbations, and comorbidities.

Airflow limitation places patients into GOLD categories (GOLD 1 through 4) with GOLD 1 being mild and GOLD 4 being

very severe (Table 1). Gold 1 and 2 are represented by classification A or B, and GOLD 3 and 4 are represented by C or D.

Patient questionnaires are used to determine the severity of symptoms and are then stratified into two groups, “less

symptoms” and “more symptoms”. A and C represent “less symptoms” and B and D represent “more symptoms.”

Exacerbations are then similarly categorized into low risk (one or less exacerbations and no hospitalizations for exacerbations

per year), or high risk (two or more exacerbations with one or more hospitalizations per year). Low risk for exacerbation is

represented by classification A or B and high risk of exacerbation by C or D.

Table 1.

Adapted from the Global initiative for Chronic Obstructive Lung Disease 2014

Pharmacologic treatment is then determined using this classification system. Limiting exposure to nicotine (personal use and

second-hand), occupational exposure to aggravating substances, and air pollution are emphasized, as exposure to all of these

has been identified as risk factors for disease progression and exacerbations. Evidence also shows that patients with

COPD may benefit from physical activity, vaccinations (particularly influenza and pneumococcal when appropriate), and

antibiotics for the treatment of current infections.

What’s New with COPD? Aya Haghamad, PharmD Candidate, Sara Schroedl, PharmD Candidate, Stephanie Hattoy, PharmD, BCPS, CGP— University of St. Joseph School of Pharmacy

Classification Pulmonary function Symptoms Exacerbation

Risk

A GOLD 1 (FEV1 > 80% predicted) GOLD 2 (50% < FEV1 < 80% predicted)

Less Low

B GOLD 1 (FEV1 > 80% predicted) GOLD 2 (50% < FEV1 < 80% predicted)

More Low

C GOLD 3 (30% < FEV1 < 50% predicted) GOLD 4 (FEV1 <30% predicted)

Less High

D GOLD 3 (30% < FEV1 < 50% predicted) GOLD 4 (FEV1 <30% predicted)

More High

3 | Fall 2014 CT-ASCP Chapter Newsletter

What’s New?

Changes from the previous iteration of the guidelines includes the use of spirometry, emphasis on pulmonary function, and a

classification-based drug therapy recommendation that includes alternatives and combination therapies for patients who have

failed first-line therapy. Airflow limitation alone has not proven to be a great indicator for disease status, so more emphasis

has been placed on the severity of symptoms and risk of exacerbations. The new guidelines maintain the same treatment

model as the old guidelines; assessments of COPD based on the patient’s level of symptoms, future risk of exacerbations, the

severity of spirometric abnormalities, and the presence of comorbidities. However, the choice of therapy was mainly

determined by airflow limitation. For example, in the previous guidelines, stage II moderate was defined as 50% < FEV1 <

80% predicted and the treatment included a long-acting bronchodilator without suggestions for alternatives. The current

guidelines provide more treatment alternatives and combination therapy for patients who fail first-line therapy.

Summary of Pharmacotherapeutic Options

Pharmacological therapies are used to reduce symptoms and reduce the risk of exacerbations in stable COPD. Current classes

of first-line pharmacological therapies include short-acting (SA) and long-acting (LA) inhaled bronchodilators such as beta2

agonists and anticholinergics, combination inhaled beta2 agonist/anticholinergic, inhaled corticosteroids (ICS), and

combination inhaled LA beta2 agonist/inhaled corticosteroid. Recommendations for second-line and alternative

pharmacological therapies include methylxanthines (theophylline), carbocysteine or the phosphodiesterase-4 (PDE-4)

inhibitor Daliresp (roflumilast). Table 2 summarizes the recommendations based on the GOLD classification.

Table 2.

Adapted from the Global initiative for Chronic Obstructive Lung Disease 2014

What’s New with COPD? … continued from page 2 Aya Haghamad, PharmD Candidate, Sara Schroedl, PharmD Candidate, Stephanie Hattoy, PharmD, BCPS, CGP— University of St. Joseph School of Pharmacy

Patient Group 1st line recommendation Alternative treatments Other possible

Treatments

A SA anticholinergic

or

SA beta2 agonist prn

LA anticholinergic

or

LA beta2 agonist

or

SA beta2 agonist and SA

anticholinergic

Theophylline

B LA anticholinergic

or

LA beta2 agonist

LA anticholinergic and LA beta2 agonist SA beta2 agonist

and/or

SA anticholinergic

Theophylline

C ICS + LA beta2 agonist or

LA anticholinergic

LA anticholinergic and LA beta2 agonist

or

LA anticholinergic and PDE-4 inhibitors

or

LA beta2 agonist and PDE-4 inhibitors

SA beta2 agonist

and/or

SA anticholinergic

Theophylline

D ICS + LA beta2 agonist

and/or

LA anticholinergic

ICS + LA beta2 agonist and LA anticholinergic

or

ICS + LA beta2 agonist and PDE-4 inhibitor

or

LA anticholinergic and LA beta2 agonist

or

LA anticholinergic and PDE-4 inhibitor

Carbocysteine

SA beta2 agonist

and/or

SA anticholinergic

Theophylline

4 | Fall 2014 CT-ASCP Chapter Newsletter

New drugs:

In 2013, the FDA approved two new inhaled combination medications for once-daily administration in maintenance therapy

for COPD, Anoro™ Ellipta™ and Breo® Ellipta®. Anoro™ Ellipta™ is the first combination inhaled long-acting

anticholinergic/beta2 agonist to be approved for once-daily use in maintenance therapy for COPD. Breo® Ellipta® is the only

once daily combination inhaled corticosteroid/beta2 agonist, compared to other combination inhaled corticosteroid/beta2

agonists that are given twice a day. Once daily dosing will provide a huge advantage to patients who struggle with adherence.

The FDA approved Incruse™ Ellipta® in April of 2014 as the only long acting inhaled anticholinergic that is approved for

long-term, once-daily monotherapy in the maintenance of COPD.

The new Ellipta® devices allow for one-step loading of the dose by simply moving the mouthpiece cover until a “click” is

heard, inhaling, and placing the cover back over the mouthpiece. The simple sliding action of these inhalers may improve

administration technique for those with dexterity issues. These new inhalers still carry side effects similar to those in their

respective classes. Common side effects associated with inhaled anticholinergics (Anoro™ Ellipta™ and Incruse™ Ellipta®)

include pharyngitis, sinusitis, constipation, diarrhea, and dry mouth. Although rare, a serious side effect that has been

reported with inhaled anticholinergic use is the worsening of narrow angle glaucoma. Common side effects of inhaled

corticosteroids (Breo® Ellipta®) include nasopharyngitis, upper respiratory tract infection, headache, and oral thrush. Serious

side effects that have been reported with inhaled corticosteroid use include an increased risk of pneumonia and bone

fractures. The LA beta2 agonist component in Anoro™ Ellipta™ and Breo® Ellipta® carry the same FDA warning as other

LA beta2 agonists of sudden asthma related death and are not indicated for monotherapy use. Anoro™ Ellipta™, Breo®

Ellipta®, and Incruse™ Ellipta® are all formulated with milk-protein, so these inhalers should be avoided in patients with

severe milk allergies.

In comparison to previous guidelines, the updated guidelines provide more directed therapy recommendations based on

patient specific factors and provide second-line and alternative therapies. Newly approved medications such as Anoro™

Ellipta™, Breo® Ellipta®, and Incruse™ Ellipta®, introduce a new device for COPD maintenance and may allow patients to

reduce the number of administrations with once-daily dosing.

References:

1. Decramer M. et al., Global Strategy for Diagnosis, Management, and Prevention of COPD [Internet]. Global Initiative for

Chronic Obstructive Lung Disease, INC. USA and Europe; 2011 {updated 2014; cited 2014 Jul 19]. Available from:

http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf. 2. What Is COPD? [Internet]. Bethasda (MD): National Institutes of Health, National Heart, Lung, and Blood Institute; 31 Jul

2013 [cited 2014 Jul 19]. Available from: https://www.nhlbi.nih.gov/health/health-topics/topics/copd/.

3. What Is COPD? [Internet] Washington DC: COPD Foundation; 2014 [cited 2014 Jul 19]. Available from:

http://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx. 4. Center for Disease Control and Prevention. What is COPD? [Internet]. Atlanta (GA): National Center for Chronic Disease

Prevention and Health Promotion, Division of Population Health; 2013 Aug 01 [updated 2013 Nov 13; cited 2014 Jul 19].

Available from: http://www.cdc.gov/copd/.

What’s New with COPD? … continued from page 2 Aya Haghamad, PharmD Candidate, Sara Schroedl, PharmD Candidate, Stephanie Hattoy, PharmD, BCPS, CGP— University of St. Joseph School of Pharmacy

5 | Fall 2014 CT-ASCP Chapter Newsletter

Winter is coming, which means so is the flu. The best way to prepare for flu season is with the annual flu shot. Influenza

immunization is especially important in elderly due to their increased risk of complications from this infection. This year’s

influenza vaccine is comprised of the same virus strains as those in the 2013/2014 formulation. The trivalent vaccine will

contain hemagglutinin derived from A/California/7/2009 (H1N1-Like Virus), A/Texas/50/2012 (H3N2-Like Virus), and

B/Massachusetts/2/2012-like (Yamagata lineage) virus. The quadrivalent vaccine will contain these antigens in addition to a

B/Brisbane/60/2008-like (Victoria lineage) virus.

The typical trivalent vaccines, with the exception of FluBlok and Flucelvax, are prepared by propagation of the influenza

virus in the embryos of chicken eggs. FluBlok is the only influenza vaccine that is considered “egg-free,” while Flucelvax

contains only 5x10-8 µg per 0.5 mL dose. Although a review of the published data has shown no reports of anaphylaxis in

patients receiving vaccines containing egg proteins, some milder reactions did occur and there have been occasional cases of

anaphylaxis in egg-allergic patients reported through the Vaccine Adverse Event Reporting System (VAERS).

The Advisory Committee for Immunization Practice (ACIP) recommends the following algorithm in regards to egg-allergic

patients:

Patients aged 18-49 who have only experienced hives after exposure to egg should receive the trivalent recombinant influenza

vaccine (RIV3 or FluBlok). Alternatively in this population, patients can receive IIV if the recombinant vaccine is not

available as long as they undergo increased monitoring in the presence of a physician experienced in severe allergic

conditions. FluBlok has not been approved in patients over age 49 due to the lack of safety and efficacy studies in this

population. For geriatric patients with documented egg allergies limited to hives, Flucelvax is approved in patients greater

than 18 years old and contains a minimal amount of egg protein. If patients, regardless of age, experience severe allergic

reactions after previous doses of the influenza vaccine, future vaccination is contraindicated.

References:

http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m6332a3f2.gif http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm

http://www.immunize.org/catg.d/p3094.pdf

Influenza Vaccinations in Patients with a History of Egg-Allergy Jonathan Angus, Mary Kovacevic, PharmD candidates 2015, University of Connecticut

Schwarting Senior Symposium 2015—SAVE THE DATE!

6 | Fall 2014 CT-ASCP Chapter Newsletter

The Schwarting Senior Symposium

Tuesday, March 17, 2015

The Aqua Turf Club

Plantsville, CT

Join us for this joint educational opportunity from

and

Connecticut Chapter of

7 | Fall 2014 CT-ASCP Chapter Newsletter

SPONSOR RECOGNITION

J. Pyron and J. Ferguson were thanked for the sponsorship.

REVIEW OF PAST MINUTES

The minutes of the 8/4/14 meeting were reviewed and unanimously

approved.

LEGISLATIVE NEWS

K. Chamberlin and M. Gemma participated in National’s legislative call

with Lynne Batshon. There will be new grassroots initiatives and

National will be sending out a list of actionable items. Virtual Lobby Day

will be on 10/16. Talking points and pre-written letters that can be

personalized will be shared once received. The STAMP out campaign is

to reduce prescription misuse and abuse in older adults and there is a free

CE webinar available to members. HB 4190 for provider status is gaining

support and has 94 co-sponsors but will likely not get any further until

next year. Members may want to invite those up for re-election to

facilities and pharmacies. CT-ASCP can donate to the ASCP advocacy

fund but only members can donate to ASCP PAC. The FDA and DEA

agreed on controlled substance disposal which was published 9/9 and will

go into effect 30 days after publishing. The state’s medical marijuana

program will go into effect likely by the end of September with

dispensaries opening soon pending on producers.

CHAPTER NEWS

Communications committee is always looking for articles/topics. A. Huie

-Li thanked S. Hattoy for the student chapter contribution. There are

issues with our new website that are being worked out. S. Hattoy and B.

Pelletier received the training however the password to access content has

been changed. The server has been switched from Bill Ward’s and the

chapter is awaiting contact from a new company representative for

resolution. Fall CE planning has been postponed. There was a general

discussion about future meeting locations, sponsorship, and frequency of

BOD meetings. Three members will be reimbursed for dinner for

tonight’s meeting. Some suggestions were to have meetings rotated at

worksites and ordering pizza. D. Chapron has officially retired from full

time work and M. Wrabel thanked everyone for their support.

SCHWARTING-SENIOR SYMPOSIUM (SSS15) – March 17, 2015

at Aqua Turf, Southington, CT

The date had been set and there are two confirmed speakers. UConn is

thinking about offering immunization again and may provide MTM

diabetes. Feedback has been received and reviewed from past Schwarting

attendees. Many conferences are moving forward with digital content and

apps as opposed to printing handouts. K. Chamberlin will check with

National to see if they have an app plan moving forward. D. Cooper has

prepared the latest save the date for vendors. One hour of unopposed

exhibit time will also be built into the schedule. Past concerns were

discussed such as the distribution of pre-populated forms and the layout of

the program.

UCONN/USJ NEWS

USJ is already reviewing applications for next year’s admission. A.

Leschak will no longer be teaching pharmacology at the UConn SON and

will be joining faculty at USJ. R. Eyler was congratulated as UConn

Faculty Preceptor of the Year. A. Barna, President of the UConn Student

Chapter was welcomed. The student chapter will be participating in a

Walk to End Alzheimer’s 9/14. Several students are interested in

attending the Annual Meeting. Members who are interested in sponsoring

a student can contact Andrew.Barna@uconn.edu and sponsorship is also

available for a limited time through National. UConn has their White

Coat Weekend coming up 10/24-10/25 including the annual

Professionalism Ceremony, White Coat Ceremony, and Alumni Gala.

Meeting adjourned at 7:45pm

Next Meeting: 10/6/14 at @ 5:30pm

Machiavelli’s 75 Center St, Southington, CT

(sponsored by Meda Pharmaceuticals )

Respectfully submitted,

Kim L. Daley, PharmD, CDP

CT-ASCP Secretary/Treasurer

Sponsorship: Jennifer Pyron and John Ferguson from Novonordisk,

Speaker: Jonathan Marquess, PharmD, CDE

Guests: Michel Fortin, Jill Fitzgerald, Andrea Leschak, Dennis Chapron,

Dave Cooper, Andrew Barna, Amy Huie-Li, Bob Tendler, Brian

Pelletier, Jennifer Dimauro

Editorial Board Amy Huie-Li, PharmD, CGP Anna Torda, PharmD Kim Daley, PharmD Kevin Chamberlin, PharmD Brian Pelletier, PharmD, CGP Jennifer Kloze, PharmD, BCPS

Notes 'n Votes - September 2014 Board Meeting Kim L. Daley, Pharm.D., CT-ASCP Secretary / Treasurer

MEMBER NAME & TITLE August September

Kevin Chamberlin, President / SS Committee

X X

Mark Wrabel Immediate Past-President

X

Mike Gemma President-Elect / Legislative Committee

Kim Daley, Secretary / Treasurer

X X

Stephanie Hattoy Board 2014-17 / CE Committee

X X

Anna Torda, Board 2014-16 / Communication Committee

X X

Rachel Eyler Board 2014-16

X X

Kathy White Board 2011-15 / SS Committee

X

Karen Rubenfeld Board 2014-15

X X