AJP Fall 2018

Arizona Journal of Pharmacy OFFICIAL PUBLICATION OF ARIZONA PHARMACY ASSOCIATION | FALL 2018

True Power Obtained Through Weakness: The Story of a Pharmacy Student in PAPA Pharmacists Can Help Care Teams Meet Quality Measures

Jessica Dileo

PharmD, BCACP, BCGP AzPA President 2018–2019 “The only way we can continue to grow and advance as a profession is if we join together to enact change. Who is with me!?”

ave S Date

2019 Spring Clinical February 22–24, 2019 Four Points by Sheraton Phoenix South Mountain 10831 S. 51st Street Phoenix, AZ 85044

2

FALL 2018

More information will be available soon at www.azpharmacy.org

CONTENTS

BOARD OF DIRECTORS 2018–2019 OFFICERS President Jessica DiLeo President Elect Virginia Boomershine Past President Keith Boesen Treasurer Lisa Tonrey Secretary Jacob Schwarz

DIRECTORS AT LARGE Community Jaime Von Glahn Health Systems Aimee (Keller) Itaaehau Technician Kevin Reger Directors at Large Patrick Hryshko Laura Moore Nancy Costlow Amy Kennedy Lanre Kolawole Sienna Miller Liason Justin Spicer Midwestern University Student Chapter Liaison Kassie Notbohm University of Arizona Student Chapter Liaison Mitchell R. Emerson Dean Midwestern University CPG Rick G. Schnellmann Dean University of Arizona COP-Tucson John Murphy Associate Dean University of Arizona COP-Phoenix Roger Morris Legal Counsel AzPA STAFF Chief Executive Officer Kelly Fine Operations Cindy Esquer Accounting Cindy Younger Continuing Education Kathy Harty Administrative Assistant/Membership Taylor Daly EDITOR Kelly Fine, RPh, FAzPA MANAGING EDITOR Cindy Esquer EDITORIAL BOARD Lindsay Davis Whitney Rice Andrea Burns Christi Jen Nicole Scovis CREATIVE COORDINATOR Elizabeth Nelson, CAE The interactive digital version of the Arizona Journal of Pharmacy is available for members only online at www.tinyurl.com/azjournal (480) 838-3385 web@azpharmacy.org EDITOR’S NOTE: Any personal opinions expressed in this magazine are not necessarily those held by the Arizona Pharmacy Association. “Arizona Journal of Pharmacy” (ISSN 1949-0941) is published quarterly by the Pharmacy Network of Arizona at: 1845 E. Southern Avenue, Tempe, AZ 85282-5831.

COVER STORY

Jessica Dileo

PharmD, BCACP, BCGP

p5

AzPA President • 2018–2019

President’s Message 6

p14

AzPA News Member Mentions 6 Save the Date 7 Welcome New Members 10 University & Alumni News 18

Editorial Pharmacy Time Capsule 13

p16

Legislative Update 2018 14 True Power Obtained Through Weakness 16 Pharmacists Can Help Care Teams Meet Quality Measures 21 Paracetamol vs Indomethacin & Ibuprofen in the Treatment of Patent Ductus Arteriosus (PDA) in Preterm Infants 23

Advocacy Arizona State Board Pharmacy Updates 11

Continuing Education Uncovering Hidden Risks with Serious Consequences in Your Workflow 27

p23

In a world where our patients’ health requires the best in care,

PTCB CHOOSES

EXCELLENCE. ptcb.org

PTCB is the leading certifying body for pharmacy technicians.

We are most trusted. All 50 states, DC, Guam, and Puerto Rico accept PTCB Certification. We are the only certification that is nationally accepted.

We specialize in pharmacy technicians. Our sole focus is on certifying technicians for their many roles across pharmacy settings.

We have nothing to hide. Our Pharmacy Technician Certification Exam (PTCE) is challenging, and we publish extensive detail about the exam.

We are informed by research.

We rely on evidence to evaluate the PTCB Program and strengthen its value.

Patient safety demands rigor.

®

Choose PTCB. Choose Excellence.

4

FALL 2018

president’s m es sa ge Dear AzPA Members,

What a fantastic few months we have had! What has your organization been working on lately you ask? Great question! Over the past couple of months, the Board of Directors & Committee Chairs: • Gathered for our annual Board Retreat to improve communication by (1) Assigning at least one Board of Director representative per Committee and (2) extending an invite for Committee Chairs to present status updates during the quarterly board meetings • Are working on advancing pharmacists scope of practice and preparing for our upcoming legislative session • Are looking at ways to improve membership across the organization

Our organization has a fantastic group of Board of Directors, Committee Chairs and Staff that continues to work collaboratively to advance our organization but we NEED YOUR HELP. I challenge each of you to get involved.

The only way we can continue to grow and advance as a profession is if we join together to enact change. Who is with me!?

We would love to hear your thoughts on how we can continue to improve as an organization and what you want to see our organization do for you. If you are not currently on a Committee, I encourage each of you to take 30 minutes from your busy schedule over the next month and call into one of our monthly committee calls. Pick a topic that interests you, visit the AzPA website to volunteer and most importantly, meet new people and have fun! Get involved and volunteer with one of the following committees: • Continuing Education Committee: meets the 4th Thursday of the month, 3pm • Legislative Affair Committee: meets the 1st Wednesday of the month, 12pm

• Marketing/Communications Committee: meetings TBD and needs volunteers!

• Membership Committee: meets the 2nd Wednesday of every month, 12pm

• Mentor Connection Program: meets the 1st Thursday of every month, 12pm (register to be a mentor or mentee!)

• PharmPAC Committee: meeting dates and times vary

• NEW COMMITTEE: Board of Pharmacy Specialties is looking for volunteers to get involved

Our organization has a fantastic group of Board of Directors, Committee Chairs and Staff that continues to work collaboratively to advance our organization but we NEED YOUR HELP. I challenge each of you to get involved. If you are already an active member of the association, I challenge you to invite a nonmember with you as you participate. The only way we can continue to grow and advance as a profession is if we join together to enact change. Who is with me!?

I look forward to working with everyone some more and I hope you all enjoy the Holiday season! 

Jessica Dileo, PharmD, BCACP, BCGP AzPA President 2018-2019

5

azpharmacy.org

editorial news

Member Mentions The National Pharmacy Campaign Has Launched!

The American Association of Colleges of Pharmacy (AACP), along with other pharmacy and healthcare organizations, has launched a new public awareness campaign aimed at educating consumers about the invaluable contributions pharmacists make to their patients and to our nation’s healthcare system as a whole. The coalition of partner organizations, known as Pharmacists for Healthier Lives, aims to raise the profile of pharmacy as an essential healthcare profession.

“Pharmacists are an integral part of a patient’s healthcare team and are often our most accessible healthcare professionals,” said Dr. Lucinda L. Maine, executive vice president and CEO of AACP. “They conduct medication reviews and make recommendations, provide immunizations and offer advice on basic healthcare issues. We and our campaign partners seek to increase awareness of how pharmacists help people live healthier lives – and to promote understanding of the many settings in which pharmacists use their extensive knowledge and expertise.” Learn more at pharmacistsforhealthierlives.org.

AzPA Member Honored with 40 Under 40 Award Congratulations to Ryan Gries, PharmD, BCPS, BC-ADM, AAHIVP; MIHS of McDowell Healthcare Center who was recognized as one of 40 Under 40 award winners in Phoenix. The Phoenix Business Journal’s annual 40 Under 40 Awards highlight young business leaders who have spent time making their community better. Congrats Ryan!

6

FALL 2018

AzPA Member Wins Prestigious Award The APhA Foundation celebrated innovative contributions to health care quality through the medication use process at its 21st Annual Pinnacle Awards program. The three award recipients, CAPT Lisa Tonrey, Balls Food Stores, and the Bureau of Prisons were honored for their achievements as an individual, corporation, and government agency, respectively. Their efforts provide and promote excellence in medication use and lead to safer and improved health outcomes for patients.

CAPT Lisa Tonrey capped off the celebration with the APhA Foundation’s 2018 Pinnacle Awards Innovation in Pharmacy Lecture presented at APhA Headquarters and streamed live on Facebook. Her topic, “Innovative Roles for the Pharmacist in Improving Population Health,” addressed the opportunities and relationships pharmacists should leverage to enhance the health of populations across the country. CAPT Tonrey’s insights highlighted her direct experiences and related work in developing platforms to combat health epidemics.

If you missed the lecture, this engaging presentation can be viewed on the APhA Foundation Facebook page at https://www.facebook.com/ APhAFoundation/.

Continued on next page

Save the Date!

11.9.18 AzPA Anticoagulation Certificate Program Flagstaff

1.22.19 TM APhA M gram ate Pro Certific dale Glen

12.8.18 AzPA Pain Management Certificate Program Live Webinar

2.22.19 APhA Cardiovascular Certificate Program Phoenix

12.15.18 AzPA Psychiatric Certificate Program Tucson

2.22.19 AzPA Ant icoa Certificate gulation Program Phoenix

For more information and additional activities, visit www.azpharmacy.org.

Member Mentions continued

AzPA Member Elected to American Health Council Congratulations to Samuel Ashu, PharmD on his recent election to the American Health Council’s Industry Board for his outstanding contributions to the pharmaceutical field. Currently serving as vice-president and the clinical director at Tilda Manor, Inc., in Mesa, AZ, Dr. Ashu oversees the clinical team, handles clinical assignments, addiction, drug counseling and monitoring patients with behavioral health issues.

The American Health Council is the nation’s only organization with a constituency representative of all sectors of the healthcare industry. In addition to having affiliates from communities of all sizes, the American Health Council provides recognition and support for those individuals and institutions making a difference in patients’ lives. 

7

azpharmacy.org

editorial news

Welcome New Members Pharmacists Camille Agosto Sayyem Akbar Shadi Asayesh Angela Balascak Sandra Barbosa Jason Barnes Kari Anne Berthold Erika M. Caine Christine Castillo Mathew Cole Bernadette Cornelison Stephanie Croteau Tenille Davis Jessica DeAngelo Jennifer Dijaili Diane Faraone Rachelle Green Barbara Guerrero Paul Gurevich Lizamarie B. Hooyman Soral Karim Zainab Khatoon Melissa Cuestas Martinez Eric McCarthy Cynthia Meyers Sara Momika Christopher Morelli Thomas Muthart Brigette Robinett Nelson Alicia Newkirk Elise Poggemeier Leslie Rodriguez Arthur Rutledge Venous Sadeghi Edna Sandoval Richard Schuster Jeffrey Schwartz Sarah A Scott Lisa Smith Bronwyn Simone Smith Lindsey Dalzell Thai Andrew Thatcher Suzanne Young Mark Ziegler Residents Zach Brock Cynthia Bui Chace Erickson Ericka Journee Julian Lamptey Taylor Naberhaus

10

FALL 2018

Carolyn Parton Geoffrey Smelski Danielle Thomas Vivi Tran Janelle Vircks Retired Peter Forni Students Doris Anne Adaralegbe Huda Ahmed Martha Akpo Melinda Allred Nicholas Averill Faheem Baki Kris Bauernsmith Lindsey Baugham Paige Bloniarz Benjamin Bright Markell Brock Brandi Brucato Christopher Buhl William Burke Brannon Chaufty Jennifer Cherian Ashley Cormier Susanna Cubberly Alexa DeMichele Dominique Devereux Natasha Djukic Emma Dutch Chloe Grace April Graybill Sarah Guest Jessica Hallett Nguyen Hien Ciera Holle Ilene Huddleston Anh Huynh R. Max Jacobson Anisa Kamel Nicole Kandilas Morgan Karrels Joshua Kessler David Knightes Marquiah Ladd Allison Lewis Weston Lewis Alfredo Lopez Henry Lopez Noe Lugo

Omar Maciel Amy Magdalany Connor Maly Carl Manzano Austin Masih Gibson Matimbire Kathryn McCulley Hayden McDade Nancy Mendoza Adrienne Metzger Sammantha Meyer Maryam Alizadeh-Miab Amanda Mikhail Ani Minasian Megan Morgan William Mueller Yukti Naik Trever Narramore Bryant Nguyen Lara Nouri Mudiaga Ogbemudia Lacey Oscarson Kwonneung Park Sabrina Prince Jessie Ray Keri Romero Martina Rose Alejandro Ines Ruiz Sunja Saville Ronda Sawa Grant Sivley Belle Soyfer Alexandra Stich Gilbert Takoeta Elaine Tan Eric Taylor Aime Tellez Margaret Towers David Tran Huy Tran Huy Tran Chibuike Ugbor Mariana Valdez My Phuong Vu Alison Weygint Marcus Willingham Michelle Wylie Technicians Jacqueline Gomez Barrios Ryan Hopkins Bronwyn Lyons. 

editorial advoc a cy

Arizona State Board Pharmacy Updates BOARD MEMBER UPDATE After 22 years of service to the Arizona State Board of Pharmacy, Dennis McAllister has made a really hard decision to step aside and give someone else an opportunity to serve the great state of Arizona. While on the Board, Dennis represented Arizona as the President of NABP and has received many accolades, most recent being the Bowl of Hygeia award. Thank you Dennis for your service and guiding the Board in the interest of public safety.

Arizona State Board of Pharmacy 1616 W. Adams St., Suite 120 Phoenix, AZ 85007 Phone: (602) 771-2727 Fax: (602) 771-2749 www.azpharmacy.gov Upcoming Board Meetings: December 5–6, 2018 January 30–31, 2019 March 27–28, 2019 May 8–9, 2019 July 31–August 1, 2019 September 25–26, 2019 December 4–5, 2019

COMPLETE THE CSPMP USER SATISFACTION SURVEY

Please take a moment to complete the Controlled Substance Prescription Monitoring Program 2018 survey at https://pharmacy.az.gov/.

SCHEDULE II OPIOID E-PRESCRIBING WAIVER

Per Arizona Revised Statutes (A.R.S.)§36-2525 the Arizona State Board of Pharmacy “shall establish a process to grant a waiver ... for electronic prescription orders to a medical practitioner who lacks adequate access to broadband or faces other hardships that prevent the medical practitioner from implementing electronic prescription orders.” After the Board receives the completed waiver request, the request will go before the full Board at the next available meeting. You may be required to appear before the Board either in person or telephonically. Once waiver form is completely filled out please email form to pmp@azpharmacy.gov. Deadline for waiver application is December 15, 2018. https://pharmacy.az.gov/

2018 ARIZONA OPIOID EPIDEMIC ACT Prescribers and pharmacists have a corresponding responsibility concerning patient care. For more information on the changes made by the 2018 First Special Session in the Arizona Opioid Epidemic Act, go online to the Final Amended Fact Sheet for SB 1001/HB2001 or the language for the Chapter Bill. The information provided herein should not be construed as a legal interpretation. To view FAQ’s: https://bit.ly/2PYa1N9

REPORTING REQUIREMENTS You must report the following within 10 days: • Change of Address

• Change of employment

• You must report any arrests, convictions, disciplinary action to the Board of Pharmacy even if the charges were dismissed.

Continued on next page

11

azpharmacy.org

IMMUNIZATION FAQ’S How do I get my certificate? Why don’t I get a separate certificate for immunizing now? Where is the immunization indicator on my license?

The Board no longer issues separate immunizing certificates. If you are an immunizing pharmacist or intern, it will be noted on your license below the type of license (i.e. Pharmacist or Intern).

When does the certificate expire?

As long as you maintain the required CEs and your CPR certificate, the ability to immunize will correspond with your pharmacist license. There is no longer a separate immunizing certificate; therefore, the expiration date is the same as your license expiration date.

How often do I renew my immunizing certificate now?

There is no longer a separate immunizing certificate. This will be renewed when your license is due to renew biennially.

How many CEs do I need to complete and how often?

1. Current certification in basic cardiopulmonary resuscitation, and

2. Completion of a minimum of two contact hours (0.2CEU) of continuing education related to immunizations during the two-year renewal period. A pharmacist may use the continuing education hours required in this subsection as part of the total continuing education hours required for pharmacist license renewal.

What is required to maintain my immunizing certificate?

The Board no longer issues separate immunizing certificates. If you are an immunizing pharmacist or intern, it will be noted on your license below the type of license (i.e. Pharmacist or Intern).

1. Current certification in basic cardiopulmonary resuscitation, and

2. Completion of a minimum of two contact hours (0.2CEU) of continuing education related to immunizations during the two-year renewal period.

A pharmacist may use the continuing education hours required in this subsection as part of the total continuing education hours required for pharmacist license renewal.

Download full document at https://pharmacy.az.gov/.

12

FALL 2018



editorial history Third Quarter 2018: Pharmacy Time Capsule By: Dennis B. Worthen, PhD, Cincinnati, OH

1993 • ACPE released proposed standards and guidelines for the PharmD as the professional entrylevel degree.

• New Mexico passed legislation to address a shortage of primary care providers making it the first state to let specially trained pharmacists provide primary patient care.

1968 • Fentanyl, developed by Janssen and marketed by McNeil, was approved as an IV analgesic.

1943 • Bulletin of the American Society of Hospital Pharmacists first published. Later renamed American Journal of HealthSystem Pharmacy.

1918 • Beginning of the Spanish flu pandemic.

1893 • New Mexico formed state pharmacy association. 

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. Membership 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

13

azpharmacy.org

editorial advoc a cy

Legislative Update 2018 103 1,166 284 257 6 14

FALL 2018

Days of session Bills introduced Bills passed Bills signed Bills vetoed

SPECIFIC ACTIONS HB 2086 schools; diabetes management policies; pharmacists (Carter) AzPA’s diabetes management in schools bill was signed by the governor on Thursday, April 12th.

SB 1034 committee of reference; standing committee (Kavanagh) The sunrise reform bill was signed by the governor on Thursday, April 12th.

HB 2107 prescription drug costs; patient notification (Syms) AzPA’s PBM bill was signed by the governor on Thursday, April 5th.

Continued next page

HB 2633 pharmacists; controlled substances (Cobb) The “opioid trailer bill” was signed by the governor on Tuesday, March 27th.

HB 2149 pharmacies; remote dispensing (Weninger) The telepharmacy bill was signed by the governor on Tuesday, March 20th.

CALL TO ACTION Step 1 • Make a donation and become a member Membership Levels • Platinum: $1200 per year ($100 per month) • Gold: $600 per year ($50 per month) • Silver: $300 per year ($25 per month) • Friends of PharmPAC: $120 per year ($10 per month) • Member: any person who makes a minimum donation of $5 during the fiscal year

Step 2 • Get involved

• Sign up to be a volunteer on our PharmPAC or Legislative Affair committee • Participate in Pharmacy Day at the Capitol • Attend a PharmPAC Fundraising event

Step 3 • Become an Arizona Pharmacy Advocate

• Write, email or call your AZ representatives to discuss AzPA’s Legislative agenda • Attend a legislative stakeholder meeting • Attend/testify at a legislative committee hearing on behalf of AzPA

CONTRIBUTIONS RAISED AS OF OCTOBER 12, 2018

$20,000 GOAL

PharmPAC is a nonpartisan voluntary committee that allows AzPA members to pool their financial resources to advance pharmacy by supporting pieces of legislation and state candidates who appreciate the value of our profession.

With your support we can work effectively together for the good of our profession.

Lawmakers can only represent your interests if you let them know what is important to you. You can join the PAC by making a contribution of any size.

$8K!

Make sure your voice is heard in the political process.

COMEDY NIGHT RECAP Thank you to all who attended the 1st Annual PharmPAC Comedy Night at the AzPA 2018 Annual Convention! We had more than 75 attendees at the inaugural event and raised almost $5,000!

And a special thank you to our generous sponsors who donated $500 or more:

DONATE ONLINE

@

www.azpharmacy.org/ advocacy

• Lorri Walmsley • Mark Boesen • Mike Blaire

• Stephanie Spark

 15

azpharmacy.org

editorial recover y

True Power Obtained Through Weakness The story of a pharmacy student in PAPA Anonymous As I embark on to my APPEs, I can’t help but look back at these past two years of my life and be in awe of how far I’ve come. This journey has been a blessing, and it is all because of PAPA.

A

s an Asian American I was raised to always save face and put up a good front. I never stole drugs. I never got arrested. On the outside, I looked happy and successful but on the inside, I was miserable and hopeless. Finally, my addiction was revealed when I overdosed on drugs. The front was gone and my reputation was ruined.

16

FALL 2018

It all started in my first year of pharmacy school. I was introduced to opiates from someone very close to me. The more we played with opiates, the more it was slowly taking control over me. I didn’t realize how bad the situation had become until I started to go through withdrawal symptoms. For me, learning about withdrawal symptoms at school and actually experiencing it are two totally different things. I have

never felt such pain and agony in my life. It was unbearable. In order to combat this dilemma, I began smoking pot to help ease the pain.

Interestingly, it worked, but only to an extent.

The problem was I had to smoke pot almost every 2 hours for it be consistently effective.

Needless to say, I fell drastically behind my classes during this time. However, I wasn’t ready to admit defeat. So, I thought in order to combat the lethargy from pot and opiates I just needed a stimulant. This is when cocaine came into the picture.

Somehow, taking this disturbing combination of opiates, pot, and cocaine daily worked for a while and I was surprisingly passing my classes.

Unfortunately, just like anyone who abuses drugs, especially such a deadly mixture, my body was deteriorating. Finally, everything came crashing down when I overdosed on cocaine during my finals week. I was so close to the finish line, but my body had given up on me before my mind did. After that moment, the mask was off and everyone knew I was an addict. I lost many friends and was completely shunned from my pharmacy class.

I needed help. Death was very close by. I knew I may not be as lucky to survive the next overdose.

This was when I was introduced to PAPA.

PAPA was a miracle for me. PAPA was not created to punish people who have substance abuse problems, but it was created to help heal, rejuvenate, and revive them back to life.

After I joined PAPA I became very open and honest about my addiction and this is when real recovery started. It’s interesting and hard to explain, but for me, the moment I admitted my weaknesses, true power was given to me.

This power is perfected in my weakness, not my strength. This power is greater than anything in this world, and I received it only when I came just as I truly am, as a broken addict.

When I look back at these past two years, I realized that the people I remember the most are not the ones who were with me during the best times of my life, but the ones who were there for me during the worst times. When I was drowning in my addiction, they were the ones who taught me how to swim and guided me back to shore.

When I was condemned and discarded by my friends and classmates, they were the ones who loved me unconditionally and still believed in me.

These were the types of people I met in PAPA. They pierced a light through my darkness, and seeing that small speck of light and hope became the difference between life or death for me. I will forever be grateful for PAPA and if I can recover, anyone can. 

Professionals Assisting Professionals (PAPA) The Arizona Pharmacy Foundation PAPA program is a peer assistance program dedicated to helping health care professionals enter a safe, supported, and successful recovery. Our program has served over 200 healthcare professionals since it was established in 1989. Our trained staff helps identify, assist, support, advocate, and monitor healthcare professionals with substance use or mental health disorders. www.azpharmacy.org/papa

480-207-7869 (confidential line)

Mistakes can happen.

Don’t put your pharmacy at risk.

MA K E YO U R PAT IE NTS AND YOU R P H AR M ACY SAFE R.

FOR LESS THAN A DOLLAR A DAY, OUR QA PROGRAM HELPS ...

• • • •

Increase patient safety – learn from collected safety data and online resources Maintain compliance – meet accreditation, credentialing, PBM and state QA requirements Reduce costs – increase operations efficiency, reduce potential risk and cut down on “re-do” Rxs Safeguard your data – Patient Safety Organizations offer confidentiality and legal protection

www.medicationsafety.org (866) 365-7472 The Alliance of Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO).

editorial news

University & Alumni News Midwestern University College of Pharmacy

Mitchell R. Emerson, PhD Dean Midwestern University CPG

New Position for MWU Faculty Member In July, Midwestern University College of Pharmacy–Glendale welcomed Shareen El- Ibiary, Pharm. D., BCPS, FCCP as the new Chair of the Department of Pharmacy Practice. Dr. El-Ibiary has been a faculty member with the College since 2008. Previously, she also served as a faculty member at the University of California–San Francisco (UCSF) School of Pharmacy for seven years. She received her Pharm.D. from the University of South Carolina and completed her general pharmacy practice residency at UCSF. Her areas of interest and publication include faculty development, work-life integration, burnout prevention, pharmacy curriculum and innovative teaching. Other interests include internal medicine and women’s health with a focus in contraception, preconception care and postpartum depression. She is involved in various local, state, and national organizations including participating as a speaker in the AzPA Women’s Reproductive Health Certificate Program. Dr. El-Ibiary has spoken nationally and internationally on various topics, written book chapters and papers, and developed continuing education programs related to faculty development topics and women’s health issues. She is a graduate of the American Association of Colleges of Pharmacy Academic Leadership Fellows Program and is a fellow of the American College of Clinical Pharmacy. We are thrilled to welcome Dr. El-Ibiary as the new Chair!

18

Updates from the Clinical Education Program

New Members Elected to Alumni Council

Midwestern University, College of Pharmacy–Glendale offers the Clinician Educators Program (CEP) for pharmacy residents and preceptors. The CEP is a 12-month longitudinal Teaching and Learning Curriculum offered from July – June each year.

Dr. Lindsay Davis serves as the program coordinator. This is the sixth year of the offering and to date the CEP has enrolled > 400 pharmacists and awarded > 260 certificates of completion.

Approximately 75% of the enrollees each year are residents, with the remaining 25% being IPPE, APPE, and/or residency preceptors. The Program features four teaching skills seminars that discuss various topics related to learning, teaching, precepting, and research. Participants also have the opportunity to develop their skills through mentored teaching experiences, which are offered as teaching skills workshops or precepting workshops. If you would like to learn more about this program, email Lindsay Davis at ldavis@midwestern.edu or azcep@ midwestern.edu. We would love to hear from you!

Over the summer, the College of Pharmacy welcomed new officers to the Alumni Council:

FALL 2018

• Travis Shelton, Pharm.D. ’09 (President, Class of 2009)

• Alison Sutton, Pharm.D. ’12 (Vice President, Class of 2012)

• Tiffany Gordon, Pharm.D. ’14 (Secretary/Treasurer, Class of 2014)

• Joy Reese, Pharm.D. ’06 (Alumni Senate Representative, Class of 2006) • Mary Gurney, Ph.D., R.Ph. (Faculty Advisor)

The new officers are busy representing alumni and they have already begun brainstorming and planning for exciting and meaningful alumni initiatives.

Continued on page 20

Rick G. Schnellmann, PhD Dean University of Arizona COP— Tucson

University of Arizona College of Pharmacy Launches PharmD Forward Since becoming Dean at the University of Arizona College of Pharmacy, I have been adamant in my vision to provide new educational opportunities for students and health care professionals in partnership with fellow UA colleges in areas that practice and industry need additional expertise: health law, public health, health care management and regulatory sciences.

In expanding our offerings and concurrently evolving the PharmD curriculum, our goal is to produce leaders in pharmacy, remain competitive for attracting the brightest students, and sustain our College as one of the nation’s best in pharmacy education. This initiative is known as PharmD Forward.

Changes to the PharmD curriculum will better prepare our students for clinical rotations starting at matriculation. This new course work went into effect this fall for the Class of 2022. The following changes were made:

1. A shift to expose students to diseases, drugs and therapeutics earlier in the curriculum to be better prepared for Introductory Pharmacy Practice Experiences, health fairs and future course work.

2. A shift to having students apply advanced medicinal chemistry, pharmacology and pharmacogenomics concepts to patientcentered drug selection closer to Advanced Pharmacy Practice Experience rotations.

3. Intentional integration of course topics by faculty collaboration with effective spacing, intentional repetition, and applied learning.

4. Adding room for elective courses (going from four credits to eight) to increase educational options and foster interest beyond core courses, including dual-degree opportunities and certificate programs.

In partnership with the UA James E. Rogers College of Law, Eller College of Management and the Mel & Enid Zuckerman College of Public Health, we offer PharmD dual degrees and graduate certificate programs. The certificates are also available for practicing health professionals who wish to expand their expertise.

PharmD Dual-Degrees:

• Master of Legal Studies: This dual-degree provides training in growing areas of health care regulation like compliance, negotiations, working with administrative agencies and corporations. This program is ideal for professionals who regularly work with lawyers and legal issues.

• Juris Doctor: Hone analytical skills, develop better critical thinking, and acquire the professional skills needed to work in

a diverse range of health care and legal areas. Graduates of the program serve as health law and regulatory policy consultants for government agencies, pharmaceutical companies and trade associations.

• Master in Business Administration: Several professional organizations, including the American Society of Health-System Pharmacists, have advocated for the creation of the PharmD/ MBA degrees for filling leadership positions in pharmacy as the professional field evolves. Graduates possess qualifications that make them attractive candidates for leadership roles in community pharmacy practice, the pharmaceutical industry, academia, and health care institutions.

• Master of Health Care Management: Develop management skills in one of three concentrations including health care leadership, health care innovation or health care informatics.

• Master’s in Public Health: Pharmacists’ services are growing to include more patient-oriented, health care administration and public health functions; accordingly, pharmacists trained in public health activities, particularly involving health education, disease prevention and health promotion, public health advocacy, and improving health quality will be at the forefront of improving health outcomes and reducing disparities across populations and communities.

• Pharmacy Graduate Programs: Graduate programs in pharmacy are divided into four tracks where students can expand their expertise in research and basic science in drug discovery and development (PhD), pharmacology and toxicology (PhD), pharmaceutics and pharmacokinetics (PhD) and health and pharmaceutical outcomes (MS and PhD).

Graduates are prepared for positions in academia, government and the pharmaceutical industry, where they are equipped to translate the results of basic and clinical research into practice, teaching or policy.

Online Certificate Programs:

• Graduate Certificate in Regulatory Sciences: Receive specialized training in how to accelerate the development of medical products through greater understanding of the ethics, policies, and regulations governing regulatory science in the United States and abroad.

• Graduate Certificate in Health Law: Gain a sophisticated and nuanced understanding of how laws, regulations and ethics operate within health care organizations, business arrangements with insurers and providers, delivery of care, and scope of practice.

• Graduate Certificate in Public Health: Learn the foundational underpinnings of public health: epidemiology, public health

Continued on next page

19

azpharmacy.org

Midwestern University College of Pharmacy continued

Alumni in the News In alumni news, Dr. Ryan Gries, class of 2014 was named one of the Phoenix Business Journal’s “40 Under 40” for 2018: The “Forty-Under 40” list annually recognizes up-and-coming leaders in business and community. In 2018, the Phoenix Business Journal selected its Class of 2018 from a pool of over 400 candidates from the Valley of the Sun. Congratulations to our incredible alumnus, Ryan Gries, Pharm.D, College of PharmacyGlendale for being selected as members of the Phoenix Business Journals’ annual “Forty-Under-40” class of 2018.

Recent and Upcoming Events

In July, the new Officer’s hosted the second annual Family Fun Day at the Arizona Science Center. In total, the event had over 45 attendees and it was an opportunity to catch up with many alumni and meet their families. Prior to entering the museum, the group shared breakfast and children were able to tap into their creativity through various CREATE Learning Space projects.

In October, the officers and fellow alumni will host the 4th annual CPG Student/Alumni Mentoring and Networking Reception on campus. This event allows PS-1/PS-II students to learn about

different pharmacy specialties and rotation types, as well as receive advice and tips from alumni who have “walked in their shoes.” This has become a favorite event by all who attend, and we consistently have had 30-plus alumni and 30-plus students participate.

The program is also looking forward to hosting various events in the coming months and into 2019. Those events include: • The program will be hosting an Alumni and Friends Reception on the evening of Sunday, December 2, at the Bubba Gump Shrimp Company in Anaheim, CA, in conjunction with the American Society of Health-Systems Pharmacists Midyear Clinical Meeting.

• On March 7, 2019, the CPG Alumni Council, Office of Experiential Education, and the MWU Office of Development and Alumni Relations are sponsoring a CE and Alumni/ Preceptor Networking Event. Guests will be invited to earn CE credit, interact with fellow alumni, and if guests are not already a preceptor, they can learn all the benefits of becoming one.

• On March 15, 2019, the program will kick-off Midwestern University’s Alumni Weekend 2019 with a CPG Alumni Reception. Details are in the works. 

The University of Arizona College of Pharmacy continued policy and administration, environmental health, biostatistics, and social/behavioral sciences.

• Clinical & Translational Research Graduate Certificate: Prepare for the complexities of clinical and translational research through didactic instruction and mentored collaborative research experiences.

• Graduate Certificate in Global Health & Development: Gain knowledge and skills necessary to function effectively in global health practice, whether at home in a diverse setting, along the border in a bi-cultural environment, or abroad where populations are under-resourced and health systems are constrained.

20

FALL 2018

• Graduate Certificate in Health Administration: Gain knowledge and skills in strategic planning, budgeting and finance, health care economics and policy, and advanced health care services administration.

The range of educational opportunities as part of PharmD Forward allows students and health professionals to diversify training and broaden career paths requiring specific areas of expertise.

For more information on any of the programs, visit www. pharmacy.arizona.edu. 

editorial qu alit y m ea sure s

Pharmacists Can Help Care Teams Meet Quality Measures Loren Bonner, Senior Editor As the U.S. health care system moves toward value-based payment and delivery models, clinical measures continue to be developed to assess whether patients are meeting certain specified care goals and outcomes.

“To achieve value, these models focus both on measuring the quality of care delivered using specific quality measures and on reducing unnecessary costs of care,” said Anne Burns, RPh, vice president of professional affairs at APhA. Pharmacists’ medication expertise can positively affect metrics focused on conditions treated by medications, as well as metrics for wellness and prevention, according to Burns.

CMS ratings

Health insurance plans have used certain quality measures—many revolving around medication use— to connect community pharmacists to pay for performance, value-based contracts, and more. Quality measures in CMS’s star rating program set the foundation. The program began when provisions in the Affordable Care Act called for quality bonus payments within the Medicare Advantage program to be awarded on the basis of how well health plans execute on a set of performance measures. For years, community pharmacists have been acutely aware of this program. Increasingly, they are being asked to improve the metrics or risk being eliminated from the plan.

“Pharmacists are much more keenly aware of what’s inside the star ratings program because the measures are being used in value-based networks, and pharmacists are being held accountable for them,” said Laura Cranston, BSPharm, CEO of the Pharmacy Quality Alliance (PQA). The nonprofit got its start developing measures for the Medicare Part D prescription drug program, and many of those measures are being used in Medicare, Medicaid, state-based, and private-sector value-based programs.

“We have started work on pharmacy-level measures, which evaluate performance of the pharmacy holistically—across all payer types,” said Cranston.

Continued on next page

21

azpharmacy.org

Reprinted with permission from the Provider Status column in the September 2018 issue of Pharmacy Today (www.pharmacytoday.org).

For more information about ways for pharmacists and student pharmacists to follow and influence the profession’s efforts to achieve provider status, access the provider status recognition section of APhA’s website (www.pharmacist.com/ providerstatusrecognition) and APhA’s Pharmacists Provide Care website (PharmacistsProvideCare.com).

Pharmacists Can Help Care Teams Meet Quality Measures continued

Copyright © 2018, American Pharmacists Association. All rights reserved.

Beginning in 2017, CMS implemented the Quality Payment Program (QPP), authorized through the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA).

Essentially, QPP represents new opportunities for pharmacists to help physicians meet quality measures.

MACRA changed the fee-for-service formula Medicare uses to pay eligible clinicians in Part B. Under MACRA, physicians and other eligible clinicians choose one of two quality payment pathways: the MeritBased Incentive Payment System (MIPS) or an APM (Advanced Payment Model).

Right now, she explained, health plans are only concerned about their select Medicare patients at a particular pharmacy. PQA wants to develop the metrics for the whole pharmacy, taking into account patients with Medicaid, commercial insurance, and those who are uninsured.

“There are lots of different opportunities to use a measure like this [for the whole pharmacy] in the valuebased landscape,” said Cranston. Some of those opportunities could even provide room for pharmacists to work with other providers to improve patient outcomes.

Team-based care

Pharmacists should be informed about quality measures affecting physicians across the country because it creates an opportunity to work more closely on a patient’s care team.

Value-based models use a team-based approach to care, where health care practitioners, working in a coordinated manner, deliver care and are held accountable for quality metrics and costs of care.

To be valued and included in these models, pharmacists need to understand quality measures, how a pharmacist can impact them, and have the skills to contribute to team-based care.

— Anne Burns, RPh

Vice President of Professional Affairs at APhA

According to CMS, roughly 600,000 Medicare Part B–eligible clinicians are subject to MIPS in 2018, and only under certain conditions will clinicians be exempted from the program. MIPS can also serve as a stepping stone for providers and organizations to move into an APM.

For pharmacists, there is opportunity to enter into partnerships with physicians to help them meet certain quality measures. Many of the roughly 300 measures in the quality category for MIPS can be affected by pharmacists. Two measures specifically mention pharmacists. They are medication reconciliation after discharge in the quality category, and population management of medications in the clinical improvement category.

“Value-based models use a team-based approach to care, where health care practitioners, working in a coordinated manner, deliver care and are held accountable for quality metrics and costs of care,” said Burns. “To be valued and included in these models, pharmacists need to understand quality measures, how a pharmacist can impact them, and have the skills to contribute to team-based care.” 

22

FALL 2018

editorial f eature

Paracetamol vs Indomethacin & Ibuprofen

... in the treatment of patent ductus arteriosus (PDA) in preterm infants Kristye J. Russell, PharmD*, PGY-1 Decentralized Clinical Staff Pharmacist Banner Boswell Medical Center Steven MacKay, PharmD, BCPS, BCGP, Clinical Pharmacist Banner Boswell Medical Center Conflicts of interest: None *Corresponding author

23

azpharmacy.org

ABSTRACT Purpose To provide a brief review of the literature evaluating acetaminophen to NSAIDs in the treatment of patent ductus arteriosus in preterm infants.

Summary The ductus arteriosus (DA) is an open channel between the pulmonary artery and the descending aorta that is present during fetal development. Following birth, the DA usually closes within 24-hours of birth in response to increased serum oxygen levels. However, in preterm infants the DA commonly fails to close resulting is what is referred to as a patent ductus arteriosus (PDA).

NSAIDs, specifically ibuprofen, represents the standard of care in the pharmacologic treatment of PDA. However, in recent years, interest has focused on paracetamol (acetaminophen) as an alternative therapy with a better side effect profile as compared to NSAIDs. Conclusion Paracetamol represents a viable alternative to ibuprofen, as the standard of therapy, in the treatment of PDA when ibuprofen use is ill-advised.

Keywords • Patent ductus arteriosus • Congenital heart disease • Preterm infants

24

FALL 2018

Paracetamol vs Indomethacin & Ibuprofen continued

Background The ductus arteriosus (DA) is an open channel between the pulmonary artery and the descending aorta that is present during fetal development.1-5 The channel functions in diverting blood flow away for the lungs while the fetus is in utero.1,2 Prostaglandins E2 (PGE2), which is a potent vasoconstricting agent secreted by the placenta and the ductus arteriosus, plays a significant role in maintaining patency of the vessel.1-3, 5 Following birth, PGE2 levels significantly decrease leading to constriction and eventual closure of the DA. This process usually occurs within 24-hours of birth.1-3, 5 However, in preterm infants the DA commonly fails to close resulting is what is referred to as a patent ductus arteriosus (PDA).1-7 Dependent on the gestational age of the preterm infant, between 30–70% will develop a clinically significant PDA requiring some type of intervention.1,7 This is particularly true of preterm infants with a gestational age < 28 weeks.4,7 PDAs have been associated with a number of adverse outcomes including bronchopulmonary dysplasia, intraventricular hemorrhage (IVH), gastrointestinal complications, retinopathy, sepsis, and even death.1,3,4,5,7 Many of these complications occur as a result of left-to-right shunting that consequently reduces cardiac output and, thus perfusion to the organs.1 For some preterm infants with asymptomatic PDAs, a conservative approach may be appropriate until such time that the PDA closes spontaneously.3 However, in those preterm infants with significant hemodynamic derangements as a result of ductal shunting, more aggressive therapies are preferred.1-7

PDAs can be treated surgically, through surgical ligation, or pharmacologically with non-steroidal antiinflammatory drugs (NSAIDs), specifically indomethacin and ibuprofen.1,3,5,6,7 Both of the agents inhibit the cyclooxygenase enzyme involved in prostaglandin production and have comparable efficacy in DA closure.1,6 However, indomethacin use has been linked to several serious adverse complications such as renal failure, altered platelet function, gastrointestinal bleeding, necrotizing enterocolitis and impaired cerebral blood flow. 1,6 For this reason ibuprofen has become the preferred agent in PDA management as it has been found to have a less negative impact as compared to indomethacin. In recent years, interest has focused on paracetamol (acetaminophen) as an alternative therapy to NSAIDs.2 However, the effectiveness and safety of paracetamol as compared to ibuprofen and indomethacin remains in question.

In a recent prospective, randomized controlled trial (RCT), the efficacy and safety of paracetamol was compared to ibuprofen and indomethacin in 300 preterm infants with a gestational age < 28 weeks diagnosed with a hemodynamically significant PDA (hs-PDA).4 Subjects were randomized to one of the three treatment groups where they received either paracetamol 15 mg/kg intravenous (IV) infusion administered over 30 minutes, followed by 15 mg/kg IV infusion every 6 hours for 3 days, ibuprofen 10 mg/kg IV infusion, followed by 5 mg/kg/day for 2 days, or indomethacin 0.2 mg/kg IV infused over 30 minutes administered every 12 hours for 3 doses. The primary outcome was achievement of PDA closure defined by an echocardiogram demonstrating no detectable blood through the duct. The incidence of PDA associated complications and side effects associated with treatment were assessed as secondary objectives of the study. The results showed that preterm neonates receiving treatment with paracetamol experienced an 80% closure rate following primary treatment compared to a 77% closure rate in the ibuprofen group and an 81% closure rate in the indomethacin group (P=0.868). The cumulative closure rate, which included those preterm infants who received a second course of therapy, was 88% in the paracetamol group, 77% in the ibuprofen group, and 81% in the indomethacin group (P=0.781). Overall, the results of this study revealed acetaminophen to be as effective as ibuprofen and indomethacin in PDA closure. Additionally, those neonates treated with paracetamol experienced fewer gastrointestinal bleeds as compared to ibuprofen and indomethacin (P = 0.007). The results of this study are noteworthy in that, to date, this is the only known published trial comparing the efficacy and safety of all three agents in the treatment of PDA.4

A Cochrane review published in 2015 reported the results of two randomized, controlled trials comparing the effectiveness and safety of paracetamol to ibuprofen for PDA in preterm or low birth weight infants.5 In both studies, a combined total of 250 preterm infants were treated with either oral paracetamol 15 mg/kg every six hours for 3 days or ibuprofen 10 mg/kg followed by 5 mg/kg after 24 to 48 hours. The primary outcome assessed was the rate of ductal closure as determined by the number of PDAs that failed to close following treatment initiation. Analysis of the pooled data revealed no statistically significant difference in PDA closure failure rates between the paracetamol and ibuprofen treatment groups following first course of drug therapy (RR = 0.90, 95% CI: 0.67 to 1.22; risk difference (RD) = 0.04, 95% CI: -0.15 to 0.08; I2 = 0% for RR and 23% for RD). Several secondary outcomes were also assessed. The only secondary outcomes of statistical significance were the duration of need for supplementary oxygen (MD -12 days, 95% CI: -23 to -2 days; P = 0.02) and the occurrence of hyperbilirubinemia (RR = 0.57, 95%

CI: 0.34 to 0.97, RD = -0.15, 95% CI: -0.29 to -0.01). Both outcomes were in favor of paracetamol over ibuprofen.5

A recently published systematic review and meta-analysis conducted by Huang and colleagues combined the results from the RCT discussed above and the two studies included in aforementioned Cochrane review with two other RCTs published in 2016 (n = 677 neonates).7 Again, the primary outcome measured was the rate of ductal closure. The mean gestational age of subject pool was 29.8 weeks (range 25.5–33.5 weeks). Of the studies included in the meta-analysis, four studies evaluated 60 mg/day of oral paracetamol to oral ibuprofen dosed 10 mg/kg once followed by 5 mg/kg/day for 2 days (3 studies) or 20 mg/kg once followed by 10 mg/kg/day for 2 days (1 study). Intravenous paracetamol at a dose of 60 mg/day for 3 days was compared to intravenous ibuprofen 10, 5, 5 mg/kg/day regimen in one study. The results showed PDA closure rates to be comparable between the two treatment groups following initial course of therapy (RR: 1.03, 95% CI: 0.93-1.13, P=0.56, I2=0%). Overall PDA closure rates between paracetamol and ibuprofen were also comparable (RR: 1.02, 95% CI: 0.95-1.09, P=0.62, I2=0%). However, neither of these outcomes were found to be statistically significant. With regards to safety, treatment with paracetamol was associated with fewer incidences of renal failure (RR: 0.20, 95%CI: 0.04-1.15, P=0.07) and gastrointestinal bleeding (RR: 0.28, 95%CI: 0.11-0.73, P=0.009).7

In conclusion, paracetamol represents a viable alternative to ibuprofen, as the standard of therapy, in the treatment of PDA when ibuprofen use is ill-advised.

Overall, paracetamol appears to be an effective agent in the treatment of PDA in preterm infants. Across all of the reviewed studies, paracetamol use was associated with fewer adverse events, especially with respect to renal function and gastrointestinal bleeding, as compared to NSAIDs. This combined efficacy and safety profile makes paracetamol an attractive therapy, especially in those preterm neonates contraindicated for NSAID use (e.g. renal failure, necrotizing enterocolitis, etc.). Furthermore, compared to intravenous ibuprofen and indomethacin, intravenous paracetamol is less expensive per course of therapy. Despite these positives, the overall body of evidence with respect to RCTs is limited and the long-term effects of early paracetamol still warrants investigation.

In conclusion, paracetamol represents a viable alternative to ibuprofen, as the standard of therapy, in the treatment of PDA when ibuprofen use is ill-advised.

REFERENCES 1. Evans N. Current controversies in the diagnosis and treatment of patent ductus arteriosus in preterm infants. Adv Neonatal Care. 2003; 3: 168-77.

2. Le J, Gales MA, Gales BJ. Acetaminophen for patent ductus arteriosus. Ann Pharmacother. 2015; 49: 241-6.

3. Mitra S, Rønnestad A, Holmstrøm H. Management of patent ductus arteriosus in preterm infants— where do we stand?. Congenit Heart Dis. 2013; 8: 500-12.

4. El-Mashad, AE, El-Mahdy, H, Amrousy, DE, et al. Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates. European journal of pediatrics. 2017;176: 233.

5. Ohlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or lowbirth-weight infants. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD010061.

DOI: 10.1002/14651858.CD010061.pub2.

6. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD003481. DOI: 10.1002/14651858.CD003481.pub6.

7. Huang X, Wang F, Wang K. Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. pp 1–7.

Continued on next page

25

azpharmacy.org

Paracetamol vs Indomethacin & Ibuprofen continued TABLE 1: Published Studies Cited Study Design

Study Groups

Outcome Measures

Results

Conclusion

El-Mashad, AE, El-Mahdy, H, Amrousy, DE, et al. Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates. European journal of pediatrics. 2017;176: 2334 Prospective, randomized controlled trial

A total of 300 preterm neonates with hemodynamically significant PDA were enrolled and randomized to receive treatment with either paracetamol 15 mg/ kg IV every 6 hours x 3 days, ibuprofen 10 mg/ kg IV infusion followed by 5 mg/kg/day for 2 days, or indomethacin 0.2 mg/kg every 12 hours x 3 doses.

Primary: PDA closure defined as no flow detected through the duct by echocardiography Secondary: A comparison of the side effects & complications following intervention of either paracetamol, ibuprofen or indomethacin.

There was no significant difference between all groups regarding efficacy of PDA closure (P = 0.868). There was no significant difference between all groups for secondary outcomes with the exception of GI bleeding, which was more observed most in the indomethacin and ibuprofen treatment groups (P = 0.07) .

Paracetamol is as effective as indomethacin and ibuprofen in closure of PDA in preterm neonates. Paracetamol use was associated with less side effect on renal function, platelet count, and GI bleeding.

Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants.

Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD003481. DOI: 10.1002/14651858.CD003481.pub6.5 Systematic review & meta-analysis

Thirty-three RCTs or quasi RCTs (n = 2190) evaluating the safety and efficacy of ibuprofen were selected for inclusion.

Types of interventions included ibuprofen administered either orally or intravenously compared with control infants who received indomethacin (PO or IV), other cyclooxygenase inhibitors, placebo, given PO or IV, or no intervention.

Primary: To determine the effectiveness and safety of ibuprofen compared with indomethacin, other cyclo-oxygenase inhibitors, placebo or no intervention for closing a PDA in pre-term, low birth weight, or both infants.

There was a statistically significant reduced RR for failure to close PDA after three doses of ibuprofen versus placebo (one study, n = 134 infants; RR 0.72, 95% CI: 0.51 to 0.99; RD -0.18, 95% CI: -0.35 to -0.01).

Ibuprofen is as effective as indomethacin in closing PDAs and caused fewer transient side effects on the kidneys and reduced the risk of necrotizing enterocolitis.

Secondary: To determine the effectiveness and safety of ibuprofen to close a PDA in relation to gestational age, birth weight, method used to diagnose a PDA and dosing regimen for ibuprofen.

Huang X, Wang F, Wang K. Paracetamol versus ibuprofen for the treatment of patent ductus arteriosus in preterm neonates: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2017:1-7.7 Meta-analysis of randomized controlled trials (RCTs)

26

FALL 2018

A total of five RCTs (n=677 preterm neonates) were selected for inclusion in this meta-analysis.

Primary: Efficacy in achieving PDA closure and overall PDA closure

Primary closures (RR: 1.03, 95% CI: 0.93-1.13, p = 0.56) and overall PDA closures (RR: 1.02, 95% Secondary: Adverse CI: 0.95-1.09, p=0.62) events associated with were comparable the use of paracetamol versus ibuprofen & PDA between paracetamol associated complication and ibuprofen. There was no significant risks heterogeneity among included studies (I2=0%).

Paracetamol use was associated with a reduced risk for renal failure (RR:0.20, 95% CI: 0.04 - 1.15, p = 0.07).

Paracetamol may confer comparable treatment efficacy for the closure of PDA as Ibuprofen and may be associated with lower risk of adverse events.

editorial contin u i n g e d

Uncovering Hidden Risks with Serious Consequences in Your Workflow John M Kessler, B.S. Pharm., PharmD, Patient Safety Expert, Alliance for Patient Medication Safety (APMS)

Learning Objectives At the completion of this activity, the participant will be able to:

1. Identify at least 3 short-cuts, work-arounds, and design flaws in the pharmacy workflow that can allow a dangerous prescription to reach the patient.

2. List at least 2 underlying causes that enable an environment whereby pharmacies “”normalize”” unsafe practices in the workflow.

3. Describe at least 2 immediate actions pharmacies could take to identify the hidden risks in their local practices.

Target Audience: Pharmacists & Pharmacy Technicians Credits: CE is 0.5 hour (0.05 CEU)

To access this activity 1. Go to www.GoToCEI.org

2. Log in or create a profile (will not be able to complete CE without a profile) 3. Once logged in, locate and click the light green box labeled “MY PROFILE”

4. This will take you to your dashboard (list of activities still active).

Enter the Access Codes(pharmacist or technician) in the “PARTNER CODE” box and press “APPLY” Pharmacists: APMS17R

Technicians: APMS17T

5. You will be directed to the Activity Summary, click “CONFIRM”

6. Once you have applied the code, you should be able to complete the activity. It will be in your “TO DO ACTIVITIES” dashboard at the bottom of the page 7. Locate the activity title you wish to complete within your profile and click the Exam

8. Complete the exam and evaluation as prompted, click SUBMIT to send your information to CPE Monitor

Questions?

Please contact Christy Lodge at CEI by calling 515-270-8118 or christy@CEImpact.com

Provided by Alliance for Patient Medication Safety — your partner in quality assurance. 

27

azpharmacy.org

Life

Tomorrow.

Imagine That.

Pharmacists Mutual Insurance Company | 808 Highway 18 W | PO Box 370 | Algona, Iowa 50511 P. 800.247.5930 | F. 515.295.9306 | info@phmic.com

phmic.com

Life insurance products are sold through PMC Advantage Insurance Services, Inc., a subsidiary of Pharmacists Mutual Insurance Company.

All products may not be available in all states and territories.