AJP Winter 2023

Arizona Journal of Pharmacy O F F I C I A L

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In This Edition: Flu Shot Season Is Here - What Is Needed for Audit

Back to Basics - Responding to Emergencies Outside of the Hospital Setting

Board of Directors 2022-2023 Officers President Dawn Gerber President Elect Kimberly Langley Past President Darren Clonts Treasurer Jacob Schwarz Secretary Nancy Costlow Director/CEO Kelly Fine Directors at Large Community Phillip Ieng Health System Christopher Edwards Technician Melinda Browning Reasol Chino Ryan Gries Brandy DeChellis Misty Brannon Nina Vadiei Liaisons University of Arizona Student Chapter Jose Espinoza Dean's Designated Representative Nancy Alvarez Midwestern University Student Chapter Lyndy Abdelsayed Dean's Designated Representative Michael Dietrich Creighton University Student Chapter Sharon Ruditser Dean's Designated Representative Jane Stein Legal Counsel Roger Morris

AzPA Staff Chief Executive Officer Kelly Fine Education & Professional Development Dawn Gerber Events & Strategic Partnerships Cindy Esquer Membership & Volunteer Services Hanna Wooldridge Digital Marketing & Engagement Irma Settle Administrative Services Melina Esquer Editor Kelly Fine Creative Coordinator Irma Settle The interactive digital version of the Arizona Journal of Pharmacy is available for members only online in your member portal.

(480) 838-3385 | admin@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 19490941) is published quarterly by the Arizona Pharmacy Association at: 1845 E. Southern Avenue, Tempe, AZ 85282-5831

Table of Contents Cover Story

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AzPA News

President's Message

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AzPA News

Welcome New Members

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AzPA News

Az-ASHP State Affiliate News

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Editorial

Preceptor Corner

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Editorial

Member Spotlight

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Back to Basics - Responding to Emergencies Outside of the Hospital Setting

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Editorial

Financial Forum

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Editorial

University & Alumni News

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Editorial

Flu Shot Season Is Here - What Is Needed for Audit

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AzPA News

AzPA State Advocacy

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UPCOMING EVENTS January 29, 2023 Virtual April 22, 2023 Glendale, AZ

February 4, 2023 Virtual

February 11 , 2023 Virtual

March 4-5, 2023 Phoenix, AZ

June 15, 2023 Glendale, AZ

June 22-25, 2023 Tucson, AZ

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WINTER 2023

PRESIDENT'S MESSAGE Dawn Gerber, PharmD, BCGP, FASCP, FAzPA

Associate Professor of Pharmacy Practice at Midwestern University College of Pharmacy-Glendale, Arizona, earned her Doctor of Pharmacy degree from Drake University, Des Moines, Iowa. She completed a pharmacy practice residency at the Creighton University Medical Center, Omaha, Nebraska. Dr. Gerber is a Board Certified Geriatric Pharmacist (BCGP) and recognized as Fellow of the American Society of Consultant Pharmacists (ASCP) and Fellow of the Arizona Pharmacy Association (AzPA). She collaborates with the Banner Geriatric Medical Fellowship Multidisciplinary Rounds. She teaches geriatric pharmacotherapy topics and the required Complementary and Alternative Medicine course. She has held leadership positions with AzPA, ASCP, and American Society of Health-System Pharmacists (ASHP). She is a Pharmacy Residency Accreditation Practitioner Surveyor with ASHP. Dear AzPA (Arizona Pharmacy Association) Members, It is that time of year to reflect on our 2022 accomplishments and look forward to the new endeavors of 2023!

In 2022, AzPA successfully transitioned educational events to in-person offerings as the COVID pandemic decreased in intensity, vaccinations became more available, and our supporters were comfortable meeting inperson again. AzPA provided three immunization certificate programs and trained 265 pharmacists, pharmacy students, and pharmacy technicians, who are now ready to administer vaccinations when needed. Without the engagement, support, and trust of the pharmacy community, AzPA would not be as successful as it has been.

On behalf of the AzPA BOD (Board of Directors), we are asking you to continue your much needed support in 2023. The 2023 Arizona legislative session begins January 9, 2023, and now more than ever, Arizona legislators need to hear from Arizona Pharmacy Association members. There are 40 new legislators that need to learn all the profession of pharmacy does for our patients, from their constituents. After January 1, 2023, please find your legislators’ contact information via https://www.azleg.gov/findmylegislator/ and contact their office if you are willing to be a resource when medication and pharmacy related bills are presented. Please take the time to explore https://www.azleg.gov as well. Visit https://apps.azleg.gov/RequestToSpeak/UpcomingAgendas to create an account on the “Request to Speak” system so you are able log in and register your opinion in addition to leaving a comment for committee members, so they know your position on bills. Be an advocate for your profession without leaving your home!

To help educate legislators, Pharmacy Day at the Capital (PD@C) is scheduled for March 28, 2023, so please join Arizona Pharmacy Association to meet and greet Arizona legislators! The more voices that join, the louder AzPA is heard! Check the https://azpharmacy.org/events/pdac/ website for more details.

Lastly, I cannot wait to see everyone at the 2023 Annual Convention. Don’t forget to mark your calendar for Thursday, June 22nd through Sunday, June 25th, at Loews Ventana Canyon Resort in Tucson. This live event is going to meet your education and networking needs!

Sincerely, Dawn Gerber, PharmD, BCGP, FASCP, FAzPA AzPA President 2022-2023

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AzPA News

New Members

Welcome New Members 1st Year Practitioner

Evan Riggert Jonathan Snyder 2nd Year Practitioner

Fizza Saeed Lucas Roach Madeline Green William Clafshenkel Pharmacist

Amy Christen Brian Strang Brianne Fife Carolyn Dewart-Wojtanowski Elizabeth Tucci Farah Raheem Hana Pajazetovic Janelle Vircks Jin Yu John Ginniman Katie Anderson Kelly Green Lea Mollon Liliane Mofor Mary Theresa Seddon Melissa DiCamillo Roseanne Lee Stephanie Bottorf Sue Ewing Vanessa Holton Premium Pharmacist

Adrienne Begaye Douglas Clark John Bouchard Joscelyn Aquiningoc

Meagan Duchein Michele Fabela Paul R. Sanchez Victoria Yan Resident

Jessica Mo Terrance Clemans Student Pharmacist

Amjad Hmlan Amy Hou Angel Saenz Brianna Foraker Brooke Hem Caroline Veevers Danielle Bauer Easter Niyongabo Jackie Tan Jennyfer Han Jerry Zeng John Drennan Kushal Shah Leonard Vandekerkhoff Marlen Cherop Megan Grieser Melvin Ani Miasel Compean Michael Nunez Michelle Hanson Miranda Arzate Monique Cazares Nguyen Pham Nicole Arizechi Phillip Adilukito Priscilla Pacheco Rana Abada Rasha Matti Rayshion Nezy

Sahr Binzager Samantha Rauch Sania Ali Savannah Christie Sohyeon Higgs Stephanie Ashkuri Victoria Frazier Waseem Alkakoz Tech in Training

Barbara Porter Theresa Hanley Technician

Amy Bollard Bartley Smith Benjamin Jones Lisa Giannini Scott Barlow

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10:45AM - 11:45AM / Focus on Hyperlipidemia: Medication Review Lauren Rimsza, PharmD; Amy Kennedy, PharmD, BCACP; Alejandro Vazquez, PharmD Pharmacist Learning Objectives: Describe the mechanisms of action (MOA) of evinacumab and bempedoic acid 2. List the adverse effect profiles of evinacumab and bempedoic acid 3. Recall the data that demonstrates the efficacy of evinacumab and bempedoic acid 1.

Technician Learning Objectives: List the new treatment options that are alternatives to statin therapy 2. Discuss the storage requirements, dosage forms, and strengths available for these alternative treatment options 1.

Saturday, March 4, 2023 8:15AM - 9:15AM / Let Your Voice Be Heard: A Discussion of Advocacy and ASHP House of Delegates Christopher Edwards, PharmD, BCPS, FASHP, FAzPA; Mindy Burnworth, PharmD, BCPS, FASHP, FAzPA; Janelle Duran, PharmD, BCPS Pharmacist Learning Objectives: Describe ways Arizona pharmacy professionals can get involved in advocacy through state and national pharmacy associations 2. Discuss the role of Arizona delegates to the ASHP House of Delegates 3. Discuss the potential impact of selected policies coming before the ASHP House of Delegates in June to the practice of pharmacy in Arizona and to pharmacy personnel 1.

Technician Learning Objectives: Describe how a pharmacy technician may contribute to ASHP policies 2. Understand how policies may impact pharmacy technicians 1.

9:15AM - 10:15AM / ASHP: A National Perspective on Current Pharmacy Issues 10:45AM - 11:45AM / Focus on Sepsis: Medication Review Kathleen Bloomquist, PharmD; Brian Kopp, PharmD, BCPS, FCCM Pharmacist Learning Objectives: Describe the pathophysiologic basis for hemodynamic instability in septic shock 2. Identify vasopressors that are likely to be of benefit in patients experiencing septic shock 3. Identify fluids used in resuscitation that are most likely to remain in the intravascular space 1.

Technician Learning Objectives: Identify vasopressors that are likely to be of benefit in patients experiencing septic shock 2. Identify fluids used in resuscitation that are most likely to remain in the intravascular space 1.

1:00PM - 2:00PM / Focus on Sepsis: Guideline Update Gabriella Gambadoro, PharmD; Brian Kopp, PharmD, BCPS, FCCM Pharmacist Learning Objectives: Summarize the role of corticosteroids in managing sepsis Review the goal timing of antibiotics when treating patients with sepsis 3. Differentiate patients with sepsis who may benefit from a fluid restricted resuscitation strategy 1.

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Technician Learning Objectives: Summarize the role of corticosteroids in managing sepsis Review the goal timing of antibiotics when treating patients with sepsis

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1:00PM - 2:00PM / Focus on Hyperlipidemia: Guideline Update Caroline Adrian, PharmD; Jacob Northrup, PharmD, BC-ADM, CDCES Pharmacist Learning Objectives: Summarize most recent updates to guideline(s) Review lipid goals and ASCVD risk factors and identify indications for treatment 3. Contrast treatment options for hyperlipidemia based on most recent guideline(s) 1.

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Technician Learning Objectives: Summarize most recent updates to guideline(s) List the first line medications recommended by the guideline(s) for the treatment of hyperlipidemia

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2:00PM - 3:00PM / Focus on Sepsis: Patient Case for the New Practitioner Jacob Schwarz, PharmD, MBA, BCIDP, BCCCP, BCPS, FAzPA; Christi Jen, PharmD, BCPS, FASHP, FAzPA Pharmacist Learning Objectives: Apply criteria for sepsis and/or septic shock to a patient case Design an appropriate resuscitation strategy for a hemodynamically unstable patient with septic shock 3. Apply criteria for initiating corticosteroid treatment to a patient case 1.

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R E G I S T R A T I O N O P E N N O W ! L e a r n M o r e a t : a z p h a r m a c y . o r g /s p r i n g 2 0 2 3 2:00PM - 3:00PM / Focus on Hyperlipidemia: Patient CaseWhen Statins Aren't Enough Erin Raney, PharmD, BCPS, BC-ADM Pharmacist Learning Objectives: Choose treatment goals for hyperlipidemia based on patient specific characteristics 2. Recommend treatment for hyperlipidemia based on patient specific characteristics 3. Monitor treatment outcomes for hyperlipidemia based on patient specific characteristics 1.

2:00PM - 3:00PM / Focus on Sepsis: Medication Safety and the Technician's Role Christi Jen, PharmD, BCPS, FASHP, FAzPA; Sylvia Gomez, CPhT Technician Learning Objectives: Describe the consequences of delays in antibiotics when treating patients with sepsis 2. List 4 medications that are truly STAT when treating patients with septic shock 1.

3:15PM - 4:15PM / Focus on Sepsis: Therapeutic Debate Christopher Edwards, PharmD, BCPS, FASHP; Brian Kopp, PharmD, BCPS, FCCM Pharmacist Learning Objectives: Critique the evidence for and against a liberal fluid resuscitation in early management of sepsis 2. Evaluate the evidence for “maximum” doses of norepinephrine when treating patients with septic shock 3. Evaluate the literature for the use of balanced salt solutions or saline as resuscitative fluids in patients with sepsis and septic shock 1.

3:15PM - 4:15PM / Focus on Hyperlipidemia: Therapeutic Debate-How Old Is Too Old? Debating the Use of Statins for Primary Prevention in the Elderly Ariane Guthrie, PharmD, BCPS; Thu Nguyen, PharmD, BCGP, BCPS Pharmacist Learning Objectives: Evaluate the evidence for initiating statin therapy for primary prevention in older adults 2. Evaluate the evidence for deprescribing statins in persons with advanced age 3. Compare risks and benefits of statins for primary prevention in older adults 1.

4:30PM - 5:30PM / Demystifying Pain Management Overview of the 2022 CDC Opioid Guidelines Update Christopher Edwards, PharmD, BCPS, FASHP; Amy Kennedy, PharmD, BCACP Learning Objectives: Given a patient case, develop a plan to taper the patient off of long-term opioid therapy 2. Evaluate a patient case to determine if co-prescribing of naloxone is appropriate 3. Differentiate between substances detectable and not detectable on commonly available opioid screening assays 1.

Sunday, March 5, 2023 8:15AM - 9:30AM / Pharmacy Law Update Roger Morris, RPh, JD; Katie Lavigne, JD; Kaitlyn Fydenkevez, JD Learning Objectives: Describe ramifications of recent pharmacy-related court cases 2. List recent changes in Federal Pharmacy Law 3. List recent changes in State Pharmacy Law 1.

9:45AM - 10:45AM / Interstitial Lung Disease Associated with Anticancer Therapy Farah Raheem, PharmD, BCOP Pharmacist Learning Objectives: Identify anticancer agents associated with pulmonary toxicity 2. Describe diagnosis of treatment related interstitial lung disease 3. Define grading of anticancer treatment-related interstitial lung disease 4. Discuss management of anticancer treatment related interstitial lung disease and pneumonitis 1.

9:45AM - 10:45AM / Immunization Update - Jeopardy Style!

Holly Van Lew, PharmD, BCPS, AAHIVP Pharmacist Learning Objectives: Discuss the most recent updates for routine vaccinations, including pneumococcal, Hepatitis B and other vaccines with updated indications and expanded age ranges 2. Apply the current recommendations for COVID-19 vaccinations to case-based scenarios and review planned commercialization activities for COVID-19 vaccinations 3. Assess current immunization practices at your practice site and determine implementation strategies for expanding vaccination efforts 4. Discuss vaccine administration best practices, including injection technique and documentation 1.

Technician Learning Objectives: Describe tools and resources available for immunization schedules and recommendations 2. Identify the appropriate age-based recommendations for immunizations that impact dose and route of administration 3. Determine ways to support increased vaccine administration and improve workflow to support vaccinations 4. Discuss vaccine administration best practices, including injection technique and documentation 1.

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R E G I S T R A T I O N O P E N N O W ! L e a r n M o r e a t : a z p h a r m a c y . o r g /s p r i n g 2 0 2 3 9:45AM - 10:45AM / Pharmacogenomics Primer for Pharmacists Adrijana Kekic, PharmD, BCACP

10:45AM - 11:45AM / Health Needs of Refugees in Arizona: Caring for Traumatized People ... And For Yourself Kathleen Fairman, MA, PhD; Mary Kaech; Juliana Davis

Pharmacist Learning Objectives: Discuss navigation of genotype-based guidelines Discuss the current and future role of the pharmacist in pharmacogenomics (PGx) implementation efforts 3. Define the role of pharmacogenomics in personalized drug therapy 4. Identify pharmacogenomics resources

Learning Objectives: Explain principles of trauma-informed care for vulnerable refugee populations 2. Explain self-care strategies to protect against negative health consequences of refugee work among health care workers 3. Describe the demographic profile of Arizona's refugees 4. Describe the health profile of refugee populations

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10:45AM - 12:15PM / Advances in Pharmacotherapy Robert Lipsy, PharmD, BCACP, FASHP, FAzPA Pharmacist Learning Objectives: 1. Identify new drugs approved in 2022-2023 2. Describe the anticipated benefits of the newly approved drugs 3. Describe the possible adverse drug reactions of the newly approved drugs 4. Summarize any specific storage or administration of the newly approved drugs

EARLY BIRD REGISTRATION OPEN UNTIL FEBRUARY 3, 2023!

REGISTER HERE

Technician Learning Objectives: 1. Identify new drugs approved in 2022-2023 2. Identify drug related questions that require the technician to refer to the pharmacist 3. Summarize any specific storage recommendation of the newly approved drugs

Location: Creighton University - School of Pharmacy and Health Sciences 3100 N Central Ave, Phoenix, AZ 85012

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AzPA News

Az-ASHP Affiliate News

Christopher J. Edwards, PharmD, BCPS, FASHP, FAzPA AzPA Board of Directors-Health System

AzPA Health System Special Interest Group (Az-ASHP) Spring Clinical Meeting - March 4th and 5th

ASHP Leadership

AzPA’s Spring Clinical Conference serves as our ASHP state affiliate chapter’s annual meeting, and we are excited to be offering many topics of interest to health systems pharmacists. The content has been designed to engage practitioners of all experience levels. We hope to see you there!

Congratulations to our very own Dr. Christi Jen on her election to the position of Chair for ASHP’s Section of Clinical Specialists and Scientists. Dr. Jen has dedicated countless hours of service to AzPA and ASHP in the interest of advancing pharmacy practice and bettering patient care. Her leadership in both organizations is truly inspiring.

Congratulations Christi and thank you for all that you do!

74th Sessions of ASHP's House of Delegates Please join our delegates for a town hall at the upcoming Spring Clinical Conference! This is your opportunity to weigh in on draft ASHP policy language so that your delegates can better represent you as a member of the Arizona Health Systems Pharmacy community.

This year, the 74th House of Delegates reviewed and ultimately approved an unprecedented 44 policies and 6 statements that will help shape ASHP’s approach to issues facing our profession.

Danielle Kamm, Melinda Burnworth, and I are proud to serve as delegates and assist with this important work. We are aided by an impressive roster of alternate delegates, including: Christi Jen, Carol Rollins, Janelle Duran, and Jacob Schwarz.

Az-ASHP Participation - We Want You! The SIG is actively recruiting new members. If you are interested in getting involved, please sign up using the link below. We meet monthly to discuss issues relevant to health systems pharmacists in Arizona.

Sign-Up HERE I look forward to seeing you on our next Health System Special Interest Group call!

All the best,

Christopher J. Edwards, PharmD, BCPS, FASHP,FAzPA AzPA Board of Directors-Health System

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EDITORIAL

PRECEPTOR CORNER

Looking Forward to Rotations: Perspectives of a First-Year Pharmacy Student "When considering pharmacy precepting, it can be tempting to focus on the precepting of Advanced Pharmacy Practice Experience (APPE) students and residents. This article presents a candid reflection from a first-year pharmacy student who shares his ideas and apprehensions of his upcoming Introductory Pharmacy Practice Experiences (IPPEs) and also, a glimpse into the thoughts, excitement, and insecurities of a student before their first rotation, reminding us all how it felt to be in the early stages of our learning."

Janet Cooley & Suzanne Larson

AUTHORS/CONTRIBUTORS Suzanne Larson, PharmD, Director of Experiential Education, Midwestern University College of Pharmacy Janet Cooley, PharmD, BCACP, Associate Professor, Director of Experiential Education, University of Arizona College of Pharmacy Michael Pham, PharmD Candidate, Class of 2025, Midwestern University College of Pharmacy DISCLOSURE The author(s) declare no real or potential conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honorarium.

FUNDING This research was not funded.

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One of the most exciting opportunities that pharmacy students look forward to is rotations. As an important element of pharmacy curricula, rotations under the supervision of preceptors occur in different types of settings, including community, ambulatory care or acute care, allowing students to gain the hands-on and realworld experience that is essential to become a wellrounded pharmacist. Between expectations, hopes, and apprehensions, what do I expect from my rotations as a first-year pharmacy student?

The first year of pharmacy school is dedicated to the foundational, didactic portion of the curriculum, rhythmed with exams, assignments, laboratory, and interview practices. We know that at the end of this preparation, we will join our classmates in beginning the next step of our pharmacy education: Introductory Pharmacy Practice Experiences (IPPEs). We are excited to finally experience the “real-world” setting, truly immersing ourselves into the profession of pharmacy and interacting with our first patients. However, the thought of applying what we have learned in a classroom to real-life practice with actual patients can be daunting.

Am I going to be up to the task? Am I going to be good enough? Will I be able to bring some added value to the team? These are some of the questions that I am asking myself as I move closer to the rotation blocks. There is an undeniable gap between theory (i.e., what is learned in class) and practice (i.e., what is experienced in patient care), and much of our ability to bridge this gap depends on our self-confidence, desire to contribute, adaptability and open-mindedness.

During my first rotations, I know that I will be hesitant at first, but I also know that I will gradually gain more assurance. Little by little, I will be more confident in what I do and say to patients as the fear of failing the team and the preceptor will slowly be replaced by the fear of failing the patient. I expect to become more and more efficient as time goes by. Feeling the pressure on our shoulders as we step into rotations is part of the learning process, and every pharmacy student has felt this mix of excitement and apprehension about rotations. There is nothing new about it and some preceptors have already seen hundreds, if not thousands, of pharmacy students over the years.

The vast majority go through rotations every year with a positive experience, however, it still represents an important challenge for us first-years. During rotations, we will have the chance to be supervised by a preceptorpharmacist who will guide us throughout the rotations and allow us to get valuable hands-on exposure to a pharmacist’s duties, tasks, and responsibilities. Our professors have repeatedly told us that pharmacy is a small world where connections do matter and will help you navigate through your career. As such, one of my main concerns is leaving a good impression at my rotation sites.

As first-years, we are eager to demonstrate that we are reliable, resilient, and can adapt to new situations. We are also aware that we are relatively new to the field, and that we have yet to learn many more important lessons before becoming licensed pharmacists. But, despite our known limitations, we are looking forward to giving our best, and

hopefully leaving a long-lasting positive impression on our preceptors. We never know what the future might bring, and when we might end up crossing paths again.

Furthermore, the first rotations for pharmacy students are a symbolic milestone as they bring us closer to becoming pharmacists. We want to give it our best and show that we have the shoulders to represent the profession best one day. We will be accompanied by faculty, preceptors, and other mentors that will help us cross these milestones. I hope that my preceptors will be able to challenge me to seek the limits of my comfort zone so that I can learn to approach challenges and obstacles with a different perspective.

Moreover, I hope my preceptor can listen to my concerns as I walk my first steps into a pharmacy as a pharmacy student. I will, inevitably, make mistakes that I will learn to correct as I move forward, but I do not want to feel like a burden or a liability to the team. It will be important for our preceptors to gently correct our mistakes, ensuring safe patient care, and providing important teachable moments.

In order to build our self-confidence and improve our skills, we are optimistic that our preceptors will be understanding and patient. Finally, I hope that they will communicate their expectations and advice on how to perform my duties so that I can acquire and improve more practical knowledge.

All in all, introductory rotations are an important and exciting rite of passage that every pharmacy student must experience. It is equally as exciting as it is intimidating. Hence, rotations are a good way to experience the profession of pharmacy, keep exploring our areas of interest, and challenge ourselves to embody the ideals and traits of a pharmacist.

We hope that reading Michael’s reflections of his upcoming rotations highlight the great impact that preceptors can have on our most novice learners.

If you’d like to learn more about becoming an IPPE preceptor, reach out to azoee@midwestern.edu or cooley@pharmacy.arizona.edu.

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Melinda Browning M.S., CPhT, FAPC

AzPA Membership Type: Technician Civic Center Pharmacy - Scientific Liaison AzPA Board of Directors-Director at Large Instagram: @melliebb_ or @civiccenterpharmacy Facebook: @melindabrowning or @civiccenterpharmacy Twitter: @healthbymel LinkedIn: @MelindaBrowningMS How long have you been an AzPA member?

3 years What do you enjoy most about being an AzPA member?

What I enjoy most about being an AzPA member is the community and the mentors that have helped me discover my potential and have helped me grow on this journey. I quickly learned that not all Pharmacy Associations advocate for technicians as strongly as AzPA, and I am beyond thankful for that.

How were you first introduced to the world of pharmacy?

I stepped into a pharmacy for the first time at the age of 16 at Walgreens 24-Hour store at Dobson & Warner in Chandler and haven't looked back. My high school DECA (formerly Distributive Education Clubs of America) teacher, Ms. Kim Frahm, introduced me to the pharmacy world. I went to school half day and worked in the pharmacy half day for a grade.

Once I started in the pharmacy, several pharmacists (Chris Meisel and Gay Holliday) took me under their wings and inspired me to go to school and further my career in pharmacy. I have worked as a technician for 24 years in various roles, such as: senior technician, floating technician, and marketing scheduler. Since then, I have moved from a technician into management at Civic Center Pharmacy.

Explain what a typical work day looks like for you.

My current role is in Senior Management at Civic Center Pharmacy, a 25-employee company.

Being a small company, I wear many hats, and every day looks different. I lead a team of inside and outside sales reps to ensure our patients and physicians get the best quality custom compounds with premiere customer service. Most days, I am in physician offices, educating them on compounding, regulations, and advocacy efforts.

Occasionally, I have the opportunity to jump in and work in the pharmacy as a technician.

In your opinion, what is the most rewarding part of practicing pharmacy?

The most rewarding part of practicing pharmacy is making a difference in the lives of the many people we are surrounded by, including the patients and physicians we serve, the teams we lead, and the community we live in. Every day I get phone calls from physicians that say they are thankful for what we do because they were out of options, and we helped them create a custom solution.

Our profession is essential for our community's wellness, as we all learned during the pandemic. And being a part of that is extremely rewarding.

How do you give back to the profession?

I give back to the profession in several ways. I am on the AZPA Board of Directors (as the Director at Large for Technicians), an active member of several AzPA Volunteer Committees (Legislative Affairs, Membership Services, and Marketing & Engagement), a Legacy Intern guide, and a Mentor for the AzPA Mentor Connection Program. Also, last year I attended Pharmacy Day at the Capital with AzPA. In the compounding space, I am an active member of the Alliance for Compounding, serving on the Foundation Education Committee and Technician Committee. I also applied to the APC Foundation Board of Directors (status pending). For the last two years, I went to Washington, DC, to advocate for compounding at Compounders on Capitol Hill and was inducted as a Class of 2022 Fellow (FAPC).

What do you enjoy doing in your free time?

When I am not working you can find me spending time with my beautiful daughters (ages 7 & 17), playing with my pets (three cats and a Chiweenie dog) or possibly at a 90’s concert.

What's something about you (a fun fact) that not many people know?

I rarely watch TV, but if I do, I binge watch New Girl, and if I were a character in a show, I feel like I would be most similar to Jessica Day.

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WINTER 2023

CONTINUING EDUCATION

Back to Basics - Responding to Emergencies Outside of the Hospital Setting CONTINUING EDUCATION INFORMATION Target Audience: Pharmacists, Pharmacy Technicians Activity Type: Knowledge Learning Objectives: 1. List basic principles that can be applied to any emergency.

2. Create recommendations based on current evidence and guidelines for responding to common emergencies.

3. Identify tools typically available in any setting during common emergencies.

4. Identify drugs typically available in any setting during common emergencies.

5. List resources to gain an understanding of more advanced skills where applicable.

Refer to page 18 for more continuing education details

AUTHORS/CONTRIBUTORS Christopher J. Edwards, PharmD, BCPS, FASHP, FAzPA - Assistant Professor* Anitha B. Ramadoss - PharmD Candidate* Brian L. Erstad, PharmD, MCCM, FCCP, FASHP - Professor & Department Head* *R. Ken Coit College of Pharmacy-University of Arizona ACKNOWLEDGEMENT- None FUNDING - This research was not funded DISCLOSURES - The authors have no relevant financial relationship to disclose

The Arizona Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as providers of continuing education.

AzPA Members may retrieve FREE CE for this article up to one year after the program release date.

Accredited Date: 01/01/2023 | Expiration Date: 01/01/2026 This program provides 0.5 contact hours of continuing education credit.

Universal Activity Number (UAN) is: 0100-0000-22-165-H99-P/T Apply for credit here: https://www.lecturepanda.com/a/AJPWinter23

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Abstract

General Principles

Medical emergencies can occur in any setting and as healthcare providers, pharmacists may be looked to for their expertise in managing medical emergencies that may occur in everyday life.

Knowing one's resources, limitations, and surroundings are paramount to safely providing any emergency care. Learning to perform cardiopulmonary resuscitation can better equip any bystander to save a life if they are put in a position to do so. Other emergencies have specific actions that can be taken to stabilize the patient, obtain useful information for emergency medical service providers, and initiate treatment using medications and equipment commonly found in the field.

Keywords pre-hospital, outpatient, bystander, emergency, resuscitation

#1 Know your resources

a. Emergency Medical Services (EMS) should be activated as soon as possible for any potentially life-threatening emergencies. b. In the United States, dialing 911 from any phone should connect to a local emergency services dispatcher. c. Other bystanders can help by doing things such as activating EMS, grabbing supplies, or providing additional information.

#2 Know your limitations

a. Most outpatient facilities lack the drugs, equipment, and personnel to properly care for patients in medical emergencies. b. The top priority is safe and prompt transport to definitive treatment. c. Bystander efforts are aimed at resuscitation and stabilization, but any patient experiencing a medical emergency should be evaluated by EMS as soon as possible.

#3 Know your surroundings Introduction

Medical emergencies can occur in any setting, including home, work, school, stores, airports, theaters, and anywhere else people tend to congregate. As healthcare professionals, pharmacists may be looked to for expertise in managing life threatening emergencies when encountered in everyday life. Pharmacy education on medical emergencies tends to focus on pharmacotherapeutic interventions that can be implemented in the acute care setting. While this is essential information for a pharmacist practicing in the acute care setting, these efforts include the use of resources that are often not available in a setting such as the home, a school, or a community pharmacy.

This article aims to familiarize the reader with basic principles that can be applied to any emergency, offers specific recommendations based on current evidence and guidelines for responding to common emergencies using tools and drugs typically available in any setting, and provides resources to learn more advanced skills where applicable.

a. Always ensure the safety of yourself, your patient, and bystanders before attempting basic first aid or life support. b. Know where to find emergency response equipment in the locations you typically visit (e.g., work, school, gym) before an emergency happens.

#4 Know how to perform Cardiopulmonary Resuscitation (CPR)

a. If patient is unresponsive and has abnormal or absent breathing, CPR should be initiated immediately, regardless of the underlying cause. b. Chest compressions should be performed at a rate of 100 to 120 compressions/minute while allowing for full chest recoil, at a depth of at least 2 inches (5 centimeters) deep for adults, around 1/3 of the depth of the chest. ¹ c. Recommended compression depth is 1.5 inches for infants, and up to 2 inches (5 centimeters) for prepubescent children. ² d. Early initiation of high-quality CPR is the foundation of both Basic Life Support (BLS), Pediatric Advanced Life Support (PALS) and Advanced Cardiac Life Support (ACLS). e. To better prepare for a variety of emergencies, consider obtaining certification in Basic Life Support from the American Heart Association or the American Red Cross.

continued on next page

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Specific Emergencies

Suspected acute coronary syndrome Call 911.

The previously described principles can and should be applied in every emergency. If the nature of the emergency is known or suspected, the specific recommendations in the following section may be helpful when responding to these emergencies.

Suspected stroke Call 911.

Use Cincinnati Prehospital Stroke Scale to assess FAST: unilateral Facial droop (ask patient to smile), Arm drift (ask patient to close eyes and hold both arms straight out), slurred Speech (ask patient to say “You can’t teach an old dog new tricks”).³ Note the Time of symptom onset if available.

If possible, while waiting for medical personnel to arrive, note time of event and obtain a quick medical history that includes medications and allergies.

To learn more, consider obtaining certification in Basic Life Support from the American Heart Association (locate in-person courses near you, or visit https://cpr.heart.org for more information).

Suspected cardiac arrest If alone, call 911. Use speakerphone, if available, to remain hands-free. If help is available, yell for help and have someone else call 911.

If patient is unresponsive and has either absent or abnormal breathing (slow, gasping breaths), start basic cardiac life support (e.g., CPR).

Determine if automatic external defibrillator (AED) is available (never leave patient alone) - if AED is available, turn it on and follow its verbal instructions.

If possible, while waiting for medical personnel to arrive, note time of event and obtain a quick medical history that includes medications and allergies.

To learn more, consider obtaining certification in Basic Life Support from the American Heart Association or the American Red Cross.

If patient is unresponsive and has either absent or abnormal breathing, or develops these symptoms, start basic cardiac life support (e.g., CPR).

Have the patient chew aspirin 325 mg (NOT enteric coated). ⁵ Use PQRST to assess pain: P for palliative (what, if anything, relieves pain), Q for quality (“feels like an 5 sitting on chest”), R for radiate (does pain elephant radiate to any area), S for severity (“On a 0 to 10 scale, with 0 being no pain and 10 being the worst pain you’ve ever had in your life, how would you rate your pain now”), T for time (when did the pain start). If it is a heart attack, this assessment may not improve the ultimate prognosis, but it may provide valuable information and may help to calm both you and the patient while you wait for help to arrive.

If possible, while waiting for medical personnel to arrive, note time of event and obtain a quick medical history that includes medications and allergies.

To learn more, consider obtaining certification in Basic Life Support from the American Heart Association or the American Red Cross.

Major trauma Call 911.

Try not to move patient unless in unsafe area (e.g., traffic); if patient must be moved, stabilize head and spine as much as possible.

If patient is unresponsive and has either absent or abnormal breathing, or develops these symptoms, start basic cardiac life support (e.g., CPR).

Hold direct pressure on sites of obvious bleeding.

Do not remove any impaled objects (may be acting as hemostat).

For extremity injuries with excessive blood loss, consider applying a tourniquet. If not available, a makeshift tourniquet can be made from a bandage or shirt (material should be 2 to 3 inches wide). 6

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First, expose the wound and then immediately re-apply direct and firm pressure. Tie the tourniquet between the injury and the heart (about 2 inches from the edge of wound). If possible, insert a stick/straight object into knot and turn tightly to secure tourniquet until there is no pulse felt below the tourniquet.

If possible, while waiting for medical personnel to arrive, note time of event and obtain a quick medical history that includes medications and allergies.

To learn more, consider taking Stop the Bleed training offered by The American College of Surgeons (visit: https://www.stopthebleed.org).

Seizures/Syncope Call 911, unless it is obvious that the person fainted (without injury during the fall) and the event is over within a couple of minutes (note the time of the event).

If patient is unresponsive and has either absent or abnormal breathing, or develops these symptoms, start basic cardiac life support (e.g., CPR).

If feeling faint, have patient lie down or at least lower their head. If patient loses consciousness, lower the patient to the ground with their head turned to the side and cushioned if possible (may not be with seizure). Clear the immediate area (move furniture if possible). Loosen tight clothing. Remove any objects that might injure patient during movement, including eyeglasses. Consider hypoglycemia if diabetic (give milk, juice, non-diet soft drink, or 1 to 2 teaspoons of sugar or honey if able to drink).

Foreign Body Airway Obstruction in Children If universal choking sign (hand by throat) in responsive child greater than 1 year of age, use abdominal thrusts (a.k.a. Heimlich); if airway obstruction in responsive infant (less than 1 year of age), use back blows (series of 5) and chest thrusts (series of 5). 2 If unresponsive, perform basic life support measures (e.g., looking for obvious foreign material that can be dislodged, opening airway, and providing rescue breaths).

Continue methods to expel object(s) (e.g., thrusts), and call 911.

To learn more, consider obtaining certification in Basic Life Support from the American Heart Association or the American Red Cross.

Drowning Remove patient from water as soon as possible.

If patient is unresponsive, give two rescue breaths (tilt head back, pinch patient’s nose, and deliver one breath per one second) and immediately initiate CPR. 8 If patient vomits during resuscitation, turn patient on side to expel with finger/cloth, and continue basic life support.

If second rescuer is available, have them call 911 immediately, otherwise call 911 after about 2 minutes of CPR.

Overdose Call 911.

If possible, while waiting for medical personnel to arrive, note time of event and obtain a quick medical history that includes medications and allergies.

If patient is unresponsive and has either absent or abnormal breathing, or develops these symptoms, start basic cardiac life support (e.g., CPR).

Severe Allergic Reactions

If patient has slow breathing, central nervous system depression, pinpoint pupils, or is unresponsive, administer naloxone if available. If using intranasal naloxone (Narcan®), tilt patient’s head back and spray deep into either nostril. 9 Do not prime the product, and do not attempt to reuse the same delivery system as intranasal Narcan® is single-use only.

Call 911.

If patient is unresponsive and has either absent or abnormal breathing, or develops these symptoms, start basic cardiac life support (e.g., CPR).

If an epinephrine autoinjector is available, follow the instructions to administer an intramuscular (IM) injection in anterolateral thigh.7 While waiting for EMS, assess scene for cause of reaction (e.g., food allergy, venomous sting, or bite). Prevent ongoing exposure if possible.

Attempt to determine substances ingested, including quantity, dose, timing of ingestion, but use caution if looking through patient belongings to avoid potential needlestick injuries.

Consider contacting local poison control center (800-2221222 in the US). continued on next page

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Hypoglycemia If patient is awake, alert, and oriented, administer milk, juice, non-diet soft drink, or 1 to 2 teaspoons of sugar or honey if able to drink. Recheck glucose levels every 15 minutes and continue providing glucose/carbohydrates 10 until glucose is at least 70 mg/dL. Call 911 if patient has decreased level of consciousness or is unresponsive, if available administer glucagon 1 mg subcutaneous injection.

Suspected heat stroke Call 911 if patient has mental status changes or is unconscious with hot, dry skin.

In heat stroke, the body’s temperature control system fails with temperatures above 40º C (104º F). ⁴ Patients with heat stroke are often unable to drink cool water or electrolyte-containing fluid. Move patient to cool, shaded area and spray or sponge patient with cool water. Can cover patient with wet cloth until dry, then replace.

Heat exhaustion occurs prior to heat stroke. In contrast, patients with heat exhaustion may have cold/clammy skin. For heat exhaustion, move patient to cool, shaded area and spray or sponge with cool water. Attempt to have the patient drink cold water or electrolyte containing solutions. Call 911 if patient begins vomiting, has mental status changes, becomes unconscious, or if symptoms persist beyond one hour.

Discussion This article outlines basic principles for responding to emergencies outside of the acute care setting as well as specific strategies that can be utilized for common emergency situations. The goal of this article is not to serve as a substitute for Basic Life Support training and certification, but rather to remind readers of key features of these training programs.

Recommendations found in this article are aligned with current recommendations from the American Heart Association’s Basic Life Support guidelines, the American College of Surgeon’s Stop the Bleed Campaign, and other resources dedicated to empowering bystanders to initiate rescue efforts in emergency situations.

This article does not provide an all-inclusive list of emergencies and does not discuss management of these patients beyond initial stabilization and resuscitative efforts. The intent of this article is to provide guidance to pharmacists who may encounter emergency scenarios in their daily life, and as such, provides recommendations on what should be done in resource-limited settings.

Pharmacists may find themselves in situations where prompt initiation of early resuscitative efforts can be the difference between life and death for the person experiencing the life-threatening event. Knowing how to respond to emergencies in general and knowing what steps to take in specific scenarios can help better equip the pharmacist to provide this type of care.

Hypothermia Call 911.

If patient is unresponsive and has either absent or abnormal breathing, or develops these symptoms, start basic cardiac life support (e.g., CPR).

While waiting for help, move patient indoors or to a warmer setting if possible.11 Replace cold/wet clothes with dry/warm clothes, or wrap patient in blankets. Warm the patient’s core (trunk/abdomen) first, rather than extremities (hands/feet). Do not warm patient too rapidly (immersing patient in warm water) and try to not allow extremities to refreeze.

Did you know AzPA has an on-demand CPR course?

Register HERE

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CE QUESTIONS 1) When responding to any emergency outside of the hospital, which of the following should be considered the highest priority?

A. Activating emergency medical services by dialing 911 B. Checking a fingerstick blood glucose C. Establishing intravenous access to administer medications D. Notifying the patient's emergency contact 2) Which of the following statements about performing cardiopulmonary resuscitation (CPR) on an adult patient is most accurate?

A. Compressions should be performed at a rate of 100-120 compressions per minute B. Compressions should be stopped every 6-10 seconds to deliver 2 rescue breaths C. CPR should only be performed after an automatic cardiac defibrillator (ACD) has evaluated the patient's heart rhythm D. CPR should only be performed by someone with a current Advanced Cardiac Life Support (ACLS) certification 3) When evaluating a patient suspected of having an acute ischemic stroke using the acronym "FAST", the "S" stands for which of the following?

A. Severe symptoms B. Slow to respond C. Speech D. Sudden onset 4) While walking down the street, you hear someone calling for help. You respond and find a person who has been stabbed in the abdomen. The handle of the knife is visible and protruding from their abdomen. Which of the following would be the best course of action?

A. Apply a tourniquet above the site of the wound using the patient's shirt B. Call 911 immediately, obtain a quick medical history while waiting for EMS to arrive C. Perform gentle reassurance to the patient and walk away D. Remove the knife, apply direct pressure to the wound 5) While having dinner at a restaurant, someone begins having a severe allergic reaction including facial swelling and respiratory distress. Which of the following would be the best course of action?

A. Give 100 mg of oral diphenhydramine B. Give 20 mg of oral famotidine C. Perform an emergency cricothyroidotomy using a pen or straw D. Use epinephrine autoinjector in the anterolateral aspect of the thigh

REFERENCES 1. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468. doi:10.1161/CIR.0000000000000916 2. Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S469-S523. doi:10.1161/CIR.0000000000000901 3. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999;33(4):373-378. doi:10.1016/s0196-0644(99)70299-4 4. Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133-2140.

5. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) [published correction appears in Circulation. 2005 Apr 19;111(15):2013]. Circulation. 2004;110(5):588-636. doi:10.1161/01.CIR.0000134791.68010.FA 6. Galante JM. Using Tourniquets to Stop Bleeding. JAMA. 2017;317(14):1490. doi:10.1001/jama.2015.8581 7. EpiPen. Prescribing information. Accessed June 19, 2022. www.accessdata.fda.gov/drugsatfda_docs/label/2008/019430s044 lbl.pdf.

8. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S829-S861. doi:10.1161/CIRCULATIONAHA.110.971069 9. Narcan. Prescribing information. Accessed June 19, 2022. www.accessdata.fda.gov/drugsatfda_docs/label/2015/208411lbl.p df 10. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S73-S84. doi:10.2337/dc21-S006 11. American Red Cross. How to Identify and Treat Hypothermia and Frostbite. Accessed June 15, 2022. https://www.redcross.org/get-help/how-to-prepare-foremergencies/types-of-emergencies/winter-storm/hypothermiaand-frostbite.html

6) Which of the following should be performed if you suspect a person has overdosed on an unknown substance?

A. Contact the local poison control center at 800-222-1222 B. Have the patient drink 250 ml of 2% or whole milk C. Induce vomiting through digital stimulation of the gag reflex D. Leave the person alone to "sleep it off" and check on them in a few hours

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EDITORIAL

FINANCIAL FORUM

Retirement Blindspots Some life and financial factors that can sometimes be overlooked.

This series, Pharmacy and the Law, is presented by PRISM Wealth Advisors, LLC and the Arizona Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

We all have our “blue sky” visions of the way retirement should be, yet our futures may unfold in ways we do not predict. So, as you think about your “second act,” you may want to consider some life and financial factors that can suddenly arise.

You may end up retiring earlier than you expect. If you leave the workforce at “full” retirement age (FRA), which is 67 for those born in 1960 and later, you may be eligible to claim “full” Social Security benefits. Working until 67 may be worthwhile because it will reduce your monthly Social Security benefits if you claim them between age 62 and your FRA.¹ Now, do most Americans retire at 67? Not according to the annual survey from the Employee Benefit Research Institute (EBRI). In EBRI’s 2020 Retirement Confidence Survey, 16% of pre-retirees expected to retire between ages 66-69, and 31% thought they would retire at age 70 or later. The reality is different. In surveying current retirees, EBRI found that only 6% had worked into their seventies. In fact, 70% percent of them had left work before age 65, and 33% had retired before age 60.² You may see retirement as an extension of the present rather than the future. This is only natural, as we all live in the present – but the future will arrive. The costs you have to shoulder later in retirement may exceed those at the

start of retirement. As you may be retired for 20 or 30 years, it is wise to take a long-term view of things.

You may have a health insurance gap. If you retire before age 65, what do you do about health coverage? You may shoulder 100% of the cost. Looking forward, you may need extended care, and it seems to get more expensive each year. Wealthy households may be able to “selfinsure” against extended care, but many other households struggle. In Genworth’s 2020 Cost of Care Survey, the median monthly cost of a semi-private room in a nursing home is $7,738. In California, it is $9,023; in Florida, $8,803.³ Suppose you become disabled or seriously ill, and working is out of the question. How do you make ends meet?

Age may catch up to you sooner rather than later. You may stay fit, active, and mentally sharp for decades to come, but if you become mentally or physically infirm, you need to find people to trust to manage your finances.

You could be alone one day. As anyone who has ever lived alone realizes, a single person does not simply live on 50% of a couple's income. Keeping up a house, or even a condo, can be tough when you are elderly. Driving can be a concern. If your spouse or partner is absent, will

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EDITORIAL

FINANCIAL FORUM

Retirement Blindspots Cont. there be someone to help you in the future?

These are some of the blind spots that can surprise us in retirement. They may quickly affect our money and quality of life. If you age with an awareness of them, you may have the opportunity to manage the outcome better.

Pat Reding and Bo Schnurr may be reached at 800-2886669 or pbh@berthelrep.com Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc.

Citations 1. Social Security Administration, December 1, 2020 2. Employee Benefit Research Institute, December 1, 2020 3. Genworth Cost of Care Survey, March 30, 2020

Deadline-January 31st

This material was prepared by MarketingPro, Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. This information has been derived from sources believed to be accurate. Please note - investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment.

Deadline-February 28th 20

EDITORIAL

UNIVERSITY & ALUMNI NEWS

Rick G. Schnellmann, PhD Dean, University of Arizona College of Pharmacy

Researchers Develop Drug to Treat Alzheimer's Disease in Down Syndrome Patients When a baby is born, each cell in his or her body contains 23 pairs of chromosomes or 46 chromosomes in total, with half coming from each parent. At least, this is the case most of the time.

Yet, the biological machinery responsible for assuring proper chromosome distribution sometimes goes awry. This can result in a range of serious genetic diseases, the most common of which is Down Syndrome. In this case, an extra copy of chromosome 21 is inherited from one parent. The condition is also known as Trisomy 21.

In addition to an array of physical abnormalities, virtually all Down Syndrome patients develop Alzheimer's disease, usually between the ages of 40 and 50. There are no available treatments to prevent or mitigate the progression to Alzheimer's disease for these individuals.

The company, Iluminos Therapeutics, LLC, has received a three-year, $3.5 million federal Small Business Technology Transfer grant to test the latest iteration of the drug to prove it ready for clinical trials. The grant comes from the National Institutes of Health Small Business Programs, also known as America's Seed Fund.

If successful, the drug will be a medical milestone for those with Down Syndrome. It also may represent a new approach to the treatment of late onset Alzheimer's disease, the most common form of dementia in the general population. The methodology may eventually be applied to other neurodegenerative diseases as well.

Now, researchers have developed a drug they hope may successfully block the development or advancement of Alzheimer's disease in Down Syndrome patients. The drug acts by decreasing the levels of DYRK1A, a particular type of enzyme known as a kinase, which is overexpressed in Down Syndrome patients.

Research on the drug, known as DYR533, was conducted at the the University of Arizona R. Ken Coit College of Pharmacy and BIO5 Institute, in partnership with the Biodesign Institute in Phoenix.

"Generating a completely original small molecule drug and bringing it from bench to bedside, in particular for central nervous system indications, is a significant achievement in terms of innovation and perseverance," said co-inventor Christopher Hulme, a professor in the Coit College of Pharmacy's Department of Pharmacology and Toxicology and a member of the BIO5 Institute. "The group is poised to complete preclinical development by 2025 when we look forward to human trials in patients with Down Syndrome and Alzheimer's disease."

Hulme and Arizona State University researcher, Travis Dunckley, founded a startup company to push the new drug through additional studies and develop it for human use.

One Step Closer to Real-World Impact The design of the new drug was completed over a 10year period by Hulme, an industry trained medicinal chemist with expertise in developing drugs that inhibit the function of kinases.

Kinases are important regulatory enzymes in the body, which add chemicals known as phosphates to other proteins. This process of phosphorylation is critical to many life processes, playing a vital role in embryonic development. In Down Syndrome, however, an overphosphorylation of critical proteins can induce classic hallmarks of Alzheimer's disease.

Hulme co-invented drug compound DYR533 with Travis Dunckley, research professor at the ASU-Banner Neurodegenerative Disease Research Center and a UArizona alumnus, and Christopher Foley, a former graduate student in the UArizona Department of Chemistry and Biochemistry. continued on next page

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EDITORIAL NEWS

UNIVERSITY & ALUMNI NEWS

By using small molecules that help inhibit the DYRK1A kinase, the researchers have demonstrated that their unique compound dramatically slows the onset of Alzheimer's disease pathology in animal models of the disease.

Cardenas were present to provide more information to PharmD alumni and answer their questions.

To bring the potential drug candidate a step closer to having real-world impact for patients, the team worked with Tech Launch Arizona, the UArizona office that commercializes inventions stemming from academic research, to patent the invention on behalf of the university. The inventing team then worked with TLA to launch Iluminos and license the technology to the startup in 2017.

"Senior Vice Provost Dr. Iris Lafferty, Dean Zelihic, and the UAGC team are wonderful partners, and I am so excited to bring this unique educational opportunity to our alumni at a reduced cost," said Dr. Rick Schnellmann, Dean of the R. Ken Coit College of Pharmacy. "This collaboration will help our graduates broaden their skillsets and set them on a path for greater career advancement."

"This is a huge accomplishment for the Iluminos team," said Bruce Burgess, TLA director of venture development. "Being awarded an STTR grant is a signal that this technology and this startup team are on the right path and well on their way to advancing a technology that would provide significant benefit to patients suffering from neurodegenerative disease."

"I applaud Dean Schnellmann's vision and commitment to his students. He is forward thinking in recognizing how a Forbes School of Business and Technology® MBA poises PharmD students for next generation leadership in the Pharmacology field," said UAGC Sr. Vice Provost Dr. Iris Lafferty. "I'm proud to support this endeavor, recognizing its promise for both UArizona and UAGC collaborations in the future."

Because the new drug targets multiple pathways of neurodegeneration, it could potentially be much more beneficial than existing drug therapies, which typically target just one symptom, often after Alzheimer's disease has already irreparably ravaged the brain.

While Iluminos Therapeutics intends to focus its development efforts on both Down Syndrome and Alzheimer's disease, additional studies suggest that, due to how the drug inhibits and decreases levels of the kinase DYRK1A, it has high potential for possible utility as a treatment for Type 1 Diabetes and in general anti-aging through DNA repair mechanisms.

UA Global Campus Partnership Offers Pathway for MBA to Alumni The first programmatic partnership between the University of Arizona (UArizona) and the University of Arizona Global Campus (UAGC) will launch between the Doctor of Pharmacy (PharmD) program at the UArizona R. Ken Coit College of Pharmacy and the Master of Business Administration (MBA) program at UAGC. The official launch took place during the Coit College of Pharmacy Homecoming celebration. Dr. Maja Zelihic, Dean of the Forbes School of Business and Technology® at UAGC and Department Chair Dr. Jorge

This partnership provides an easier and more affordable path for UArizona Doctor of Pharmacy alumni to pursue their MBA. They can save time by applying completed PharmD credits and transferring them to the UAGC MBA to receive up to nine credits.* In addition, this MBA program will save them up to $7,560. Additional savings on tuition and fees may apply.

"With our shared commitment to the University of Arizona community, we are excited to offer Doctor of Pharmacy graduates a cost-efficient opportunity to earn their MBA," said Dean Zelihic. "The University of Arizona PharmD alumni can now discover a challenging, rich, and relevant Forbes School of Business and Technology® MBA program that aligns with the Forbes brand, one of the most respected names in the business world."

LEARN MORE ABOUT THE PROGRAM AND APPLY TODAY! *The transferability of credits is subject to the University of Arizona Global Campus transfer credit policies and requires the submission of official transcripts. The official transcripts will be evaluated to determine the credits that will officially apply toward a UAGC degree program.

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EDITORIAL NEWS

UNIVERSITY & ALUMNI NEWS

Midwestern University College of Pharmacy Mitchell R. Emerson, PhD Dean, Midwestern University College of Pharmacy

Happy Holidays from the College of Pharmacy at Midwestern University!

We have a lot to celebrate as we wrap up a busy Fall and get ready for the new year.

In October, the college hosted a variety of events in celebration of National Pharmacy Month. These educational and fun events culminated in a fantastic Pharmacy Carnival that highlighted the various roles of the pharmacist on the health care team. Many thanks to the Student Government Association (SGA) for hosting this month-long celebration.

We hosted and connected with hundreds of alumni, preceptors, and friends at our annual Alumni and Friends Reception held in conjunction with the ASHP Midyear Clinical Meeting in Las Vegas. In addition to the reception, our college students and colleagues were busy at the Clinical Skills competition and presenting many posters and presentations during the meeting. Special recognition goes to Dr. Salfee Bhathal (CPG 2022), Dr. Eldo Joseph (CPG 2022), and their mentors Dr. Kellie Goodlet and Dr. Michael Nailor, who were awarded the 2022 ASHP Foundation Student Research Award.

Thank you to everyone who joined us and to our awesome faculty and students!

until graduation in May. The Class of 2025 enters their 3rd quarter, and the Class of 2024 is leading our SGA and outreach.

In Spring, we’re looking forward to hosting and bringing everyone together on campus for an Alumni/Student mentoring event. Look for more details in early 2023.

We’re also excited to host APhA in March 2023 in downtown Phoenix with our Alumni and Friends Reception and more. Please be on the lookout for more details.

We are looking forward to catching up with all of you and connecting at a future event. If you're ever back in the Glendale area, please reach out and stop by the campus. So much has changed, but still remains the same welcoming place. Thank you to Dr. Ushani (Lincoln) Bowman, CPG 2007 who recently stopped by.

If you’ve recently moved or relocated, please ensure we have your updated contact information. Please email updates to your Manager of Alumni Relations, Kimberly Hastings at KHastings@midwestern.edu.

The Fall quarter is in full swing, as our Class of 2023 are mid-way through APPEs and preparing for residency applications and interviews while counting the days

Like us on Facebook: Midwestern University-College of Pharmacy Follow us on Twitter: @MWUpharmacy Follow us on Instagram: @MWUpharmacy

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Flu Shot Season Is Here - What Is Needed for Audit?

COVID-19 has forced a significant increase in the number of vaccinations pharmacies do daily. With this increase also comes additional audits. PAAS National® frequently sees PBMs audit for all vaccinations, including influenza. Now is the time to check that you have all documentation in place for this year’s flu shot season.

What you will need for an audit: 1. Order • A signed order from an authorized prescriber or • A signed protocol that is up to date and includes specific vaccination(s) to be administered- When using a protocol, create a placeholder prescription with all prescription elements 2. Vaccination Information Statement (VIS) • Required to be given to patient prior to each administration • Be sure you have the most current VIS forms 3. Vaccination Administration Record (VAR) • Name of vaccine administered • Lot and Expiration Date of vaccine given • Site of administration (i.e. right arm) • Signature or initials and title of person administering • What VIS form was given • Form can be used as proof of receipt on audit VAR and VIS forms, and information regarding what the CDC requires for health care providers to record, can be found on the CDC website.¹ PAAS Tips: • Check dates and vaccines on your protocols to ensure they are up-to-date • Have current VIS forms printed for each vaccine you administer • Have VAR forms printed and educate all staff on how to complete the forms • All vaccines should be submitted using days’ supply of “1” • All vaccines administered with protocol should be submitted with origin code of “5” (pharmacy created) • Be sure correct quantity is billed, typically 0.5 mL, may need to consult with software vendor for guidance • Keep vaccine documents stored in a system that makes access easy in case of an audit References: https://www.cdc.gov/vaccines/hcp/admin/document-vaccines.html PAAS National® is committed to serving community pharmacies and helping keep hard-earned money where it belongs. Contact us today at (608) 873-1342 or info@paasnational.com to see why membership might be right for you. By Trenton Thiede, PharmD, MBA, President at PAAS National®, expert third party audit assistance and FWA/HIPAA compliance.

Copyright © 2022 PAAS National, LLC.

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AzPA News

AzPA State Advocacy

AzPA Legislative Affairs Update

YOUR TEAM

Dianne McCallister AzPA Lobbyist

Ken Bykowski AzPA Legislative Affairs Committee Co-Chair

Kelly Fine AzPA CEO

Mark Boesen AzPA Legislative Affairs Committee Co-Chair

BE INVOLVED WHILE GETTING TO KNOW YOUR LEGISLATORS

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Update Your Legislative District Help us with target campaigns by updating your LD (Legislative District) in your AzPA profile. Due to legislative redistricting, several areas have altered legislative districts. Click Here to find your legislative district. You can log into your member portal by clicking here.

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Get to know your State Legislators Using your district number from Step 1, identify your state legislators. Note: Each Arizona district (1-30) has 2 elected Representatives and 1 elected Senator. https://www.azleg.gov/ Get to know your Federal Legislators Click Here Representatives • David Schweikert (R) Re-elected • Eli Crane (R) • Ruben Gallego (D) Re-elected • Greg Stanton (D) Re-elected • Andy Biggs (R) Re-elected • Juan Ciscomoni (R) • Raúl Grijalva (D) Re-elected • Debbie Lesko (R) Re-elected • Paul Gosar (R) Re-elected Federal Senators • Kyrsten Sinema (D) • Mark Kelly (D) https://www.senate.gov/states/AZ/intro.htm

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Donate to PharmPAC AzPA utilizes its political action funds carefully and wisely to provide support to legislators and candidates who are supportive of the pharmacist’s role in delivering patient care. PharmPAC plays an essential role in improving the advocacy efforts within the profession of pharmacy in Arizona. Our ability to interact with key legislators is vital and allows us to keep our issues visible and top of mind at the state capitol. The advancement and protection of the profession of pharmacy depends on all of us. Donate to PharmPAC by clicking here.

Pharmacy Day at the Capitol | March 28 1700 West Washington Street, Phoenix, AZ 85007 (Arizona State Capitol) This event offers pharmacy professionals the opportunity to connect with each other over issues important to the pharmacy profession while bringing those issues to the attention of our state legislators.

Purpose: • Meet with state legislators to discuss current issues relating to pharmacy and health care.

• Highlight the advanced patient care services pharmacists provide throughout our community.

• Network with our pharmacists, students, and technicians to help raise awareness about our profession.

Our joined voices can make a difference. Save the Date!

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EDITORIAL

ADVOCACY

Arizona State Board of Pharmacy Update Mailing Address: P.O. Box 18520 Phoenix, AZ 85005 Physical Address: 1110 W. Washington St., Suite 260, Phoenix, AZ 85007

Board Members Joseph Leyba, RPh, President Lorri Walmsley, RPh, Vice President Cedar Lahann, PharmD, RPh, Member Theodore Tong, PharmD, RPh, Member Kevin Dang, PharmD, RPh, Member Kristen Snair, CPhT, Member Tenille Davis, PharmD, Member Frank Thorwald, Member (Public) Randy Schoch, Member (Public)

Meeting Complaint Review

Submission Deadline

Meeting Date February 7, 2023

Board Meeting

February 15-16, 2023

Complaint Review

March 28, 2023

Board Meeting

April 5-6, 2023

January 6, 2023

March 3, 2023

DEA Prescriptions Q&A (added October 27, 2022)

Note for Arizona Candidates for Licensure

Schedule II CS Prescriptions

NABP confirms eligibility to sit for the NAPLEX and MPJE for candidates seeking licensure in Arizona. See the NAPLEX/MPJE Application Bulletin for details on related fees and processes. If you are transferring your license to Arizona, you must pass the MPJE prior to submitting your Licensure Transfer application. Visit the MPJE section of the website to find out more about taking the MPJE and the eligibility process for this state.

Board staff are receiving calls and emails inquiring about the continued ability for pharmacists to document certain information on prescriptions for Schedule II controlled substances (CS), such as patient address.

21 Code of Federal Regulations (CFR) 1306.05(A) A.R.S. 362525 A federal law enacted in 2019 required all federal agencies to undertake review of various informal guidance documents. As a result of this review, Drug Enforcement Administration (DEA) removed informal guidance from its website concerning changes to prescriptions for Schedule II CS. The National Association of Chain Drug Stores issued a letter on June 17, 2022, describing a private phone call with DEA officials. The letter indicated that, despite DEA’s historical guidance permitting pharmacist annotations to Schedule II CS prescriptions, all prescriptions for Schedule II CS must now arrive at the pharmacy with all elements required by 21 CFR 1306.05(A) in final form. NABP is sharing the attached guidance document from DEA which addresses changes pharmacists may make to Schedule II paper prescriptions. DEA will provide guidance documents to DEA-registered pharmacies via email. A Prescriptions Q&A is also posted on the DEA Diversion website.

Need to verify a license, permit, or application?

• • • • •

Check the status of your application Verify an existing license Verify an existing permit Submit public records request Disciplinary Actions

References https://pharmacy.az.gov/ https://nabp.pharmacy/bop_members/arizona/ https://deadiversion.usdoj.gov/faq/prescriptions_faq.htm

Holiday Civil Rights / Martin Luther King Jr. Day George Washington's Birthday

Day Board Office is Closed Monday, January 16, 2023 Monday, February 20, 2023

In the meantime, please direct any questions regarding this matter to: DEA Office of Diversion Control, Liaison and Policy Section ODLP@dea.gov (571) 362-3260

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PHARMACY DAY AT THE CAPITOL TUESDAY, MARCH 28, 2023 Pharmacy Professionals UNITE to paint it white!

Come together in person with pharmacists, pharmacy technicians and student pharmacists, and help fill our state’s capitol with white coats! We need your help more than ever to promote and protect our profession.

Learn More

Arizona State Capitol 1700 W Washington St, Phoenix, AZ 85007

Schedule At A Glance: 9:00 AM-10:00 AM | Set Up 10:00 AM-10:45 AM | Legislative Briefing (All attendees) 11:00 AM-12:30 PM | Education and Lunch on Capitol Lawn 11:00 AM-4:30 PM | Capitol Visits 12:30 PM-1:00 PM | Tear Down 1:00 PM | Recognition on House and Senate Floor 1:30 PM | Group Photo

Other Details • Please dress professionally and wear your white coats!

• We will be outside so dress according to weather condition • Wear comfortable shoes (Heels are not recommended-most of the time the lawn is wet and muddy this time of year)

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