the georgia pharmacy journal: december 2011

*This is not a claims reporting site. You cannot electronically report a claim to us. To report a claim, call 800.247.5930.**Compensated endorsement.Not all products available in every state. The Pharmacists Life is licensed in the District of Columbia and all states except AK, FL, HI, MA, ME, NH, NJ, NY and VT. Check with your representative or the company for details on coverages and carriers.

For more information, contact your local representative:

www.phmic.com*

Guarantee a better

Quality of Life for your family.Life Insurance can provide for your loved ones by:

Paying outstanding debtsCreating an estate for those you care aboutProviding college funding

Life insurance solutions from The Pharmacists Life Insurance Company.

Endorsed by:**

Hutton Madden800.247.5930 ext. 7149

678.714.9198

Q

Quality

y of Life

Life Ins

Q

Providing colleg Creating an esta Paying outstand

surance can p

Quality

ge funding ate for those you c

ding debts

provide for you

y of Life

e about car

r loved ones bfor your faf y f

l d b

by: amily.

b

Insuranc Life insu

.ce Company urance solutio

008

H

om The ons fr

amroffonnfieromroF

8919417876.txe0395.742.0ddaMnottuH

e Pharmacists

colruoytcatnoc,noit

9417

ned

s Life

:evitatneserperla

representative or the company for details on coverages and carriers.al and Columbia

a products all Not Compensated endorsement.**

a claim, call 800.247.5930.claim a not is This *

the company for details on coverages and carriers.NH, ME, MA, HI, FL, AK, except states ll

Pharmacis The state. every in available endorsement.

247.5930.electronically cannot You site. reporting ms

8919.417.876

c.cimhp.www

and carriers.your with Check VT. and NY NJ,

of District the in licensed is Life sts

report To us. to claim a report ally

*moc

The Georgia Pharmacy Journal December 20113

F E A T U R E A R T I C L E S

9 Board of Pharmacy President’s Message: Comment on the Pharmacist in Charge Responsibilities

10 GPhA Members Meet with Their Congressional Delegates

11 VIP Day at the Capitol: February 9

15 Department of Insurance Complaint Form

23 Senator Buddy Carter Named UGA’s Alumnus of the Year

24 CPE Opportunity: Head Lice Infestations: Counseling Your Patients

C O L U M N S

4 President’s Message

6 Editorial

7Laird Miller, R.Ph., Appointed to the Georgia State Board of Pharmacy

Departments5 NPLC Nomination Form12 Pharm PAC Contributors14 Pharm PAC Contribution Card18 GPhA New Members18 GPhA Website Tutorial22 2012 Award Nomination Form30 GPhA Board of Directors30 Masthead

Advertisers2 Pharmacists Mutual Companies10 Frances Cullen, PC13 Financial Network Associates13 Melvin Goldstein, P.C.17 AIP18 Barbara Cole, Attorney at Law19 GPhA Convention Information20 Girls of Pharmacy Leadership Weekend21 GPhA Workers’ Compensation23 Logix, Inc.23 Winter CPE Ski Trip32 UBS

For an up-to-date calendarof events, log ontowww.gpha.org.

P R E S I D E N T ’ S M E S S A G E


As the New Year approaches, each pharmacist mustdetermine what kind of pharmacist he or she is going to represent for the New Year. As a

pharmacist of this state, are you going to be apathetic orare you going to be an advocate for your profession? Lastyear the pharmacists of this state were instrumental in thepassing of three bills that were vital to our profession. Thedrug-monitoring bill will give the pharmacist a mechanismto help retard potential abuse of controlled drugs. Thesecond bill, the immunization bill, gave pharmacists theopportunity to further develop the wellness programs inour state by allowing the pharmacist to give flu shotsunder the protocol of a doctor. The third bill was theannual drug bill. This bill established pseudoephedrine asa schedule V exempt narcotic drug to help impede themethamphetamine labs. As pharmacists, we are alwaysproud of the bills that are passed in the legislature thatpromote our profession. We also need to be aware of allthe bills that were detrimental to our profession that werehalted due to our lobbying efforts. An example of aonesuch bill was adding sales tax to prescription drug costs.

As pharmacists, we must be aware of the bills in thelegislature that impact our profession. The pharmacists inthis state MUST be involved with advocacy. We have setthe bar high for our profession; therefore, we must remaininvolved in all issues that will arise that restrict or couldmake our profession less valuable. February 9, 2012, isVIP DAY at the Capital. We want you to be a VIP, “a veryimportant pharmacist,” and contact your representativeand senator for next year’s meeting. Please, do not hesitatein establishing that important dialogue between you and

your representatives. It is imperative that our voices beheard so that our profession can continue to grow andprosper.

From all the GPhA executive committee, we want to wisheveryone a safe and happy holiday season.

L. Jack Dunn, Jr., R.Ph.GPhA President

You Can be a VIP in 2012


Would You Like to Help Jump Start the Future of a PharmacyLeader?The Georgia Pharmacy Foundation New Practitioner Leadership Conference will expose the attendee to thedevelopment of personal and professional leadership skills.

This could be a decisive step in the leadership career of a young pharmacy professional.

Three Top Desired Qualities of Nominees1. Leadership potential2. Active involvement in student activities and or professional organizations3. Activity in community organizations

Nominees may not have practiced more than 10 years in pharmacy.

The 2012 class will not exceed 20 in total.

Conference Location:Legacy Lodge & Conference CenterLake Lanier Islands, GAConference Dates: April 13-15, 2012

If there is a person you would like to nominate, please complete the form below and return it by January 23, 2012.

Nominee’s Name: _________________________________________Address: _____________________________________________________________________________________________________Phone: ________________________________________________Email: _________________________________________________

Nominator’s Name: ________________________________________Address:______________________________________________________________________________________________________Phone: ________________________________________________Email: _________________________________________________

Return to :Georgia Pharmacy Foundation50 Lenox PointeAtlanta, GA 30324OrFax 404-237-8435

If you need additional information contact Regena Banks at 404-237-8435 or email [email protected].

Some years ago, on a whim, I began to keep a list ofquotes, quips, and interesting thoughts that I hadpicked up from friends, various articles, and some

observations of my own. I shared my list with my twosons, who were not as impressed because they are stillyoung enough to know more than their Dad. I, however,was undeterred by their critique of my list. This month Iam now using the platform you have afforded me as yourExecutive Vice President to share these “words ofwisdom.” You, of course, like my sons, are free to expressyour comments at [email protected] or you can alsoshare with me your “words of wisdom” to live by. Allfeedback is welcomed.

Time and tide wait for no man and neither does Delta.

Men are like fine wine; they start out as grapes and itis up to some woman to stomp on them until they turninto something acceptable to have dinner with.

There is no key to happiness, the door is always open.

A grudge is a very heavy thing to carry.

Growing old is inevitable, growing up is optional.

You should not confuse your career with your life.

A consultant is someone who takes your watch offyour wrist to tell you the time.

You should never lick a steak knife.

Silence is often misinterpreted but never misquoted.

He who dies with the most toys is still dead.

With a map you can go where others have been, with acompass you can go wherever you want.

Time seals, time heals, and time reveals all things.

The juice is often not worth the squeeze.

It is easier to grow older than it is to grow wiser.

No pressure – no diamonds.

Don’t wrestle with a pig, you will get dirty and the pigloves it.

Failure is an event, not a person.

Help me to be the man my dog thinks I am.

Don’t pick up pennies in front of a steam roller.

There is no saturation of education, new knowledgecomes each day.

The best way to predict the future is to create it.

None of us is as smart as all of us.

Destiny is not a chance, it is a choice.

Friends go and come but enemies accumulate.

Feedback is the breakfast of champions.

I wish you and your family a glorious and happy holidayseason and a most prosperous New Year. Thank you forthe opportunity to serve what I believe is the bestprofessional association in the world, GPhA.

Jim

PS: I thank everyone from whom I borrowed a quote orthought. I failed to keep a list of the sources.

E X E C U T I V E V I C E P R E S I D E N T ’ S E D I T O R I A L

Jim BracewellExecutive Vice President / CEO

6The Georgia Pharmacy Journal December 2011

Quotes, Quips and Interesting Thoughts


M e m b e r N e w s

Laird Miller, R.Ph., Appointed to the Georgia StateBoard of Pharmacy

Laird Miller, R.Ph., has been a pharmacist for over threedecades. In that time, he has seen and experienced manychanges in the profession, and he has served in positions

that allowed him to have some influence over those changes.Recently, Governor Nathan Deal appointed Laird to serve onthe Georgia State Board of Pharmacy, fulfilling the culminationof a lifelong commitment to pharmacy.

We asked Laird to share some thoughts about his boardappointment and what it means to him and what he hopes toaccomplish through the board. Following are some excerpts ofhis comments.

“I’ve said for years that I feel each pharmacist needs toput something back into their profession. I’ve oftenwritten that the difference in a job and a profession isthat a profession offers the opportunity to be part of adynamic group of like-minded people, not justsomeone who punches a clock for forty years thenretires. For those who embrace this concept therewards are great. It’s like saving money. The more youput in, the more you’ll get out. A profession demandsthat you give something back, to ensure the viabilityand prosperity for those who come after you. To me,appointment to the State Board is the crown jewel ofservice within our profession. It’s a huge honor toreceive this appointment, but it’s also a hugeresponsibility.

“Feeling as I do about serving one’s profession, andbeing able to look in the mirror and see that I am notthirty anymore, I decided that now was the time for meto step up and really serve my profession. I amfortunate enough to have known Governor Deal foryears, so I let it be known that I had a desire to serve inthis capacity, and the Governor and his staff were kindenough to consider me, and ultimately select me, fromamong several very qualified candidates. I receivedsupport from many pharmacists across the State, fromlegislators, and from my GPhA and NCPA contacts. Ilike to think I was selected because I have a realpassion for this profession, and over the years, theGovernor and his staff have come to know that Ibelieve strongly in what pharmacy can offer. When I

sent in my packet of information that each candidatesupplies, I included a cover letter saying that I thoughtgreat changes are coming in the next three to five years,and that I wanted to be a part of molding pharmacy’splace in that new system, so that our profession isempowered to make Georgians healthier and ourprofession stronger. I hope that my appointment to theboard came about because the administration agreesthat all health care professions need to work harder toprovide their members with the tools we need toactually improve the quality of life for our citizens. Weneed to empower people with great knowledge andskills to put their education and their talents to work.”

As chairman of GPhA’s Academy of Independent Pharmacy(AIP) for eleven years, Laird was instrumental in fosteringchanges in pharmacy in Georgia. He has always been a forward-thinker and realizes that pharmacy must adapt to the ongoingchanges in the healthcare delivery system and recognizes thecontributions that young pharmacists will make to theprofession.

“Pharmacy, as a profession, has really evolved in the last thirtyyears,” said Laird. “To me this is good. Much more is expectedof us as providers of healthcare. Each generation that graduates


seems to take the profession to a higher plane of competencyand ability. We old pharmacists are good, but the youngones have the skills and the confidence to step up and take theirrightful place in this new era of delivery of health services,including pharmacy care. They will take our profession to newheights.”

With all the good that can be accomplished, however, Laird alsoemphasizes that work remains to make pharmacy competitivein the future. He says, “On the downside, the reimbursementissues and the financial stresses force pharmacists to limit timeimproving outcomes and make it difficult to be able to meet thefinancial obligations of running a profitable business. Whetherwe work for others or for ourselves, and across the spectrum ofpractice settings, we have to deliver the best care we can in alimited amount of time, because for the most part, payers haveyet to recognize the value our profession can play in diseasemanagement. Prevention and management are concepts stilllargely foreign to most payers, and unfortunately ourcompensation is still often tied to the product, and not theservice.”

And he’s not just spouting rhetoric. As a co-owner of twopharmacies, Medical Park Pharmacy in Gainesville andJennings Pharmacy in Demorest, Laird has helped to instituteservices in his pharmacies that seek to serve the patient beyondproviding prescriptions: medication therapy management,diabetes training and counseling, assisted living packaging andpediatric compounding.

Laird hasn’t always been an independent pharmacy owner,however, so he is able to understand issues affecting otherpractice settings as well. As a new pharmacy graduate, Laird’sfirst job was as an employee pharmacist at an independentpharmacy in Savannah, and later at Revco, a large chainpharmacy. After Revco transferred him to Gainesville, he andhis partner and friend, Butch Bowling, decided to open apharmacy and Medical Park Pharmacy was born, 28 years ago.In early 2011, Butch and Laird, along with Tim Short, boughtJennings Pharmacy. In May, Medical Park Pharmacy moved toa new, larger building. These pharmacist-owners believe thesecret to success is the ability to adapt to the ever evolvingprofession and their dedication to their patients.

As most successful leaders do, Laird attributes much of hisaccomplishments to great mentors, who taught him to workhard and to stay involved in the leadership aspect of his chosenprofession. He says, “I always think of Bill Little of Athens, mychildhood pharmacist, who told me if I worked hard, some dayI might find myself making 20-25k per year (this was in the60s). And I credit Larry Braden for encouraging me to getinvolved in pharmacy and GPhA; Joe Mengoni for pulling meoff the sidelines and encouraging me to step up when AIP waslooking for new leadership; and Jeff Lurey, who leads by

example, for inspiring me stay involved.”

Involvement has been a hallmark of Laird’s career. Not only didhe serve as chairman of AIP for eleven years, which alsogarnered a seat on the GPhA board of directors, but he has alsoremained on the board of directors of AIP. Laird has served onseveral of GPhA’s standing committees, and never hesitates tolend a hand when the association needs volunteers. He is afaithful attendee of GPhA’s annual convention and othermeetings throughout the year. Laird also serves on thelegislative steering committee for the National CommunityPharmacists Association (NCPA).

The Georgia Pharmacy Association has recognized Laird’sdedication and commitment to his profession, awarding himthe Larry L. Braden Meritorious Service award in 2006, one ofthe association’s highest honors. The AIP has also recognizedLaird, presenting him with the Georgia IndependentPharmacist of the Year award in 2004. He is also the recipientof the University of Georgia’s College of PharmacyDistinguished Alumni award, presented in 2003, as well asPfizer’s Visionary Leadership award, also presented in 2003.

A graduate of UGA’s College of Pharmacy, Laird has not onlybeen passionate about his profession, but also about hisBulldogs, and can be found most Saturdays in the fall eithercursing or cheering them on to victory—usually in thepharmacy with a television in the background.

Laird’s wish list for the future of pharmacy is extensive, but hebelieves the possibilities are endless. “I believe that pharmacy,especially in the community setting, needs to step up and takeour rightful place on the healthcare team. I believe we have anidentity crisis among outsiders who have to deal with us. On theone hand, they know we are knowledgeable, but on the otherthey’re caught up in the vision of us as providers of product.WE have to demand recognition for the services we canprovide. We need to promote the clinical side of our training, aswe do the product side. I have no idea what the battle overnational health insurance will result in, but I believe that therewill be a new paradigm in health care delivery, and this may beour best opportunity to step up and show what our professioncan do.

“Everyone wants better outcomes for less money. The oldsystem of treating the results of bad health, without enoughattention to the causes, is where we need to step in and beproblem solvers. One of the things that impresses me aboutour new Governor is his recognition that four or fivedisease states consume much of our resources. Diseaseslike diabetes, high blood pressure, asthma, and thecholesterol related conditions, are opportunities forpharmacy. We see these patients more often than any othermember of their health team. In many cases we know them


better than other health providers. We can, as the Ashevilleproject and our own Dublin and Dalton studies haveshown, improve patient health, and reduce total healthexpenditures in the process. We need to step up and seizethe day, and proliferate pharmacy care. Funds are limitedright now, and governments struggle with how to pay forincreasing health costs. I believe that our state is going tobe open to new ideas, and we need to come up with somenew ways to achieve success.”

As a new member of the State Board of Pharmacy, Lairdrealizes he has much to learn on his latest venture, but his hopesare that the board will assist in ensuring the viability of thepharmacy profession in Georgia. He says, “I hope in the comingyears we will see pharmacists becoming more central in patientcare. Using technology to share information in the time-testedtriad of patient, physician and pharmacist can yield betteroutcomes, and we need to make that happen. We need to be inon the development phase of ACOs and other patient carestructures. As we develop the patient care side of pharmacy, weneed to keep in mind that central to our profession will alwaysbe the mentality of the ‘right drug for the right patient at theright time, used in the right way.’ MTM and adherence are agreat way to further the cause. Adherence is the first step inimproving outcomes, and we don’t need new rules orregulations or laws to make it happen. MTM is an ongoing way

to be sure that as therapies or conditions change, the patient’smedication regimens are being reviewed and if need be,updated. Our board, just like everyone from legislators to thatsmallest company buying health insurance for its employees,needs to do everything we can to make sure pharmacists areable to do what they spent years studying and training to do—helping the complete healthcare team manage patients.

“I am very excited to be a part of the Board of Pharmacy. Ihave a lot to learn being the ‘new guy.’ Several of thecurrent members have already reached out to try to get meup to speed as I prepare to attend my first meeting. I’veknown many of these board members for years, and havegreat respect for them and what they do on behalf of thecitizens of Georgia and for pharmacists in all practicesettings. I hope I can live up to the high standard ofprofessionalism that they exhibit each time they gather onour behalf.”

We have no doubt that Laird will exemplify that standard ofprofessionalism as a member of the State Board of Pharmacy,just as he has in every other area of the profession. The GeorgiaPharmacy Association wishes Laird much success and offerssincerest appreciation for his commitment to pharmacy.

B o a r d o f P h a r m a c y N e w s

Board of Pharmacy President’s Message:Comment on the Pharmacist in Charge Responsibilities

Ga. Code 26-4-41 says “(29) ‘Pharmacist in Charge’means a pharmacist currently licensed in this state whoaccepts responsibility for the operation of a pharmacy

in conformance with all laws and rules pertinent to the practiceof pharmacy and the distribution of drugs and who is personallyin full and actual charge of such pharmacy and personnel.”

The Georgia Board of Pharmacy has become aware that manypharmacists in Georgia are unaware of the responsibilities thatare involved with being “PIC.” As PIC you should be aware thatthe stance of the board is that by definition, you either knew orshould have known about problems that occur in the pharmacy,whether they be of a legal or ethical nature. Why? Because it isyour job and your responsibility as PIC. Take a moment and re-read the legal definition above. It is your job to put into placewhatever checks and balances you deem necessary to be sure

that your pharmacy is “in conformance with all laws and rulespertinent to the practice of pharmacy and the distribution ofdrugs.”

If you allow overbearing supervisors, managers, owners, etc. toput you in a bad position concerning Georgia laws and boardrules, remember as PIC your license is the one on the line. Inthese days of “pill mills” and other schemes to distributeschedule narcotics in an unethical manner, the board will belooking very, very closely at what the PIC knew or should haveknown. If you have questions on this or other pharmacy issuesthat come under board purvue please do not hesitate to contactthe board office at 478-207-2440.

Phone is OK but email is better.

Bill Prather, R.Ph. President, Georgia Board of Pharmacy


siesnecilruoY

doohilevvilruoy .

!titcetorP

elluCsecnarFnisnneciLlanoisseffeorP

608)404( -6771608)404( - 137

n.een.rancullffrancullwww.

olely tsede devotticcaPredenslicof tion entaesrepr

ervO iencerexpof sryea02slionassofepr , BgiaeorG

ADE

CPneyyenrottAgn

6771 onephfax91

comn.

theo olely tlsnaiossofepred

th e wiienc edensclidsroaB &ADNG,

ADEerormF ctrisDint tatant isssA

ttorney Ant taisssAerormFl iminarC e ensicL& feDe

ttorneyAt clareneGttorney

ensfe

G P h A N E W S

GPhA Members Meet with Their Congressional Delegates

As members of Congress are coming home for theholidays or any other time, they are making time tovisit with their constituents and GPhA is working

to make sure that they are visiting with Georgiapharmacists to learn the truth about PBMs and howCongress can help with these problems.

Recently, Congressman Phil Gingrey stopped by LaceyDrugs in Acworth, GA, to see first-hand what goes on in apharmacy. Congressman Rob Woodall visited withemployees and customers of Duluth Rexall during a recenttrip home from DC.

If you are interested in helping host or meet with yourCongressman contact Andy Freeman [email protected].

At left: Larry Braden, R.Ph., discusses issues of importance withCongressman Phil Gingrey and Ben Flanagan, R.Ph., during arecent stop by Congressman Gingrey at Lacey Drug in Acworth,GA.

Above: Lynda D. Alley, R.Ph., welcomes Congressman Rob Woodall to herpharmacy, Duluth Rexall.


2012 VIP Day at the Capitol Save-the-Date

Notice to all Pharmacists and Pharmacy Technicians: All members and potential members arewelcome to attend.

Register online today at www.gpha.org or by calling 404-231-5074.

When: Thursday, February 9, 2012

Where: The Georgia Railroad Freight Depot - Freight Room65 Martin Luther King, Jr., Drive, S.E.Atlanta, Georgia 30334

Schedule of Events: *NOTE: This schedule is tentative. We will continue to update you as it becomes more permanent.

6:00 a.m.: Registration & Exhibit Hall Opens with Coffee6:30 a.m.: GPhA Attendee Orientation7:00 a.m.: Breakfast with Your Legislator(s) 8:00 a.m.: Presentation of GPhA Legislator of the Year Award & Closing Remarks 9:15 a.m.: Group Photo on the Capitol Steps 10:00 a.m.: Tour the Georgia Capitol BuildingSpecial GPhA Recognitions to be made by Georgia House and Senate Members

Wear your white coat to make our presence more effective!

Parking directions available online.

If you have any questions, please contact Sarah Bigorowski at [email protected] or 404-418-8126.


Titanium Level($2400 minimum pledge)T.M. Bridges, R.Ph.Ben Cravey, R.Ph.Michael E. Farmer, R.Ph.David B. Graves, R.Ph.Raymond G Hickman, R.Ph.Robert A. Ledbetter, R.Ph.Jeffrey L. Lurey, R.Ph.Marvin O. McCord, R.Ph.Scott Meeks, R.Ph.Judson Mullican, R.Ph.Mark Parris, Pharm.D.Fred F. Sharpe, R.Ph.Jeff Sikes, R.Ph.Dean Stone, R.Ph., CDM

Platinum Level($1200 minimum pledge)Barry M. Bilbro, R.Ph.Robert Bowles, Jr., R.Ph., CDM, CftsJim R. BracewellLarry L. Braden, R.Ph.William G. Cagle, R.Ph.Hugh M. Chancy, R.Ph.Keith E. Chapman, R.Ph.Dale M. Coker, R.Ph., FIACPJack Dunn, Jr. R.Ph.Neal Florence, R.Ph.Andy FreemanMartin T. Grizzard, R.Ph.Robert M. Hatton, Pharm.D.Ted Hunt, R.Ph.Alan M. Jones, R.Ph.Ira Katz, R.Ph.Hal M. Kemp, Pharm.D.J. Thomas Lindsey, R.Ph.Brandall S. Lovvorn, Pharm.D.Eddie M. Madden, R.Ph.Jonathan Marquess, Pharm.D., CDE, CPTPam Marquess, Pharm.D.

Kenneth A. McCarthy, R.Ph.Drew Miller, R.Ph., CDMLaird Miller, R.Ph.Cynthia K. MoonJay Mosley, R.Ph.Allen Partridge, R.Ph.Houston Lee Rogers, Pharm.D., CDMTim Short, R.Ph.Danny Toth, R.Ph.Tommy Whitworth, R.Ph., CDM

Gold Level($600 minimum pledge)James Bartling, Pharm.D., ADC, CACIILarry Batten, R.Ph.Liza G. Chapman, Pharm.D.Mahlon Davidson, R.Ph., CDMJames Gordon Elrod, R.Ph.Kevin M. Florence, Pharm.D.Robert B. Moody, R.Ph.Sherri S. Moody, Pharm.D.William A. Moye, R.Ph.Jeffrey Grady Richardson, R.Ph.Andy Rogers, R.Ph.Daniel C. Royal, Jr., R.Ph.Michael T. Tarrant

Silver Level($300 minimum pledge)Renee D. Adamson, Pharm.D.Chandler M. Conner, Pharm.D.Terry Dunn, R.Ph.Marshall L. Frost, Pharm.D.Johnathan Wyndell Hamrick, Pharm.D.Michael O. Iteogu, Pharm.D.James E. Jordan, Pharm.D.Willie O. Latch, R.Ph.W. Lon Lewis, R.Ph.Kalen Porter Manasco, Pharm.D.Michael L. McGee, R.Ph.William J. McLeer, R.Ph.

Albert B. Nichols, R.Ph.Richard Noell, R.Ph.William Lee Prather, R.Ph.Sara W. Reece, Pharm.D., BC-ADM, CDEEdward Franklin Reynolds, R.Ph.Sukhmani Kaur Sarao, Pharm.D.David J. Simpson, R.Ph.James N. Thomas, R.Ph.Alex S, Tucker, Pharm.D.Flynn W. Warren, M.S., R.Ph.William T. Wolfe, R.Ph.

Bronze Level($150 minimum pledge)Monica M. Ali-Warren, R.Ph.Fred W. Barber, R.Ph.John R. Bowen, R.Ph.Michael A. Crooks, Pharm.D.William Crowley, R.Ph.Charles Alan Earnest, R.Ph.Randall W. Ellison, R.Ph.Mary Ashley Faulk, Pharm.D.Amanda R. Gaddy, R.Ph.Ed KalvelageJohn D. KalvelageSteve D. KalvelageMarsha C. Kapiloff, R.Ph.Joshua D. Kinsey, Pharm.D.Brenton Lake, R.Ph.William E. Lee, R.Ph.Michael Lewis, Pharm.D.Ashley Sherwood LondonCharles Robert Lott, R.Ph.Max A. Mason, R.Ph.Amanda McCall, Pharm.D.Susan W. McLeer, R.Ph.Mary P. Meredith, R.Ph.Rose Pinkstaff, R.Ph.Leslie Ernest Ponder, R.Ph.Kristy Lanford Pucylowski, Pharm.D.Leonard Franklin Reynolds, R.Ph.

Current Pharm PACMembers

If you made a gift or pledge to Pharm PAC in the last 12 months and your name does not appear above, please contactAndy Freeman at [email protected] or 404-419-8118. Donations made to Pharm PAC are not considered charitabledonations and are not tax deductible.


Pharm PAC Contributors’ List ContinuedLaurence Neil Ryan, Pharm.D.Richard Brian Smith, R.Ph.Charles Storey, III, R.Ph.Archie Thompson, Jr., R.Ph.Marion J. Wainright, R.Ph.Jackie WhiteCarrie-Anne WilsonSteve Wilson, Pharm.D.Sharon B. Zerillo, R.Ph.

Members(no minimum pledge)John J. Anderson, Sr., R.Ph.Mark T. Barnes, R.Ph.Henry Cobb, III, R.Ph., CDMCarleton C. Crabill, R.Ph.Wendy A. Dorminey, Pharm.D., CDMDavid M. Eldridge, Pharm.D.James Fetterman, Jr., Pharm.D.Charles C. Gass, R.Ph.Christina GonzalezChristopher Gurley, Pharm.D.Ann R. Hansford, R.Ph.Joel Andrew Hill, R.Ph.Carey B. Jones, R.Ph.Susan M Kane, R.Ph.Emily KrausCarroll Mack Lowrey, R.Ph.Tracie Lunde, Pharm.D.Roy W. McClendon, R.Ph.Tom E. Menighan, R.Ph., MBA, ScD, FAPhADarby R. Norman, R.Ph.Christopher Brown Painter, R.Ph.Steve Gordon Perry, R.Ph.Victor Serafy, R.Ph.James E. Stowe, R.Ph.James R. Strickland, R.Ph.Celia M. Taylor, Pharm.D.Leonard E. Templeton, R.Ph.Heatwole C. Thomas, R.Ph.Erica Lynn Veasley, R.Ph.William D. Whitaker, R.Ph.Elizabeth Williams, R.Ph.Jonathon Williams, Pharm.D.

Your �nancial plan may need another look.

�is ad entitles you to:A CUP OF COFFEE, AND A SECOND OPINION.

MICHAEL T. TARRANT

Securities, certain advisory services and insurance products are o�ered through INVEST Financial Corporation

Member FINRA/SIPC, and a�liated insurance agencies. INVEST is not a�liated with Financial Network Associates, Inc. INVEST does not provide tax or legal advice. Other advisory services may

be o�ered through Financial Network Associates, Inc., a registered investment advisor. i.ad.9343.0000.00000

Financial Network Associates1117 Perimeter Center West, Suite N-307

I would be happy to give you my opinion – without obligation.

And the co�ee is on me.


Circle the Level in which you would like to participate with a monthly contribution:

Titanium ($200/month) Platinum ($100/month) Gold ($50/month)

Silver ($25/month) Bronze ($12.50/month)Or

If you wish to make a one time contribution write the amount you wish tocontribute here: _____________________________________________

If you are making a monthly contribution you will be contacted for additional information to set up yourmonthly contribution. If you are making a one time payment please mail your check in with your form.

Join Pharm PAC Today!Pharm PAC is GPhA's Political ActionCommittee, providing the resources for theassociation to lobby and advocate on behalfpharmacy. GPhA leads the way in influencingpharmacy-related legislation in Georgia. Thereare two ways in which to become a member.Once you have completed this form please mailit to Pharm PAC, 50 Lenox Pointe, NE, Atlanta,GA 30324.

Name: __________________________________________________Address: _________________________________________________Phone#: _________________________________________________Email Address: ____________________________________________


A Community Pharmacists AlertAre your patients having problems with their PBMs?

Earlier this year, the Department of Insurance implemented rules and regulations overseeing Pharmacy BenefitManagers in Georgia. If a patient comes into your pharmacy with problems involving PBM’s, they now have anopportunity to complain about the issue.

Please give them this form to complete and send in to the Insurance Commissioner’s Office. If there is not sufficientroom on the form they may attach a separate page explaining what problem they are having with their PBM.

Here are two examples of complaints that have been reported to GPhA:

I am forced to use mail order. I have not received my medicines and I am out of my prescription and my health isbeing harmed.

My insurance PBM requires a prior authorization for my medication, so my pharmacist could not fill my prescription.I must come back to get my medicine after the PBM has approved my doctor’s prescription for my medicine.

You have asked for help for your patients problems with PBMs interfering with good patient care. Now is there is aplace to voice those complaints rather than just to you at the pharmacy counter.

Change only happens with PBMS with a level of noise is loud enough to get their attention. Help your patients getthe can of healthcare they need and deserve.

Please use the complaint form attached when mailing or faxing their insurance issues to the Department.

• Clearly state the full name of the PBM against whom the patient is lodging their complaint. (Do not abbreviate the company’s name as this may cause delays in identifying the correct company.)

• The completed form must be signed and dated.

• Attach copies of pertinent documents to support their complaint.

• Have your patient keep the originals for their records and only send copies to DOI.

• Mail or fax (not both) the completed form and all documents to:Mailing address: Georgia Insurance Commissioner’s OfficeConsumer Services Division2 Martin Luther King, Jr., DriveSuite 716, West TowerAtlanta, GA 30334Fax: (404) 657-8542

Upon receipt of their complaint, a case will be created and assigned to an investigator in the Consumer ServicesDivision. Your patient will receive an acknowledgement letter stating their case number and the name of theirinvestigator. Once a response is received from the PBM, the investigator will notify your patient with a writtenresponse. Please allow adequate time for the process.

OFFICE OF INSURANCE AND SAFETY FIRE COMMISSIONER Ralph T. Hudgens, Commissioner

2 Martin Luther King Jr., Dr., Suite 716, West Tower, Atlanta, GA 30334Phone: 404-656-2070 ◊ TDD: 404-656-4031 ◊ Fax: 404-657-8542

E-mail: [email protected] SERVICES

CONSUMER COMPLAINT FORM GID-CS-CF-1

Type of Insurance:

Automobile Homeowners Life & Annuity Accident & Health Commercial Miscellaneous

FOR OFFICIAL USE ONLY:OPEN / CLOSED DATE FIELD INVESTIGA CASE#:

SOURCE: INCIDENT GROUP: TYPE: REASON:

DISPOSITION: NAIC#:

PLEASE TYPE OR PRINT LEGIBLY IN BLUE OR BLACK INK

Mr. Mrs. Ms. Dr. ___________

COMPLAINANT INFORMATION

NAME: ________________________________________

ADDRESS: _____________________________________

CITY ________________STATE ___________ ZIP ____________

COUNTY: ________________________________________________

HOME PHONE: ___________________________________________

WORK PHONE: ___________________________________________

CELL PHONE: ___________________________________________

EMAIL: __________________________________________________

(If different from complainant)INSURED INFORMATION

NAME: ___________________________________________

ADDRESS: ____________________________________________________

CITY ________________STATE ___________ ZIP ________________

COUNTY: ____________________________________________________

HOME PHONE: _______________________________________________

WORK PHONE: _______________________________________________

CELL PHONE: _______________________________________________

EMAIL: ______________________________________________________

ADMINISTRATOR:COMPANY NAME: ________________________________________

MY COMPLAINT IS AGAINST THE FOLLOWINGINSURANCE COMPANY OR THIRD PARTY

TELEPHONE: _____________________________________________

POLICY/ID NO: ____________________________________________

CLAIM NO.: ______________________________________________

DATE OF LOSS: __________________________________________

POLICY PERIOD: _________________________________________

AGENCY NAME: ______________________________________________

AGENCY/ADJUSTER INFORMATION

AGENT/ADJUSTER NAME: _____________________________________

______________________________________________________________

ADDRESS: ___________________________________________________

CITY ________________STATE ___________ ZIP _______________

PHONE: ______________________________________________________

Briefly describe your issue and clearly state your complaint. Attach supporting documents.

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Authorization & Release: By signing below, I hereby authorize Commissioner Ralph T. Hudgens and members of his staff to receive and disclose such information, includingprotected health or financial information, as they may deem necessary and appropriate for purposes of making inquiries into the subject matter contained herein and allmatters related thereto. I also specifically authorize the insurer, agent, third party administrator, or other party to release any and all information necessary for the Office ofInsurance and Safety Fire Commissioner to investigate the matter contained herein. I further acknowledge that the information contained in this form is accurate to thebest of my knowledge. A copy of this request may be shared with any/all parties involved.

__________________________________ _____________________________________________________ Date Signature

___________ Mr. Mrs. Ms. Dr.

This office does not discriminate by race, color, national origin, sex religion, age or disability in employment, programs or services. Disabled persons needing this document in another format can contact the ADA Coordinator for this office at: 2 Martin Luther King Jr. Dr., Suite 620, Atlanta, GA 30334 - Phone 404-656-2056

Page2 of 2

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

COMMISSIONER OF INSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER•COMPTROLLER GENERAL

Reset Form

Under rule 120-2-97-.06 of the Department of Insurance I would like to make the following complaint on a Pharmacy BenefitManager licensed by the state of Georgia.

x

��

��

�� !�"#!$" %�

&��'(��(

OFFICE OF INSURANCE AND SAFETY FIRE COMMISSIONER Ralph T. Hudgens, Commissioner

2 Martin Luther King Jr., Dr., Suite 716, West Tower, Atlanta, GA 30334Phone: 404-656-2070 ◊ TDD: 404-656-4031 ◊ Fax: 404-657-8542

E-mail: [email protected] SERVICES

CONSUMER COMPLAINT FORM GID-CS-CF-1

Type of Insurance:

Automobile Homeowners Life & Annuity Accident & Health Commercial Miscellaneous

FOR OFFICIAL USE ONLY:OPEN / CLOSED DATE FIELD INVESTIGA CASE#:

SOURCE: INCIDENT GROUP: TYPE: REASON:

DISPOSITION: NAIC#:

PLEASE TYPE OR PRINT LEGIBLY IN BLUE OR BLACK INK

Mr. Mrs. Ms. Dr. ___________

COMPLAINANT INFORMATION

NAME: ________________________________________

ADDRESS: _____________________________________

CITY ________________STATE ___________ ZIP ____________

COUNTY: ________________________________________________

HOME PHONE: ___________________________________________

WORK PHONE: ___________________________________________

CELL PHONE: ___________________________________________

EMAIL: __________________________________________________

(If different from complainant)INSURED INFORMATION

NAME: ___________________________________________

ADDRESS: ____________________________________________________

CITY ________________STATE ___________ ZIP ________________

COUNTY: ____________________________________________________

HOME PHONE: _______________________________________________

WORK PHONE: _______________________________________________

CELL PHONE: _______________________________________________

EMAIL: ______________________________________________________

ADMINISTRATOR:COMPANY NAME: ________________________________________

MY COMPLAINT IS AGAINST THE FOLLOWINGINSURANCE COMPANY OR THIRD PARTY

TELEPHONE: _____________________________________________

POLICY/ID NO: ____________________________________________

CLAIM NO.: ______________________________________________

DATE OF LOSS: __________________________________________

POLICY PERIOD: _________________________________________

AGENCY NAME: ______________________________________________

AGENCY/ADJUSTER INFORMATION

AGENT/ADJUSTER NAME: _____________________________________

______________________________________________________________

ADDRESS: ___________________________________________________

CITY ________________STATE ___________ ZIP _______________

PHONE: ______________________________________________________

Briefly describe your issue and clearly state your complaint. Attach supporting documents.

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Authorization & Release: By signing below, I hereby authorize Commissioner Ralph T. Hudgens and members of his staff to receive and disclose such information, includingprotected health or financial information, as they may deem necessary and appropriate for purposes of making inquiries into the subject matter contained herein and allmatters related thereto. I also specifically authorize the insurer, agent, third party administrator, or other party to release any and all information necessary for the Office ofInsurance and Safety Fire Commissioner to investigate the matter contained herein. I further acknowledge that the information contained in this form is accurate to thebest of my knowledge. A copy of this request may be shared with any/all parties involved.

__________________________________ _____________________________________________________ Date Signature

___________ Mr. Mrs. Ms. Dr.

This office does not discriminate by race, color, national origin, sex religion, age or disability in employment, programs or services. Disabled persons needing this document in another format can contact the ADA Coordinator for this office at: 2 Martin Luther King Jr. Dr., Suite 620, Atlanta, GA 30334 - Phone 404-656-2056

Page2 of 2

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

COMMISSIONER OF INSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER•COMPTROLLER GENERAL

Reset Form

Individual Pharmacist MembersKrystal Staples Bugden, Pharm.D., NewnanCasandra L. Roberts, Pharm.D., Evans

Michael Lewis, Pharm.D., Saint Simons IslandJanet Spekter, Pharm.D., McDonoughAnyasor Vincent Ehule, R.Ph., RiverdaleNancy Martin, R.Ph., Pine Mountain

New Graduate Pharmacist Members Travis A. Waldrep, Pharm.D., PelhamMaame K. Dontoh, Pharm.D., Augusta

Pharmacy School Student MembersAsha Elizabeth Varghese, Lawrenceville

Jason Scott Bauer, AthensMindy Daniel, Augusta


G P h A M E M B E R N E W S

Welcome to GPhA!The following is a list of new members who have joined Georgia’s premier

professional pharmacy association! If you or someone you know would like to joinGPhA go to www.gpha.org and click “Join” under the GPhA logo.

BARBARA COLEATTORNEY AT LAW, LLC

539 Green Street, NWGainesville, GA 30501

678-971-9088email [email protected]

All Aspects of Representation of Health CareProfessionalsLicensure MedicareAdministrative MedicaidCriminalBankruptcyCompliance

State Bar Health Law SectionFormer Chief Magistrate Judge

GPhA understands that not everyone has thesame level of comfort on the Internet. As a

result, GPhA has created an online tutorial onhow to use the GPhA website. It features how-to’s and tools that you might not be aware of.

If you are interested in viewing the GPhAWebsite Tutorial go to www.gpha.org and clickon “GPhA Website Orientation Video.” Ittakes a moment to load, but will start

automatically.

We hope you enjoy this brief video, and learnabout the tools available to you.

G P h A W E B S I T E N E W S

GPhA WebsiteTutorial

Please save the date for our Georgia Pharmacy Association137th Annual Convention!Hilton Head Marriott Resort & Spa, Hilton Head Island, SCJuly 7-11, 2012GPhA Room Rates:Island View $199Ocean View $219Ocean Front $239To make reservation, call 1-800-228-9290, and mention that you are inthe Georgia Pharmacy Association Room Block.



Gather your girlfriends for a weekend of fun, facts, and facials! Register today to ensure your spot at the 2012 Southeastern “Girls of Pharmacy” Leadership Weekend. Full registration includes: CE programming, event materials, two breakfasts, and one dinner reception with included drink ticket. Extra reception tickets can be purchased separately. New for 2012! We have two optional events that you can sign up for with your registration. On Saturday we’ll be having a special cooking demonstration and lunch with one of the Grove Park Inn’s award-winning chefs. Tickets for this lunch and demo are $60. On Saturday evening we will be hosting a “Sips and Sweets” wine and dessert pairing event. The cost is $45 per person.

Rooms are available at the Grove Park Inn for $144 per night. Call (800) 438-5800 to book your room today.

Spa appointments are available for reservation through the Grove Park Inn. You must be registered for the event to make reservations through SCPhA’s reserved appointment times. The Spa will offer SC Pharmacy Association participants a 20% discount off any Massage, Body Treatments and/or Facials. This offer will be valid January 20, 2012 - January 22, 2012. This offer is not valid on Nail Treatments and may not be combined with other discounts or packages. Call the spa directly at 828-253-0299 to make your reservations today.

For questions, please call 803.354.9977.

South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is eligible for ACPE

NABP E ID ____________________________________ Birth Day (DD)________ Birth Month (MM)__________

Address_____________________________________________________________________________

City, State, Zip________________________________________________________________________

Phone__________________ Email______________________________________________________

Registration Fees (Guest registrations DO NOT include CE credit but do cover meal function costs):

Optional Events:

Event PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design):Short Sleeve ($20 each): ___Small ____Medium ____ Large ____ XLarge ____ XXLargeLong Sleeve ($25 each): ___Small ____Medium ____ Large ____ XLarge ____ XXLarge Additional PharmDiva apparel and accessory options are available for purchase at www.pharmdiva.com.

Please make checks payable to SCPhA

cancellation policy.

Return to SCPhA at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207. You can also register online at www.scrx.org.

Gather your girlfriends for a weekend of fun, facts, and facials! Register today to ensure your spot at the 2012 Southeastern “Girls of Pharmacy” Leadership

eekend. Full registration includes: CE programming, event materials, two WWeekend. Full registration includes: CE programming, event materials, two


eekend. Full registration includes: CE programming, event materials, two





breakfasts, and one dinner reception with included drink ticket. Extra reception tickets can be purchased separately

New for 2012! registration. On Saturday we’ll be having a special cooking demonstration and lunch with one of the Grove Park Inn’and demo are $60. On Saturday evening we will be hosting a “Sips and Sweets” wine and dessert pairing event.

Rooms are available at the Grove Park Inn for $144 per night. Call (800) 438-

breakfasts, and one dinner reception with included drink ticket. Extra reception tickets can be purchased separately

New for 2012! e have two optional events that you can sign up for with your W We have two optional events that you can sign up for with your registration. On Saturday we’ll be having a special cooking demonstration and lunch with one of the Grove Park Inn’and demo are $60. On Saturday evening we will be hosting a “Sips and Sweets”

The cost is $45 per person. wine and dessert pairing event.


breakfasts, and one dinner reception with included drink ticket. Extra reception . tickets can be purchased separately

e have two optional events that you can sign up for with your registration. On Saturday we’ll be having a special cooking demonstration and

s award-winning chefs. lunch with one of the Grove Park Inn’and demo are $60. On Saturday evening we will be hosting a “Sips and Sweets”

The cost is $45 per person.


breakfasts, and one dinner reception with included drink ticket. Extra reception

e have two optional events that you can sign up for with your registration. On Saturday we’ll be having a special cooking demonstration and

ickets for this lunch Tand demo are $60. On Saturday evening we will be hosting a “Sips and Sweets”


Rooms are available at the Grove Park Inn for $144 per night. Call (800) 438-5800 to book your room today

Spa appointments are available for reservation through the Grove Park Inn. must be registered for the event to make reservations through SCPhAappointment times. a 20% discount ofwill be valid January 20, 2012 - January 22, 2012.

reatments and may not be combined with other discounts or packages. Call the Tspa directly at 828-253-0299 to make your reservations today

Rooms are available at the Grove Park Inn for $144 per night. Call (800) 438-. 5800 to book your room today

Spa appointments are available for reservation through the Grove Park Inn. must be registered for the event to make reservations through SCPhA

The Spa will ofappointment times. f any Massage, Body a 20% discount ofa 20% discount off any Massage, Body

will be valid January 20, 2012 - January 22, 2012. reatments and may not be combined with other discounts or packages. Call the

spa directly at 828-253-0299 to make your reservations today


Spa appointments are available for reservation through the Grove Park Inn. must be registered for the event to make reservations through SCPhA

Association participants fer SC Pharmacy The Spa will ofThe Spa will offer SC Pharmacy reatments and/or Facials. Tf any Massage, Body

fer is not valid on Nail This ofThis offer is not valid on Nail will be valid January 20, 2012 - January 22, 2012. reatments and may not be combined with other discounts or packages. Call the

spa directly at 828-253-0299 to make your reservations today


ou YSpa appointments are available for reservation through the Grove Park Inn. s reserved ’must be registered for the event to make reservations through SCPhA

Association participants fer This ofThis offer reatments and/or Facials.

fer is not valid on Nail reatments and may not be combined with other discounts or packages. Call the

. spa directly at 828-253-0299 to make your reservations today



Association is accredited by the South Carolina Pharmacy Education as a provider of continuing pharmacy education.


Accreditation Council for Pharmacy Association is accredited by the This activity is eligible for Education as a provider of continuing pharmacy education.

Accreditation Council for Pharmacy ACPE This activity is eligible for

E ID ____________________________________ Birth Day (DD)________ Birth Month (MM)__________NABP

Address_____________________________________________________________________________

, State, Zip________________________________________________________________________City

Phone__________________ Email______________________________________________________

Registration Fees (Guest registrations DO NOT

E ID ____________________________________ Birth Day (DD)________ Birth Month (MM)__________

Address_____________________________________________________________________________

, State, Zip________________________________________________________________________

Phone__________________ Email______________________________________________________

Registration Fees (Guest registrations DO NOT


Address_____________________________________________________________________________

, State, Zip________________________________________________________________________

Phone__________________ Email______________________________________________________

include CE credit but do cover meal function costs):Registration Fees (Guest registrations DO NOTRegistration Fees (Guest registrations DO NOT include CE credit but do cover meal function costs):


Address_____________________________________________________________________________

, State, Zip________________________________________________________________________

Phone__________________ Email______________________________________________________

include CE credit but do cover meal function costs):


Address_____________________________________________________________________________

, State, Zip________________________________________________________________________

Phone__________________ Email______________________________________________________

include CE credit but do cover meal function costs):

Optional Events:

Long Sleeve ($25 each): ___SmallShort Sleeve ($20 each): ___SmallEvent PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design):

Optional Events:

Long Sleeve ($25 each): ___SmallShort Sleeve ($20 each): ___SmallEvent PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design):

____Medium ____ Large ____ XLarge ____ XXLarge

____Medium ____ Large ____ XLarge ____ XXLargeEvent PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design):


____Medium ____ Large ____ XLarge ____ XXLargeEvent PharmDiva Shirts (shirts will be slate grey with hot pink PharmDiva design):



Long Sleeve ($25 each): ___Small

Additional PharmDiva apparel and accessory options are available for purchase at www

Return to SCPhA

Long Sleeve ($25 each): ___Small


. cancellation policy

at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207. Return to SCPhAReturn to SCPhA at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207. ou can also register online at wwwYYou can also register online at www



at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207. ou can also register online at www


.pharmdiva.com.Additional PharmDiva apparel and accessory options are available for purchase at wwwAdditional PharmDiva apparel and accessory options are available for purchase at www.pharmdiva.com.


at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207. .scrx.org.ou can also register online at www


.pharmdiva.com.


at 1350 Browning Road, Columbia, SC 29210 or via fax to 803.354.9207.


Call for awards nominations...The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA137th Annual Convention in 2012. A brief description and criteria of each award is included below. Please select the awardfor which you would like to nominate someone and indicate their name on the form below. Deadline for submitting thecompleted nomination form is March 1, 2012. Nominations will be received by the Awards Committee and an individualwill be selected for presentation of the Award at GPhA’s 137th Annual Convention at the Hilton Head Marriott Resort &Spa on Hilton Head Island.

Bowl of Hygeia AwardRecognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacyassociations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously;3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within theimmediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has anoutstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist AwardCreated in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one ofGPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate inassociation and community activities, and 2) To annually recognize an individual in each state for involvement in and dedicationto the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten yearsago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4)Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programsor activities and community service projects.

Innovative Pharmacy Practice Award This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which hasresulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practicewhich has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a memberof the GPhA in the year of selection.

2012 Awards Nomination FormBowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Award

Nominee’s Full Name _______________________________________________ Nickname ___________________

Home Address _________________________________________ City _______________ State _____ Zip ______

Practice Site __________________________________________________________________________________

Work Address __________________________________________ City _______________ State _____ Zip ______

College/School of Pharmacy _____________________________________________________________________

List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:

____________________________________________________________________________________________

____________________________________________________________________________________________

Supporting information: _________________________________________________________________________

____________________________________________________________________________________________

Submitted by (optional): _________________________________________________________________________

Submit this form completed by March 1, 2012 to:

GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.


20th Annual Winter CE Seminar Westin Riverfront Resort & Spa at Beaver Creek Mtn. in the Vail Valley-Avon, CO

January 8-11, 2012

15 hours of CE 7-9 am & 4:30-6:30 pm Full, "First Tracks" and other CE

registration options Gondola at Ski Valet door

Social dinner & reception; Lodging, rental & lift discounts.

Visit www.copharm.org to JOIN US! [email protected] 303-756-3069 "As a first time attendee, this program FAR exceeded my expectations. Its no wonder you’re

celebrating the 20th one next year.” ....2011 guest

M e m b e r N e w s

Sen. Buddy Carter, R.Ph., NamedUGA’s Alumnus of the Year

More than 250College ofPharmacy alumni

and their families attended therecent Homecoming tailgate;70 of that number made upthe five reunion classes of2006, 2001, 1996, 1991 and1986.

The highlight of theHomecoming event was the

presentation of Distinguished Alumnus and DistinguishedService awards to Senator Earl L. “Buddy” Carter (‘80) ofPooler and Marjorie Phillips of Augusta, respectively.

Carter was selected for the 2011 Distinguished Alumnus Awardfor his work in promoting the profession of pharmacy and insupporting the College of Pharmacy. He is a practicingpharmacist with Carter’s Pharmacy and a new member of theCollege’s Pharmacy Advisory Board. He also funded theSenator Buddy Carter Distinguished Pharmacy LeadershipEndowment.

Carter is serving his first full term as a Republican senator,representing Senate District I, which includes Bryan Countyand portions of Chatham and Liberty counties. He wassuccessful this year in getting the drug monitoring bill passed,as well as making pseudoephedrine an OTC product that can only be sold in pharmacies.


to feed, generally every four to six hours. Head lice engorged with blood may appear reddish-brown in color. In most climates, they survive only 15 to 20 hours off the host.

Head lice are transmitted primarily by direct contact with an infested person. Outbreaks occur in greater numbers in August, then

reopen, and continue to increase with onset of autumn. Infestation occurs primarily in children at all elementary grade levels and when-ever children assemble, and in communal living conditions. Mem-bers of households with infested children are also at risk.

Head lice are transmitted indi-rectly from wearing clothing that has been in contact with infested apparel on school coat racks. They are also spread by sharing combs, hair brushes and scarves of chil-dren infected with lice. Bed linens and headrests on chair and couch backs are other sources of indirect contact. Infestation may also be acquired by direct contact with the head of an infested person, com-monly during play. Infestations are twice as common in girls than in boys, perhaps due to their greater willingness than boys to share personal hair-grooming aids. Hair length or frequency of shampooing are not important criteria.

Lice infestations are wide-spread throughout the world and discriminate neither on socioeco-nomic status nor personal hygiene. Caucasians are infested more often than non-Caucasians, perhaps be-cause of African-Americans’ greater use of pomades and the character-istics of lice that make them better adapted to grasp the more cylindri-cal hair shafts of Caucasians.

Eggs. Lice eggs, or their empty egg casings (nits) are small, spheri-cal or oval protrusions about the size of the period at the end of this sentence. Nits appear translucent; after hatching in seven to 10 days, they appear initially as yellowish-

onto the hair shaft by a sticky substance secreted by the female insect. Bonding is strong enough to protect nits from being dislodged by ordinary washing or combing. Each female louse can produce ap-

over her 30 to 35 day lifespan. A typical infestation may involve 10 to 30 adult lice at any one time but the range is large. Juvenile lice (nymphs) take about six to 10 days

to grow into adulthood. Nymphs will molt three times as they trans-form into sexually mature adults.

Clinical Manifestations Itching is the principal symptom, appearing in response to histamine

including the proteinaceous sali-vary secretion released following the insect’s bite. Itching may per-sist a week or longer, even after the lice have been eradicated.

into four phases: phase I is noted by lack of clinical symptoms; phase II entails papules (small elevations of the skin) with moderate itch-ing; phase III consists of wheals (smooth, slightly elevated dermal elevations, which are redder or paler than surrounding areas) immediately following a bite with subsequent delayed papules and intense itching; and phase IV is characterized by smaller papules with mild itching. The phases presumably are related to evolution of immune sensitivity and adher-ence. Notably, new bites may cause reactivation of older, healed bitten

to lice saliva or anticoagulant has been suggested as the most likely cause of the bite reactions.

If lice infestation is not treated, intense itching with vigorous scratching may incite secondary bacterial or fungal infection. Impe-tigo and furunculosis (boils) may be outcomes. Uncommonly, in heavily infested and untreated patients, the hair can become tangled with exudates, predisposing the area to fungal infection, resulting in a malodorous mass. Countless lice and nits can be found under the entangled hair mass.

Detection Most experts agree that before treatment begins, there must be

louse. Although itching and the presence of eggs or nits attached to the hair raises suspicion, only

infestation. Dandruff, dried hair-spray, lint, sand and hair casts,

Table 1Patient information for

head lice detectionDry combing for detection 1. Straighten and untangle the dry hair using an ordinary comb.2. Once the comb moves freely through the hair without dragging,

3. Comb the hair from the scalp down, being sure to raise the comb near the end of the hair so as not to miss detection of lice.4. After each stroke, examine the teeth of the comb for living lice.5. A magnifying glass will be help-ful to distinguish lice and eggs from debris (e.g., dandruff).6. Continue combing the hair section by section until the whole head of hair is combed through.

Wet combing for detection 1. Wash the hair in the normal way with ordinary shampoo.2. Rinse out the shampoo and put on ordinary conditioner.3. Comb the hair with a normal comb to untangle and straighten. When the hair is untangled, switch to the detec-tion comb.4. Place the teeth of the detection comb into the hair at the roots, so that the comb touches the scalp.5. Draw the detection comb through to the tips of the hair.6. Comb systematically working around the head.7. Check the comb for lice after each stroke by wiping both sides on a tis-sue.8. After all the hair has been thor-oughly combed, rinse out the condi-tioner.9. While the hair is still wet, use an ordinary comb to untangle and straighten it again.10. Repeat detection combing in the rinsed hair to check for any lice which might have been missed the

Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio andJ. Richard Wuest, R.Ph., PharmD, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio

continuing educat ion for pharmacists

Head Lice Infestat ions: Counsel ing Your Pat ients

Volume XXIX, No. 9

Dr. Thomas A. Gossel and Dr. J. Richard -

ships to disclose.

Goal. The goal of this lesson is to review head lice infestations and their management, with emphasis on key points of information to pass along to patients.

Objectives. At the conclusion of this lesson, successful participants should be able to:

1. recognize the cause and trig-gers, epidemiology and prevalence, pathogenesis, and clinical impres-sions of head lice infestations;

2. demonstrate an understand-ing of the mechanism of action and major adverse events associated with the drugs used in treating head lice infestations;

3. select nonpharmacologic measures that are reported to con-trol head lice infestations; and

4. exhibit knowledge of infor-mation relative to the prevention and management of head lice infes-tations to convey to patients and/or their caregivers.

Head lice infestation has been known since antiquity. Described in ancient Egyptian and Greek medical texts, head lice have been a source of irritation and disgust for thousands of years. Its preva-lence is not known today, since the reporting of infestations is not mandatory. The U.S. Centers for Disease Control and Prevention

(CDC) estimates that six to 12 mil-lion infestations occur each year in the United States. Health authori-ties report that the number of cases is increasing each year, primarily because of emerging treatment re-sistance. Infestations have annual combined direct and indirect costs in the United States estimated to be as high as $1 billion.

Although head lice are not vectors of human disease, and

risk, their presence can lead to sub-stantial psychological frustration, discomfort, parental anxiety, em-barrassment for both children and parents, and unnecessary absence from school and work. Preventive and therapeutic practices, along with the “no-nit” policy of excluding infested children from school, can

Head Lice The insects are ectoparasites of humans, that is, they live on the surface of the host’s body. An infes-tation of lice is termed pediculosis. A pediculicide is an agent that kills lice.

Head lice appear as tiny yellow-brown to dark gray “spots” measuring approximately 1 to 3 mm in length, about the size of a sesame seed. Their physical fea-tures cannot be distinguished by the unaided eye, but can be viewed with ease with a strong magnify-ing glass in good lighting. Insects

pairs of clawed legs adapted for grasping hair shafts for stability when feeding. Their cylindrical shape enables them to move freely among dense hair growth. The insects live in the hair of the scalp and neck and are not usually found elsewhere on the body. Mature lice are wingless. They neither hop,

another, although there are reports that combing dry hair can build up

-cally eject an adult louse from an infested scalp.

Lice breathe through seven pair of spiracles, one pair on the thorax and six on the abdomen. These spiracles can open and close in response to wetting and may remain closed for up to 12 hours without injury to the insect.

The blood-sucking insects depend solely upon human blood for nutrition; thus, they are hema-tophagous. Their saliva contains an anticoagulant that is introduced under the skin of the infested host during feeding, which prolongs their feeding period; lice may re-main attached to the same site for several days while they continue


to feed, generally every four to six hours. Head lice engorged with blood may appear reddish-brown in color. In most climates, they survive only 15 to 20 hours off the host.

Head lice are transmitted primarily by direct contact with an infested person. Outbreaks occur in greater numbers in August, then

reopen, and continue to increase with onset of autumn. Infestation occurs primarily in children at all elementary grade levels and when-ever children assemble, and in communal living conditions. Mem-bers of households with infested children are also at risk.

Head lice are transmitted indi-rectly from wearing clothing that has been in contact with infested apparel on school coat racks. They are also spread by sharing combs, hair brushes and scarves of chil-dren infected with lice. Bed linens and headrests on chair and couch backs are other sources of indirect contact. Infestation may also be acquired by direct contact with the head of an infested person, com-monly during play. Infestations are twice as common in girls than in boys, perhaps due to their greater willingness than boys to share personal hair-grooming aids. Hair length or frequency of shampooing are not important criteria.

Lice infestations are wide-spread throughout the world and discriminate neither on socioeco-nomic status nor personal hygiene. Caucasians are infested more often than non-Caucasians, perhaps be-cause of African-Americans’ greater use of pomades and the character-istics of lice that make them better adapted to grasp the more cylindri-cal hair shafts of Caucasians.

Eggs. Lice eggs, or their empty egg casings (nits) are small, spheri-cal or oval protrusions about the size of the period at the end of this sentence. Nits appear translucent; after hatching in seven to 10 days, they appear initially as yellowish-

onto the hair shaft by a sticky substance secreted by the female insect. Bonding is strong enough to protect nits from being dislodged by ordinary washing or combing. Each female louse can produce ap-

over her 30 to 35 day lifespan. A typical infestation may involve 10 to 30 adult lice at any one time but the range is large. Juvenile lice (nymphs) take about six to 10 days

to grow into adulthood. Nymphs will molt three times as they trans-form into sexually mature adults.

Clinical Manifestations Itching is the principal symptom, appearing in response to histamine

including the proteinaceous sali-vary secretion released following the insect’s bite. Itching may per-sist a week or longer, even after the lice have been eradicated.

into four phases: phase I is noted by lack of clinical symptoms; phase II entails papules (small elevations of the skin) with moderate itch-ing; phase III consists of wheals (smooth, slightly elevated dermal elevations, which are redder or paler than surrounding areas) immediately following a bite with subsequent delayed papules and intense itching; and phase IV is characterized by smaller papules with mild itching. The phases presumably are related to evolution of immune sensitivity and adher-ence. Notably, new bites may cause reactivation of older, healed bitten

to lice saliva or anticoagulant has been suggested as the most likely cause of the bite reactions.

If lice infestation is not treated, intense itching with vigorous scratching may incite secondary bacterial or fungal infection. Impe-tigo and furunculosis (boils) may be outcomes. Uncommonly, in heavily infested and untreated patients, the hair can become tangled with exudates, predisposing the area to fungal infection, resulting in a malodorous mass. Countless lice and nits can be found under the entangled hair mass.

Detection Most experts agree that before treatment begins, there must be

louse. Although itching and the presence of eggs or nits attached to the hair raises suspicion, only

infestation. Dandruff, dried hair-spray, lint, sand and hair casts,

Table 1Patient information for

head lice detectionDry combing for detection 1. Straighten and untangle the dry hair using an ordinary comb.2. Once the comb moves freely through the hair without dragging,

3. Comb the hair from the scalp down, being sure to raise the comb near the end of the hair so as not to miss detection of lice.4. After each stroke, examine the teeth of the comb for living lice.5. A magnifying glass will be help-ful to distinguish lice and eggs from debris (e.g., dandruff).6. Continue combing the hair section by section until the whole head of hair is combed through.

Wet combing for detection 1. Wash the hair in the normal way with ordinary shampoo.2. Rinse out the shampoo and put on ordinary conditioner.3. Comb the hair with a normal comb to untangle and straighten. When the hair is untangled, switch to the detec-tion comb.4. Place the teeth of the detection comb into the hair at the roots, so that the comb touches the scalp.5. Draw the detection comb through to the tips of the hair.6. Comb systematically working around the head.7. Check the comb for lice after each stroke by wiping both sides on a tis-sue.8. After all the hair has been thor-oughly combed, rinse out the condi-tioner.9. While the hair is still wet, use an ordinary comb to untangle and straighten it again.10. Repeat detection combing in the rinsed hair to check for any lice which might have been missed the


Table 2Agents for management of head lice

Generic name Dosage Form Strength Trade name Availability Permethrin Liquid 1% Nix, and generics OTC Spray 0.4% Pronto OTC 0.5% A-200, RID OTC Pyrethrins with Liquid 0.3%/2% Tisit OTC piperonyl butoxide Shampoo 0.3%/3% Tisit 0.33%/4% A-200, Clear, Licide Pronto, RID, Pyrinyl Plus, and generics

Gel 0.3%/3% Tisit Blue, Innogel Plus 0.33%/4% A-200

Lindane Liquid 1% generics Rx Shampoo 1% generics Rx

Malathion Lotion 0.5% Ovide Rx and generics Rx

Spinosad Suspension 0.9% Natroba Rx

Lindane

is an organochloride marketed in a 1 percent concentration liquid and shampoo. It is absorbed rapidly across the exoskeleton of insects. As a gamma-aminobutyric acid (GABA) inhibitor, and with neuro-toxic properties similar to DDT, lindane causes excess CNS stimu-lation in, and ultimate death of, the ectoparasite. It has low ovacidal activity, and resistance has been reported worldwide for many years.

About 10 percent of topically applied lindane is absorbed. It con-centrates in adipose tissue and the brain of humans. Small amounts may persist within the brain for up to two weeks following topical use. Absorption through the louse exoskeleton occurs much more ef-

Lindane is reported to cause CNS stimulation, nausea and vomiting, lethargy, disorientation, restless-ness and convulsions in humans. Toxic symptoms are often the result of misuse of the product.

The use of lindane for treat-

ment of lice or scabies was banned in California in 2002 due to con-cern about neurotoxicity and nega-tive effects on the environment. It is available elsewhere by prescrip-tion only. Some would argue that this agent is seldom an appropriate choice since other, safer agents are available and the ovacidal effect of lindane appears to be inferior to that of other agents.

Malathion This pediculicide (Ovide, and oth-ers) is an organophosphate (acetyl-cholinesterase inhibitor) insecticide that is safe and effective for treat-ment of head lice, and is ovacidal. Malathion causes respiratory pa-ralysis in the arthropod by causing accumulation of acetylcholine at its nicotinic receptor sites. It is toxic within three seconds of application to both lice and their eggs.

Human toxicity is minimal when the product is used as di-rected because absorbed malathion

percent of the drug applied to the skin is absorbed.

Some people

product objection-able due to its un-appealing odor and need for prolonged (eight to 12 hours) application time. The product’s vehicle, 78 percent isopropyl alcohol,

alcohol contributes

product. Patients should be warned to avoid lighted cigarettes, open

-tric heat sources. Because of these restrictions, mala-thion is consid-ered a second-line agent.

Benzyl Alcohol One of the latest approvals to treat head lice is a lotion containing benzyl alcohol 5 percent in min-

alcohol is present in other products as an excipient, it has not previ-ously been approved as a new drug. Lice exposed to benzyl alcohol lose the ability to close their respiratory spiracles. The lotion vehicle also obstructs their airways to cause asphyxiation. Benzyl alcohol is not ovacidal.

Benzyl alcohol is generally well tolerated, with eye irritation and contact dermatitis reported. Also reported is that preterm neonates injected intravenously with prod-ucts containing benzyl alcohol have developed a “gasping syndrome” with CNS depression, metabolic acidosis and respiratory distress, sometimes progressing to neuro-logical deterioration and cardiovas-cular collapse.

Spinosad The newest pediculicide, spinosad (Natroba), is a nonsynthetic,

which have all been mistaken for eggs and nits, are much more eas-ily removed.

Detection is best achieved us-

teeth less than 0.3 mm) to system-atically check all areas of the scalp and hair. Both dry and wet detec-tion combing (Table 1) have been shown to be better for detecting head lice than simple direct visual inspection. Whether or not wet combing is better than dry comb-ing remains controversial. The length of time required for each is largely dependent on hair length and density. A wet combing session will take longer, perhaps up to 30 minutes, than dry combing, up to

Nits remain attached to hair shafts for as long as six months. Human hair grows at a rate of approximately 1 cm/month. As the hair grows, the bonded nits move away from the scalp. After two to three months, empty nits become more visible, especially on dark hair. Appearance of nits several months after a treatment can lead to a false-positive diagnosis of an active infestation because most people cannot differentiate between viable eggs and nits and assume that if eggs or nits are present the child must also have lice. There-fore, treatment is initiated.

Treatment The goals of treatment are to kill the insects and their eggs, and con-trol symptoms of infestation such as itching and secondary infection. When infestation is determined, every member of the household and all other close-contacts should be examined carefully and completely.

An OTC antipruritic cream containing an antihistamine, local anesthetic or hydrocortisone may be applied topically and is usually

itching may require stronger thera-py or use of systemic antipruritics. Treatment of secondary infection includes topical application of an appropriate antibiotic or antifungal agent. Infections that fail to heal within seven days or worsen should

be evaluated by a physician. Their treatment may require systemic anti-infectives.

Current guidelines still recom-mend use of OTC pediculicides in most cases, usually with a maxi-mum of two applications. Physician involvement usually is recommend-ed if lice are not eradicated after

Pyrethroids Pyrethrins. Commercial prepa-rations of pyrethrins consist of a mixture of substances obtained

Chrysan-themum cinerariaefolium. This mixture contains substances identi-

acid and pyrethric acid, and three alcohols.

Pyrethrins (0.33 percent) in combination with piperonyl butox-ide (4 percent) is a commonly used treatment for self-management of head lice. Piperonyl butoxide is included with pyrethrins because it potentiates the insecticide’s ac-tion, by suppressing the insect’s oxidative degradation mechanism. This combination of ingredients is, therefore, synergistic. Contact time with pyrethrins is prolonged and the kill rate is increased.

Pyrethrins kill insects by dis-rupting ion transport mechanisms at their nerve membranes. Affected insects experience convulsions, paralysis and death. None of the natural pyrethrins are completely ovacidal because developing insects within newly laid eggs lack a

days. About 20 to 30 percent of

treatment. Successful treatment requires reapplication seven to 10 days later to kill newly emerged nymphs hatched from eggs that survived.

Products (Table 2) containing pyrethrins/piperonyl butoxide are safe for human use when used cor-rectly. The drugs are not absorbed appreciably following topical appli-cation. Small quantities that may enter the blood will be metabolized rapidly.

Although the rigorous testing

currently required by FDA was not

marketed, systematic review of the safety of pyrethrins-containing products reveals only minor ad-verse reactions. Adverse effects are rare when products are used as directed, with contact dermatitis

-tion. Since pyrethrins are obtained from natural plant origin, allergic rhinitis, wheezing and coughing, and asthma attacks may be pre-cipitated in individuals sensitive to ragweed. Inhaled pyrethrins may cause nausea and vomiting, and rarely, muscle paralysis and death. Most reports of clinical toxicity with synergized pyrethrins can be traced to solvents, typically petro-leum distillates, in the preparation.

Permethrin. Permethrin is a synthetic pyrethroid that has been altered chemically to provide better stability with exposure to light and heat. It is believed to act by the same mechanism as pyrethrins. Ac-ticin (and others) 5 percent is mar-keted as a treatment for scabies, but not head lice. It has been used in an effort to overcome relative resistance to permethrin 1 percent. Unfortunately, permethrin-resis-tant lice may be resistant over a wide range of doses.

Permethrin has low toxicity in mammals since it is poorly ab-sorbed and inactivated rapidly by ester hydrolysis. Like pyrethrins, permethrin is contraindicated in persons hypersensitive to chrysan-themums or synthetic pyrethroid. Adverse effects include temporary itching, burning, stinging, numb-ness and pain, but these are rare. Permethrin should not be used on infants because of the greater per-meability of their skin, and their reduced ability to metabolize it.

Permethrin is retained on the hair after an initial application and thereby has “residual action” for two to three weeks, although retreatment at one week is still widely recommended. Currently, permethrin 1 percent is considered

line treatment for head lice infesta-tion.


Table 2Agents for management of head lice

Generic name Dosage Form Strength Trade name Availability Permethrin Liquid 1% Nix, and generics OTC Spray 0.4% Pronto OTC 0.5% A-200, RID OTC Pyrethrins with Liquid 0.3%/2% Tisit OTC piperonyl butoxide Shampoo 0.3%/3% Tisit 0.33%/4% A-200, Clear, Licide Pronto, RID, Pyrinyl Plus, and generics

Gel 0.3%/3% Tisit Blue, Innogel Plus 0.33%/4% A-200

Lindane Liquid 1% generics Rx Shampoo 1% generics Rx

Malathion Lotion 0.5% Ovide Rx and generics Rx

Spinosad Suspension 0.9% Natroba Rx

Lindane

is an organochloride marketed in a 1 percent concentration liquid and shampoo. It is absorbed rapidly across the exoskeleton of insects. As a gamma-aminobutyric acid (GABA) inhibitor, and with neuro-toxic properties similar to DDT, lindane causes excess CNS stimu-lation in, and ultimate death of, the ectoparasite. It has low ovacidal activity, and resistance has been reported worldwide for many years.

About 10 percent of topically applied lindane is absorbed. It con-centrates in adipose tissue and the brain of humans. Small amounts may persist within the brain for up to two weeks following topical use. Absorption through the louse exoskeleton occurs much more ef-

Lindane is reported to cause CNS stimulation, nausea and vomiting, lethargy, disorientation, restless-ness and convulsions in humans. Toxic symptoms are often the result of misuse of the product.

The use of lindane for treat-

ment of lice or scabies was banned in California in 2002 due to con-cern about neurotoxicity and nega-tive effects on the environment. It is available elsewhere by prescrip-tion only. Some would argue that this agent is seldom an appropriate choice since other, safer agents are available and the ovacidal effect of lindane appears to be inferior to that of other agents.

Malathion This pediculicide (Ovide, and oth-ers) is an organophosphate (acetyl-cholinesterase inhibitor) insecticide that is safe and effective for treat-ment of head lice, and is ovacidal. Malathion causes respiratory pa-ralysis in the arthropod by causing accumulation of acetylcholine at its nicotinic receptor sites. It is toxic within three seconds of application to both lice and their eggs.

Human toxicity is minimal when the product is used as di-rected because absorbed malathion

percent of the drug applied to the skin is absorbed.

Some people

product objection-able due to its un-appealing odor and need for prolonged (eight to 12 hours) application time. The product’s vehicle, 78 percent isopropyl alcohol,

alcohol contributes

product. Patients should be warned to avoid lighted cigarettes, open

-tric heat sources. Because of these restrictions, mala-thion is consid-ered a second-line agent.

Benzyl Alcohol One of the latest approvals to treat head lice is a lotion containing benzyl alcohol 5 percent in min-

alcohol is present in other products as an excipient, it has not previ-ously been approved as a new drug. Lice exposed to benzyl alcohol lose the ability to close their respiratory spiracles. The lotion vehicle also obstructs their airways to cause asphyxiation. Benzyl alcohol is not ovacidal.

Benzyl alcohol is generally well tolerated, with eye irritation and contact dermatitis reported. Also reported is that preterm neonates injected intravenously with prod-ucts containing benzyl alcohol have developed a “gasping syndrome” with CNS depression, metabolic acidosis and respiratory distress, sometimes progressing to neuro-logical deterioration and cardiovas-cular collapse.

Spinosad The newest pediculicide, spinosad (Natroba), is a nonsynthetic,


fermentation product of the bacte-rium, Saccharopolyspora spinosa, discovered in 1982 from soil in an abandoned rum distillery. The in-secticide has been used on outdoor ornamentals, lawns, vegetables and fruit trees to control most insects.

Spinosad alters the function of nicotinic acid and GABA-gated ion channels in a manner consistent with the observed neuronal excita-tion. Spinosad does not interact with known binding sites for other nicotinic or GABA-ergic insecti-cides. These data indicate that spinosad acts through a unique insecticidal mechanism. After a period of hyperexcitation, lice be-come paralyzed and die, with death within one to two days following ingestion of the substance.

Spinosad is not acutely toxic to mammals and is nonhazardous by oral, dermal, ocular and inhalation-al routes. In long-term mammalian studies, it did not cause tumors, neurotoxicity, embryotoxicity, fetal toxicity or teratogenicity.

Resistance With misdiagnosis of head lice and/or misuse of chemical pediculicides, the question of drug resistance has emerged as an important issue in recent years. Early studies showing that pyrethrins, permethrin and malathion were equally effective in treating head lice infestations may no longer be clinically relevant in communities with resistant lice. The current prevalence of resistance in the United States is therefore unknown. To slow the emergence of resistance, therapeu-tic agents can be rotated.

Mechanical Removal Lice and nits can be effectively

tooth comb. They can also be

or tweezers. While some sources may recommend that the hair be back-combed because of the angle of the attached nit relative to the hair shaft, it is recommended that the hair be combed outward from the scalp.

There is increased interest in treating head lice infestation by removing the insects and their eggs solely with combing, in part due to the emerging fear that lice are becoming increasingly resistant to chemical pediculicides, and as an alternative to pediculicides for chil-dren two years of age and younger. Moreover, the potential for toxicity when chemical pediculicides are misused has helped popularize the use of these combs. Plastic combs may break, especially with heavy nit infestation in thick hair, and some parents may complain that

through dense hair. Sturdier metal nit combs are available. The use of ample water, conditioner, diluted vinegar or a commercial nit re-moval system may help with the combing process.

Combing alone without wet-ting the hair is often unreliable. Application of diluted vinegar or commercial preparations contain-ing formic acid 8 percent (Step 2, and others) may aid in nit removal by softening the bonding agent and may improve compliance by mak-ing combing easier.

Oral Agents Used Off-Label A broad-spectrum anti-parasitic, oral ivermectin (Stromectol) has been used off-label for treatment of head lice when other therapies have failed. Given in an oral dose of 200 µg/kg, ivermectin effectively kills nymphs and lice, but not eggs. To kill newly hatched nymphs, a second dose is given seven to 10

with ivermectin occasionally is as-sociated with mild, transient side effects such as rash or pruritus, but no serious adverse reactions have been reported. Resistance has not been reported to ivermectin.

Combination products contain-ing trimethoprim and sulfamethox-azole (Bactrim, Septra, and others) have also been cited in small ob-servational studies and anecdotal reports, as an alternative to topical pediculicides. This antimicrobial action is believed to kill the symbi-otic bacteria in the lice gut, which

ultimately kills the lice. However, the potential for allergic reactions and risk for promoting bacterial resistance limit its widespread use for this purpose. Like ivermectin, this treatment is not FDA ap-proved.

Unconventional Treatments Some people may consider insecti-cides unacceptable, due to concern about potential adverse effects such as skin irritation and exacerbation of asthma, or consequences for the environment. They may have expe-rienced previous treatment failure when using insecticides, perhaps due to using an ineffective formula-tion, using the product incorrectly, or having an infestation of resis-tant lice. Moreover, aerosols, sold for environmental use, can cause severe bronchoconstriction and should never be used on the head. Patients who do not wish to use topical insecticides to treat head lice infestation may try alternate treatments.

Unconventional remedies in-clude oil-based treatments, gaso-line or kerosene, sulfur, garden

-poos and head shaving. Shaving the head is an effective means to remove all insects and their nits; however, routine shaving is no longer advocated since modern pediculicides and/or insect removal by combing are effective when used properly.

Oil-based remedies such as olive oil are thought to immobilize and suffocate the lice. Lice, includ-

by suffocation. Applying olive oil or petrolatum and covering the head with a shower cap for four to six hours a day for three or four consecutive days may succeed. No reliable data support such claims; however, these substances may be

shampooing and may be irritating to the eyes and skin. Petrolatum is the preferred treatment for infesta-tion of the eyelashes and eyebrows. It should be rubbed in well.


Program 0129-0000-11-009-H01-PRelease date: 9-15-11

Expiration date: 9-15-14CE Hours: 1.5 (0.15 CEU)

The authors, the Ohio Pharmacists Founda-tion and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the infor-mation contained herein. Bibliography for additional reading and inquiry is available upon request.

This lesson is a knowledge-based CE activ-ity and is targeted to pharmacists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Auxiliary Measures Fomite (object that does not convey pathology by itself, but can harbor pathogenic organisms that may be transmitted to people) control is a controversial aspect of lice manage-ment. Head lice rarely survive off the host for more than a day or so and intensive efforts to treat the environment are often time-con-suming, disruptive and perhaps, unwarranted. At the same time, many experts continue to endorse strategies to minimize fomite transmission. The CDC recom-mends that all clothing and bed-ding in contact with the infested person during the two days before pediculicide treatment be laun-dered in hot water (60°C [140°F]) and placed in the dryer using the hot cycle, or dry cleaned. All non-washable items should be quaran-teed in plastic bags for two weeks should any surviving eggs hatch in that time period. Disinfection of combs and brushes in hot water or alcohol is also recommended. Although various home fumigation sprays for use on furniture and environmental insecticide sprays are marketed, little experimental or epidemiologic data on their ef-fectiveness or safety are available to warrant their use.

Patient InformationPediculicidal products may cause irritation to the eyes and mucous membranes. They should not be used near these areas.

Individuals being treated for lice should be observed closely for the presence of nits for eight to 10 days after initial drug application. Persons with lice or nit infesta-tions that remain after two treat-ments should be evaluated by a physician to determine the source of infestation or reason for treat-ment failures. Patients should be advised to not confuse hair spray globules, dandruff or other extrane-ous debris with nits. The former are easily dislodged and brushed

as explained earlier.Patients may decide to apply

a pediculicide product more often

than directed because of persis-tent itching. This subjects them to increased risk of adverse effects, in-cluding excessive drying of the skin which, in turn, can incite further itching.

All topical pediculicides should be rinsed from the hair over a sink, rather than in the shower or bath to limit exposure, and with cool water, in order to minimize absorp-tion due to vasodilatation.

By counseling patients on the proper use of pediculicidal prod-ucts, pharmacists can help de-crease the likelihood of resistance and unnecessary treatment expo-sures. Pediculicidal therapy should only be initiated when head lice is appropriately diagnosed, and thor-ough directions regarding treat-ment should always be provided to all caregivers and family members. Strict compliance with a complete regimen will improve the likelihood of eradicating the insects.

A valuable source of patient information is the National Pe-diculosis Association. This group is active in lice prevention education and supplies material that can help parents deal with the condition. This association can be accessed at www.headlice.org.

September 2011

continuing educat ion quiz Head Lice Infestat ions: Counsel ing Your Pat ients

Program 0129-0000-11-009-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

Birthdate____________

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

yes no

yes no

yes no

1.

-

as pyrethrins.

10. Lindane is an:

-

--

The Georgia Pharmacy Journal December 2011 30

The Georgia Pharmacy JournalEditor: Jim Bracewell

[email protected]

Managing Editor & Designer: Kelly [email protected]

The Georgia Pharmacy Journal® (GPJ) is the official publication of theGeorgia Pharmacy Association, Inc. (GPhA). Copyright © 2011, GeorgiaPharmacy Association, Inc. All rights reserved. No part of this publicationmay be reproduced or transmitted in any form or by any means, electronicor mechanical including by photocopy, recording or information storageretrieval systems, without prior written permission from the publisher andmanaging editor.

All views expressed in bylined articles are the opinions of the author anddo not necessarily express the views or policies of the editors, officers ormembers of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose who are interested in writing for this publication are encouraged torequest the official GPJ Guidelines for Writers. Artists or photographerswishing to submit artwork for use on the cover should call, write or e-mailthe editorial offices as listed above.

SUBSCRIPTIONS AND CHANGE OF ADDRESSThe Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed asa regular membership service, paid for through allocation of membershipdues. Subscription rate for non-members is $50.00 per year domestic and$10.00 per single copy; international rates $65.00 per year and $20.00single copy. Subscriptions are not available for non-GPhA memberpharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is publishedmonthly by the GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324.Periodicals postage paid at Atlanta, GA and additional offices.POSTMASTER: Send address changes to The Georgia PharmacyJournal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

ADVERTISINGAdvertising copy deadline and rates are available at www.gpha.org uponrequest. All advertising and production orders should be sent to the GPhAheadquarters as listed above.

GPHA HEADQUARTERS50 Lenox Pointe, NEAtlanta, Georgia 30324Office: 404.231.5074Fax: 404.237.8435 www.gpha.org

Print: Star Printing - 770.974.6195

2011 - 2012 GPhA BOARD OF DIRECTORS

Name PositionDale Coker Chairman of the BoardJack Dunn PresidentRobert Hatton President-ElectPam Marquess First Vice PresidentBobby Moody Second Vice PresidentRobert Bowles State At LargeHugh Chancy State At LargeKeith Herist State At LargeEddie Madden State At LargeJonathan Marquess State At LargeTim Short State At LargeRichard Smith State At LargeChristine Somers 1st Region PresidentFred Sharpe 2nd Region PresidentRenee Adamson 3rd Region PresidentAmanda Gaddy 4th Region PresidentJulie Bierster 5th Region PresidentAshley Faulk 6th Region PresidentAmanda McCall 7th Region PresidentLarry Batten 8th Region PresidentKristy Pucylowski 9th Region President Christopher Thurmond 10th Region PresidentAshley London 11th Region President Ken Eiland 12th Region PresidentThomas Jeter ACP ChairmanJosh Kinsey AEP ChairmanSonny Rader AHP ChairmanIra Katz AIP ChairmanGail Lowney APT ChairmanChristina Gonzalez ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael Farmer Insurance Trust ChairmanSteve Wilson Georgia State Board of Pharmacy

RepresentativePatricia Knowles Georgia Society of Health Systems

PharmacistsAmy Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeSukh Sarao UGA Faculty Rep.Negin Sovaidi ASP Mercer University Rep.Annie Tran ASP South University Rep.David Bray ASP UGA Rep.Jim Bracewell Executive Vice President

September 2011

continuing educat ion quiz Head Lice Infestat ions: Counsel ing Your Pat ients

Program 0129-0000-11-009-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

Birthdate____________

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

yes no

yes no

yes no

1.

-

as pyrethrins.

10. Lindane is an:

-

--


Introducing the GPhA/UBS Wealth Management Program

UBS has agreed to provide all members of the Georgia Pharmacy Association with exclusive access

been recognized as one of Barron’sGroup is the endorsed wealth management provider for the Georgia Dental Association and also

Harris Gignilliat, CRPS®

Vice President–Investments

ubs.com/team/wile

exclusively for GPhA members at a group discount rate

discount rate

income replacement system

– Lending capabilities with competitive interest rates

Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®.

UBS Financial Services Inc. is a subsidiary of UBS AG. Financial Services Inc. All rights reserved. Member SIPC.

UBS has agreed to provide

Introducing the GPhA/UBS

members of the Georgia Pharmacy Association all UBS has agreed to provide

Introducing the GPhA/UBS

members of the Georgia Pharmacy Association

Wealth Management ProgramIntroducing the GPhA/UBS

access exclusive with members of the Georgia Pharmacy Association

Wealth Management Program

access

Wealth Management Program

is the endorsed wealth management provider Group been recognized

is the endorsed wealth management provider sBarron’Barron’sof as one been recognized

ice VHarris

for the Georgia Dental Association is the endorsed wealth management provider

President–Investmentsice

®CRPSGignilliat, Harris

and for the Georgia Dental Association

also

Lending capabilities with competitive interest rates–


discount rate


Lending capabilities with competitive interest rates


discount rate


Lending capabilities with competitive interest rates


ubs.com/team/wile

ice V

ubs.com/team/wile

President–Investmentsice

eserved. Member SIPC. Financial Services Inc. All rights r

and CRPSSMement Plans Specialisted RetirCharter

eserved. Member SIPC.

ed service marks of the College for Financial Planningegistere r ar® and CRPS

.®ed service marks of the College for Financial Planning

UBS Financial Services Inc. is a subsidiary of UBS AG.

UBS Financial Services Inc. is a subsidiary of UBS AG.

Georgia Pharmacy Association50 Lenox Pointe, NEAtlanta, GA 30324

the georgia pharmacy journal: december 2011

Documents