the kentucky pharmacist vol. 7, #3

News & Information for Members

of the Kentucky Pharmacists Association

Vol. 7, No. 3

May 2012

TTHEHE KKENTUCKYENTUCKY

PPHARMACISTHARMACIST

Registration form and

schedule inside! CPE Monitor:

What does it

mean for you?

CE: Compounding

for Scalp

Disorders

Also inside:

Gov. Beshear signs

Pharmacy Audit Bill

2012 Legislative Session Recap, Pg. 12

May 2012

THE KENTUCKY PHARMACIST 2

Table of Contents

Table of Contents

Table of Contents— Oath— Mission Statement 2 President’s Perspective 3 ASCP/HD Smith 4 KPhA Annual Meeting 2012 5 KPhA Invitation for Membership 11 Kentucky Legislative Session Summary 12 May CE—Compounding for Scalp Disorders 16 May Pharmacist/Pharmacy Tech Quiz 24 KPPAC Contribution Form 25 Pharmacy Law Brief 26 CPE Monitor: Change is coming 28 Pharmacy Technician Certification Board 29

Agency for Healthcare Research and Quality 30 Pharmacy Time Capsules 31 KPhA at NASPA Leadership Conference 32 KPhA Government Affairs 33 June CE— Reducing the Burden of ADEs 34 June Pharmacist/Pharmacy Tech Quiz 38 APhA Annual Conference—the Student Perspective 39 Why Do I Need To Be Certified? 40 McWhorter College of Pharmacy 41 Pharmacy Policy Issues 42 Long Term Care CE Event 44 Pharmacists Mutual Companies 45 KPhA Board of Directors 46 Frequently Called and Contacted/Classifieds 47

Oath of a Pharmacist

At this time, I vow to devote my professional life to the service of all humankind through the profession of

pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy

outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Kentucky Pharmacists Association

The mission of the Kentucky Pharmacists Associa-

tion is to promote the profession of pharmacy, en-

hance the practice standards of the profession, and

demonstrate the value of pharmacist services within the

health care system.

Editorial Office:

© Copyright 2012 to the Kentucky Pharmacists Asso-ciation. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of member-ship dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association.

Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email [email protected]. Website http://www.kphanet.org.

The Kentucky Pharmacy Education and Research Foun-

dation (KPERF), established in 1980 as a non-profit sub-

sidiary corporation of the Kentucky Pharmacists Associa-

tion (KPhA), fosters educational activities and research

projects in the field of pharmacy including career coun-

seling, student assistance, post-graduate education, con-

tinuing and professional development and public health

education and assistance.

It is the goal of KPERF to ensure that pharmacy in Ken-

tucky and throughout the nation may sustain the continu-

ing need for sufficient and adequately trained pharma-

cists. KPERF will provide a minimum of 15 continuing

pharmacy education hours. In addition, KPERF will pro-

vide at least three educational interventions through oth-

er mediums — such as webinars — to continuously im-

prove healthcare for all. Programming will be determined

by assessing the gaps between actual practice and ideal

practice, with activities designed to narrow those gaps

using interaction, learning assessment, and evaluation.

Additionally, feedback from learners will be used to im-

prove the overall programming designed by KPERF.

May 2012


President’s Perspective

As I sit down to write this last article, it’s hard for me to be-lieve that a year has nearly passed, and what a tremen-dous year it has been……A year full of opportunities, chal-lenges, advancements, set-backs, colleagues, students, mentors, old friends and new friends. I can’t tell you how rewarding it has been to be President of your Association, and I thank you for the opportunity.

Over the year, I have harped on the fact that I believe apa-thy has been one of the single largest problems impacting our profession. My goal has been to challenge individuals to say, “Yes I Will,” and be involved. As I’ve stated, leader-ship has to come from a willingness to first be engaged. I’m happy to report that I believe our association and profes-sion have made great strides in being more engaged, yet there is still a tremendous amount to accomplish.

In my many years of involvement with the association, I’ve never experienced a more engaged and active Board of Directors. We have seen an increased activity with our lo-cal associations, as local leaders have stepped up to lead. Individuals not previously engaged with the association have stepped up to serve on or even chair committees. In addition to our standing committees (Organizational, Pro-fessional and Public Affairs), we have very involved and active special called committees, including Government Affairs, Budget and Audit, Contract Review, Policy Review, Past-Presidents, Health Information Technology, and Emergency Preparedness committees. The work these committees are doing is important and is strengthening our association and our profession.

I was inspired by the number of pharmacists and student pharmacists that attended the April 13 and 14 Advancing Pharmacy Practice Summit that KPhA helped sponsor. The event was hosted by UK COP’s Center for Advancement of Pharmacy Practice (CAPP), and in addition to KPhA, APSC, KY BOP, KSHP and SUCOP also sponsored the event. On a weekend in April with many competing hap-penings, almost 100 individuals came from different prac-

tice settings with different pharmacy experience to discuss and plan the path forward for pharmacy. By all accounts, the meeting was a success and proved that a coalition of pharmacists is possible, necessary and meaningful in order to advance our profession. I am not going to attempt to recap the meeting in this article, as the coalition will be de-veloping a report with the proceedings of the summit. How-ever, four broad categories were identified as important in advancing the profession. They include Communication, Redefining the Pharmacist’s Role, Education & Credential-ing and Practice Model.

Go visit Gloria and Lynn’s Kentucky Pharmacy History Mu-seum, and you’ll certainly see that our profession has not been a stagnant one. I don’t know a lot, but I know that change in our profession is destined to continue and it will continue to change at a pace unlike we have seen before. With the changing landscape of healthcare and the contin-ued introduction of technology, the practice of pharmacy, as it stands today, will not be the same tomorrow. Will we internally chart the course for our future, or will we allow outside sources to continue to shape our profession? I hope you will join the coalition in saying, “Yes We Will”, and get engaged. Your next opportunity to get involved with the discussion will occur June 14 at the KPhA annual meeting. Although being held during the KPhA meeting, it will be a continuation of the coalition discussion. Even if you haven’t registered for the meeting, we welcome your attendance and input during this discussion from 8 to 10 pm.

Having said that, I hope you have made plans to attend part – if not all – of the 134

th KPhA Annual Meeting. It will

be held at the Marriott Griffin Gate in Lexington, Ky., on June 13 – 16. If you have never attended, or if you haven’t attended in more than five years or maybe since you were a student, please consider attending. Our association moves forward only through your engagement!

I continue to want to hear from you. If you have a desire to be or questions about how to be involved, please email me at [email protected].

Lewis Wilkerson

PharmD, CGP

KPhA President

2011-2012

KPhA Social Media Links

www.facebook.com/KyPharmAssoc

www.twitter.com/KyPharmAssoc

President’s Perspective

mailto:[email protected]

May 2012


APSC—HD Smith

May 2012


134th KPhA Annual Meeting

Tentative Program Description

The Kentucky Pharmacists Association supports the pharmacists and pharmacy technicians of Kentucky by providing programming on up-to-date topics faced in pharmacy practice. Pharmacists and pharmacy techni-cians that practice in hospital/health systems, community, retail, consultant, long term care and insurance industries are the targeted audience for this meeting.

Since patient centered care is paramount, this convention targets topics such as diabetes, probiotics and new drugs, as well as topics related to improving patient medication use and safety and more! Attendees will get an update on pharmacy law; fraud, waste and abuse; and drug shortages.

As an ACPE accredited provider, the Kentucky Pharmacy Research and Education Foundation (KPERF) must ensure balance, independence, objectivity and scientific rigor in all its educational activities. Any per-son who is in a position to control the content or direction of a CPE activity must disclose any financial inter-est or other relationship with a commercial interest producing healthcare goods or services that have a di-rect bearing on the subject matter of the programming. Full Disclosure will be given verbally prior to the ac-tivity.

For successful completion of the Knowledge Based CPE activities and subsequent awarding of credit, each participant (Pharmacists and Technicians) must COMPLETE and TURN IN an activity

evaluation form TO THE MODERATOR at the end of each activity.

You will receive your certificates no later than six to eight weeks after the meeting.

Meal functions are open to all registered attendees; name tags required.

Registration is required to attend all continuing education programs.

Meeting attire is casual; President’s Reception and Ray Wirth Banquet are semi-formal.

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing

Pharmacy education.

May 2012



134th Kentucky Pharmacists Association Annual Meeting Registration Form

June 13-16, 2012 Marriott Griffin Gate, Lexington, KY

Please Type or Print the following:

__________________________________ ________ __________________________

First Name MI Last Name

____________________________________________________ PharmD RPh CPhT Other

Business Affiliation

_____________________________________________ _________________________ ______ _____

Street Address City State Zip

__________________________ _______________________________________________________________

Daytime Phone Email Address

Registration Fees: Please circle applicable Fee

Student- Free Member Non-Member Technician/Resident

Full Registration:

By June 1 $200 $375 $85 $25

After June 1 $250 $425 $110 $35

Single Day Registration:

By June 1 $105 $195 $55 $20

After June 1 $130 $220 $80 $30

Circle Day: Thursday Friday Saturday

Meal Events: Please indicate the total number that will be attending each meal event.

Welcome Luncheon: Thursday ____ yes ____ no _____ additional guest $30

Kroger Luncheon: Friday ____ yes ____ no _____ additional guest $30

Ray Wirth Awards Banquet: Friday ____ yes ____ no _____ additional guest $45

Luncheon: Saturday ____ yes ____ no _____ additional guest $30

Guest Name(s): ______________________________________________________________________________

Please include your guests’ name(s) if you have purchased additional event tickets

Registration $ _______ Additional Meal Tickets $ _______ Total Enclosed $_________

Credit Card Information: AMEX Discover MasterCard Visa

Number: ___________________________________________ Expiration Date:______________

NOTE: If billing address is different than above, please include on back of sheet, or separate sheet.

Please make checks payable to KPhA Annual Meeting.

Mail to: KPhA Annual Meeting 1228 US 127 South Frankfort, KY 40601.

For overnight accommodations: Contact Marriott Griffin Gate via the KPhA custom web reservation site at https://resweb.passkey.com/go/KYPharmacistAssoc, or call1-800-266-9432 and reference Group Code KY Pharmacists Association for the special rate of $129/night. Cut-off for this rate is May 22, 2012. Lodging rate includes parking on site and wireless internet access.

Special Assistance. If you require special assistance or diet to attend, please indicate need on back of this sheet, call 502.227.2303 or email [email protected].

https://resweb.passkey.com/go/KYPharmacistAssoc

https://resweb.passkey.com/go/KYPharmacistAssoc


May 2012



7:30 AM Registration

7:30 AM to 9:00 AM Welcome Breakfast (Open to All)

Sponsored By Kentucky Health Information Exchange

8:30 AM to 10:30 AM Quality Medication in the Elderly

Demetra Antimisiaris, Pharm.D., CGP, FASCP, Assistant Professor, Di-

rector of Geriatric Pharmacotherapy, University of Louisville.

10:30 AM to 10:45 AM Refreshment Break

10:45 AM to 11:45 AM

Option 1

Medication Therapy Management Update

Matt Worthy, Pharm.D., Director of Professional and Clinical Services, Rx

Therapy Management.

Christine Richardson, PharmD., Clinical Pharmacist, Rx Therapy

Management

10:45 AM to 11:45 AM

Option 2

Lawsuit Protection

Luke Morgan, J.D., McBrayer, McGinnis, Leslie and Kirkland, PLLC

11:45 AM to 1:00 PM Lunch

Sponsored By University of Kentucky College of Pharmacy

1:00 PM to 2:00 PM CHEST Guidelines Update

Sarah F. White, Pharm.D., Assistant Professor, Clinical and

Administrative Sciences, Sullivan University College of Pharmacy

2:00 PM to 4:00 PM

Option 1

Overview of eHealth in KY: The Impact of HITECH and the Kentucky

Health Information Exchange

Polly Mullins-Bentley, Acting Director, Kentucky Health Information

Exchange

2:00 PM to 4:00 PM

Option 2

Clinical Pearls (Specific topics to be determined)

4:00 PM to 5:00 PM Situation Critical: Managing Drug Shortages

Rola Kaakeh, PharmD, CFPH, Assistant Professor and Founding

Director, International Center for Health Outcomes Policy, Sullivan

University College of Pharmacy

4:00 PM to 5:30 PM House of Delegates Opening Session

5:30 PM to 7:30 PM Grand Opening of Hall of Exhibitors

8 PM to 10 PM Follow-Up for Advancing Pharmacy Practice in Kentucky Summit

10 PM Hospitality Suite

Thursday, June 14, 2012 Tentative Schedule

May 2012



7:30 AM to 9:00 AM Breakfast/Registration

8:00 AM to 9:00 AM Clinical Services in Community Pharmacy

Amy Thompson, PharmD,.Kroger Pharmacy, D5 Patient Care Specialist

9:00 AM to 9:30 AM Reference Committee

9:00 AM to 11:30 AM

10:15 AM to 10:30 AM

Hall of Exhibitors Open

Refreshment Break in Hall of Exhibitors

11:00 AM to Noon Fraud, Waste and Abuse

Molly Nicole Lewis, McBrayer, McGinnis, Leslie and Kirkland, PLLC

Noon to 1:45 PM KPhA Awards Lunch

Sponsored By Kroger

1:45 PM to 3:45 PM NASPA-NMA Student Pharmacist Self-Care Championship

Endowed by Procter & Gamble

3:45 PM to 4:00 PM Refreshment Break

4:00 PM to 5:00 PM

Option 1

Avoiding Liability Landmines for the Kentucky Pharmacist

Bruce A. Lafferre, Field Representative, Pharmacists Mutual Companies

4:00 PM to 5:00 PM

Option 2

Mythbusters Diabetes Management

Sarah Lawrence, PharmD, MA, Community Pharmacy PGY1 Resident,

Clinical Assistant Professor, College of Pharmacy, Sullivan University

6:00 PM to 7:00 PM President’s Reception

Sponsored By Rx Therapy Management

7:00 PM to 9:00 PM Ray Wirth Banquet

9 PM Hospitality Suite

Friday, June 15, 2012

Saturday, June 16, 2012

7:30 AM to 9:00 AM Continental Breakfast

Sponsored By American Pharmacy Services Corporation

8:00 AM to 10:00 AM New Drugs Update

Trish Rippetoe Freeman, R.Ph., Ph.D., Clinical Associate Professor and Director of Professional Practice Programs, University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science.

8:00 AM to 10:00 AM Closing House of Delegates

10:00 AM to 10:15 AM Refreshment Break

May 2012



10:30 AM to 11:30 AM

Option 1

Demystifying Probiotics: Role in Health and Disease

Michel Farhat, PhD, Director of Global Professional and Techincal Affairs

at Procter and Gamble Healthcare

10:30 AM to 11:30 AM

Option 2

Preceptor update

Anne Policastri, Pharm.D., MBA, Assistant Director of Experiential Educa-

tion, UK College of Pharmacy.

11:45 AM to 1:00 PM Lunch

Sponsored by Sullivan University College of Pharmacy

1:00 PM to 2:00 PM Kentucky Legislative and Pharmacy Law Update

Ralph Bouvette, B.Sc.Pharm, Ph.D., J.D., Executive Vice-President, Amer-

ican Pharmacy Services Corporation.

2:00 PM to 3:00 PM Business Meetings for Academies

Saturday, June 16, 2012 Continued

Check the KPhA website for

registration forms and more

information updates on the

134th KPhA

Annual Meeting

www.kphanet.org/2012annualmeeting

May 2012



May 2012



$25 Academy for Consultant Pharmacist Member $15 Academy for Compounding Pharmacist Member

CONTACT ME—I want to be involved with KPhA!

Send to: Kentucky Pharmacists Association For more information: www.kphanet.org 1228 US 127 South Phone: 502-227-2303 Frankfort, KY 40601 Fax: 502-227-2258

The Kentucky Pharmacists Association Invitation to Membership Name

Home Address

City/State/Zip

College & Year of Graduation

Home Phone

Home Fax

E-Mail

License Number

Business Name

Business Address

City/State/Zip

Business Phone

Business Fax

Preferred Mailing Address Home Office Charge to my: American Express Discover _MasterCard VISA

Card#

Card Expiration Date

Signature

Membership Investment:

$210 Active Member (licensed in KY) $315 Joint Member (both spouses licensed in KY)

$210 Associate Member (Licensed only in other state or non-pharmacist)

$120 Retired Member $180 Joint Retired $50 Certified Technician

$70 1st Year Tiered $140 2nd Year Tiered

May 2012


SUMMARY OF PHARMACY ISSUES 2012 Kentucky General Assembly

Prepared by Jan Gould, Gay Dwyer, Bob McFalls and Laura Leigh Goins

Overview: KPhA gratefully acknowledges the en-gagement of pharmacist members throughout the Commonwealth who made legislative advocacy a per-sonal priority during the 2012 regular and special ses-sions. Pharmacists were united in your resolve to make a difference by conducting regular telephone calls and engaging in one-on-one conversations with your state senators and representatives. From the Government Affairs Committee, Chair Richard Slone, and the entire Board of Directors: Give yourself and your colleagues a well-deserved “pat on the back” for your due diligence and commitment. Your advocacy continues to make a difference! KPhA acknowledges and thanks our advocacy part-ners for this session: American Pharmacy Coopera-tive, Inc., American Pharmacy Services Cooperative, EPIC Pharmacies, Inc., Kentucky Independent Phar-macy Alliance, Kentucky Retail Federation National Association of Chain Drug Stores, National Communi-ty Pharmacists Association and HD Smith. Lawmakers adjourned the 2012 General Assembly without resolving two key issues that caused Gover-nor Steve Beshear to immediately call legislators into Special Session on April 16. The legislature ad-journed on April 12 without enacting a budget to im-plement the state road plan and without acting on comprehensive anti-prescription drug abuse legisla-tion. Both issues were on the call and addressed dur-ing the Special Session. KPhA’s “watch list” for the 2012 Session included more than 30 bills and resolutions. Working with its partners and through a concerted effort by engaged pharmacists, KPhA was successful in making signifi-cant changes to the state’s pharmacy audit law, stopped efforts by physicians’ assistants to obtain the ability to dispense drugs and had significant input into the deliberations on the pain clinic/prescription drug abuse issue. While the legislature failed to pass legis-lation addressing the problems with Medicaid man-aged care, the session provided KPhA with many op-portunities to educate legislators about issues with the managed care organizations that now serve the ma-jority of the Medicaid population. These opportunities

will continue during the interim and into the next ses-sion. The following summary provides a narrative regarding the activity on some of the major issues affecting pharmacists that were considered during this year’s legislative session. Visit www.lrc.ky.gov to access complete summaries of the bills prepared by legisla-tive staff on all action taken on the measures, as well as to review the full text of individual bills and resolu-tions. Bills enacted during the 2012 Regular Session will take effect on July 12 unless a specific effective date was included in the legislation or the legislation contained an emergency clause making it effective as soon as it was signed by the Governor. The compre-hensive anti-prescription drug abuse bill enacted in the 2012 Extraordinary Session takes effect July 20. Prescription Drug Abuse/Pain Clinics: Despite spending considerable time this session discussing the issue of prescription drug abuse, lawmakers failed to reach a compromise on legislation to address the issue before adjourning the 2012 Kentucky General Assembly. The issue, however, was on the agenda of the Special Session called by Governor Beshear which began on April 16 where a much-revised ver-sion of HB 1 passed on April 20. Background: While many proposals were filed ad-dressing the prescription drug abuse issue, including the regulation of pain clinics, the major focus was on HB 4 sponsored by House Speaker Greg Stumbo (D-Prestonsburg). As the bill passed the House, it re-quired pain clinics to be owned by physicians or ad-vanced practice registered nurses and placed re-strictions on the dispensing of controlled substances by prescribers. The bill also made significant changes to the state’s electronic prescription reporting system (KASPER). Among the changes was a provision that moved the administration of KASPER from the Cabi-net for Health and Family Services to the Office of Attorney General. It also called for an assessment on prescribers and pharmacists to fund the program and required pharmacists to report data to the KASPER system daily rather than weekly.

Kentucky General Assembly Summary

http://www.lrc.ky.gov

http://www.lrc.ky.gov/record/12RS/HB4.htm

May 2012


The Senate passed an amended version of the bill retaining many of the original provisions but also mak-ing some significant changes. The Senate stripped the language in the original bill that established a fee on prescribers and pharmacists to fund KASPER. It also delayed the effective date for the accelerated re-porting of KASPER data until July 1, 2013. Additional-ly, the Senate added several provisions taken from SB 2 that further regulated the activities of pain clin-ics. The Senate passed the revised version of the bill on March 28 but the House failed to concur with the Senate changes. Ultimately the bill wound up in a free conference committee where legislators tried to work out the differences between the House and Senate versions. In the waning days of the session, several draft com-promise proposals were put forward. The initial com-promise included a fee on prescribers and pharma-cists to fund KASPER. The fee, however, was set at $50 annually with allowances for annual adjustments based on inflation. It retained most of the provisions that the Senate added to regulate pain clinics and also retained the requirement that pharmacists enter data into the KASPER system daily rather than on the current weekly schedule with the delayed effective date. The draft added a new provision that placed re-strictions on the dispensing of certain controlled sub-stances by prescribers. Additionally, it prohibited pharmacies from dispensing more than a 30-day sup-ply of Schedule II drugs, Schedule III drugs containing hydrocodone and drugs containing alprazolam, clonazepam or diazepam. This version was never offi-cially acted upon by either chamber. On the last day of the session, another draft compro-mise was put forth that removed the fee language and made other slight modifications to the bill. The legisla-ture adjourned without considering the proposal. During the course of the discussion on prescription drug abuse, KPhA was instrumental in seeking changes to various proposals that surfaced. An early proposal would have required pharmacists to obtain KASPER reports before dispensing any controlled substance. Another proposal would have required pharmacists to obtain photo identification from per-sons picking up controlled substance prescriptions. KPhA effectively worked with lawmakers and its part-ners to get these proposals off the table. Outcome: HB 1 passed the Kentucky legislature as its last act during the Special Session that ended on April 20. In noting its passage, President Lewis D. Wilkerson noted, “KPhA is gratified to see the im-portant issue of prescription drug abuse addressed,

along with the fact that legislators were responsive to hearing and addressing concerns from the pharmacist community as well as those from other provider groups. We remain committed to continuing our work with legislators and other healthcare providers to combat prescription drug abuse, and pharmacists will continue to assure appropriate medication use for our patients." Highlights of the legislation include: The KASPER program is retained in the Cabinet

for Health and Family Services rather than being moved to the Office of Attorney General as origi-nally proposed.

The fee on pharmacists and prescribers was elimi-nated.

Language clarifying who must register for KASPER was added in the Senate.

Language was removed from the original bill tying registration to DEA permits.

Language was removed from the original bill that would have allowed significantly broader access to KASPER reports by law enforcement person-nel.

Pain clinics operating today will be grandfathered from the requirement that pain clinics be owned by physicians.

HB 1 establishes new rules for the operation of pain clinics and, in the future, requires that they be owned by physicians. It requires physicians to obtain KASPER reports before prescribing controlled sub-stances under certain circumstances and limits dis-pensing by prescribers. It requires that pharmacists who are authorized to dispense controlled substances register for a KASPER account but does not mandate that pharmacists obtain KASPER reports. The provi-sion requiring daily rather than weekly reporting of KASPER data by pharmacies is included in the bill, but the effective date for this provision is delayed until July 1, 2013. Also, the penalties for failure to report to KASPER were reduced. Pharmacy Audits: HB 349, a KPhA-backed proposal to revise Kentucky’s pharmacy audit law, was signed into law by Governor Beshear after passing both chambers unanimously. The bill, sponsored by Repre-sentative Tommy Thompson (D-Owensboro), amends Kentucky’s current audit law to address continuing problems faced by pharmacists with audits conducted by insurers and pharmacy benefit managers. HB 349 specifies that an auditing entity may not recoup pay-ments because of clerical errors or omissions, unless there is evidence of fraud or an actual overpayment has been made. Under the provisions of HB 349, re-coupment of overpayments is limited to the actual amount of the overpayment and would not include the


http://www.lrc.ky.gov/record/12RS/SB2.htm

http://www.lrc.ky.gov/record/12SS/HB1.htm




May 2012


dispensing fee. The bill also limits the length of time an auditing entity can require a pharmacy to keep rec-ords. The bill limits record retention to two years or the period of time required by state or federal law.

Another significant provision of HB 349 is the removal of the exemption for managed care organizations (MCOs) serving the Medicaid population. The current law exempted these entities from the audit re-strictions. With the expansion of managed care in the Medicaid program late last year, private companies are now responsible for providing benefits to the ma-jority of the Medicaid population. Implementing improvements to Kentucky’s pharmacy audit law was a legislative priority established by the 2011 KPhA House of Delegates and pharmacists’ ma-jor achievement in this legislative session. Medicaid Managed Care: Despite multiple hearings on the problems with the implementation of managed care for Medicaid recipients, the legislature did not act on any significant legislation addressing Medicaid managed care. Lawmakers were reluctant to inter-vene, citing concerns over the potential budget impact if the Medicaid managed care program was revised. A comprehensive proposal to require the Medicaid man-aged care organizations (MCOs) to comply with pro-vider and patient protections in the insurance code (HB 566) was introduced. Despite being supported by a broad range of patient and provider groups, includ-ing KPhA, the proposal never received a vote in the House. Several bills relating to the pharmacy portion of the managed care program were filed, but all of them ulti-mately stalled. Two bills requiring the MCOs to charge uniform copayments (HB 262 and SB 137) received considerable discussion during the session but both died in the Senate after the MCOs testified that the measures would cause them to open their contracts with the state which would result in additional Medi-caid expenditures. The bills would have increased pharmacy reimbursement by allowing pharmacies to keep the copayments in addition to the contractual reimbursement. A proposal that established guide-lines for the establishment of “maximum allowable cost” pricing mechanisms for not only the MCOs but for all PBMs (SB 125) was introduced. The bill was strongly opposed by PBMs, health insurers, the MCOs and payor groups. SB 125 received a hearing in the Senate Health and Welfare Committee and was approved by the committee. It was later recommitted to the Senate Appropriations and Revenue Commit-tee where it died. Another bill affecting “maximum al-

lowable cost” pricing was filed in the House but failed to receive a hearing.

Significant problems remain for both health care pro-viders and patients in the new Medicaid managed care environment. The issue will no doubt be a major topic of discussion during the interim and KPhA will continue to keep legislators informed about the prob-lems pharmacists are experiencing with the managed care organizations. Therapeutic Shoes: HB 403, a bill that clarified that pharmacy technicians and pharmacist interns can continue to assist pharmacists in the fitting of thera-peutic shoes for diabetics died in the Senate Licens-ing, Occupations and Administrative Regulations Committee. The measure was introduced by Repre-sentative Leslie Combs (D-Pikeville) to address a problem that surfaced with the existing orthotics, pe-dorthics and prosthetics licensing law that is sched-uled to go into effect in 2013. Although the law allows pharmacists to fit therapeutic shoes for diabetics, it restricts the ability of pharmacy personnel to assist pharmacists in the process. Despite unanimously passing the House, the bill never received a commit-tee hearing after a member of Senate leadership ex-pressed concerns about the proposal. Medicaid Fraud: A bill sponsored by House Speaker Greg Stumbo (D-Prestonsburg) proposing to establish the “Kentucky False Claims Act” cleared the House but died in the Senate Judiciary Committee. HB 401 allowed a third party (“whistleblower”) to bring an ac-tion for fraud against anyone doing business with the state. If fraud was found, the whistleblower was enti-tled to a portion of the money recovered. Representa-tive Jimmy Glenn (D- Owensboro) filed a similar pro-posal (HB 51) early in the Session. Glenn’s bill was limited to Medicaid providers and did not receive a hearing in the House committee to which it was as-signed. KPhA was part of a health care provider coali-tion that mounted an aggressive campaign opposed to these bills.

Physicians’ Assistants: Senator Tom Buford (R-Nicholasville) introduced a bill to permit physicians’ assistants to prescribe controlled substances as des-ignated by a supervising physician. SB 96 also would have allowed PAs to dispense all legend drugs. After KPhA objected to allowing PAs to dispense drugs, the sponsor agreed to remove the dispensing language from the bill before it received further consideration. SB 96 received a hearing in the Senate Judiciary Committee but no vote was taken, ending considera-tion of the proposal for the session.













May 2012


PSE Regulation: A compromise proposal restricting the sale of products containing pseudoephedrine (PSE) passed the legislature this year and was signed into law by the Governor. SB 3 allows an individual to purchase up to 7.2 grams of PSE per month with a maximum annual limit of 24 grams without a prescrip-tion. Sales limits would be monitored by the current MethCheck (NPLEX) system. Once that amount is exceeded, a prescription would be required. Gel caps and liquid preparations are exempted. The bill also incorporates provisions of other bills introduced this session that would block sales of PSE to persons convicted of meth-related offenses. The regulation of PSE has been a much-debated issue for several years as legislators grappled with the growing prob-lem of illegal methamphetamine production. SB 3 was one of many bills introduced this session that dealt with the issue.

DME Licensing: Anoth-er new licensing re-quirement was passed in HB 282 that calls for the Board of Pharmacy to license providers of home medical equip-ment and services. Un-less the equipment and related services are provided through a sep-arate legal entity, li-censed pharmacies that sell, rent or lease dura-ble medical equipment (DME) are not required to obtain the new li-cense. Neither are equipment manufacturers or wholesale distributors that do not deal directly with the patient. The bill authorizes licensees to provide home medical equipment and services that require a pre-scription or order from a practitioner. Prescription Drug Disposal: Representative Joni Jenkins (D-Shively) filed legislation (HB 238) estab-lishing a disposal program for unused prescription drugs. The bill easily passed the House but died in the Senate Veterans, Military Affairs and Public Pro-tection Committee. The bill called for the Energy and Environment Cabinet to work with local governments to set up collection points for unused prescription drugs in unopened containers. APRN Prescribing: The APRN association sought legislation this session to eliminate the requirement

that APRNs have a collaborative practice agreement with a physician in order to prescribe non-controlled drugs. While the bill (SB 187) never received a hear-ing in the Senate Judiciary Committee, its provisions were added to HB 512 in the House. HB 512 passed the House but died in the Senate Judiciary Committee as well.

A competing proposal backed by the Kentucky Medi-cal Association was also introduced but likewise failed to pass. SB 190 sought to place additional require-ments on APRNs wishing to prescribe drugs. It out-lined specific elements required to be in collaborative practice agreements and gave the Board of Medical Licensure more oversight of these agreements, Mail Order Pharmacy: The House unanimously

adopted HR 198 urging the Personnel Cabinet, the Kentucky Retire-ment System and the Kentucky Teachers’ Re-tirement System to evaluate the policies of the mail order pharma-cy benefit programs they provide to make sure the policies are compliant with state laws requiring that local pharmacies have the opportunity to partici-pate. As a simple reso-lution, it required no ac-tion by the Senate.

Other Pharmacy Issues: Legislation to place re-strictions on e-prescribing systems has been signed by the Governor (SB 144). The bill prohibits e-prescribing systems from being designed to limit a physician’s choice of drug and calls for the state to incorporate national standards once they have been developed. The Governor also signed SB 114, a bill placing restrictions on the use of step therapies for drugs by insurance companies. The legislature failed to pass HB 377, a bill essentially prohibiting generic substitution for tamper-resistant opioids. It was ap-proved by the House Health and Welfare Committee but was later recommitted to the House Appropria-tions and Revenue Committee. A measure to prohibit the sale of products containing dextromethorphan as the only active ingredient to anyone under age 18 was introduced in the House but HB 106 was not consid-ered in the House Judiciary Committee.










http://www.lrc.ky.gov/record/12RS/HR198.htm





May 2012


May 2012 CE-Compounding for Scalp

Compounding for Scalp Disorders

and Conditions By: Y. Pramar, Ph.D., Professor of Pharmaceutics

Xavier University of Louisiana, College of Pharmacy, New Orleans, Louisiana.

Reprinted with permission of the author and the Louisiana Pharmacists Association where this

article originally appeared. This activity may appear in other state pharmacy association journals.

There are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity # 0143-9999-12-005-H04-P

1.5 Credit Hours (0.15 CEUs)

Goals: The goals of this article are to provide information on the physiology and disorders of the scalp, and typical

drug therapy used to treat these disorders.

Objectives: At the conclusion of this lesson, the reader should be able to:

1. Discuss the physiology of the scalp and the function of the sebum, sweat glands and pores.

2. List at least five disorders/conditions of the scalp.

3. Describe different treatment approaches used in scalp disorders.

4. Become familiar with various formulations used in the treatment of seborrheic dermatitis, dandruff, psoriasis, hair

loss, lice and ringworm.

KPERF offers all

CE articles to

members online at

www.kphanet.org

Introduction

Scalp disorders may be painful, annoying, unsightly

and embarrassing. Scalp problems may require short-

term treatment, but many of them need long-term

therapy over months, and sometimes years. Com-

pounding pharmacists have a significant role in

achieving successful therapeutic outcomes in this

emerging field.

Anatomy and Physiology

The scalp consists primarily of the skin, sweat glands,

sebaceous glands, hair shafts and hair. When these

appendages are not functioning properly in harmony

with one another, various scalp disorders can occur.

Scalp: The scalp is the portion of the body consisting

of skin and subcutaneous tissue normally containing

hair that covers the neuro-cranium. It is especially rich

in blood vessels; therefore, profuse bleeding may oc-

cur with scalp injuries. The functions of the scalp

(skin) include protection and excretion. It secretes

metabolic waste materials and toxins in order to rid

the body of them. It also secretes sweat to cool the

body, and sebum to protect the skin.

Skin: Each layer of the skin (epidermis, dermis, sub-

cutaneous) has a specific function. Included in the

skin are the sebaceous glands that produce sebum

and secrete it through the sebaceous ducts into hair

follicles where it migrates to the surface of the skin.

This flow of sebum removes dead skin cells that flake

off from inside the hair follicle. Sebum consists of fatty

acids and other substances and protects the skin by

reducing the evaporation of water from the skin and

blocks the penetration of excess water into the skin.

This sebum is one of two constituents making up the

lipid film present on the skin surface, the other being

the lipids of the epidermal cells.

Pores: The pores in the skin are where the hair folli-

cles reside. The pore size is related to sebaceous

gland size. Pores enlarge to accommodate a greater

oil flow. Acne caused by blocked pores often clears

up when the pores enlarge allowing unimpeded

movement of sebum through the pore.

Sweat Glands: Sweat glands consist of a single tube,

the lower portion of which is coiled into a ball and the

upper part (the duct) opens onto the surface of the

skin. There are two types of sweat glands, the eccrine

May 2012



and the apocrine. The eccrine sweat glands, distribut-

ed all over the body, primarily regulate body tempera-

ture and eliminate toxic substances and waste prod-

ucts; the perspiration is clear and consists of traces of

salt, carbohydrates, protein and oil. The sweat they

produce is primarily odorless. The apocrine sweat

glands are primarily in the underarm area, around the

nipples and in the genital area. They are stimulated

by the same hormones that stimulate hair growth in

the underarms and genital area. The fluid they se-

crete is milky and rich in organic material that is sub-

ject to bacterial decay, causing body odor. The hair

entraps both sweat and bacteria.

Sebum: When the sebum gets stuck in the pores,

whiteheads, blackheads, papules, pimples and cysts

can ultimately occur. It is a result of the sebum getting

blocked during its transport and clumping with dead

skin cells, being acted upon by bacteria and ultimately

blocking the opening to the skin surface. If pressure

builds up, pustules and cysts result.

Hair: Hair grows on the scalp and each hair filament

originates in a deep hair follicle which penetrates into

the dermis. At the base of the follicle is the papilla

which is the center of hair growth containing the capil-

laries and nerves that supply the hair. As new cells

are formed and older cells are pushed upward, they

gradually die and harden into a hair shaft, consisting

of two layers, the cuticle and cortex. The outer layer,

the cuticle, consists of flat, colorless, overlapping

cells. The cortex contains pigment and a tough pro-

tein called keratin, forming the bulk of the hair shaft.

Coarse hair, as on the scalp, contains an additional

inner core called the medulla. The hair is lubricated by

sebaceous glands that are located in the hair follicle.

In general, human scalp hair is shed every two to four

years; body hairs are shed more frequently.

Hair growth: Hair growth is cyclical, consisting of three

phases. The growing phase is the “Anagen” phase;

about 90 percent of scalp hairs are in the anagen

phase at any point in time. On a daily basis, about 50

to 100 scalp follicles go into the resting phase, or the

“Catagen” phase, which involves 1 percent of the

hairs daily. The shedding phase is the “Telogen”

phase and approximately 10-20 percent of scalp hairs

may be in the telogen phase at any point in time.

SCALP DISORDERS AND THEIR TREATMENT

Seborrheic Dermatitis and Dandruff

Description: Seborrheic dermatitis is an acute or

chronic papulosquamous dermatitis presenting with

dry scales and underlying erythema. In some cases

pruritis is present. Dandruff occurs when there is a

mild scaling without any erythema, and can occur if

the scalp is dry or oily. It may be the result of several

factors, including hormonal imbalance, impaired met-

abolic nutrition, diet, tension, increased bacterial and

fungal activity, biochemical changes in the scalp, the

use of topical medications and cosmetics. Seborrheic

dermatitis occurs when there is general erythema

without tight, thick, silvery scales. Psoriasis is evi-

denced by the presence of well-demarcated red

plaques.

Treatment: Routine treatment for seborrhea of the

scalp involves a shampoo that may contain tar, zinc

pyrithione or selenium, used daily if necessary. A ke-

toconazole 1 percent or 2 percent shampoo can be

used twice weekly. If needed, solutions or lotions of

topical corticosteroids can be used twice daily.

Psoriasis

Description: Psoriasis is an inflammatory skin disease

that may be based upon a genetic predisposition.

When the skin is injured or irritated, it tends to induce

lesions of psoriasis at the site. There are several vari-

ants of psoriasis, with the most common being the

plaque type. Psoriasis presents as silvery scales on

bright red, well-demarcated plaques that may be ac-

companied by itching.

Treatment: The treatment selected for psoriasis of the

scalp is based on its extent and severity. Therapy can

be initiated using a corticosteroid preparation. Other

measures include tar preparations, such as coal tar

solution (LCD, Liquor Carbonis Detergens), anthralin,

calcipotriene and tazarotene. Treatment can be initiat-

ed with a tar shampoo used daily. For thick scales on

the scalp, a 6 percent salicylic acid gel, or a phenol :

mineral oil : glycerin mixture can be used. Alternative-

ly, fluocinolone acetonide 0.01 percent in oil can be

applied under a shower cap at night followed by tar

shampoo in the morning. Corticosteroids such as tri-

amcinolone, fluocinolone, betamethasone dipropio-

May 2012



nate, fluocinonide, amcinonide, or clobetasol in solu-

tion form can be used twice daily.

Hair Loss

I. Description: Pattern, or androgenetic baldness, is

the most common form of alopecia. It is of genetic

predetermination with the earliest changes occurring

on the front sides of the scalp and at the crown of the

skull. The extent of hair loss is variable and unpredict-

able, but may be experienced by approximately 80

percent of all men.

Treatment: A 5 percent solution of minoxidil alone or

in combination with other active ingredients can be

used in both male and female patients, generally

twice daily. Those that respond are usually less than

five years into their hair loss.

II. Description: Alopecia areata is believed to be the

result of an imuunologic process. Typically, there are

patches that are smooth, without scarring. Tiny hairs,

generally 2-3 mm in length, may be seen. In some

cases, all the scalp hair may eventually be involved.

Alopecia areata is a self-limiting disease where there

may be complete re-growth of hair in about 80 per-

cent of cases. In some cases, mild alopecia areata is

resistant to therapy.

Treatment: Severe forms may be treated by systemic

corticosteroids; however, recurrences generally occur

when therapy is discontinued. Corticosteroids can

also be administered intralesionally; for example, tri-

amcinolone acetonide 2.5 to 10 mg/mL can be inject-

ed in aliquots of 0.1 mL every 1 to 2 cm in the in-

volved areas. The total dose should not exceed 30

mg per month for adults. Another treatment includes

daily use of anthralin 0.5 percent ointment.

Other therapeutic approaches involve the use of topi-

cal diphenylcyclopropenone and squaric acid dibutyl

ester. These agents serve to sensitize the skin; this is

followed by application of progressively weaker con-

centrations designed to produce a slight dermatitis.

This results in hair re-growth in 3 to 6 months in some

patients.

III. Description: Drug-induced alopecia may result

from thallium, excessive vitamin A, retinoids, antimi-

totic agents, anticoagulants, antithyroid drugs, oral

contraceptives, trimethadione, allopurinol, proprano-

lol, indomethacin, amphetamines, salicylates, gen-

tamicin and levodopa. Drug-induced alopecia is very

disconcerting to the patient, but it is reversible when

the causative agent is discontinued.

Treatment: No real treatment is indicated in such cas-

es, other than discontinuation of the causative agent.

Lice

Description: Pediculus humanus var capitis (the head

louse, approximately 3-4 mm long) is the causative

agent for pediculosis of the skin of the scalp. It is pre-

sented as pruritis with excoriation and the presence

of nits on hair shafts; they are easiest to see above

the ears and at the nape of the neck. Head lice can

be spread by individuals sharing hats or combs and it

is epidemic among children of all socioeconomic clas-

ses, especially in elementary schools. Adults in close

contact with children may also get the infestation.

Treatment: Options for treating head lice include iver-

mectin 0.8 percent lotion, malathion 0.5 percent or 1

percent lotion, permethrin 1 percent cream rinse and

pyrethrins 0/17 percent to 0.33 percent. The ivermec-

tin lotion is left on for 8 to 12 hours prior to rinsing off.

The malathion is applied to the scalp and left on for

about 12 hours. The permethrin cream rinse is left on

from 30 minutes to 8 hours prior to rinsing off and

treatment is repeated in one week. Following applica-

tion of these preparations, it is important to meticu-

lously remove the nits with a fine-tooth comb.

Ringworm

Description: Ringworm presents as a ring-shaped le-

sion with an advancing scaly border and central

cleared area, or as scaly patches with a distinct bor-

der on the skin or scalp. The affected areas may also

itch. Trichophyton rubrum is the most common causa-

tive agent.

Treatment: Many of the topical antifungal agents can

be used, including miconazole, clotrimazole, ketocon-

azole, econazole, sulconazole, oxiconazole, ciclopir-

ox, butenafine and terbinafine. Topical dosage forms

commonly used include creams, solutions and gels.

If the product is expected to be exposed to a wet en-

vironment, an ointment would be more appropriate.

Treatment should be continued up to two weeks after

symptoms have resolved.

May 2012



References

1. ‘A practical guide to contemporary pharmacy prac-

tice’ by Judith E. Thompson, Third Edition. Lip-

pincott, Williams & Wilkins. 2009

2. ‘Pharmaceutical Dosage Forms and Drug Delivery

Systems’ by Howard C. Ansel, Nicholas G. Popo-

vich, and Loyd V. Allen, Jr. Ninth Edition. Lip-

pincott, Williams & Wilkins. 2011.

3. ‘The Art, Science, and Technology of Pharmaceu-

tical Compounding’ by Loyd V. Allen, Jr. Third Edi-

tion. American Pharmacists Association. 2008.

General Applications for Pruritus of the Scalp

Rx Hydrocortisone 1 percent Antipruritic Scalp Lotion

Hydrocortisone 1 g

Menthol 250 mg

Polysorbate 80 0.25 mL

Ethanol 95 percent 25 mL

Propylene glycol 25 mL

Purified water, qs 100 mL

Mix the hydrocortisone and menthol with the Polysorb-ate 80. Add the propylene glycol and ethanol and mix well. Add sufficient purified water to volume and mix well. Package and label.

Formulations for Seborrheic

Dermatitis and Dandruff

Rx Selenium Sulfide 1 percent Shampoo

Selenium Sulfide 1 g


Shampoo vehicle (commercial), qs 100 mL

Levigate the selenium sulfide with the propylene glycol. Add the shampoo vehicle to volume and mix well. Pack-age and label.

Rx Zinc Pyrithione 1 percent Shampoo.

Zinc pyrithione 1 g (equivalent)

Propylene glycol 10 mL.

Shampoo vehicle (Commercial), qs 100 mL

Levigate the zinc pyrithione with the propylene glycol. Add the shampoo vehicle to volume and mix well. Pack-age and label.

Rx Triamcinolone 0.1 percent Scalp Lotion

Triamcinolone 100 mg


Ethanol 95 percent 25 ml

Purified Water, qs 100 mL

Mix the triamcinolone with the propylene glycol and eth-anol. Add sufficient purified water to volume and mix well. Package and label.

Rx Anti-Seborrhea Clear Lotion

Progesterone 500 mg


Ethoxy diglycol 50 mL

Methylparaben 50 mg

Propylparaben 20 mg



Dissolve the progesterone in the ethanol. Add the eth-oxy diglycol. Dissolve the methylparaben and propylparaben in the propylene glycol and add to the progesterone solution. Add sufficient purified water to volume and mix well. Package and label.

Rx Sulfur Shampoo

Sulfur (colloidal) 1 g

Magnesium aluminum silicate 1 g

Ammonium lauryl sulfate 40 g

Lauramide DEA 4.5 g

Sodium chloride 200 mg

Methylparaben 50 mg

Propylparaben 20 mg


Slowly add the magnesium aluminum silicate to about 50 mL of purified water while agitating and mix until smooth and uniform. Add the colloidal sulfur, ammoni-um lauryl sulfate, lauramide DEA, sodium chloride,

Formulations For Treating Scalp Disorders and Conditions

May 2012



methylparaben and propylparaben and mix well. Add sufficient purified water to volume and mix well. Pack-age and label.

Rx Phenol, Glycerin and Mineral Oil Shake Lotion

Phenol 1 g

Glycerin 10 mL

Purified water 20 mL

Methylparaben 50 mg

Propylparaben 20 mg

Mineral Oil, Light, qs 100 mL

Dissolve the phenol, methylparaben and propylpara-ben in the glycerin. Add the purified water and mix well. Add the mineral oil and agitate. This is not an emulsion, but is an immiscible shake-type lotion.

Formulations for Psoriasis

Rx Coal Tar Shampoo

Coal tar solution 2.8 g

Polysorbate 80 5 mL

Shampoo vehicle (commercial), qs 100 mL

Mix the coal tar solution with the polysorbate 80. In-corporate the shampoo vehicle and mix well. Pack-age and label.

Rx Coal Tar and Salicylic Acid Scalp Lotion

Coal tar solution 10 mL

Salicylic acid 6 g

Polysorbate 80 1 mL


Propylene glycol, qs 100 mL

Mix the polysorbate 80 with the coal tar solution. Mix the salicylic acid with the alcohol and about 60 mL of the propylene glycol. Add the coal tar solution mixture slowly with mixing to the propylene glycol mixture. Add sufficient propylene glycol to volume and mix well. Package and label.

Rx Anthralin 1 percent and Coal Tar 1 percent Ointment

Anthralin 1 g

Coal tar 1 g

Polysorbate 80 2 g

Aquaphor, qs 100 g

Mix the coal tar with the polysorbate 80 and incorpo-rate the anthralin. Incorporate into the Aquaphor and mix until uniform. Package and label.

Rx Anthralin 1 percent Medication Stick

Anthralin 200 mg

Polyethylene glycol 3350 6.5 g

Polyethylene glycol 300 15 mL

Mix the polyethylene glycols together by heating to a temperature of about 550C. Incorporate the anthralin and mix well. Pour into medication stick molds and allow to cool. Package and label.

Rx Calcipotriene 0.003 percent Lotion

Calcipotriene 0.005 percent Cream 60 g

Propylene glycol, qs 100 mL

Mix the commercial calcipotriene 0.005 percent cream with sufficient propylene glycol to make 100 mL. Package and label.

Rx Fluocinolone Acetonide 0.01 percent in Oil

Fluocinolone acetonide 10 mg

Vegetable oil, qs 100 mL

Incorporate the fluocinolone acetonide into a vegeta-ble oil, such as sesame oil, or almond oil, and mix well. Package and label.

Formulations for Hair Loss

Rx Minoxidil 5 percent and Retinoic Acid 0.01 percent Scalp Lotion

Minoxidil 5 g

Retinoic acid 10 mg


Ethanol 95 percent, qs 100 mL

Mix the minoxidil and retinoic acid with the propylene glycol. Add sufficient ethanol to volume and mix well. Package and label.

Rx Minoxidil 2 percent and Finasteride 0.1 percent Scalp Lotion

Minoxidil 2 g

Finasteride 100 mg



Pulverize the required number of finasteride tablets and mix with about 75 mL of ethanol in a covered con-

May 2012



tainer and let sit for a couple of hours. Filter through a paper filter to remove the excipients. Add the minoxidil and propylene glycol to the filtrate and mix well. Add sufficient ethanol to volume and mix well. Package and label.

Rx Spironolactone Scalp Lotion

Spironolactone 1 g

Methylcellulose 0.25 g




Mix the spironolactone and methylcellulose with the propylene glycol. Add the ethanol and mix well. Add sufficient purified water to volume and mix well. Package and label.

Rx Diphenylcyclopropenone 0.1 percent to 2 per-cent Solutions

Diphenylcyclopropenone 100 mg to 2 g

Acetone, qs 100 mL

Dissolve the diphenylcyclopropenone in sufficient ac-etone to volume. Package and label. Caution: Diphe-nylcyclopropenone is a strong sensitizing agent. Ex-ercise care when preparing these solutions; wear ap-propriate masks, garb and gloves.

Rx Squaric Acid Dibutyl Ester 0.1 percent to 1 percent Solutions

Squaric acid dibutyl ester 100m g to 1g

Acetone or Ethanol 95 percent, qs 100 mL

Dissolve the squaric acid dibutyl ester in sufficient acetone OR ethanol to volume. Package and label.

Formulations for Lice Infestation

Rx Malathion 0.5 percent Topical Lotion

Malathion 500 mg

Isopropyl alcohol 70 percent 70 mL

Lavender oil 30 drops

Bay oil 3 drops


Note: Compound this preparation in a well-ventilated area or use an exhaust hood, since malathion fumes can be irritating to the mucous membranes of the na-

sal passages. Wear disposable gloves to prevent re-tention of odor on the hands.

Disperse the malathion in the isopropyl alcohol. Add the fragrances and mix well. Add sufficient ethanol to volume and mix well. Package and label.

Rx Ivermectin 1 percent Creme Rinse

Ivermectin 1 g


Creme Rinse (Commercial), qs 100 mL

Mix the ivermectin with the polyethylene glycol 300 to form a smooth paste. Incorporate the creme rinse and mix well. It may be necessary to work the prod-uct in a mortar with a pestle to ensure uniform and small particle size of the ivermectin. Package and label.

Rx Ivermectin 1 percent Lotion

Ivermectin 1 g


Dermabase 30 g


Mix the ivermectin with the propylene glycol to form a smooth paste using a mortar and pestle. Incorporate the Dermabase and mix well. Slowly add sufficient purified water to volume and mix well. Package and label.

Formulations for Ringworm

Rx Clotrimazole 1 percent Scalp Lotion

Clotrimazole 1 g


Polyethylene glycol 300, qs 100 mL

Dissolve the clotrimazole in the propylene glycol and add sufficient polyethylene glycol 300 to volume and mix well. Package and label.

Rx Miconazole 1 percent and Tolnaftate 1 percent Scalp Lotion

Miconazole 1 g

Tolnaftate 1 g


Polyethylene glycol 300, qs 100 mL

Dissolve the miconazole and tolnaftate in the propyl-ene glycol and add sufficient polyethylene glycol 300 to volume and mix well. Package and label.

May 2012



CPE Monitor:

Information for Pharmacists and Pharmacy Technicians

What is CPE Monitor?

CPE MonitorTM is a national, collaborative effort by the Ac-creditation Council for Pharmacy Education (ACPE) and the

National Association of Boards of Pharmacy (NABP) to provide an electronic system for pharmacists and pharmacy technicians to track their completed continuing pharmacy education (CPE) credits. It will also offer boards of pharmacy the opportunity to electronically authenticate the CPE units completed by their licensees, rather than requiring pharmacists and pharmacy technicians to submit their proof of completion statements (i.e. statements of credit) upon request or for random audits.

How CPE Monitor Works

Pharmacists and pharmacy technicians will receive a unique identification number (ID), known as the NABP e-Profile ID, after setting up their e-Profile with NABP (see How to Register for CPE Monitor). Many ACPE-accredited CPE providers are now requiring pharmacist and pharmacy technician participants to provide their NABP e-Profile ID and date of birth (DOB in MMDD format) to the ACPE-accredited provider when they register for a CPE activity or submit a request for credit. It will be the responsibility of the phar-macist or pharmacy technician to provide the correct information [i.e. ID and DOB (in MMDD format)] in order to receive credit for participating in a CPE activity.

The CPE Monitor system will direct electronic data from ACPE-accredited providers to ACPE and then to NABP, ensuring that CPE credit is officially verified by the providers. Once information is received by NABP, pharmacists and pharmacy technicians will be able to log in to access information about their com-pleted CPE activities.

How to Register for CPE Monitor

Pharmacists and pharmacy technicians are asked to obtain their NABP e-Profile ID now at www.MyCPEmonitor.net to ensure their e-Profile is properly setup prior to implementation of CPE Monitor. As ACPE-accredited providers begin transitioning their systems to CPE Monitor throughout 2012, the e-Profile ID and DOB in MMDD format will be required by those providers to receive credit for any ACPE-accredited CPE activities. By the end of 2012, all ACPE-accredited CPE providers will require the e-Profile ID and the DOB in MMDD format to receive CPE credit.

NABP Customer Service [email protected] Tel: 847-391-4406 Fax: 847-391-4502 Hours: M-F, 9 AM to 5 PM central

Attention all Pharmacists and Pharmacy Technicians!!!!

You MUST sign up for a NABP e-Profile ID to receive CE credit from KPERF or any

other ACPE Provider as of this year. Visit www.kphanet.org/CPEMonitor for more.

Rx Ketoconazole 2 percent Solution

Ketoconazole 2 g



Dissolve the ketoconazole in the polyethylene glycol 300 and propylene glycol and mix well. Package and

label.

Note: With the exception of a few formulations con-taining drugs such as triamcinolone, fluocinolone ace-tonide, spironolactone, finasteride, and squaric acid dibutyl ester, the remaining preparations can be dis-pensed over-the-counter.

http://www.MyCPEmonitor.net


May 2012



May 2012 — Compounding for Scalp Disorders and Conditions

1. Components of the scalp include:

A. Skin

B. Sebaceous glands

C. Hair shafts

D. Sweat glands

E. All of the above

2. Common disorders of the scalp include all of the fol-lowing, EXCEPT:

A. Hyperhidrosis

B. Dandruff

C. Seborrheic dermatitis

D. Lice infestation

E. Ringworm

3. All of the following may be used to treat psoriasis, EXCEPT:

A. Coal tar solution

B. Anthralin

C. Minoxidil

D. Fluocinolone acetonide

E. Clobetasol

4. Individuals may have a genetic predisposition to:

A. Ringworm

B. Lice

C. Dandruff

D. Psoriasis

E. Seborrheic dermatitis

5. Which of the following should be used to treat ring-worm?

A. Coal tar solution

B. Miconazole

C. Hydrocortisone

D. Anthralin

E. Malathion

6. All of the following may be used to treat a lice infes-tation, EXCEPT:

A. Terbinafine

B. Malathion

C. Ivermectin

D. Permethrin

E. Pyrethrins

7. Squaric acid dibutyl ester can be used in the treat-ment of:

A. Seborrheic dermatitis

B. Dandruff

C. Psoriasis

D. Alopecia

E. Lice

8. Seborrhea of the scalp may be treated with:

A. Zinc pyrithione

B. Selenium

C. Ketoconazole shampoo

D. Topical corticosteroids

E. All of the above

9. Select the FALSE statement about lice infestations from the following:

A. It is epidemic among children of all socioeconomic

classes.

B. It presents with dry scale and underlying erythema.

C. It is spread by sharing hats or combs.

D. The nits on hair shafts are easiest to see above the

ears and at the nape of the neck.

E. Adults in close contact with children may also get the infestation.

10. Special precautions are required when dealing with the following drugs:

I. Malathion

II. Diphenylcyclopropenone

III. Coal tar

A. I only

B. III only

C. I and II only

D. II and III only

E. I, II and III

May 2012



May 2012 — Compounding for Scalp Disorders and Conditions Universal Activity # 0143-9999-12-005-H04-P PHARMACISTS ANSWER SHEET Name ________________________________________________ KY Lic. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 3. A B C D E 5. A B C D E 7. A B C D E 9. A B C D E 2. A B C D E 4. A B C D E 6. A B C D E 8. A B C D E 10.A B C D E Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________

NABP #_________________________________ Birthdate _______________________(MM/DD)

This activity is a FREE service to members of the Kentucky Pharmacists Association. The

fee for non-members is $30. The fee for duplicate certificates is $5. Please send a self

addressed, stamped envelope to KPERF, 1228 US 127 South, Frankfort, KY 40601.

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.

Expiration Date: May 15, 2015

Successful Completion: Score of 80 percent will result in 1.5 contact hours or 0.15 CEUs.

Participants who score less than 80 percent will be notified and permitted one re-examination.

May 2012 — Compounding for Scalp Disorders and Conditions TECHNICIANS ANSWER SHEET. Universal Activity # 0143-9999-12-005-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 3. A B C D E 5. A B C D E 7. A B C D E 9. A B C D E 2. A B C D E 4. A B C D E 6. A B C D E 8. A B C D E 10.A B C D E Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________

NABP #_________________________________ Birthdate _______________________(MM/DD)_

May 2012


KPPAC Contribution

Name: _________________________________ Pharmacy: __________________________________________

Address: _________________________ City: ___________________ State: _________ Zip: ____________

Phone: ________________ Fax: _________________ E-Mail: ______________________________________

Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)

Credit Card (AMEX; Discover; MasterCard; VISA)

Account #: ____________________________________________________________ Expiration date: _______

Address to which credit card statement is mailed (if different from above)

____________________________________________________________________________________________

CONTRIBUTION LIMITS

The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a

candidate or slate of candidates is $1,000 per election. Contributions from a PAC to a school board candidate are limited to $200 per election.

Individuals may contribute no more than $1,500 per year to all PACs in the aggregate.

In-kind contributions are subject to the same limits as monetary contributions.

Cash Contributions: $50 per contributor, per election. Contributions by cashier’s check or money order are limited to

$50 per election unless the instrument identifies the payor and payee. KRS 121.150(4)

Anonymous Contributions: $50 per contributor, per election, maximum total of $1,000 per election.

(This information is in accordance with KRS 121. 150)

Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601

KPPAC Contribution Form

Support the Candidates who Support YOU!

Make your Donation Today!

May 2012


Pharmacy Law Brief

Pharmacy Law Brief: Importation of Prescription Drugs

Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy, Department of Pharmacy Practice and Science, UK College of Pharmacy

Question: What is the current status of the law with regard to prescription medications entering the coun-try, both when brought in by a patient and when shipped from outside the country to a patient? I seem to re-call that there even were some programs sponsored by a number of states to facilitate their citizens getting medications from sources in Canada. Response: The federal law in this area is unchanged and has been the same for quite some time. Suc-cinctly stated, it prohibits anyone, including an individual private citizen or a business organization, from bringing into the country an unapproved new drug product that violates the Federal Food, Drug and Cosmetic Act. It does not matter whether the products are for personal use or for resale. The legal position is that the category of unapproved new drugs includes “any drugs, including foreign-made versions of U.S. approved drugs that have not been manufactured in accordance with and pursuant to an FDA approved process.” A number of studies have documented that pharmaceuticals coming into the US and purporting to have been made in one country really come from manufacturers based in other lands. Products labeled to appear to have been manufactured in Canada have been found to originate in Brazil or any number of African nations. It is important to bear in mind that the highly controlled system of drug product approval, manufacturing and distribution was put in place over the past century with the goal of having only approved drug products availa-ble for use by those in the U.S. Some measure of validity attached to the notion of importing medications for personal use from Canada arose when several states launched initiatives to encourage their citizens to take advantage of potential sav-ings claimed to exist. Probably the highest profile initiative of this type was “I-Save Rx” promoted by the now-discredited Gov. Rod Blagojevich of Illinois. This program used both Canadian sources as well as ones in Eu-rope. At least four other states joined the effort but the program died when the Canadian supplier withdrew, claiming that the states had not adequately promoted the program to their citizens. All this being said, the U.S. Food and Drug Administration has the same enforcement discretion as does any law enforcement agency. Just like the state trooper who pulls over a speeding motorist and then decides to issue a warning rather than a ticket, the FDA has some latitude in how it approaches enforcement of the stat-utes and regulations under its jurisdiction. As a general rule, FDA does not bring its enforcement might to bear on individual patients who are importing medications for personal use. The agency has bigger fish to fry,

Resources for further information:

APhA, Drug importation: The realities of safety and security.

http://www.pharmacist.com/AM/Template.cfm?Section=Home2&CONTENTID=17842&TEMPLATE=/CM/

ContentDisplay.cfm

FDA, Information on importation of drugs.

http://www.fda.gov/ForIndustry/ImportProgram/ImportPolicyandInformationbyProduct/default.htm

FDA, FDA operation reveals many drugs promoted as “Canadian” products really originate from other countries.

http://www.fda.gov/NewsEvents/ Newsroom/ Press Announcements/2005/ucm108534.htm.

FDA, Importing prescription drugs: Letters to state and local officials.

http://www.fda.gov/Drugs/DrugSafety/ucm170594.htm.

May 2012


Pharmacy Law Brief

The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the

Museum, our state's leading preservation organization for pharmacy.

While contributions of any size are greatly appreciated, the following levels of annual giving have

been established for your consideration.

Friend of the Museum $100 Proctor Society $250 Damien Society $500 Galen Society $1,000

Name_________________________________ Specify gift amount________________________

Address ______________________________ City____________________Zip______________

Phone H_______________W____________ Email___________________________________

Employer name_____________________________________________for possible matching gift

Tributes in honor or memory of_____________________________________________________

Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502

The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax

deductible. A notice of your tax deductible contributions will be mailed to you annually.

Questions: Contact Lynn Harrelson @ 502-425-8642 or [email protected]

e.g., tracking down the source of the counterfeit Avastin® that recently made its way into the nation’s drug supply. Some of the factors the FDA will weight when deciding whether to pursue enforcement in a given case have been laid out by the agency this way: The intended use of the imported product is unapproved, and it is for a serious condition which has no

approved treatment in the U.S. There is no known commercialization or promotion of the product to U.S. citizens by those distributing the

product. The product is not deemed to pose an unreasonable risk. The individual affirms in writing that it is for personal use, supplies the name and address of the U.S.-

based physician responsible for supervising use of the product, or provides evidence the product being imported is for continuation of a treatment regimen begun abroad.

For the pharmacist an important consideration is that when patients procure medications from a foreign source they may be reluctant to report that to their local pharmacist or physician. Hence, those health profes-sionals may have an incomplete picture of the medications actually being used by the patient. Given the re-luctance of patients to volunteer such information and their hesitance to inquire about the desirability of drug importation from their trusted pharmacist who may be their traditional source for drug products and infor-mation about them, the local pharmacy practitioner may be unaware of the extent of such activities in his or her area.

Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief dis-

cussion of an issue or topic for educational or discussion purposes can adequately and fully address the mul-tifaceted and often complex issues that arise in the course of professional practice. It is always the best ad-vice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intrica-

cies of a specific situation, and render advice in accordance with the full information.

Submit Questions: [email protected]

May 2012


CPE Monitor

CPE MONITOR:

Change is coming By: Scott Sisco, Director of Communications and Continuing Education

Change can be good. Change can

be easy. Change can be challeng-

ing. Change can be scary, but it

doesn’t have to be.

CPE Monitor is a

change. For some phar-

macists and certified

pharmacy technicians

(yes techs, this includes

you), this is a welcome

change that will simplify

one aspect of your pro-

fessional life. For those

who are not as technol-

ogy friendly, this

change will require

some assistance from your tech-

savvy associates.

CPE Monitor was developed

through collaboration between the

Accreditation Council for Pharmacy

Education (ACPE) and the National

Association of Boards of Pharmacy

(NABP) to create an electronic sys-

tem for pharmacists and certified

pharmacy technicians to track com-

pleted continuing education credits.

Since the initial launch of the CPE

Monitor service in March 2011,

more than 93,100 pharmacists and

36,500 pharmacy technicians set

up NABP e-Profiles to prepare for

the shift to electronic tracking of all

ACPE-accredited CPE units.

The continuing education programs

you attend and journal articles you

read WILL NOT change. The Ken-

tucky Pharmacy Education and Re-

search Foundation (KPERF), and

all other ACPE CE Providers, will

continue to offer quality, education-

al programs. The way you earn

your CE will not change.

CPE Monitor only changes how the

certification of your CE is delivered.

No longer will you have to snail

mail a self-addressed stamped en-

velope with your journal answer

sheets. For those over-worked

pharmacists and technicians who

send in that last CE at the end of

the year, this eliminates the wait

time to receive the certificate in the

mail.

Instead, you will be able to go to

your computer and print out either

a list of the CE activities you com-

pleted or certificates for those activ-

ities. You won’t have to keep your

binder of certificates in your phar-

macy. If the Board of Pharmacy

audits your license, your CPE units

will be authenticated electronically

by the investigator.

You may have noticed the new

lines on the answer

sheets for the CE articles

in The Kentucky Pharma-

cist in 2012 requesting

NABP # and Birthdate.

These lines were added

in anticipation of

KPERF’s changeover to

CPE Monitor later this

year. And ladies, you only

have to provide month

and day on the birthdate.

We don’t have to know how old you

are, just the month and day you

were born. ALL ACPE Providers

will completely implement CPE

Monitor by the end of 2012 and will

be requiring this information.

Your first step in this process is to

sign up for your NABP eProfile ID

at www.nabp.net. Click on the CPE

Monitor logo, and it will take you to

the sign up page. NABP Customer

Service is available to answer your

questions at [email protected] or

on the telephone Monday through

Friday 9 a.m. to 5 p.m. Central

Time at 847-391-4406.

Watch this journal and email mes-

sages from KPhA for updates on

CPE Monitor. Updates will also be

posted at www.kphanet.org/

CPEMonitor.

http://www.nabp.net


May 2012


Pharmacy Technician Certification Board

May 2012


The Federal Agency for Healthcare Research and

Quality (AHRQ) launched a nationwide initiative to

raise awareness of patient-centered outcomes re-

search and to encourage its use. AHRQ provides

pharmacists, other clinicians and patients free re-

sources and tools that objectively summarize current

clinical evidence on various treatment methods to in-

form health care decision making. KPhA is partnering

with AHRQ to provide our members quick access to

these materials and to announce new products as

they become available.

Patient-centered outcomes research informs health

care decision making by comparing the evidence on

the effectiveness, benefits and harms of different

treatment options for common health conditions.

Many of the research studies compare medication

therapies used to treat a wide range of conditions,

including cancers, cardiovascular diseases and relat-

ed conditions, diabetes, arthritis and mental health

disorders.

In conducting systematic reviews, researchers synthe-

size the available evidence on drugs, medical devic-

es, tests, surgeries or ways to deliver health care. The

research findings are translated into practical re-

sources, including:

Clinician research summaries (most are two pag-

es)

Plain language patient research summary bro-

chures (in English and Spanish)

Accredited CME/CE modules (including several

accredited for pharmacists)

Faculty slide presentations

All of these tools are designed to encourage and sup-

port shared decision making between clinicians and

patients, with a goal of better care and increased pa-

tient satisfaction. Clinician materials provide clinical

bottom line information, citing research gaps, when

applicable. Patient materials are written in plain lan-

guage and contain an overview of the condition in ad-

dition to the comparative effectiveness information.

These unbiased resources can help pharmacists:

Identify issues to discuss with patients.

Talk about side effects.

Analyze treatments and assess benefits and

harms for patient outcomes.

Examples of currently available titles include:

Treating Cholesterol With Combination Therapy

Comparing Medications for Adults With Type 2

Diabetes

ACEIs, ARBs or DRI for Adults With Hypertension

Analgesics for Osteoarthritis

To view or download AHRQ resources, visit

www.EffectiveHealthCare.ahrq.gov. To order free

printed copies of the clinician or patient research sum-

maries, including bulk quantities, call the AHRQ Publi-

cations Clearinghouse at 1-800-358-9295 and provide

the code C-02.

For more information about this initiative, contact Vic-

toria McGhee in AHRQ’s Atlanta Regional Office at

404-836-2303 or [email protected].

KPhA partners with AHRQ to offer

free resources for members, patients

Watch your email box for updates on

new information in eNews!

Agency for Healthcare Research and Quality

May 2012


You MUST sign up for a NABP

e-Profile ID to receive CE credit from KPERF

or any other ACPE Provider.

Visit www.kphanet.org/CPEMonitor for more.

Pharmacy Time Capsules 1987—Twenty-five years ago:

Petition requesting recognition of Nutrition Support Pharmacy Practice as a specialty was submitted to the Board of Pharmaceutical Specialties.

1962—Fifty Years Ago:

New England College of Pharmacy affiliated with Northeastern University.

The Indian Hospital at Crow Agency, Montana began filling outpatient pre-scriptions directly from the patient’s medical record. This was eventually adopted throughout the Indian Health Service.

1937—Seventy-five Years Ago:

National Cancer Institute was established to conduct and support research relating to the cause, diagnosis, and treatment of cancer.

1912—One hundred Years Ago:

Public Health and Marine Hospital Service was renamed the Public Health Service (PHS) and the mission was expanded to include communicable diseases field investigations, navigable stream pollution, and infor-mation dissemination.

APhA House of Delegates was established as a forum for all branches of the profession to have a voice.

By: Dennis B. Worthen

Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH

One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America's history. Mem-bership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more

historical publications to your door each year. To learn more, check out: www.aihp.org

Pharmacy Time Capsules

http://www.aihp.org

May 2012


NASPA Leadership Conference

President-Elect Kimberly Croley and

Executive Director Robert McFalls at-

tended the National Alliance of State

Pharmacy Association Leadership Con-

ference sponsored by Pharmacists Mu-

tual Companies April 29-May 1 at U.S.

Pharmacopeia in Rockville, Md. Associ-

ation directors and president-elects

learned leadership skills and shared

ideas to solve problems faced by many

of the state pharmacy associations.

Pictured are leaders from Georgia, Ex-

ecutive Jim Bracewell and President-

Elect Robert Hatton; Alabama Execu-

tive Louise Jones; NCPA President-

Elect Donnie Calhoun; and McFalls and

Croley.

KPhA at NASPA Leadership Conference

sponsored by Pharmacists Mutual Companies

UKCOP student shares study-abroad experience

Katy Monson, a fourth-year pharmacy and MPA stu-

dent in the Martin School of Public Policy & Admin-

istration at the University of Kentucky, is studying on

a six week experiential education rotation in Ecuador.

She is blogging about her experiences there -

http://pharmdstudentinecuador.blogspot.com/.

KPhA sends email announcements weekly.

If you aren’t receiving:

eNews, Legislative Updates, Grassroots Alerts and

other important announcements, send your email

address to [email protected] to get on the

distribution list.

http://pharmdstudentinecuador.blogspot.com/

May 2012


KPhA Government Affairs

Contribution

Name: _________________________________ Pharmacy: ___________________________________

Address: ____________________________________________________________________________

City: _______________________________________________ State: _________ Zip: ____________

Phone: ________________ Fax: _________________

E-Mail: ______________________________________________________

Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)

Credit Card (AMEX; Discover; MasterCard; VISA)

Account #: ____________________________________________________ Expiration date: _______

Address to which credit card statement is mailed (if different from above)

___________________________________________________________________________________

Mail to: Kentucky Pharmacists Association

1228 US Highway 127 South Frankfort, KY 40601

Support the Candidates who Support YOU!

Make your Donation Today!

KPhA Government Affairs Contribution

May 2012


June 2012 CE—Reducing the Burden of Adverse Drug Events

Reducing the Burden

of Adverse Drug Events By: Lewis Wilkerson, PharmD, CGP

M. Trent Blacketer, MBA, PharmD candidate at University of Kentucky College of Pharmacy

There are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity # 0143-9999-12-005-H04-P

1.0 Credit Hours (0.1 CEUs)

Objectives

- Discuss the scope of Adverse Drug Events in practice and the importance of prevention - Identify the drug classes most at risk for Adverse Drug Events - Assess patient characteristics that may increase the risk for Adverse Drug Events - Recognize the need for complete patient analysis

KPERF offers all

CE articles to

members online at

www.kphanet.org

Background

Adverse Drug Events (ADEs) are one of the leading

causes of preventable morbidity in our healthcare

practices. A review of studies assessing the incidence

of ADEs in inpatient and outpatient settings reveals

disturbing results for providers. The median ADE prev-

alence rate was 9.5 percent within analysis of pro-

spective studies. ADEs have the potential to elevate

costs within the healthcare system as well, most nota-

bly when leading to unnecessary hospitalizations.

Studies have shown that nearly 5 percent of ADEs will

lead to an additional hospitalization for our patients.1, 2

It has also been exposed that more than 20 percent of

all ADEs could have been prevented if medications

were prescribed and monitored correctly. Prevention

and timely recognition of potential ADEs will help to

improve patient and medication safety within our prac-

tices.3,4

This article will discuss drug classes common-

ly leading to ADEs, as well as patient characteristics to

make ourselves more aware of, in hopes of decreas-

ing the troubling ADE rates encountered today.

Common Drug Class Offenders

A substantial portion of the ADEs encountered by pro-

viders are caused by a limited number of drug classes.

Analgesic, cardiovascular, and hypoglycemic agents

combine to account for more than 85 percent of ADEs.

Opioids and NSAIDS are the obvious offenders in the

analgesic class. Many cardiovascular agents have a

high potential to cause ADEs ranging from diuretics to

anticoagulants. Some diabetic agents merit concern

due to their potential for hypoglycemia. Hypoglycemic

agents do not result in a large majority of the ADEs

that we come across, but a higher percentage of the

events are of serious nature and therefore lead to

more hospitalizations. This explains why they are in-

cluded on most high-risk drug lists. Table 1 lists drug

groups that most commonly led to ADEs in a recent

prospective study.5

As illustrated in the table, NSAIDs should be of utmost

concern for pharmacists when verifying and monitor-

ing patient therapies. Past histories of bleeding or ul-

ceration, as well as potential for renal impairment, are

important factors to be proactive about when providing

care for patients. The other drug group of high con-

cern with nearly 30 percent of ADE cases is diuretics.

Over- or under-diuresing a patient can lead to a num-

ber of avoidable effects, such as hypotension or elec-

trolyte imbalances. Stressing the importance of accu-

rate dosing and frequency of diuretics are necessary

steps in preventing negative outcomes.5

The potential ADE risk drops significantly for anticoag-

ulants when compared to the NSAIDs and diuretics.

This is most likely due to the attitude that clinicians

May 2012



have adopted regarding warfarin monitoring. The

medication itself is just as dangerous, if not more so

compared to the aforementioned drug groups, but

comprehensive anticoagulant follow-up has become

standard practice today. This likely decreases the

amount of ADEs that warfarin causes and is a testa-

ment to the effect that pharmacists contributions can

have.

The remainder of the drug classes noted in the study

caused less than 10 percent of the total reported

ADEs.5 The data in Table 1 clearly demonstrates that

a small subset of the total number of drug groups lead

to an overwhelming majority of the ADEs that we en-

counter within our healthcare practices. By digesting

this evidence based knowledge and using it to direct

our efforts toward these concerning classes, the total

number and impact of ADEs could be significantly re-

duced. Assessing the appropriateness of medications

within these drug classes is a great place to start. Al-

ways be alert and consider if the benefits outweigh

the risks before exposing patients to the potential

harmful effects of medications.

Patient Characteristics Predicting Risk

Now that we have discussed which drug classes are

most likely to lead to ADEs, we next must determine

which patients have the highest potential for develop-

ing ADEs. Focusing on statistics regarding patient

demographics helps signify what a high-risk patient

may appear like to us as healthcare providers.

ADEs vary widely in prevalence between different age

groups. A review of multiple studies, looking at differ-

ent age brackets, found that the median prevalence

rates ranged from 2.45 percent for children, to 5.27

percent for adults, and up to 16.1 percent for the el-

derly population. Pediatric patients normally have a

lower patient/healthcare provider ratio and are always

under close supervision, which explains their lower

rate of ADEs. Additionally, the trend shows that as a

patient becomes older they seem to be more suscep-

tible to ADEs.6 As providers, we need to recognize

this and prioritize our elderly patients in order to pre-

vent their higher ADE rates. The Beers’ criteria are a

great resource for clinicians to use for uncovering po-

Table 1: Drug Groups Commonly Leading to Adverse Drug Events

Drug group percent of ADE

cases Individual drugs Adverse reactions

NSAIDs 29.6 Aspirin, diclofenac, ibu-profen, rofecoxib, celecox-ib, ketoprofen, naproxen

GI bleeding, peptic ulceration, haemor-rhagic cerebrovascular accident, renal impairment, wheezing, rash

Diuretics 27.3 Furosemide, bumetanide, spironolactone, amiloride, metolazone, indapamide

Renal impairment, hypotension, elec-trolyte disturbances, gout

Anticoagulants 10.5 Warfarin GI bleeding, haematuria, high INR, haematoma

ACE inhibitors/ARB 7.7 Ramipril, enalaparil, cap-topril, lisinopril, irbesartan, losartan

Renal impairment, hypotension, elec-trolyte disturbance, angioedema

Antidepressants 7.1 Fluoxetine, paroxetine, amitriptyline, citalopram, lithium, venlafaxine

Confusion, hypotension, constipation, GI bleed, hyponataemia

β blockers 6.8 Atenolol, propranolol, so-talol, bisoprolol, metopro-lol, carvedilol

Bradycardia, heart block, hypotension, wheezing

Opiates 6.0 Morphine, dihydrocodeine, tramadol, fentanyl

Constipation, vomiting, confusion, uri-nary retention

May 2012



tential medication threats in elderly patients. The re-

cently updated criteria can be found on The American

Geriatrics Society website, which is linked in the refer-

ences section .10

Patient demographics other than age do not tend to

reveal such dramatic statistical variances with respect

to ADE rates, but there are some others worth noting.

With respect to gender, females tend to present with

more ADEs in comparison to males. One specific study

focusing on ADEs leading to emergency room visits

found that 60 percent of all ADEs are from the female

population.7 This could be attributed to differing severity

tolerance levels of the events. Race is also a demo-

graphic that has shown to present with differing ADE

rates. Non-Hispanic whites tend to have the lowest

ADE rates, with Hispanics and Blacks having a higher

adjusted risk ratio.8

Past medical history is a characteristic of patient health

that can further inform providers of possible ADE risks.

Comorbid disease states are too often overlooked

when dispensing and monitoring a patient’s therapy.

Medications that are beneficial in treating one condition

can be extremely dangerous when exposed to a patient

with secondary conditions. Secondary disease states

such as cancer or even an acute infection can signifi-

cantly alter the pharmacokinetics of drug therapies.11

Analyzing how comorbid disease states may affect

medications in our patients will undoubtedly reduce the

occurrence of ADEs in our practices.

Another section of patient health that is frequently

skipped over when reviewing for potential ADEs is so-

cial history. Diet and exercise routines, as well as to-

bacco and recreational drug use, are important aspects

to be informed about for proper medication evaluation.

It is well known that certain food and supplements have

the potential to cause drug interactions, yet practition-

ers monitoring regimens often have no knowledge re-

garding their patients diets. Vigorous exercise has the

potential to alter metabolism and excretion of medica-

tions. Additionally, knowing about a patients tobacco

and recreational drug use is extremely valuable when

assessing therapies, especially concerning cardiovas-

cular agents. Social history can sometimes seem like

insignificant information, but the risk for ADEs can defi-

nitely be affected by our patients daily habits.

Another key to assessing patient’s for adverse drug

events is to do a thorough medication review. This in-

cludes medications that they might obtain via another

pharmacy, samples, and OTC’s or supplements. Phar-

macists should also be on the alert when patients have

multiple prescribers as this increases the risk of poten-

tial drug-drug or drug-disease interactions and potential

adverse events.

Health literacy is not often a topic associated with re-

ducing ADEs, but many health safety experts believe it

should be. Recent studies have shown that around 20

percent of Americans read at or below a fifth grade

level, yet package inserts and other health information

data are often written at or above the 10th grade level.9

It is reasonable to assume that many ADEs could be

prevented if patients simply understood what their med-

ications are for and exactly how and when they are

supposed to use them. Understanding the health

literacy gap between providers and patients, and taking

steps to assure patients are well informed about their

regimens may result in reductions in ADEs.

Conclusion

Improving health safety and decreasing the burden of

ADEs for patients requires constantly addressing medi-

cation risks versus benefits. We must not only deter-

mine the appropriateness of physicians prescribing de-

cisions, but also focus on recognizing and preventing

unseen ADEs before they occur. Simply glancing over

a patient’s profile for drug interactions needs to be-

come a routine of the past. Instead, we need to im-

prove quality and outcomes by actively monitoring,

managing, and reassessing all aspects of our patients

health. Diminishing the prevalence of ADEs will elimi-

nate the excess costs from our healthcare system and,

most importantly, improve our patients’ lives.

References

1. Miller GC, Britth HC, Valenti L. Adverse drug events in general practice patients in Australia. Med J Aust. 2006 Apr 3;184(7):321-4.

2. Thomsen LA, Winterstein AG, et al. Systematic re-view of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharma-cother. 2007 Sep;41(9):1411-26. Epub 2007 Jul 31.

3. Kanjanarat P, Winterstein AG, et al. Nature of pre-ventable adverse drug events in hospitals: a literature review. Am J Health Syst Pharm. 2003 Sep 1;60(17):1750-9.

May 2012



4. Von Laue NC, Schwappach DL, et al. The epidemi-ology of preventable adverse drug events: a review of the literature. Wien Klin Wochenschr. 2003 Jul 15;115(12):407-15.

5. Pirmohamed M, James S, et al. Adverse drug reac-tions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ. 2004 July 3; 329(7456): 15–19.

6. Tache SV, Sonnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systemic review. Ann Pharmacother. 2011 Jul;45(7-8):977-89. Epub 2011 Jun 21.

7. Sikdar KC, Alaghehbandan R, et al. Adverse drug events in adult patients leading to emergency depart-ment visits. Ann Pharmacother. 2010 Apr;44(4):641-9.

Epub 2010 Mar 16.

8. Metersky ML, Hunt DR, et al. Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring Pro-gram. Med Care. 2011 May;49(5):504-10.

9. Safeer RS, Keenen J. Health literacy: the gap be-tween physicians and patients. Am Fam Physician. 2005 Aug 1;72(3):463-8.

10. The American Geriatrics Society. AGS Beers Cri-teria pocket card. http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf.

11. GR Robertson, C Liddle, SJ Clarke. Inflammation and Altered Drug Clearance in Cancer: Transcription-al Repression of a Human CYP3A4 Transgene. Clini-cal Pharmacology & Therapeutics (2008); 83, 6, 894–897.

June 2012 — Reducing the Burden of Adverse Drug Events

1. What was the median ADE prevalence rate within the analysis of prospective studies discussed in the article?

A. 5.4 percent

B. 9.5 percent

C. 14.0 percent

D. 25.5 percent 2. What percent of ADEs are found to lead to additional hospitalizations?

A. 1 percent

B. 3 percent

C. 5 percent

D. 12 percent 3. What percent of ADEs have the potential to be pre-vented if monitored correctly?

A. 5 percent

B. 10 percent

C. 15 percent

D. 20 percent

4. Which three drug classes account for over 85 percent of all ADEs?

A. oncologic, antipsychotic, cardiovascular

B. hypoglycemic, immunosuppressant, oncologic

C. analgesic, cardiovascular, and hypoglycemic

D. analgesic, antipsychotic, cardiovascular

5. Which two drug groups each account for more than 25 percent of the total ADEs respectively?

A. NSAIDs and diuretics

B. antidepressants and anticoagulants

C. opiates and diuretics

D. β blockers and NSAIDs

6. What should every healthcare provider conclude be-fore exposing patients to the potential harmful side ef-fects of medications?

A. Side effects are mild in nature

B. Benefits will outweigh risks

C. Patient is a non-smoker

D. Patient has no other common disease states

7. Which age group tends to encounter ADEs at the highest rate?

A. Infants

B. Pediatrics

C. Adults

D. Elderly

8. True or False: Males present with more ADEs than females.

A. True

B. False 9. Which race demographic has the lowest ADEs rates?

A. Asians

B. Blacks

C. Hispanics

D. Non-Hispanic Whites

10. Health information data is often written at or above which grade level?

A. 3rd grade

B. 6th grade

C. 10th grade

D. 12th grade

May 2012



June 2012 — Reducing the Burden of Adverse Drug Events Universal Activity # 0143-0000-12-006-H04-P PHARMACISTS ANSWER SHEET Name ________________________________________________ KY Lic. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B 10.A B C D Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________

NABP #_________________________________ Birthdate _______________________(MM/DD)

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. The fee for duplicate certificates is $5. Please send a self

addressed, stamped envelope to KPERF, 1228 US 127 South, Frankfort, KY 40601.

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.

Expiration Date: May 15, 2015 Successful Completion: Score of 80 percent will result in 1.0 contact hours or 0.1 CEUs.

Participants who score less than 80 percent will be notified and permitted one re-examination.

June 2012 — Reducing the Burden of Adverse Drug Events TECHNICIANS ANSWER SHEET. Universal Activity # 0143-0000-12-006-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ________________________________________________________________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B 10.A B C D Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature _________________________________________________ Date _________________________________

NABP #_________________________________ Birthdate _______________________(MM/DD)_

May 2012


Student Perspective at APhA

APHA ANNUAL CONFERENCE—THE STUDENT PERSPECTIVE

APhA Annual Meeting and Exposition Not Just for Practicing Pharmacists

By: Amanda Jett, Sullivan University College of Pharmacy PharmD Candidate 2013

This was not my first APhA Annual Meeting. With that being said, my expectations of what I would learn were not as high as when I attended last year’s meeting in Seattle. Having served as the President of the Sullivan University College of Pharmacy’s chapter of APhA-ASP for almost a year, I thought I was pretty well set in my knowledge of how to run a chapter, ideas for member recruitment, how to get members interested and involved in advocacy, as well as all of the other responsi-bilities that come with being a chapter president. However, when I arrived in New Orleans and attended the first ASP workshop, I immediately knew it was going to be a long and exhausting, yet extremely rewarding weekend.

Despite the meeting occurring during finals week, SUCOP was able to send four members of our current Executive Committee to New Orleans. The first event we attended was the Executive Committee Leadership Workshop, sponsored by Tar-get. At this workshop national leaders from Target spoke on ways of effective communication within an organization and addressed the issue of smart decision-making. Questions based on hypothetical business scenarios were posed to the chapter committees, and groups had to work together to come up with acceptable answers. While it seemed as though this workshop was geared more toward leading a business, it still challenged our group to communicate with each other and make decisions that would affect our “business.”

The four of us then went our separate ways to attend our respective positions’ workshops. Although I attend-ed the President-Elect workshop last year, I went again with my current President-Elect to share examples of what our chapter has accomplished over the past year. I was sure that I would receive the same information and ideas that were discussed previously, and that this would be a waste of an hour and fifteen minutes. While our chapter has been very successful in recruiting and maintaining members this year – due in part to the ideas I received at the last APhA Annual Meeting – we took pages and pages of notes on ways that other chapters recognize outstanding members and boost morale. We were even able to share some of our ways to make sure that committee leaders can be held accountable for responsibilities and deadlines of which oth-er chapters had not thought. The other members of our group came back from their workshops with some great ideas as well to implement next year.

My favorite portion of the meeting was the House of Delegate sessions and the meetings on proposed resolu-tions. These events gave our chapter members an opportunity to hear several of the current issues surround-ing our profession, our education and the way in which pharmacists interact with other healthcare providers. Again, we were challenged to sit down together and discuss what we as a chapter felt were the best deci-sions to make to lead the future of our profession. Even though most groaned when they were told to attend a three-hour session, I could tell by the end of the weekend that the House of Delegates sessions were others’ favorites as well, as it was exciting to watch our chapter’s opinion of an issue be supported or opposed.

Although I will not be leading our chapter next year, I am still excited to see the progress our new executive committee will make having had an opportunity to attend the APhA Annual Meeting. After returning from this trip, I believe that you cannot attend too many of these types of events, as they all have something unique and new to offer.

Editor’s Note: Amanda

is a recipient of the Dr.

Ralph Bouvette KPhA

Student Leadership

Institute Scholarship to

attend the APhA Annual

Conference.

May 2012


Pharmacy Technicians

I teach an annual 5-month pharmacy technician certifi-cation class for GrandView Pharmacy, which is cur-rently in session. One of the questions I receive from prospective students, employees or from the public, is, “Why do I need to be certified?” “What’s in it for me?” While many answers have come to mind, over the years, I have gleaned down my responses to those below. Certification is a quality indicator. Indiana currently does not require a pharmacy techni-cian to become certified, only licensed*. Many states, 17 in total (34 percent of the US), require certification by one of the certifying bodies. However, whether or not you need to be certified to work in your state is im-material, because certification is about so much more than entrance into your profession—it’s a very clear way to demonstrate to employers, customers and peers that your professional knowledge and skills meet nationally recognized standards. In discussions with hundreds of pharmacists in the last five years, all have commented on how much they rely on their certified technicians because of the level of knowledge and credibility they bring into the clinical practice. Dr. Lisa O’Hara, Director of Pharmacy Services at GrandView Pharmacy, states, “Any technician that is willing to learn to the level of national certification exemplifies a commitment to personal growth. Individuals that are committed to personal growth do better work. I need to know that the pharmacy technicians that I trust with my license are willing to go to that level”. Certification leads to increased job prospects. The employment rate for pharmacy technicians is ex-pected to increase 31 percent by 2018.** What’s also interesting about this promising number is that, as the Bureau of Labor Statistics notes, “job prospects are expected to be good, especially for those who are cer-tified.” Essentially, adding a CPhT designation to your resume can mean having an advantage in the job mar-ket when it comes to finding a job, commanding a high-er salary and being considered for promotions. Certification increases patient care. Another important reason to consider certifying is be-cause of the effect it can have on the quality of patient care you provide. As a pharmacy technician, one of

your main duties is to prepare prescription medications under the supervision of a licensed pharmacist. These medications are critical to the management of a vast array of conditions, and staying on top of the latest technological advances in pharmaceuticals can prove critical to how well you serve your customers. Once you become a certified pharmacy technician, you will re-certify every two years. The continuing education requirement requires you to keep up with the changes in our industry that occur every day. You must com-plete a minimum of 20 hours of continuing education with at least one hour in pharmacy law. This continued learning can facilitate the extended pharmaceutical knowledge that will prove valuable to your patients. Certification is attainable. You can choose to prepare for the certification exami-nation in one of three ways—on your own with study material you’ve purchased from an organization, at work in an employer-sponsored training program or through a pharmacy technician program at an accredit-ed school. Pharmacy technician programs typically range from six months to two years, depending on which level of education you pursue (certificate, diplo-ma, or associate’s degree). Through classroom instruc-tion and hands-on laboratory experience, you can learn everything from pharmaceutical calculations, terminolo-gy, and recordkeeping to the laws and ethics related to the pharmacy technology field. Many of these pro-grams also include internships in professional pharma-cies, which provide you with a valuable opportunity to practice your skills and network with potential employ-ers. Certified pharmacy technicians collaborate as co-professionals with pharmacists to ensure that the medi-cations dispensed in a variety of practice settings are of the highest quality in the most efficient ways possi-ble. Pharmacists depend on CPhTs to help them serve their patients. CPhTs increase quality while earning more money than their uncertified counterparts. The decision is easy and the path clear, now go get certi-fied! * Kentucky requires technicians to register with the Kentucky Board of Pharmacy. ** Bureau of Labor Statistics, U.S. Department of Labor, Occupa-tional Outlook Handbook, 2010-11 Edition, web site accessed on Nov. 12, 2010.

Why Do I Need To Be Certified? What’s In It For Me?

Article written by Mark Prifogle, 2011 President of the Indiana Academy of Pharmacy Technicians (IAPT), an academy of the Indiana Pharmacists Alliance (IPA). Reprinted with permission. Original article appeared in the Indiana Pharmacist (Vol. 92, No. 3), third quarter, 2011.

May 2012


McWhorter School of Pharmacy

May 2012


Pharmacy Policy Issues

PHARMACY POLICY ISSUES: Behind-the-Counter (BTC) Medication - A New Third Class

By: Tam N. Ho

Author: Tam N. Ho is a 2012 Pharm.D. graduate of the UK College of Pharmacy who is now practicing

pharmacy with RiteAid. A native of Ho Chi Minh City, Viet Nam, she earned a B.S. in Biology at the University of Kentucky prior to beginning pharmacy school.

Issue: Should a new category of medications be established based on an intermediate level of consumer access?

Discussion: The nomenclature “Behind-the-Counter” (BTC) signifies an intermediate class of medications that falls between the relatively more widely established classes of prescription medications and over-the-counter (OTC) medications. Consumers can purchase BTC medications without the need to visit a physician; however, a pharmacist’s intervention is required prior to dispensing of any BTC products. The concept of an in-termediate drug class was established in an effort to mitigate controversial issues surrounding the potential for improper use of medications such as pseudoephedrine, Plan B, and dextromethorphan by patients, where such products were previously available OTC or by prescription.

This third class of medications (BTC) has found widespread use interna-tionally in Europe, and in countries such as Australia, Canada and New Zealand. International implementations of BTC programs highlight the po-tential need to establish an official third class of medications in the United States. Specific drug products that have been suggested for inclusion in BTC programs in the United States are medications that treat chronic con-ditions such as asthma, diabetes, hypercholesterolemia, hypertension, osteoporosis and urinary inconti-nence.

Arguments for and against the relatively new concept of a category of BTC medications are numerous. Pro-ponents for a third class of medication (i.e., proponents for BTC programs) assert that such implementations could increase drug availably to patients, especially those patients from underserved populations, e.g., those who are uninsured, underinsured and those with limited access to primary care providers. Further, within the context of administering BTC products, it is argued that pharmacists are well qualified to do so, given that pharmacists generally possess thorough knowledge of drug information. Additionally, pharmacists have typi-cally undergone patient-focused training. With increased interaction between pharmacists and patients through BTC programs, increases in patient adherence rates and ultimately improved health outcomes are anticipated.

Opponents argue that the adoption of the BTC classification for administering selected medications could potentially decrease drug availability to consumers, especially if there is a lack of adequate communication regarding which medications are available through the BTC program. Also, there are concerns that since community pharmacists are generally fully occupied while managing the activities in the pharmacy, fulfillment of such duties may not leave sufficient time to provide high quality intervention services to patients. Lastly, it is argued that BTC programs may lead to patients not being treated properly, i.e., treated for symptoms while undue attention is not provided to treating the underlying illness.

Have an Idea?:

This column is designed to address timely and practical

issues of interest to pharmacists, pharmacy

interns and pharmacy technicians with the goal

being to encourage thought, reflection and exchange

among practitioners. Suggestions regarding topics

for consideration are welcome. Please send them

to [email protected].

May 2012


Pharmacy Policy Issues

Do you have a

story to tell?

Coming in future editions of

The Kentucky Pharmacist

My Story: A Profile of a

KPhA Member

The Kentucky Pharmacists Association is

looking for members with a story to tell.

Have a patient success story to share?

Find a new way to provide a service to the

community?

What makes you stand out in a crowd?

Why did you become a pharmacist?

If you would like to be featured in The

Kentucky Pharmacist, email Scott Sisco at

[email protected] with a brief descrip-

tion of your story.

WANTED:

Blood Glucose Test Strips

I buy unopened, unexpired

diabetic test strips.

The following brands are what I look for

Accu Chek Aviva

Accu Chek Compact Accu Chek Active plus

Bayer Contour Bayer Breeze2 Freestyle lite

One Touch Ultra Blue

Please contact Tim at Green Horseshoe Healthcare

at 502 287 2763.

Check the KPhA website for

registration forms and more

information updates on the

134th KPhA Annual Meeting www.kphanet.org/2012annualmeeting

Prior to the implementation of BTC classifications, some issues pertaining to costs, pharmacists and infra-structure must be addressed. Pharmacist-related issues include defining the role, responsibility, liability and additional training that may be required. Potential cost-related issues include insurance coverage for such products, reimbursement for pharmacists’ services, and possible out-of-pocket cost for consumers. Last, in-frastructure-related issues include providing sufficient lab data regarding patient health status with due regard for patient privacy.

May 2012


KPhA Academy of Consultant Pharmacists -KY ASCP CE Event

KPhA's Academy of Consult-

ant Pharmacists and the

Kentucky Chapter of ASCP

held a joint continuing educa-

tion program, April 29, 2012

at the Kentucky Renaissance

Pharmacy Museum. Several

new members were added to

both the KY-ASCP Chapter

and KPhA's Academy. The

group raised several hundred

dollars for the Museum. The

meeting organizers, Leah

Tolliver, Jason Baker, Rob

Godwin and Kim Croley,

hope that this meeting will

spark a Renaissance in op-

portunities to educate and

learn how the practice of

consultant pharmacy can

positively influence the

health of all Kentuckians!

Long Term Care

Continuing Education

For more information

For KY-ASCP Chapter: http://www.kyascp.com

Or contact: Leah Tolliver at [email protected] or (859) 333-4748

For KPhA Academy: Go to http://www.kphanet.org

Photos by

Jason and Jennifer Baker

http://r20.rs6.net/tn.jsp?et=1109638860351&s=4387&e=001diwULEtMYwBjF1JxMWcaj0RJMg3E1KmVTENMqdc0Ud_TRQHNJyeJcsmswG--RZWYSzeZA7ZZxwq0U0IcYYhZuOP723mHPpbt9RIWwECHJHEhcy_P_cwJxA==


http://r20.rs6.net/tn.jsp?et=1109638860351&s=4387&e=001diwULEtMYwAjFhuxPyZDyd74FGnE8DhQTGeUfHUx3v5CFefIPe6B4QmrLN4GKSElXPhOVAv0RO0yYrvs6bwDDU8Y7_YTF8sBtVVzKOeEj9SY4XNps3pXtQ==

May 2012


Pharmacists Mutual Companies

May 2012


KPhA BOARD OF DIRECTORS

Clay Rhodes, Louisville Chairman

[email protected] 502.476.1796

Lewis Wilkerson, Frankfort President


Frankie Hammons, Barbourville Secretary


Duane Parsons, Richmond Treasurer


Kimberly Croley, Corbin President-Elect


Leon Claywell Past President

[email protected]

Kelley Ratermann Student Representative

[email protected]

Amanda Jett Student Representative

[email protected]

Amanda Burton, Lexington

[email protected]

Chris Clifton, Erlanger

[email protected]

Trish Freeman, Lexington

[email protected]

Joey Mattingly, Prospect

[email protected]

Matt Martin, Louisville

[email protected]

Jeff Mills, Louisville

[email protected]

Glenn Stark, Frankfort

[email protected]

Sam Willett, Mayfield

[email protected]

Leah Tolliver, Lexington

[email protected]

Richard Slone, Hindman

[email protected]

HOUSE OF DELEGATES

Tyler Whisman, Florence Speaker of the House

[email protected]

Matt Martin, Louisville Vice Speaker of the House

[email protected]

KPERF ADVISORY COUNCIL

Ann Amerson, Lexington

[email protected]

Kim Croley, Corbin

[email protected]

KPhA/KPERF HEADQUARTERS

1228 US 127 South, Frankfort, KY 40601

502.227.2303 (Phone) 502.227.2258 (Fax)

www.kphanet.org

www.facebook.com/KyPharmAssoc

www.twitter.com/KyPharmAssoc

Robert McFalls

Executive Director

[email protected]

Matt Worthy, PharmD

Director of Professional & Clinical Services

[email protected]

Scott Sisco

Director of Communications and Continuing Education

[email protected]

Kelli Sheets

Office Manager

[email protected]

Christine Richardson, PharmD

Clinical Pharmacist

[email protected]

Darcie Nixon

Administrative Coordinator & Billing Specialist

[email protected]

Nancy Baldwin

Receptionist/Office Assistant

[email protected]

KPhA Board of Directors

May 2012


Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org Kentucky Society of Health Systems Pharmacists 1501 Twilight Trail Frankfort, KY 40601 (502) 223-5322 www.kshp.org

Kentucky Regional Poison Center (800) 222-1222

American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org

National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 [email protected]

Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu

Frequently Called and Contacted

Frequently Called and Contacted

KPhA Remembers KPhA desires to honor members who are no longer with us.

Please keep KPhA informed by sending this information to [email protected].

Deceased members for each year will be honored permanently at the KPhA office with a White Coat.

KPhA Classifieds

Western Kentucky Pharmacist available for relief/part-time work. Experienced in retail, long-term care, home IVs, hos-pital and consulting. Willing to drive. Respond to The Ken-tucky Pharmacist ([email protected]) or cell (270-625-2434.)

Director of Pharmacy

75-bed hospital in South-central KY seeking pharmacist director. Doctorate of Pharmacy or 10 years experience as Registered Pharmacist. KY license. Hospital experience, preferred. Ability to develop/implement policies/processes consistent with hospital, state and federal regulatory guide-lines and maintain continuous compliance. Email [email protected] resume and salary require-ments.


May 2012


THE

Kentucky PHARMACIST

1228 US 127 South

Frankfort, KY 40601


June 13-16, 2012

Griffin Gate Marriott Resort and Spa

Lexington, KY

Visit www.kphanet.org for updates.

Look inside for a tentative schedule!

the kentucky pharmacist vol. 7, #3

Documents

kentucky pharmacy education

profession of pharmacy

field of pharmacy

pharmacy time capsules

pharmacy policy issues

pharmacy law brief

mcwhorter college of

kpha members