AJP Spring 2019

Arizona Journal of Pharmacy O F F I C I A L P U B L I C AT I O N O F A R I ZO N A P H A R M ACY A S S O C I AT I O N | S P R I N G 2 0 1 9

Breakthrough to Excellence AzPA 2019 Annual Convention June 20–23 • Tucson, AZ

ASHP and AzPA Partnership; Perspective of an Active Member in the ASHP House of Delegates Controversies in Flumazenil Administration and Seizure — a Review of Current Literature A Practical and Stepwise Approach to Evaluating QREs Associated with Patient Harm

SOUTH W ESTE RN STATES RESIDENCY CONFERENCE JUNE 14, 2019 UNIVERSITY OF ARIZONA PHOENIX

Certificate Programs at Convention AzPA Immunization Certificate Program AzPA Psychiatric Certificate Program APhA Diabetes Certificate Program

June 20, 2019 Tucson 2 SPRING 2019

CONTENTS

COVER STORY BOARD OF DIRECTORS 2018–2019

Annual Convention June 21–23

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 Liaison 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 Nancy Alvarez 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 CREATIVE COORDINATOR Elizabeth Nelson, CAE THANK YOU TO OUR AzPA VOLUNTEERS Misty Brannon Somaya Hegazy Robert McMahon Melissa Reay McKenzie Stratton

p12 President’s Message 5 AzPA News Welcome New Members 4 Save the Date 4 Annual Convention Highlights 12 University & Alumni News 22

Editorial ASHP and AzPA Partnership; Perspective of an Active Member in the ASHP House of Delegates 6 Controversies in Flumazenil Administration and Seizure — a Review of Current Literature: Flumazenil and Seizure Risk 8 First Quarter 2019: Pharmacy Time Capsule 26

Advocacy To Advocate or Not? The Importance of Advocacy: AzPA APPE Rotation Student’s Perspective 17 Arizona State Board of Pharmacy Update 19 Legislative Update 20

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.

Continuing Education A Practical and Stepwise Approach to Evaluating QREs Associated with Patient Harm 27

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editorial news Pharmacists Nancy Alvarez Cassandra Anderson Renu Bala Heather Bartelt Susan Bazzell Michael Biegelman Rebecca Chauvin Tina Conlee Nhung Decano Andrew S DeMotto Tara DiSanto Christopher Edwards Jordan Ezeanyim

Welcome New Members William Fry Louis Grubler Richard Gutoski Ken Hewitt Lillian M. Howden Robert L Judd Marie-Nys Kassi Eric Kutscher Linda Luzania Shannon Miller Henry Ofori Jacqueline Paluch Cory McGuinn-Parks Ngoc Pham

Vi Pham Alina Price Marilyn Semenchuk Christina Thompson Randall Thornton Tammy Tran

Retired Pharmacist Martin Stimac

Students Cade Bustamante Stephen Moore Erin McGuire

Phuong Trang Nguyen Judith Gray Wilfredo Gonzalez-Trinidad Andrew Schonberger Fizza Saeed Robert Nguyen Michelle Ta Ron Meadows Dawn Cleveland

Technicians Justine Hisel Jennifer Spates



SAVE T H E DATE !

April 13, 2019 AzPA Immunization Certificate Course • Glendale June 20, 2019 AzPA Immunization Certificate Course • Tucson

June 20, 2019 APhA Pharmacist and Patient-Centered Diabetes Care Certificate Program • Tucson

July 27, 2019 AzPA Pain Management Certificate Program • Virtual

June 20, 2019 AzPA Psychiatric Certificate Program • Tucson

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

president’s m es sa ge Dear AzPA Members,

It’s that time of year! Trees and bushes are in full bloom, allergy season is in full swing and we Arizonans are soaking up the sunshine before it becomes too hot to leave the comfort of our air conditioned buildings. With the changing of the seasons comes the time for change on your AzPA Board of Directors. Your 2018-2019 Board of Directors have been an amazing group of individuals to work and I couldn’t be prouder of them. Over the past year they have worked diligently to support and develop the growth of our organization while successfully trialing our new board and committee structure.

They have set a great foundation for our organization’s strategic plan moving forward focusing on: • Serving, supporting, and strengthening our membership • Influencing public policy to advance our profession

I encourage all of you to get involved and stay involved, even if it is as simple as writing an article for our journal or extending our membership invitation to a colleague or student.

• Optimizing and expanding our organization’s business development • Educating our profession

As we look to new leaders to join our board, remember ... they cannot succeed without you. YOU are the backbone to our organization! Your involvement is vital to our continued success and growth as well as the advancement of our profession. I encourage all of you to get involved and stay involved, even if it is as simple as writing an article for our journal or extending our membership invitation to a colleague or student. If you take anything from away from these letters over the past year, take away this message. Change starts with you. I truly believe that change starts small. We cannot advance our practice, locally or nationally, without your input and involvement.

As my time as your President comes to an end, I want to thank each of you for allowing me to serve as your President. I have met so many new people along the way, made so many new friends and grown both personally and professionally over the past year. It has been an amazing year and a truly amazing experience. Serving the association as your recent President has only fueled my passion for our profession and I share that passion with each of you. I have no doubt that the next year will be even more successful as you are in great hands with my successor, Virgina Boomershine. Again, I thank you and I hope to see all of you at the Annual Convention in June! 

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

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editorial editori a l ASHP and AzPA Partnership; Perspective of an Active Member in the ASHP House of Delegates Aimee Itaaehau, PharmD, BCACP; Director At Large, Health Systems, AzPA Board of Directors In an effort to understand what being a member of the ASHP House of Delegates entails, I had the opportunity to interview Carol Rollins, MS, RD, PharmD, BCNSP, IASPEN. Carol Rollins is an expert in the field of parenteral nutrition and was elected to be an Arizona representative as a delegate to the ASHP House of Delegates. I asked her a few key questions to gain perspective on what it means to be a member of the ASHP House of Delegates.

Q

Carol Rollins

A

Can you explain what you do as a member of the House of Delegates?

As a member of the House of Delegates, I am responsible for recognizing what ASHP in Arizona would like, and how pharmacists that we represent would like us to vote on specific issues. When we meet, we hear different interstate opinions and perspectives on the various issues that affect Health Systems Pharmacists. Ultimately, the members of the House of Delegates are responsible for voting on ASHP Policies that demonstrate how ASHP pharmacists stand on a particular issue.

Q

Why do you participate in the House of Delegates?

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It’s one of those things where you either like it, or you don’t. The first thing I did was to observe the executive committee in (our) clinical section trying to get pharmacists’ provider status into Medicare law. The process itself can be daunting if someone was to be thrown into that position, and I was glad to have the chance to sit with an active member who explained what was happening as we went through the process. The truly appealing thing is I had a chance to see how the legislative process works. I felt strongly about how to help move pharmacy forward, and this was the way to get something done! I have had the opportunity to meet incredible people who want to make things better for Health Systems pharmacists. I have made connections with people that I wouldn’t have otherwise had the opportunity to meet, such as lawyers and hospice workers. Being a member of the House of Delegates has given me a chance to understand why things move slowly…they ARE working on issues. One of the challenges is you have to start from scratch every time new legislators are elected.

The Arizona Representatives for the ASHP House of Delegates: (l–r) Renee Tyree, Mindy Burnworth, Carol Rollins, and Christi Jen at the AzPA 2019 Spring Clinical.

Q

How are you impacting the practice of pharmacy in the state of Arizona?

A

Being a member of the AzPA Legislative Committee keeps me updated on the laws of interest to the practice of pharmacy. At the meetings that we have, we get a chance to bring up any issues that need to be looked at. We get a chance to consider the impact on pharmacy as new laws are passed. Usually, they impact community pharmacy practice, but it is important to be able to interject the opinion of Health Systems pharmacy.

Q

Why do you think it’s important for pharmacists to become members of AzPA?

A

Q

Is there anything you would like to add?

A

We have breakout sessions scheduled for the next clinical AzPA meeting in February in order to discuss debatable policies, and to address various concerns and issues. The results of these sessions will be communicated to ASHP. I would be willing to have one or two interested parties sit with me during one of those sessions to help them understand the process. 

We need a professional organization to help us come together on bigger issues, such as getting laws passed and/or changed that impact the practice of pharmacy. I believe that we have a professional obligation to get involved, and that we (as pharmacists) SHOULD be getting together to actively participate in molding our profession.

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editorial f eature

Controversies in Flumazenil Administration and Seizure — a Review of Current Literature Flumazenil and Seizure Risk M. Jill Romero-Aleshire, MS, PharmD candidate1; Jamie Natkowski2, PharmD, BCPS; Georgina Rubal-Peace2, PharmD, BCPS. 1 2

University of Arizona College of Pharmacy, Banner University Medical Center South

Conflicts of interest: None The authors gratefully acknowledge the Banner UMC-South Clinical Newsletter editors for helping with the article concept. This research was not funded.

ABSTRACT Purpose To provide a brief review of recent research regarding the incidence of seizures after flumazenil administration for benzodiazepine toxicity.

Summary Flumazenil is the predominant reversal agent for benzodiazepine toxicity. Of note benzodiazepine toxicity is rarely fatal as a single agent. Although flumazenil was once considered a relatively safe medication, there is concern of the serious adverse event of seizure following flumazenil administration. A review of recent literature suggests the incidence of seizure occurs rarely, with the largest reported incidence of 1.4%. One of the key factors associated with post-flumazenil seizure is the presence of other overdose agents.

Conclusion To date, the occurrence of seizure post flumazenil administration is low and is most commonly associated with the presence of co-ingestion of other intoxicants with benzodiazepine toxicity.

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Drug overdoses are the leading cause of accidental death in the United States, surpassing automobile accidents.1,2 Reversal agents for toxicities are of special interest currently given the high rate of overdoses presenting in emergency departments around the country and have resulted in the current push for greater Naloxone accessibility and education. Common symptoms following intranasal or intramuscular Naloxone administration are relatively mild, including agitation and irritation.3 Opioid overdose lethality increases in the presence of sedative medications, such as benzodiazepines. Given the enhanced negative effects of this combination, it is important to consider benzodiazepines when an accurate history of ingestants cannot be assessed in an overdose.

Benzodiazepine toxicity, when limited to benzodiaze­ pine ingestion alone, causes sedation but rarely results in mortality. Flumazenil is a specific reversal agent for benzodiazepine toxicity that acts by blocking benzodiazepine receptors with low receptor activation, thereby reversing sedative effects.4 In addition to benzodiazepine toxicity reversal, initial use of flumazenil included diagnostic administration for suspected benzodiazepine intoxication because flumazenil was considered a low risk intervention.

However early studies indicated the potential serious adverse side effect of seizure.4,5 Patients that also ingested proconvulsant agents such as tricyclic antidepressants, have a history of seizures, or use benzodiazepines chronically are at an increased risk of seizure after flumazenil administrations.5,6,7 The clinical safety of flumazenil for non-life threatening toxicity is therefore a current topic of debate, and data on the frequency of seizures across multiple centers is not well established.

The purpose of this brief review of recent literature is to assess the incidence of seizure from flumazenil toxicity reversal in more detail in order for pharmacists to assess the risk for individual patients when making recommendations to physicians in the acute hospital setting.

CLINICAL TRIALS

Early Reports of Seizure Incidence The first double blind, placebo-controlled largescale study of flumazenil treatment identified 326 patients with suspected benzodiazepine overdose.

Of these, 162 patients received cumulative doses to a maximum of 3 mg flumazenil (total dose dependent on assessment of satisfactory response or maximum reached) and 164 received placebo. Successful response was determined by scoring 1 or 2 on the Clinical Global Impression Scale (GCIS) 10 minutes after administration of test drug. Of patients that received flumazenil, three developed seizures, two of which co-ingested tricyclic antidepressants. However, 77% of patients had successful response to flumazenil via GCIS score, compared to 16% of placebo. This study was

limited to a single site and a small sample size.5 That same year (1992) a literature analysis identified 43 patients who seized following flumazenil treatment. Of those, 20 had also ingested proconvulsants, seven had been treated for acute seizures with benzodiazepines followed by flumazenil reversal, three chronically took benzodiazepines, five had conditions that made them prone to seizures, and six had overdosed on drugs that did not include benzodiazepines. Of note, given the systematic review nature of the article, there was not consistency in flumazenil treatment regimens with doses ranging from 0.2-10 mg. In addition the small sample size of the study limits interpretation to a larger population.8 Meta-analysis of Seizure Risk

In 2016, a systematic review with meta-analysis of 13 randomized, double-blind, placebo controlled prospective clinical trials compared the risk of seizure in flumazenil-treated patients with benzodiazepine intoxication. A total of 990 patients admitted to the emergency department with suspected or verified benzodiazepine overdose, including multi coingestions, were included in analysis. Of those, 498 were administered intravenous flumazenil and 492 had no intervention. Three patients in the flumazenil group experienced convulsions, compared to no patients in the non-intervention group. The overall incidences of serious adverse events, which included cardiac arrhythmias and seizures, was significantly higher in the flumazenil group compared to placebo.

No patients in either group died, thus seizure and arrhythmias did not increase mortality. The authors concluded that flumazenil should not be used routinely, with decisions for administration based on patientspecific circumstances and increased monitoring post administration recommended. This study is limited by the systematic review nature of the study design.

Biases that were present in the studies used in the meta-analysis are also still applicable in the results.

Furthermore meta-analysis authors also report that trial methodology was not adequately reported in most of the trials used. Given the number of studies evaluated, there is also heterogeneity in study design, fluamzenil doses (range 1-10mg), and execution, making direct comparisons difficult.9 Poison Center Reports of Seizure Risk

A ten year poison control system historical case series analyzed the frequency of seizures in patients that were administered flumazenil. A total of 904 adult patients that received flumazenil were included, regardless of whether they had benzodiazepine toxicity, of which 13 developed seizures (1.4%). Nine patients developed seizures immediately after flumazenil was administered, the remaining four developed seizures in a time range of 30 minutes to 24 hours post administration. Seizure onset was significantly associated with co-ingestion of proconvulsant medications (odds ratio 3.41, 95% confidence interval 1.13-10.72). Of this sample, 293 patients had proconvulsant drug exposure, and of these

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eight developed seizures. In addition, 226 patients were administered flumazenil without known drug ingestion (i.e. unknown drug exposure or overdose cause), and none of these developed seizures. Limitations of this study include the retrospective nature of the report and voluntary nature of Poison Control Center reporting.

In addition, lack of confirmation beyond historical reporting on toxicity ingestion, lack of indication reporting for flumazenil administration, mental status of patients, whether flumazenil administration induced seizures and intervals between flumazenil administration and seizure, and patient history of benzodiazepine use are also self-reported limitations of the study. Strengths of this study include the large sample size and the wide range in data collection years covered.7

In another analysis of poison center data, the occurrence of seizures following flumazenil administration in 83 pediatric patients was analyzed in a retrospective cohort study. No flumazenil-induced seizures were identified by the researchers. A total of 68 patients were exposed to benzodiazepines, 10 were not exposed to benzodiazepines, and five had unknown exposures. Of note there was a 22 month old boy that had a seizure 3.5 hours after flumazenil administration, however the attending medical toxicologist considered the events unrelated due to time between exposure and seizure.

The potential for misinterpretation of relation of seizure to flumazenil administration cannot be ignored in analyzing this result. The retrospective design of this study, voluntary reporting to poison centers, lack of transparency regarding dosages, and potential for discrepant records between the poison center and hospital records are limitations of this study. In addition if flumazenil was abbreviated or not correctly spelled it was not included in the chart analysis, which would lead to an inaccurate inclusion of pediatric patients.10

DISCUSSION

Risk of overdoses are a growing problem in the U.S., given current trends. Oftentimes it is difficult to assess patient history in an emergency setting where reversal agents are administered. Therefore, it is imperative pharmacists are aware of risk and benefits of using flumazenil. Seizure risk has been well-documented in the literature; however benefit (i.e. mortality reduction, hospital stay duration changes, etc.) of flumazenil administration in an overdose setting still needs to be assessed.

Single benzodiazepine overdose is not commonly fatal, particularly when not in the presence of other toxicants.

However, the risk of seizure following administration of a reversal agent merits consideration given the potential for negative patient outcome. A brief review of published research from 2012 to present day on the development of seizures post flumazenil administration shows that rates are low, with the highest rate reported as 1.4% in an analysis of 10 years of poison control

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reporting.7 A meta-analysis of seizure risk estimating 0.6% incidence, while other studies reported no seizures in smaller samples sizes following flumazenil treatment. However, the risk of seizure is still a serious negative outcome for a condition that may be selfresolving, and thus patients should be assessed on a clinical basis.

CONCLUSION

Risks of seizure development are associated with coingestion of proconvulsant agents, which can be hard to evaluate without an accurate history. In the event that flumazenil is warranted, post flumazenil administration monitoring for up to 24 hours is recommended by a meta-analysis of current literature. Of note, mortality was not increased in flumazenil-treated patients, regardless of incidence of seizure.9 Further studies designed to detect outcomes beyond seizure alone are needed before a conclusive decision can be made regarding the benefit of flumazenil in an overdose setting.

REFERENCES

1. Wermeling D. A response to the opioid overdose epidemic: naloxone nasal spray. Drug Deliv Transl Res. 2012;3(1):6374. doi:10.1007/s13346-012-0092-0.

2. Mack, K. Drug-induced deaths-United States, 1999-2010.

MMWR. 2013;62(03):161-163.

3. Kelly A, Keer D, Dietze P, Patrick I, Walker T, Koutsogiannis Z. Randomized trial of intranasal versys intramuscular naloxone in prehospital treatment for suspected opioid overdose. Med J Aust. 2005;182:24-27 4. Knudsen L, Lonka L, Sorensen B, Kirkegaard L, Jensen O, Jensen S. Benzodiazepine intoxication treated with flumazenil (Anexate, RO 15-1788). Anaesthesia.

2007;43(4):274-276. doi:10.1111/j.1365-2044.1988. tb08971.x.

5. Treatment of benzodiazepine overdose with flumazenil.

The Flumazenil in Benzodiazepine Intoxication Multicenter Study Group. Clin Ther. 1992;14;978-995

6. Spivey WH, Roberts JR, Derlet RW. A clinical trial of escalating dosing of flumazenil for reversal of suspected benzodiazepine overdose in the emergency department.

Ann Emerg Med. 1993:22(12):1813-21.

7. Kreshak A, Cantrell F, Clark R, Tomaszewski C. A Poison Center’s Ten-year Experience with Flumazenil Administration to Acutely Poisoned Adults. J Emerg Med. 2012;43(4):677-682. doi:10.1016/j. jemermed.2012.01.059.

8. Spivey WH. Flumazenil and seizures: analysis of 43 cases.

Clin Ther. 1992;14:292-305.

9. Penninga E, Graudal N, Ladekarl M, Jürgens G. Adverse Events Associated with Flumazenil Treatment for the Management of Suspected Benzodiazepine Intoxication ­— A Systematic Review with Meta-Analyses of Randomised Trials. Basic Clin Pharmacol Toxicol. 2015;118(1):37-44. doi:10.1111/bcpt.12434.

10. Kreshak A, Tomaszewski C, Clark R, Cantrell F. Flumazenil Administration in Poisoned Pediatric Patients. Pediatr Emerg Care. 2012;28(5):448-450. doi:10.1097/ pec.0b013e3182531d0d. 

Join us this June for our four-day annual conference providing continuing education, recognition, and networking opportunities for pharmacy professionals of all practice settings.

REGISTRATION FEES FULL CONFERENCE

ONE DAY

Member Prices

Member Prices

Pharmacist: $350.00

Pharmacist: $150.00

Student: $125.00

Non-Member Prices

Student: $50.00

Pharmacist: $400.00

Pharmacist: $175.00

Student: $150.00

Student: $60.00

Technician/Associate: $250.00 Resident: $250.00

Resident: $100.00

Non-Member Prices

Technician/Associate: $300.00 Resident: $300.00

Technician/Associate: $100.00

Technician: $125.00 Resident: $125.00

HOTEL ACCOMMODATIONS Westin La Paloma 3800 E Sunrise Drive Tucson, AZ 85718 Phone: (520) 742-6000 Group Rate: $129

Register Online: https://bit.ly/2JaTPcc

Please do NOT book through outside vendors such as Hotels.com etc. AzPA will not get credit for the room and in addition, the resort fees of $29 are not included in those prices. Be sure to mention The Arizona Pharmacy Association Convention to receive the special rate.

12 SPRING 2019

TENTATIVE AGENDA THURSDAY, JUNE 20  8:00AM–5:00PM AzPA Immunization Certificate Program* AzPA Psychiatric Certificate Program* APhA Diabetes Certificate Program* *Separate Registration Required

FRIDAY, JUNE 21  8:00AM–12:00PM • WORKSHOP I (APhA) Travel Health Certificate Program * Conchetta Lesser, PharmD, BCACP; Kelly Fine, R.Ph. 1. Provide pharmacists with comprehensive knowledge, skills, and resources necessary to establish and deliver a successful travel health service

2. Teach pharmacists to identify at-risk patient populations in need of preventative and travel care 3. Enhance pharmacists’ ability to effectively counsel patients on travel health

4. Motivate increased numbers of pharmacists to establish travel health services  8:00AM–11:00AM • WORKSHOP II Statistic Workshop Jon Glover, PharmD.; Tim Hartman, PharmD, BCPS, CDE 1. Outline the basic elements of a project and data considerations

2. List the scales of data types and most commonly used statistical approach 3. Describe the differences and when to employ descriptive vs inferential statistical tests 4. Define methods to determine heterogeneity of data and implications in statistical analyses

5. Articulate the differences between standard deviation, standard error of the mean, confidence intervals and p values 6. List the most commonly employed parametric and nonparametric tests, and when to use

7. Demonstrate a basic understanding of one statistical package by uploading data and completing at least two parametric tests 8. Using data provided, a trial version of a statistical package, and series of questions, complete an analysis individually or as a small group  8:00AM–11:30AM • WORKSHOP III

Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)* Timothy J. Atkinson, PharmD, BCPS; Christopher Gharibo, MD 1. Identify risk factors and vulnerabilities associated with addiction to opioid analgesics and provide patient/caregiver counseling when necessary

2. Discuss the components of an effective treatment plan, including patient interactions, treatment goals, and collaboration within the healthcare team

5. Explain the decision to initiate long-term opioid analgesics including ER/LA opioids, with consideration to providing inhome naloxone

6. Determine when referral to a pain specialist is appropriate for a patient with chronic pain  11:15AM–12:15PM • BREAKOUT SESSIONS 1 & 2

The Future of Pharmacy: How to Use New Technology and Advancements in Existing Technology to Grow and Succeed in the 21st Century of Healthcare Adam Chesler PharmD. Pharmacist learning objectives: 1. Identify advances in technology and how it is impacting the delivery of services

2. Describe upcoming trends seen in the pharmacy industry and how it might change the practice 3. Describe possible legal barriers to entry and ramifications of implementation 4. Recognize the future implications of the safe practice of pharmacy

Clinical Controversies in the Management of Antimicrobial Stewardship Programs in Acute Care Settings Kimberly Welker, PharmD. Pharmacist learning objectives: 1. Review major clinical controversies surrounding data obtained from specific laboratory testing, including procalcitonin, rapid diagnostic testing, and susceptibility testing 2. Recognize the standardized antimicrobial administration ratio (SAAR), why it was developed by the CDC, and how it will be implemented

3. Consult with the ID team on how to apply susceptibility testing when breakpoints do not exist, such as ECOFF values, and how to find these in the literature and world wide web

4. Describe how to present a business model for your stewardship program 5. Review 5 studies which examine the current role of polymyxins in treatment of gram-negative infections  1:45PM–2:45PM • BREAKOUT SESSIONS 3 & 4

Enhancing Diabetes Care Using Dietary Supplements Beth Zerr, PharmD, BCACP, AE-C; Bernadette Cornelison, PharmD, MS, BCPS Pharmacist learning objectives: 1. List dietary supplements commonly used to enhance diabetes care 2. Explain the proposed mechanism of action of dietary supplements in diabetes

3. Evaluate the current evidence supporting or not supporting dietary supplement use in diabetes

4. Identify patient characteristics that would increase the risk of using a dietary supplement as part of diabetes treatment

Continued on page 14

3. Analyze the specific benefits and risks to initiating nonmedication therapies before utilizing long-term medications 4. Recognize patients who are candidates for treatment with nonopioid pharmacologic analgesics

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An Immunization Update for the Arizona Pharmacist

Pharmacist learning objectives:

Conchetta Lesser, PharmD, BCACP

1. Describe common pitfalls for miscommunication with learners

Pharmacist learning objectives: 1. Apply new CDC recommendations for vaccines to current practice

2. Utilize recent changes in Arizona laws to improve access to vaccines in your practice population

3. Describe how to make strong recommendations for available vaccines

2. Develop a plan to help address and improve communication issues with students

3. Describe student perspectives and factors that may influence behaviors on rotation

SATURDAY, JUNE 22

 8:00AM- 9:30AM • General Session I

 3:00PM–4:00PM • BREAKOUT SESSIONS 5, 6, & 7

2019 Pharmacy Law Update

PPI Stewardship: When Less is More

Roger Morris, RPh, JD

Danielle Thomas, PharmD, PGY-2

Pharmacist learning objectives:

Pharmacist learning objectives: 1. Debate the risks of chronic PPI use

1. Identify major developments in U.S. pharmacy law and related fields

4. Describe a deprescribing method for PPIs

3. Recognize emerging patterns that will broadly affect the healthcare profession and pharmacy practice

2. Compare and contrast PPIs and H2RAs

3. Review current PPI Stewardship Programs Tuberculosis Control for Pharmacists: Partners in TB Elimination Reasol Chino, PharmD, BCACP Pharmacist learning objectives: 1. Describe the challenges of TB control in special populations

2. Describe the practical ramifications of proposed state and national legislative initiatives  9:45AM-11:15AM • GENERAL SESSION II

Legislative Town Hall — Hear from your Arizona Legislators, AzPA Board of Directors and Legislative Committee Members Pharmacist learning objectives:

2. List therapeutic options for pharmacists

1. Recognize the impact the Pharmacist Political Action Committee (PPAC) of Arizona has in our state

New Practitioner Track: When Being Smart is Not Enough: Developing Emotional Intelligence for Profession Success

3. Review legislation considered in Arizona that can impact the profession

3. Describe the pharmacist’s role as a partner in Tuberculosis elimination Erin Raney, PharmD, BCPS, FCCP; Bill Bowman, PhD. Pharmacist learning objectives:

1. Define emotional intelligence and identify its key components 2. Recognize the impact of emotional intelligence upon professional success

3. Describe key behaviors of emotionally intelligent individuals 4. Access your emotional intelligence using an appropriate tool

5. Create an action plan for developing your emotional intelligence  4:15PM–5:15PM • BREAKOUT SESSION 8

Empowering the Pharmacist with Telepharmacy Jessica Adams, PharmD. Pharmacist learning objectives: 1. List the different types of telepharmacy and how it’s improving patient care

2. Describe the regulatory environment and what states are doing with rules surrounding telepharmacy

3. Review DEA requirements and the legal process of implementing telepharmacy regulations  4:00PM–5:30PM • BREAKOUT SESSIONS 9 & 10 Billing for Pharmacists’ Services Panel of Speakers Pharmacist learning objectives: TBD

Preceptors Are From Mars, Learners Are From Venus

2. Evaluate critical legislative issues that will impact the practice of pharmacy 4. Participate in an open forum discussion with current leadership to discuss practice changes  11:30AM – 12:00PM • BREAKOUT SESSIONS 11, 12, 13, & 14 Updates on Neutropenic Fever: Addressing Changes in Guidelines and Practice Implementation Ali McBride, PharmD, MS, BCPS Pharmacist learning objectives: 1. Evaluate updates on neutropenic fever guidelines

2. Summarize clinical studies for biosimilar use in neutropenic fever treatment and prophylaxis

3. Describe implementation of an outpatient neutropenic fever regimen

Using PharmAcademic to Meet ASHP Residency Accreditation Standards Dawn Gerber, PharmD, CGP, FASCP Pharmacist learning objectives: (Pharmacist only) 1. Identify commonly cited critical factors during ASHP residency accreditation surveys 2. Identify strategies to documentation of feedback to meet ASHP Residency Accreditation Standards 3. Improve quality of documented feedback to meet ASHP Residency Accreditation

4. Identify under-utilized tools in PharmAcademic to meet ASHP Residency Accreditation Standards Specialty Pharmacy 101 Jennifer Craig, PharmD.

Suzanne Larson, PharmD; Janet Cooley, PharmD.

Pharmacist learning objectives:

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2. Describe trends in specialty pharmacy

SPRING 2019

1. Define a specialty drug

3. Describe the role of specialty pharmacies

New Practitioner Track: Dynamic Communications: Enhancing Pharmacy Effectiveness through Understanding Yourself and Others Around You Jimmy Stevens, PharmD; Juan Kingsbury Pharmacist learning objectives: 1. Identify your preferred pharmacy environment

2. Describe communication strategies for people with different behavior styles

2. Identify the elements of dependency contributing to the addiction and abuse of commercial tobacco products

3. Compare a brief intervention to an intensive intervention for smoking cessation From A to Z: Clinical Pearls for Pharmacists Speaker: TBD Pharmacist learning objectives:

3. Recognize how to work with other co-workers to be most efficient

1. Evaluate clinical scenarios or “clinical pearls” that might not be widely known or published.

 2:00PM–3:30PM • General Session III

3. Value medication management strategies in difficult or controversial patient care situations.

4. Design interviewing framework to select ideal job candidates

5. Demonstrate motivation techniques for working well in interprofessional teams Medical Marijuana Alaa Abd-Elsayed, MD, MPH Pharmacist learning objectives: TBD

 3:45PM–4:45PM • BREAKOUT SESSION 15 First, Do No Harm: Review of Treatment Options for Parkinson’s Disease Psychosis Dawn Gerber, PharmD, CGP, FASCP; Brian Seigfied, PharmD Candidate 2019 Pharmacist learning objectives 1. Describe Parkinson’s Disease Psychosis

2. Describe the impact of Parkinson’s Disease Psychosis on patients and caregivers 3. Compare and contrast the adverse effect profiles of available antipsychotics in the treatment of Parkinson’s Disease Psychosis.  3:45PM–5:15PM • BREAKOUT SESSION 16 & 17

Rx for Change: Ask, Advice, Refer — Smoking Cessation Velliyah Beauvais, RPh, Thomas Addison, PharmD; GayleTucket, PharmD; Jing Li, PharmD, BCPS; Amit Patel PharmD. Pharmacist learning objectives: 1. Identify patients with commercial tobacco addictions and offer services available to help patient quit

2. Apply novel clinical practice options for patient care in various health settings.

4. Assemble clinical information that can be applied to applicable work settings.

SUNDAY, JUNE 23

 8:00AM–9:00AM • BREAKOUT SESSIONS 18, 19, & 20 The Role of Pharmacotherapy in the Treatment of Obesity Kerry-Ann Fuller, PharmD, BCACP Pharmacist learning objectives: 1. Recognize the general principles of obesity treatment

2. Identify efficacy and precautions of FDA-approved obesity agents

3. Determine appropriateness of obesity pharmacotherapy agents Treatment Options for Non-small Cell Lung Cancer Mark Harmon, PharmD, CSP Pharmacist learning objectives: 1. Recognize the impact Non-small Cell Lung Cancer (NSCLC) has on the general population 2. Describe clinical presentation of NSCLS 3. Identify risks of NSCLC

4. Describe recent studies and the impact they have on treatment options and outcomes for NSCLC

Continued on page 16

Celebration Event

Casino Night Music, Games, & Networking

Saturday, June 22 8:00 p.m.–10:00 p.m.

15 azpharmacy.org

Clinical Pearls from Genotype Guided Therapy Management Adrijana Kekic, PharmD, BCACP Pharmacist learning objectives:

Breakthrough to Excellence: Applying the Science of Expertise to Pharmacy Stephen Perona, PharmD, BCPS

1. Recognize impact of genetic variations on medication response

Pharmacist learning objectives:

2. Navigate and interpret pharmacogenomics results

1. Differentiate between an experienced and an expert clinician

 9:15AM–10:15AM • BREAKOUT SESSIONS 21, 22, & 23

3. Describe the importance of using a mental model during critical thinking

3. Integrate PGx knowledge in your clinical practice

The Treatment of VTE in Cancer: The Role of DOACs Marti Larriva, PharmD, BCPS Pharmacist learning objectives 1. Choose appropriate anticoagulation for treatment of VTE in the cancer patient 2. Identify cancer patients who are candidates for DOAC therapy

3. Compare and contrast the strength of data supporting the use of each DOAC in the cancer patient Putting “Yes, And” to Work: How Using IMPROV Can Promote Communication, Enhance Listening, and Lead to Stronger Teamwork Cory Jenks, PharmD, BCPS Pharmacist learning objectives: 1. List the core tenets that make improv a useful tool for working in healthcare 2. Describe how the guiding principles of improv can enhance healthcare communication

3. Identify how improv fundamentals can foster an environment of collaboration and teamwork Managing Adverse Events in the Specialty Pharmacy Setting Carrie Bader, PharmD

Pharmacist learning objectives: 1. Recognize the pharmacist’s role in post marketing surveillance 2. Discuss common adverse events with oral oncology agents

3. Apply management strategies for top reported adverse events in your practice setting 4. Establish patient touch points for managing adverse events in your practice setting 5. Analyze data on adverse event trends

 10:30AM–11:30AM • BREAKOUT SESSIONS 24, 25, & 26 Oncology Pain Management Logan Cast, PharmD. Pharmacist learning objectives: 1. Characterize leadership and what it means to be a leader.

2. Assess different leadership styles.

3. Distinguish the everyday pharmacist’s role in leadership.

4. Identify skills that pharmacists can use to be effective everyday leaders.

Biostatistics 101: Back to Basics

Bernadette Cornelison PharmD, MS, BCPS; Christopher Edwards, PharmD, BCPS Pharmacist learning objectives: 1. Identify the primary and secondary outcomes in a study 2. Discuss power, why it matters, and how its calculated

3. Assess appropriateness of statistical testing used based off the type of variables being studied

4. Compare and contrast an intent to treat and per protocol study population 5. Evaluate statistical and clinical significance of a study

6. Provide an interpretation of the results based off the information presented

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2. Apply the concept of purposeful practice to the development of expertise in clinical pharmacy practice 4. Devise a personal strategy to obtain regular feedback on the outcomes of your patients  1:30PM–2:45PM • GENERAL SESSION IV New Drug Update 2018 Robert Lipsy, PharmD, BCPS, FASHP Pharmacist learning objectives: 1. Recommend appropriate drugs and biologics for the treatment of unique patients

2. Compare and contrast new therapies with existing standards of care 3. Recognize common adverse reactions for new therapeutic entities  3:00PM–4:00PM • BREAKOUT SESSION 27 & 28

Bridging the Therapeutic Gap: Statin Use in Diabetes Kimberly Smith, PharmD; Andrea Cole, PharmD. Pharmacist learning objectives:

1. Describe ACC/AHA recommendations for statin use in diabetes 2. Describe ADA recommendations for statin use in diabetes

3. Apply recommendations to diabetic patients not prescribed statin therapy 4. Measure ASCVD risk percentage and analyze results to appropriately recommend statins in diabetes Adherence and Persistence with Oral Medications: Implications for Pharmacists Carolyn Parton, PharmD, PGY-1 Pharmacist learning objectives:

1. Recognize the impact of the increase in oral cancer therapies on the pharmacist regarding patient care management 2. Define adherence and persistence

3. Review the clinical outcomes associated with medication nonadherence 4. Identify strategies and resources pharmacists can use to help improve adherence and persistence

Lean more at www.azpharmacy.org

AWARDS LUNCHEON Eat & Celebrate the Accomplishments of Your Peers

SUNDAY, JUNE 23

11:45 A.M.–1:15 P.M. AzPA is an ACPE accredited provider.

Final program details and CE requirements are listed on the website.

editorial advoc a cy

To Advocate or Not? The Importance of Advocacy

AzPA APPE Rotation Student’s Perspective Esther Heo, PharmD Candidate — Midwestern University To advocate or not? That is the question. Of course, the answer is very obvious. Yes, we should. But why and how many of us actually get involved in advocacy?

As I sat in the back row during the AzPA Spring Clinical Conference, I listened to a variety of lectures. One of the first lectures was a panel of ASHP House of Delegates representatives discussing advocacy and new proposed ASHP policy statements. Each pharmacist shared a different policy such as promoting suicide awareness and

prevention, pharmacy technician certification training, and the therapeutic use of cannabidiol (CBD).

All of these policies were interesting, but there was one idea that stood out the most to me and it wasn’t a policy.

It was a definition. The definition of advocacy and the philosophy behind it was what intrigued me.

So, what is advocacy? Dr. Melinda Burnworth started the lecture defining what advocacy means, and I’m grateful that she did because I was unsure of the meaning. She defined it as “the act or

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To Advocate or Not continued from page 17 process of advocating something.”

Still sounds very confusing to me.

She also defined it as “the act or process of supporting a cause or proposal.” Nice, makes more sense, now I get it. The word advocacy comes from the Latin word advocare, which means “to add a voice”. To advocate for a cause is to add a voice to it, and hopefully when people hear that voice there is a positive change.

As pharmacists, we are the drug experts. No one knows drugs better than us. Therefore, it is our duty and responsibility to promote and advocate for proper and safe medication use. However, sometimes it’s not that easy to do. Sometimes we don’t have the time to talk to each patient in our practice setting; sometimes we are too busy with personal responsibilities to volunteer; and unfortunately, maybe for some of us, sometimes we just don’t care.

Then I began to wonder, what happens when pharmacists don’t advocate? What happens in our communities?

I started thinking about healthcare issues going on in this country. One of the big topics right now is the increase of prescription drug overdoses in the past 20 years, particularly from opiates. Every time I think about this opioid epidemic I feel sad and confused. Since pharmacists are one of the most accessible healthcare professionals and on the front line when it comes to prescription drugs, I feel like we could have done more to advocate for safer drug use and talked more to our patients about addiction. But at the same time, I totally understand why we didn’t either, especially when it comes to dependence and addiction.

Addiction is a very controversial topic and the stigmatization of it has deterred many of us from openly discussing it with our patients. If we do decide to talk about addiction, what are we supposed to say? Are we

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SPRING 2019

supposed to talk about different treatment centers around the area? Are we supposed to give a pamphlet that shows all the free 12 step Alcoholics Anonymous, Pill Anonymous, and Heroin Anonymous meetings in the city?

Are we supposed to recommend a methadone clinic? I don’t know.

As a profession, many of us never received the proper education to identify all the different signs and symptoms of substance use disorder, and many of us never received the proper training to provide the resources to manage and treat it. Even though our profession has advanced and we have expanded our role in healthcare over the past 20 years, our practice still has many educational gaps related to addiction that we need to address. Addiction is a complex disease and a variety of groups such as physicians, psychologists, politicians, and social workers have advocated for it over the past years, which is great. However, it is a disease related to drugs.

So, isn’t it time that we, the drug experts, join the team and publicly advocate for it too?

Another hot topic going on in our country is the anti-vaccination movement. I had the opportunity to attend the legislative hearing on 3 bills, HB 2470, 2471, and 2472. HB 2470 would allow parents of students from K-12 to opt out from the required vaccinations needed to attend school due to a religious belief (they are already allowed to opt out due to a personal belief). HB 2471 would make it a requirement for healthcare professionals to give patients all the detailed information about the vaccination including the benefits and risks of each vaccine, how to report a vaccine adverse event, and the manufacturer’s package insert before administrating a vaccine (we already provide the benefits/risks and how to report adverse events on the VIS). Finally,

HB 2472 would require all vaccine providers to offer an antibody titer blood test to determine if the person needs a vaccine or is already immune.

As I looked around the room, I realized how many people were there in support of these perceived “anti-vaccination” bills from our community. It was a much larger crowd than I expected. Many of them shared stories and information that was scientifically unreliable with no clinical evidence to support it. I was starting to feel really frustrated, and I wasn’t sure why. Was I frustrated at all the inaccurate information or was I frustrated that so many people are beginning to believe this information?

The anti-vaccination movement has been growing and spreading throughout the world. It has become such a big problem that the World Health Organization (WHO) recently listed vaccine hesitancy in the top 10 threats to global health, and it was even higher on the list than HIV. This anti-vaccine problem, which can easily be prevented by just advocating truthful scientific information is a bigger threat in the world than an incurable virus, which humanity has spent billions of dollars on trying to treat it and find a cure. Wow, it boggles my mind.

So, to advocate or not? Of course, the answer is still yes. But it’s not that we should advocate, it’s that we need to. We have to be the voice of reason, the voice of knowledge, and the voice of truth when it comes to drugs. Why? Because no one knows drugs better than us. As pharmacists and student pharmacists, we need to be more proactive, because if we don’t, preventable problems like the opioid epidemic and the anti-vaccination movement will continue to get worse and other new preventable problems could be created. 

Arizona State Board of Pharmacy Update

editorial advoc a cy

Pharmacy Technician Trainee License Reapply/Extensions Pharmacy technician trainees with an expiration date on or before July 31, 2019 are eligible to reapply for a twoyear extension of their license up to 60 days before their license expires. No reapply/extension applications will be accepted after July 31, 2019. A reapply/ extension is not available for a technician trainee license that has already expired or has already been extended.

An extension is only allowed one time.

Technician trainees who are granted a reapply extension will receive a one time, two-year extension of their license. Processing may take 3–4 weeks. If your license expires, you may not work until you receive your new license. Please note: A reapply/extension application IS NOT the same as a renewal.

Trainee License Holders Not Eligible for Trainee Reapply/Extension

Currently-licensed pharmacy technician trainees whose license expires after July 31, 2019 are required to take and pass the PTCB or ExCPT exams. Once you have passed the exam, apply for a pharmacy technician license. A PTCB or ExCPT certification alone does not qualify technicians to work in an Arizona pharmacy.

You must have a license from the ASBP. If your trainee license expires, you may not work as a trainee or a pharmacy tech until you receive a pharmacy technician license. Allow 6–8 weeks for processing of an online application. A hard-copy application may take 1012 weeks. If an application is not complete, it may take longer to process. Pharmacy Technician License Application Requirements can be downloaded here: https://bit.ly/2TjTFzg. Should you find yourself between licenses, a list of pharmacy clerk duties you may perform without a license can be found here: https://bit.ly/2TPFbMk.

Other News

Joe Leyba, PharmD was named ASBP President at the January Board Meeting.

Kristen Snair, CPhT was named ASBP Vice President.

Upcoming Board Meetings: • May 8–9th

• July 31–August 1st

• September 25–26th • December 4–5th

Arizona State Board of Pharmacy

President Joeseph Leyba, PharmD

Vice-President Kristen Snair, CPhT

Member Reuben Minkus

Member Michael Blaire, RPh

Member Mohammad Salari, RPh

President Kevin Dang, PharmD

Member Theodore Tong, PharmD

Member Kyra Locnikar

Member Lorri Walmsley, RPh

19 azpharmacy.org

editorial advoc a cy

Legislative Update Michael Fan, PharmD Candidate — University of Arizona

Electronic Prescribing of Controlled Substances (EPCS) HB 2075, signed by Governor Ducey on February 14, 2019 overrides a portion of the opioid law passed in 2018 (SB1001) stating that retroactively from December 31st of 2018, CII opioids are not required to be sent electronically. The new deadline to acquire electronic prescribing software has been extended to January 1st of 2020. No waivers will be granted.

Here are all of the major provisions contained in HB 2075:

• Moves the 2019 implementation dates for urban and rural counties to January 1, 2020.

• Allows for written prescriptions if the e-prescribing system is not operational or available in a timely manner. The occurrence must be noted in records maintained by the pharmacy for a period of time set by the Arizona Board of Pharmacy.

• Exempts requirements for Indian Health Services and federal facilities.

• Eliminates the waiver process through the Arizona Board of Pharmacy but provides rulemaking authority in consultation with a Task Force to add additional exceptions.

• Allow for prescriptions to be faxed if the prescription is compounded for direct administration to a patient, residents of a long-term care facility and hospice patients.

• Resolves a statutory conflict that inadvertently imposed a prohibition on physician assistants prescribing more than a 72-hour dosage of opioids or benzodiazepines.

• Contains a retroactive clause to December 31, 2018 so the legislation takes effect immediately once it becomes law.

Exceptions:

20 SPRING 2019

An exception to the electronic prescription software mandate are veterinarians. Until the board of veterinarians deem that electronical prescription software is widely available, veterinarians are not required to send in schedule II opioids via electronic means.

Faxed prescriptions are also allowed for controlled substance if it falls under one of these conditions: • The medication is compounded for direct administration to a patient • The patient is a resident of a long-term care facility • The patient is in hospice

Is an out-of-state prescription required to comply by these electronic prescribing laws?

No. If a prescription for a schedule II opioid presented originating from another state, a pharmacist may fill that prescription as long as it meets the requirements in that state.

Who’s Representing

New legislation being introduced this session:

(AzPA Bill): HB 2285 is a bill that attempts to add transparency and regulations pertaining to Pharmacy Benefit Managers (PBMs). This bill will allow all network retail pharmacies to fill for 90-days if allowed by PBM for any other in network retail pharmacy and prevents a prohibition on delivery service to patients. Furthermore, it requires PBMs to update their MAC drug pricing and information every 7 days as well as have an appeals process.

HB 2166 is a bill that helps aid in the payment towards a patient’s medical expenses. Recently, many insurers and pharmacy benefit managers are adding restrictions towards which payment types they are calculating towards a patient’s deductible. This bill requires that ALL payment made towards a prescription medication be applied towards the deductible. This includes but is not limited to: payments from family members and payments from pharmaceutical companies such as copay cards.

(ASBP Bill): SB 1103 is a bill that expands the definition of “unethical conduct” and “unprofessional conduct” of which the State Board of Pharmacy can discipline a pharmacist for. This bill includes “being disciplined by a federal agency or state licensing agency or board” as falling under “unethical conduct” and “unprofessional conduct”. “Unethical conduct” in this bill is also expanded to include the failure to operate according to the permittee’s hour of operations as submitted to the Board. “Unprofessional conduct” in this bill is expanded to include the failure to promptly produce any book or record. License and permit applicants are required to pay a convenience fee as determined by the Board when using the online application process.

Jessie Armendt

Compass Strategies, AzPA Contract Lobbyist

Mark Boesen, JD, PharmD, FAzPA AzPA Legislative Committee Co-Chair

(ASBP Bill): SB 1402 is a bill that defers control substance scheduling from a state level to a federal level. Currently, states are allowed to create their own list of schedule drugs and law dictates the use of the stricter scheduling in the case of a conflict. This bill removes the need for Arizona to provide its own schedule list and complies by the federal scheduling conducted by the FDA. (ASBP Bill): SB 1403 is a bill that expands the definition of “unethical conduct” and “unprofessional conduct” of which the State Board of Pharmacy can discipline a pharmacist for. “Unethical conduct” in this bill is expanded to include the failure to operate according to the permittee’s hour of operations as submitted to the Board and being disciplined by a federal or state agency.

“Unprofessional conduct in this bill is expanded to include the failure to promptly produce any book, record or being disciplined by a federal agency or state licensing agency or board. License and permit applicants are required to pay a convenience fee as determined by the Board when using the online application process.

Ken Bykowski, BSPharm, MSHSA AzPA Legislative Committee Co-Chair

SB 1170 is a bill that removes the current requirement that retailers that sell over-the-counter products must obtain a permit from the Board of Pharmacy.

This would allow any retailer to sell over-the-counter products, such as vitamins, sunscreen, etc., without obtaining a permit.

HB 2548 is a pharmacist scope of practice bill that passed through the House Rules Committee and had the potential to reach the Committee of the Whole.

However, after consideration, it was in the best interest of the bill sponsor (Representative Nancy Barto) and stakeholders to pull the bill to continue work in the interim to ensure we have the votes and do not have to water it down to get it passed. We plan to introduce another bill in 2020. 

Kelly Fine, RPh, FAzPA

AzPA Chief Executive Officer

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editorial new s

University & Alumni News Midwestern University College of Pharmacy Mitchell R. Emerson, PhD

Dean, Midwestern University CPG

Rare Disease Day Proclamation signed by Governor Ducey By: Taran Goodballet, PharmD Candidate 2020 & Mindy Burnworth, PharmD, BCPS, FASHP, FAzPA

On Thursday, February 28, 2019, the National Organization for Rare Disorders (NORD) Arizona Rare Action Network (RAN) collaborated with Midwestern University College of Pharmacy-Glendale (MWU CPG) and Pharm.peDs MWU Pediatric Pharmacy Club to host the second annual 2019 Arizona Rare Disease Day held at the Arizona State Capitol. Over 40 attendees met with other rare disease patients, caregivers, and health care professionals. In addition, attendees visited the Executive Office of the Arizona Governor to pick up the Rare Disease Day proclamation signed by Governor Ducey. Christina Corieri, Office of the Arizona Governor’s Senior Policy Advisor, greeted advocates and shared in the reading of the proclamation in the Governor’s Conference Room. In addition, reading of the proclamation occurred during official floor proceedings of the Arizona State House of Representatives and Arizona State Senate. Recognition of rare disease advocates watching in the Public Galleries of the Arizona State Legislature occurred by name and district represented.

Taran Goodballet, MWU CPG PharmD Candidate 2020, participated in the advocacy event as the Pharm. peDs Rare Disease Day volunteer student liaison. She also interviewed Mindy Burnworth, Arizona RAN Ambassador and Professor at MWU CPG, to learn more about rare disorders and advocacy.

Q

What is NORD? What is Arizona RAN?

NORD, National Organization for Rare Disorders, is a patient advocacy organization dedicated to individuals with rare diseases and the organizations that serve them. NORD is committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and patient services. NORD was founded in 1983 in Connecticut. NORD has a membership program

22 SPRING 2019

for 501(c)(3) nonprofit patient organizations that specialize in rare diseases. NORD currently has over 280 member organizations, and works with the organizations on peer to peer networking and guidance, advocacy, access, promotion, and education. Another membership platform for individuals is through the Rare Action Network™ (RAN) that serves to connect and empower a unified network of individuals and organizations with tools,

training, and resources to become effective advocates for rare diseases. NORD stands for equitable access to timely diagnosis, treatment, and care for every person impacted by a rare disease. Members who join RAN are connected to other advocates within their state to work on state based policy initiatives and awareness activities in their local communities while working with their state’s volunteer

Continued on page 24

Rick G. Schnellmann, PhD

Dean, University of Arizona COP—Tucson

Longtime Faculty Member and Leader, John E. Murphy, PharmD, Prepares for Retirement For 28 years, John E. Murphy, PharmD has been a familiar face in the UA College of Pharmacy. From Professor of Pharmacy Practice and Science to Interim Dean, he has served the College in many roles, driven by a desire for student success. This June, Dr. Murphy will be retiring.

“Over the years, I have been given the opportunity to work with amazing students, staff, faculty, and administrators,” he said. “Seeing our graduates become successful pharmacists and scientists has been a real treat.”

Dr. Murphy received his BS in Pharmacy (1976) and PharmD (1979) degrees from the University of Florida, and he joined the UA College of Pharmacy in 1991. Since then, he has seen great change in both the College and the larger industry.

“When I began at the College of Pharmacy,” he recalled, “there were 55 students per year – now, there are approximately 140.

The curriculum has also changed considerably to reflect important changes in the profession that enable greater direct patient care by pharmacists.”

Similarly, he noted the differences in the field. “I was involved with a private practice clinical pharmacokinetics service in the 1980s. At the time, few practitioners had such opportunities. Now, pharmacists can have collaborative

practice agreements in almost every state.”

John E. Murphy, PharmD

Over the years, I have been given the opportunity to work with amazing students, staff, faculty and administrators.

Seeing our graduates become successful pharmacists and scientists has been a real treat.

Throughout his career, Dr. Murphy has authored multiple books and hundreds of original research papers. He has served as President of the American Society of Health-System Pharmacists and the American College of Clinical Pharmacy. He has also been the recipient of numerous awards, including the College of Pharmacy’s 2018 Findlay E. Russell Distinguished Citizen Award.

Dr. Murphy has been an active member of AzPA since 1991 when he arrived in Arizona. He has been recognized by the organization as its Pharmacist of the Year in 1997 and was awarded the Elias Schlossberg Memorial Lecture Award in 1998.

AzPA members attending annual meetings will remember Dr. Murphy serving as banquet emcee over the past 22 years, a role he will miss.

Looking ahead to his retirement, Dr. Murphy plans to spend time with his family and pursue his hobbies of travelling, skiing and fly-fishing.

He will also continue working on a number of professional activities and remain affiliated with the College as a Professor Emeritus. Reflecting on his career at UA, he said, “It has been a great ride. Thanks to all of you that have shared the journey with me.”

The UA College of Pharmacy thanks Dr. Murphy for his years of dedicated service and wishes him a happy retirement!

23 azpharmacy.org

Rare Disease Day Proclamation continued from page 22 ambassador for RAN. Mindy Burnworth melinda. burnworth@rareaction.org is the volunteer Arizona RAN Ambassador.

Q

How many rare diseases are known?

According to the National Institutes of Health (NIH), a disease is considered rare if it has a prevalence of fewer than 200,000 affected individuals in the United States. There are roughly 7,000 rare diseases currently identified (many are undiagnosed). Some more commonly known rare diseases are ALS (“Lou Gehrig’s Disease”), Cystic Fibrosis, and approximately 50% of people with cancer. Rare cancers include brain, pancreatic, ovarian, thyroid, and stomach cancers; leukemia and lymphoma; and all pediatric cancers. Over half of rare disorders occur in the pediatric population.

In Arizona, 1 in 10 individuals (nearly 700,000) have a rare disorder.

Q

What are some challenges individuals with rare diseases and their caregivers encounter?

Challenges individuals with rare diseases encounter include: average of 5-7 years for a diagnosis, few medical experts on the disease, little to no research known about the disease, extensive and life-long medical needs, high cost of care and treatment, small scattered patient populations, social isolation, and only 5% of rare diseases have an Food and Drug Administration (FDA) approved therapy.

NORD and Arizona RAN help to overcome these challenges by working with the rare community through patient assistance programs, education, research support, public policy, and advocacy.

Over the past 35 years, NORD has been instru­ mental in many legislative initiatives such as the 1985 Orphan Drug Act. Through the launch of the RAN program in 2014, NORD has been able to have

Members of Arizona Rare Action Network seated in the Public Gallery at the Arizona State House of Representa­ tives listening to the inaugural reading of the Rare Disease Day Proclamation

an impact on state-based initiatives. In 2016, NORD piloted a RAN State Ambassador program with five states. In January 2017, NORD RAN launched a more comprehensive ambassador program.

Moving into 2019, almost all 50 states have a state ambassador in place. In January 2018, Mindy Burnworth joined as the Arizona RAN volunteer ambassador.

Q

To make meaningful change in the lives of rare disease patients and their families in the state of Arizona, become active and join AZ RAN. Join today by clicking on the orange box in the upper right hand corner of the AZ RAN webpage rareaz. org or www.rareaction.org. As part of this rare community, you will receive timely updates about rare disease advocacy events throughout the state, such as Rare Disease Day. Many of the AZ RAN members are patients, caregivers, and health care professionals including members of MWU Pharm. peDs. This specialized group is a pharmacy student organization committed to improving the health of children and promoting pediatric patient education among health professionals, students, and the community at large. The group’s faculty advisor and MWU CPG assistant professor, Titilola Afolabi, specializes in pediatric pharmacy. The focus of Rare Disease Day matches the mission of this specialized pediatric group.

Q Members of Arizona Rare Action Network at Arizona State Capitol

24 SPRING 2019

How can one become involved with AZ RAN?

What is a proclamation?

A proclamation is a formal public statement made in front of an audience or the authoritative word on some subject. These statements are often referenced within official or government documents. Proclamations can go through the

local, state, and federal level. Proclamations are one of many ways to raise awareness within the community about rare diseases. It is also an opportunity to educate the community on the impact rare diseases have within their own municipalities. The 2019 Rare Disease Day proclamation was signed by Arizona Governor Ducey and recognized by the Arizona State Legislature (House of Representatives and Senate).

Q

What steps can help make an advocacy event successful?

When you speak (or advocate) from the heart, success is inevitable. Sharing anecdotes about rare disorders and how regulations may touch those with rare disorders is most meaningful.

Regular contact with your designated legislative district representatives is helpful in advancing a proposal or cause. Such was the case with the Rare Disease Day proclamation. Arizona State House of Representative Kelli Butler (LD28) and Arizona State Senator Kate Brophy McGee (LD28) facilitated the reading of the proclamation on the respective floors. In addition, maintaining close relationships with a dedicated lobbyist or advocate at the State Capitol can assist with in-person events and last minute schedule changes. MWU’s lobbyist, Kelsey Lundy, Managing Partner Compass Strategies navigated the rare advocacy group around the State Capitol the day of the event and assisted with

scheduling meetings in advance. All of these efforts allowed for a successful Rare Disease Day for those that attended the event.

Q

What final thoughts can you share about NORD and rare diseases?

Until the establishment of NORD, patients and families living with rare diseases walked alone.

There was little research being done on these diseases and their treatment, which left patients and their families with few resources and limited guidance. For more than 30 years, NORD has been advocating for the needs of the rare disease community. Through the advancement of medical research, creation of diagnostic tests and therapies, and driving supportive policies, NORD has given the rare disease community a voice. Because 1 in every 10 Arizonians is diagnosed with a rare disease, it is important that healthcare providers and pharmacists are knowledgeable about rare disorders. The Arizona Rare Action Network allows for this type of information sharing and advocating for those impacted by rare disorders. Taran Goodballet, MWU CPG PharmD Candidate 2020, reflects on her inaugural Rare Disease Day, “Knowing that rare disorders primarily affect pediatric patients, I believe events like this are crucial to helping this population have their voices heard.”

Alone we are rare. Together we are strong.



25 azpharmacy.org

editorial history First Quarter 2019: Pharmacy Time Capsule By: Dennis B. Worthen, PhD, Cincinnati, OH

1994 • The first organized movement to train pharmacists to provide immunizations began in Washington state

1969 • Fentanyl marketed by McNeil in US

• Clinical pharmacy defined as dealing with patient care with emphasis on drug therapy • Martin Luther King murdered in Memphis

1944 Most of American life was focused on the progress of WW II in Europe and the Pacific • D-Day June 6, 1944

• The United States Forest Service and the Wartime Advertising Council release posters featuring Smokey Bear for the first time

1919 • Webb et al v.

United States court case confirms that physicians and pharmacists cannot supply an addict just to maintain his or her addiction

1894 • Formation of the University of Washington College of Pharmacy

• The first bottles of Coca-Cola were sold in Vicksburg, Mississippi 

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

editorial contin u i n g e d A Practical and Stepwise Approach to Evaluating QREs Associated with Patient Harm John M Kessler, BSPharm, 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. List at least 3 key steps in the investigation of QREs associated with harm.

2. Describe the 2 expected outcomes of a Harm Investigation.

3. Describe who “owns” the Harm Investigation checklist.

4. List at least 4 characteristics of the QRE that are evaluated in the Harm Investigation.

5. List at least 2 evidence based corrective actions that are on the Corrective Action Hierarchy — adapted for community pharmacy use.

Target Audience: Pharmacists & Pharmacy Technicians

Credits:

CE is 1.0 hour (0.1 CEU)

To access this activity

1. Go to https://ceimpact.com/ *Google Chrome browser is recommended

2. Log in or create a profile (will not be able to complete CE without a profile) 3. Once logged in, locate the ‘Enter Code” box at the bottom left-hand side 4. Enter the Partner Code per the CE you wish to complete Pharmacists: 2018RPH Technicians: 2018TECH

5. You will see a green box at the top right corner – this will be your confirmation that the Partner Code was successful 6. Once you have applied the code, you should be able to complete the activity. It will be in your “My Courses” dashboard. You can find your courses link at the bottom left-hand side.

7. Locate the activity title you wish to complete within your courses and go through the steps: Instructions | Course | Exam 8. Complete the exam and evaluation as prompted, click SUBMIT to send your information to CPE Monitor Questions? Please contact the Alliance for Patient Medication Safety at info@medicationsafety.org or (866) 365-7472

Pharmacy Insurance

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

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