Page 1

April 2014 VOLUME 36, ISSUE 4

ON

GWINNETT GWINNETT

MACON

N

STO

U HO

C

BLE

ER

EEL

JEFF DAVIS

IRWIN

COFFEE

LONG WAYNE

BACON

McINTOSH

PIERCE

ATKINSON WARE

COOK

CHATHAM

LIBERTY

TIFT

LAN

BROOKS

TATTNALL

APPLING

BRANTLEY

GLYNN

CLINCH

CHARLTON

CAMDEN

ES

THOMAS

EFFINGHAM BRYAN

ND

GRADY

MBS

WH

TURNER

COLQUITT

SCREVEN

BULLOCH

EVANS

TOO

SEMINOLE

DECATUR

CANDLE

TELFAIR HILL BEN HILL

BERRIEN MITCHELL

R

TLEN

TREU

DODGE

BAKER

MILLER

JENKINS

LAURENS

WILCOX

WORTH

BURKE

EMANUEL Y KLE

PULASKI

CRISP LEE

RICHMOND

JEFFER -SON

JOHNSON

TWIGGS

DOOLY

DOUGHERTY

WASHINGTON WILKINSON

CH

PEA

COLUMBIA

K

MONTGOMERY

LEY SCH

STER

CALHOUN

EARLY

LN

OC

SC

GLA

WIN

BIBB

SUMTER

TERRELL

HANCOCK

JONES

MONROE CRAWFORD

WEB

RANDOLPH CLAY

EN

IER

ER

QUITMAN

WA RR

BALD

TAYLOR MARION

CO

RO

AFER

TALI

JASPER PUTNAM

UPSON

TALBOT

CHATTAHOOCHEE

LIN

WILKES

GREENE

MORGAN NEWTON NEWTON

BUTTS

LAMA R

TH IWE MER

PIKE

MUSCOGEE

STEWART

EE

E

N

TTE FAYE

HARRIS

ELBERT

OGLETHORPE

HENRY SPALDING

TROUP

ON

WALTON

ROCK

LTOFU NLTO

CLAYTON

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RKE

IE UFF

FULT

COWETA

HEARD

DEKALB

CLA

McD

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FU

UG

LAS

HART

MADISON

DAL

COBB

DO

CARROLL

FR

JACKSON BARROW

IN

KL

AN

BANKS

HALL

FORSYTH

STEPHENS

HAB

PICKENS

PAU LDIN G

HARALSON

LUMPKIN

DA WS

CHEROKEE

BARTOW

POLK

WHITE

LOW

GORDON

FLOYD

RABUN

UNION

GILMER

ERS HAM

LD TFIE

WHI

CHATTOOGA

TOWNS

FANNIN

MMUUR RRRAY AY

DAD E

CATOOSA

WALKER

ECHOLS

REGION MEETINGS It’s time for the GPhA Spring Region Meetings and you’re invited! - PLUS GPhA Election Nominees Legislative Recap GPhA Convention Preliminary Program


April 2014

LAMA

AM ERSH HAB

R

N

R TELFAIR

WORTH

COFFEE

TIFT

COOK

EFFINGHAM

BRYAN LIBERTY LIBERTY

APPLING

LONG WAYNE

McINTOSH

CHATHAM

REGION MEETINGS

PIERCE

ATKINSON

CLINCH

ES

BROOKS

EVANS

BRANTLEY

GLYNN

CHARLTON

CAMDEN

ND

THOMAS

LOW

GRADY

SCREVEN

BULLOCH

TATTNALL TATTNALL

BACON

WARE LAN

COLQUITT

JEFF DAVIS

BEN HILL HILL

BERRIEN MITCHELL

R

CANDLE

BS

DECATUR

EELE

DOUGHERTY

DODGE

IRWIN

BAKER

MILLER

TLEN

TREU

WILCOX

TURNER

JENKINS EMANUEL

LAURENS

BLEC

WH

LEE

BURKE

JOHNSON

TOOM

CALHOUN

EARLY

CRISP

TERRELL

RICHMOND

JEFFER -SON

WASHINGTON

PULASKI

DOOLY

COLUMBIA

CK

CO

AS

GL

MONTGOMERY

RANDOLPH CLAY

HANCOCK

WIN

KLEY

USTO

HO

SUMTER

LN

WILKINSON

CH

EY

QUITMAN

EN

TWIGGS

PEA MACON

SCHL

STEWART

SEMINOLE

The Georgia Pharmacy Journal

MARION MARION

TER

www.gpha.org

CHATTAHOOCHEE

WA RR

BALD

BIBB

CRAWFORD TAYLOR

MUSCOGEE

WEBS

GPhA Headquarters 50 Lenox Pointe, NE Atlanta, Georgia 30324 t 404-231-5074 f 404-237-8435

UPSON

TALBOT

JONES

MONROE

CO

RO

AFER

TALI

JASPER PUTNAM

BUTTS

LIN

WILKES

GREENE

NEWTON NEWTON MORGAN

E

PIKE

HER

ADVERTISING Advertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org.

HARRIS

ELBERT

HENRY SPALDING

TROUP

EE

UFFI

COWETA

HART

OGLETHORPE

KE

ON

WALTON

ROCK

N LTO FU N DEKALB LAS UG LTO DO OFNU CLAYFULT TON

OC

McD

CARROLL HEARD

GWINNETT GWINNETT

COBB

MADISON CLAR

DALE

LDIN

HARALSON

IWET

POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

BARROW

G

POLK

LIN

NK

FRA

JACKSON

MER

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offices.

STEPHENS

BANKS

HALL

FORSYTH

TE

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

ON

CHEROKEE

BARTOW

WHITE

LUMPKIN

DA WS

PICKENS

RABUN

UNION

GILMER

IER

LD

GORDON

FLOYD

TOWNS

FANNIN MMUR URRA RAYY

DADE

CATOOSA

WALKER CHATTOOGA

FAYET

ARTICLES AND ARTWORK Those interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org.

2 Message from Jim Bracewell ......................... 4 Member News .................................................. 5 2014 GPhA Election Nominees..................... 7 Legislative Recap............................................... 8 Message from Pamala Marquess .................

TFIE

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

Contents

WHI

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

PAU

Editor: Jim Bracewell jbracewell@gpha.org

ECHOLS

10

It’s time for the Spring Region Meetings ................

13

2014 GPhA Convention Preliminary Program................................

16 PharmPAC Supporters ................................18 Continuing Education ............................... 21 GPhA Board of Directors ......................... 28 Industry News ...............................................

1


April 2014

LAMA

AM ERSH HAB

R

N

R TELFAIR

WORTH

COFFEE

TIFT

COOK

EFFINGHAM

BRYAN LIBERTY LIBERTY

APPLING

LONG WAYNE

McINTOSH

CHATHAM

REGION MEETINGS

PIERCE

ATKINSON

CLINCH

ES

BROOKS

EVANS

BRANTLEY

GLYNN

CHARLTON

CAMDEN

ND

THOMAS

LOW

GRADY

SCREVEN

BULLOCH

TATTNALL TATTNALL

BACON

WARE LAN

COLQUITT

JEFF DAVIS

BEN HILL HILL

BERRIEN MITCHELL

R

CANDLE

BS

DECATUR

EELE

DOUGHERTY

DODGE

IRWIN

BAKER

MILLER

TLEN

TREU

WILCOX

TURNER

JENKINS EMANUEL

LAURENS

BLEC

WH

LEE

BURKE

JOHNSON

TOOM

CALHOUN

EARLY

CRISP

TERRELL

RICHMOND

JEFFER -SON

WASHINGTON

PULASKI

DOOLY

COLUMBIA

CK

CO

AS

GL

MONTGOMERY

RANDOLPH CLAY

HANCOCK

WIN

KLEY

USTO

HO

SUMTER

LN

WILKINSON

CH

EY

QUITMAN

EN

TWIGGS

PEA MACON

SCHL

STEWART

SEMINOLE

The Georgia Pharmacy Journal

MARION MARION

TER

www.gpha.org

CHATTAHOOCHEE

WA RR

BALD

BIBB

CRAWFORD TAYLOR

MUSCOGEE

WEBS

GPhA Headquarters 50 Lenox Pointe, NE Atlanta, Georgia 30324 t 404-231-5074 f 404-237-8435

UPSON

TALBOT

JONES

MONROE

CO

RO

AFER

TALI

JASPER PUTNAM

BUTTS

LIN

WILKES

GREENE

NEWTON NEWTON MORGAN

E

PIKE

HER

ADVERTISING Advertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org.

HARRIS

ELBERT

HENRY SPALDING

TROUP

EE

UFFI

COWETA

HART

OGLETHORPE

KE

ON

WALTON

ROCK

N LTO FU N DEKALB LAS UG LTO DO OFNU CLAYFULT TON

OC

McD

CARROLL HEARD

GWINNETT GWINNETT

COBB

MADISON CLAR

DALE

LDIN

HARALSON

IWET

POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

BARROW

G

POLK

LIN

NK

FRA

JACKSON

MER

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offices.

STEPHENS

BANKS

HALL

FORSYTH

TE

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

ON

CHEROKEE

BARTOW

WHITE

LUMPKIN

DA WS

PICKENS

RABUN

UNION

GILMER

IER

LD

GORDON

FLOYD

TOWNS

FANNIN MMUR URRA RAYY

DADE

CATOOSA

WALKER CHATTOOGA

FAYET

ARTICLES AND ARTWORK Those interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org.

2 Message from Jim Bracewell ......................... 4 Member News .................................................. 5 2014 GPhA Election Nominees..................... 7 Legislative Recap............................................... 8 Message from Pamala Marquess .................

TFIE

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

Contents

WHI

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

PAU

Editor: Jim Bracewell jbracewell@gpha.org

ECHOLS

10

It’s time for the Spring Region Meetings ................

13

2014 GPhA Convention Preliminary Program................................

16 PharmPAC Supporters ................................18 Continuing Education ............................... 21 GPhA Board of Directors ......................... 28 Industry News ...............................................

1


MESSAGE

• Pharmacists Mutual Insurance Company • Pharmacists Life Insurance Company • Pro Advantage Services®, Inc.

from Pamala Marquess

“GPhA Strong”

let our experts

do the math

Only strong, diverse professional groups, which have the ability to change and

adapt to meet the demands of a growing profession will survive in the future. The Georgia Pharmacy Association prides itself on adaptability and changing with the Pamala Marquess times to address the challenges facing pharmacy. With a clear mission and a purpose GPhA President of advancing and protecting the pharmacy profession in Georgia, GPhA employs strategies to achieve its goals. Through the years, these goals have changed and evolved much like the profession. Think about the many challenges that GPhA and our profession has encountered in the past twenty years. Decreasing reimbursements, increasing regula“Now is the time tions, electronic prescriptions, prescription pad requirements, Medicare audits, Medicare part D, and more. GPhA has been there every step of to finalize your plans for the 2014 the way. Georgia is one of the most progressive states in which pharmaGPhA Convention, cists can practice. We lead the nation with 5 Pharmacists Legislators; Ron Stephens, Buddy Harden, Buddy Carter, Butch Parrish, and June 26-29 at the Bruce Broadrick. These gentlemen understand our challenges as well Wyndham Bay Point as our viewpoints and I would like to personally thank each of them for Resort in Panama their service. This Spring, we have the unique opportunity to elect the City Beach, Florida.” only Pharmacist in the U.S. Congress - Buddy Carter. I hope you have been actively involved with your support of Buddy Carter. With the many challenges we face, we need a pharmacist in Congress. GPhA is committed to developing programs to further advance the role of the pharmacist. MTM and STAR ratings will be a focus of this year’s annual convention. GPhA understands that information and communication are vital to the success of any professional group. We are here to ensure you are trained and prepared for success. In closing, I want to mention one other point. Now is the time to make and finalize your plans for the 2014 GPhA Annual Convention, June 26-29, at the Wyndham Bay Point Resort in Panama City Beach, Florida. This year’s theme will be “Anchored in Excellence”. I hope to see you there! n

d/b/a Pharmacists Insurance Agency (in California) CA License No. 0G22035

Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment. Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.

Hutton Madden

800.247.5930 ext. 7149 404.375.7209

800.247.5930 www.phmic.com

Pam

Pamala S. Marquess

Find us on Social Media:

2

The Georgia Pharmacy Journal

Not licensed to sell all products in all states.


MESSAGE

• Pharmacists Mutual Insurance Company • Pharmacists Life Insurance Company • Pro Advantage Services®, Inc.

from Pamala Marquess

“GPhA Strong”

let our experts

do the math

Only strong, diverse professional groups, which have the ability to change and

adapt to meet the demands of a growing profession will survive in the future. The Georgia Pharmacy Association prides itself on adaptability and changing with the Pamala Marquess times to address the challenges facing pharmacy. With a clear mission and a purpose GPhA President of advancing and protecting the pharmacy profession in Georgia, GPhA employs strategies to achieve its goals. Through the years, these goals have changed and evolved much like the profession. Think about the many challenges that GPhA and our profession has encountered in the past twenty years. Decreasing reimbursements, increasing regula“Now is the time tions, electronic prescriptions, prescription pad requirements, Medicare audits, Medicare part D, and more. GPhA has been there every step of to finalize your plans for the 2014 the way. Georgia is one of the most progressive states in which pharmaGPhA Convention, cists can practice. We lead the nation with 5 Pharmacists Legislators; Ron Stephens, Buddy Harden, Buddy Carter, Butch Parrish, and June 26-29 at the Bruce Broadrick. These gentlemen understand our challenges as well Wyndham Bay Point as our viewpoints and I would like to personally thank each of them for Resort in Panama their service. This Spring, we have the unique opportunity to elect the City Beach, Florida.” only Pharmacist in the U.S. Congress - Buddy Carter. I hope you have been actively involved with your support of Buddy Carter. With the many challenges we face, we need a pharmacist in Congress. GPhA is committed to developing programs to further advance the role of the pharmacist. MTM and STAR ratings will be a focus of this year’s annual convention. GPhA understands that information and communication are vital to the success of any professional group. We are here to ensure you are trained and prepared for success. In closing, I want to mention one other point. Now is the time to make and finalize your plans for the 2014 GPhA Annual Convention, June 26-29, at the Wyndham Bay Point Resort in Panama City Beach, Florida. This year’s theme will be “Anchored in Excellence”. I hope to see you there! n

d/b/a Pharmacists Insurance Agency (in California) CA License No. 0G22035

Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment. Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.

Hutton Madden

800.247.5930 ext. 7149 404.375.7209

800.247.5930 www.phmic.com

Pam

Pamala S. Marquess

Find us on Social Media:

2

The Georgia Pharmacy Journal

Not licensed to sell all products in all states.


M E M B E R

Can a Pharmacist Learn From a Raccoon?

I am sure most of us have had personal encounters with Raccoons. Perhaps like me, you have experienced these fury animals on more than one occasion. One of my most intrigu-

ing encounters was at a fine Hilton Head Island restaurant as the masked creatures peered through the widow by my dining table. Another time at my brother’s house in an upscale neighborhood in North Atlanta, I watched them come onto his back deck in search of food – undaunted by lights and the noise of the family activities. The raccoons had adapted nicely Jim Bracewell and successfully into their new environment of opportunity. Raccoons originally started out in the tropics but they moved north and all along the way Executive Vice President they changed their diet. At one time they only lived in trees. Today they live as far north as Alaska. They have multiplied in some of America’s most bustling cities like Chicago, New York and even Toronto, Canada. Today there are 50 times more raccoons in Toronto than in the Canadian countryside. If raccoons sense that there is a reward to be had, they will doggedly work on the problem until it is solved and the goal is reached. Raccoons are perhaps the most adaptable creature on planet earth. They readily take advantage of the novel environments of a “If raccoons sense large city. They know how to open doors, both figuratively and literally to find their fit into an urban environment. Raccoons can handle most anything the that there is a reward world can put on them. Pharmacy started out as a specialty segment of medicine in the early 1800’s. to be had, they will Anecdotally we are told doctors in most communities realized that it would doggedly work on better for the health of the community if one practitioner specialized and the problem until set up an apothecary. Later, schools were established, formal education was required and the pharmacy profession began to evolve. it is solved.” Pharmacists provided prescription drugs to patients but did not counsel patients, or even interact a great deal with physicians. In 1990, Medicaid said pharmacists were required to offer patient counseling on prescriptions. Today, CMS calls for pharmacists to perform annual MTM reviews. Hospitals are seeking pharmacists to improve the readmit numbers by assuring patients are compliant to their meds upon discharge. The healthcare community is crying out for patient adherence to drug therapy. Another huge opportunity for pharmacy to adapt to and profit as a profession. Like raccoons, pharmacists have adapted to the change of their practice environments. Pharmacists today have the most expansive opportunity for the profession’s future as we move toward provider status. (See the related story on page 16 of the January issue of the GPhA Journal.) Maybe Pharmacy ought to adopt the raccoon as a mascot for the profession? Pharmacists are unstoppable, innovative and adaptable to the fast pace change of the provision of healthcare. I am not sure if pharmacists learned much adaptivity from raccoons or maybe raccoons watched pharmacists and said those guys really know how to profit from adjustments to change and thrive in a fast arriving future. The next time you are uncertain about how to cope with your changing profession, take a look at the raccoons in your neighborhood. Ask for encouragement from the planet’s most adaptive creature (next to pharmacists of course). n

N E W S

PCOM School of Pharmacy Impacting the Local Diabetic Community By Ashley Groves, APhA-ASP President and Joylaina Speaks, APhA-ASP Secretary

T

his past winter, the APhA-ASP chapter at Philadelphia College of Osteopathic Medicine School of Pharmacy (PCOM) had the opportunity to work with a local Diabetes Awareness Foundation. The Foundation’s goal is to raise diabetes awareness through outreach, advocacy and education. They are able to achieve their goal by recommending and promoting diabetes management, prevention and support services for groups who are disproportionately affected by diabetes, in rural, low-income and under served communities throughout the state of Georgia. As an organization we wanted to help promote diabetes management through the production of care packages for the less fortunate members of the community. Many diabetics are not able to maintain their glucose levels because they cannot afford the expensive materials it takes to properly manage diabetes. As an organization, our goal was

WELCOME

New Members Pharmacists Randy Wheeler, Alma, GA Tara Rogers, Gainesville, GA Brandon Teal, Gulf Shores, AL Lindsay McCoy, Athens, GA

Associate Max Clifford North Star Resource Group Scottdale, GA

PCOM students assemble essential diabetic materials for a local Diabetes Awareness Foundation. Photos by Jis Joseph, APhA-ASP Historian to provide essential materials needed for proper diabetes management through fifty care packages. The packages included diabetic gloves, alcohol swabs, mini sharps containers, band aids, hard candy for hyperglycemia, single syringe cases, logbooks, and small diabetes information booklets. We were able to fund our efforts through a generous donation from the Walgreens Diversity Fund Initiative.

The leaders of this event were Ashley Groves, our APhA President, and Crystal Crawford, our Operation Self-Care Committee Chair. Through their efforts, the students had a wonderful time organizing the care packages and interacting with fellow students and faculty members. The foundation was ecstatic to receive our care packages and we look forward to this event being one of the continued traditions of our chapter. n

Real Financial Planning. No Generics.

It means having real strategies for all your financial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their families and their practices. It means working with an independent firm you can trust. Michael T. Tarrant, CFP® • Speaker & Author • PharmPAC Supporter • Creating Real Financial Planning for over 20 Years

Jim THE GEORGIA PHARMACY ASSOCIATION

4

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • mike@FNAplanners.com Registered Representative of INVEST Financial Corporation, member FINRA/SIPC. INVEST and its affiliated insurance agencies offer securities, advisory services and certain insurance products and are not affiliated with Financial Network Associates, Inc. Other advisory services offered through Financial Network Associates, Inc. ad.10040.110749


M E M B E R

Can a Pharmacist Learn From a Raccoon?

I am sure most of us have had personal encounters with Raccoons. Perhaps like me, you have experienced these fury animals on more than one occasion. One of my most intrigu-

ing encounters was at a fine Hilton Head Island restaurant as the masked creatures peered through the widow by my dining table. Another time at my brother’s house in an upscale neighborhood in North Atlanta, I watched them come onto his back deck in search of food – undaunted by lights and the noise of the family activities. The raccoons had adapted nicely Jim Bracewell and successfully into their new environment of opportunity. Raccoons originally started out in the tropics but they moved north and all along the way Executive Vice President they changed their diet. At one time they only lived in trees. Today they live as far north as Alaska. They have multiplied in some of America’s most bustling cities like Chicago, New York and even Toronto, Canada. Today there are 50 times more raccoons in Toronto than in the Canadian countryside. If raccoons sense that there is a reward to be had, they will doggedly work on the problem until it is solved and the goal is reached. Raccoons are perhaps the most adaptable creature on planet earth. They readily take advantage of the novel environments of a “If raccoons sense large city. They know how to open doors, both figuratively and literally to find their fit into an urban environment. Raccoons can handle most anything the that there is a reward world can put on them. Pharmacy started out as a specialty segment of medicine in the early 1800’s. to be had, they will Anecdotally we are told doctors in most communities realized that it would doggedly work on better for the health of the community if one practitioner specialized and the problem until set up an apothecary. Later, schools were established, formal education was required and the pharmacy profession began to evolve. it is solved.” Pharmacists provided prescription drugs to patients but did not counsel patients, or even interact a great deal with physicians. In 1990, Medicaid said pharmacists were required to offer patient counseling on prescriptions. Today, CMS calls for pharmacists to perform annual MTM reviews. Hospitals are seeking pharmacists to improve the readmit numbers by assuring patients are compliant to their meds upon discharge. The healthcare community is crying out for patient adherence to drug therapy. Another huge opportunity for pharmacy to adapt to and profit as a profession. Like raccoons, pharmacists have adapted to the change of their practice environments. Pharmacists today have the most expansive opportunity for the profession’s future as we move toward provider status. (See the related story on page 16 of the January issue of the GPhA Journal.) Maybe Pharmacy ought to adopt the raccoon as a mascot for the profession? Pharmacists are unstoppable, innovative and adaptable to the fast pace change of the provision of healthcare. I am not sure if pharmacists learned much adaptivity from raccoons or maybe raccoons watched pharmacists and said those guys really know how to profit from adjustments to change and thrive in a fast arriving future. The next time you are uncertain about how to cope with your changing profession, take a look at the raccoons in your neighborhood. Ask for encouragement from the planet’s most adaptive creature (next to pharmacists of course). n

N E W S

PCOM School of Pharmacy Impacting the Local Diabetic Community By Ashley Groves, APhA-ASP President and Joylaina Speaks, APhA-ASP Secretary

T

his past winter, the APhA-ASP chapter at Philadelphia College of Osteopathic Medicine School of Pharmacy (PCOM) had the opportunity to work with a local Diabetes Awareness Foundation. The Foundation’s goal is to raise diabetes awareness through outreach, advocacy and education. They are able to achieve their goal by recommending and promoting diabetes management, prevention and support services for groups who are disproportionately affected by diabetes, in rural, low-income and under served communities throughout the state of Georgia. As an organization we wanted to help promote diabetes management through the production of care packages for the less fortunate members of the community. Many diabetics are not able to maintain their glucose levels because they cannot afford the expensive materials it takes to properly manage diabetes. As an organization, our goal was

WELCOME

New Members Pharmacists Randy Wheeler, Alma, GA Tara Rogers, Gainesville, GA Brandon Teal, Gulf Shores, AL Lindsay McCoy, Athens, GA

Associate Max Clifford North Star Resource Group Scottdale, GA

PCOM students assemble essential diabetic materials for a local Diabetes Awareness Foundation. Photos by Jis Joseph, APhA-ASP Historian to provide essential materials needed for proper diabetes management through fifty care packages. The packages included diabetic gloves, alcohol swabs, mini sharps containers, band aids, hard candy for hyperglycemia, single syringe cases, logbooks, and small diabetes information booklets. We were able to fund our efforts through a generous donation from the Walgreens Diversity Fund Initiative.

The leaders of this event were Ashley Groves, our APhA President, and Crystal Crawford, our Operation Self-Care Committee Chair. Through their efforts, the students had a wonderful time organizing the care packages and interacting with fellow students and faculty members. The foundation was ecstatic to receive our care packages and we look forward to this event being one of the continued traditions of our chapter. n

Real Financial Planning. No Generics.

It means having real strategies for all your financial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their families and their practices. It means working with an independent firm you can trust. Michael T. Tarrant, CFP® • Speaker & Author • PharmPAC Supporter • Creating Real Financial Planning for over 20 Years

Jim THE GEORGIA PHARMACY ASSOCIATION

4

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • mike@FNAplanners.com Registered Representative of INVEST Financial Corporation, member FINRA/SIPC. INVEST and its affiliated insurance agencies offer securities, advisory services and certain insurance products and are not affiliated with Financial Network Associates, Inc. Other advisory services offered through Financial Network Associates, Inc. ad.10040.110749


M E M B E R

Thursday, May 8th Atlanta, GA Atlanta Marriott Century Center/Emory Area 2000 Century Boulevard NE Atlanta, GA 30345

A CERTIFICATE TRAINING PROGRAM

N E W S

GPhA 2014 Election Nominees

In Partnership with the Georgia Pharmacy Association

New program offering for 2014! Special promotional rate of only $99! The Pharmacist and Patient-Centered Diabetes Care Certificate Training Program is a newly revised, practice-based activity designed to equip pharmacists with the knowledge, skills, and confidence needed to provide effective, evidencebased diabetes care. Five self-study modules provide comprehensive instruction in current diabetes concepts and standards of care. The live seminar incorporates case studies and hands-on skills training focused on the situations most likely to be encountered—as well as the services most needed—in community and ambulatory care practice settings. Participants will gain experience evaluating and adjusting drug therapy regimens for patients with type 1 and type 2 diabetes, counseling patients about lifestyle interventions, analyzing and interpreting self-monitoring of blood glucose results, and assessing the overall health status of patients to identify needed monitoring and interventions. • • • • •

PROGRAM GOALS Provide comprehensive instruction in current standards of care for patients with diabetes. Increase pharmacists’ confidence in serving as the drug therapy expert on the diabetes health care team. Refresh pharmacists’ knowledge of the pathophysiology of diabetes and the acute and long‐term complications of the disease. Familiarize pharmacists with important concepts in nutrition, exercise, and weight control that contribute to optimal diabetes care. Offer hands-on training in diabetes-related devices and physical assessment skills relevant to optimal diabetes care. Describe ways in which pharmacists can keep abreast of new developments and take advantage of professional opportunities in diabetes care. Introduce pharmacists to the many varied ways in which they can help to improve health outcomes among patients with diabetes. SEMINAR AGENDA Comprehensive Diabetes Care <BREAK> Treating Type 2 Diabetes Insulin Therapy <LUNCH> Nutrition and Lifestyle Counseling <BREAK> Hands-On Skills Practice Next Steps <ADJOURN>

• • • •

SEMINAR LEARNING OBJECTIVES Evaluate the overall health status of patients with diabetes in terms of recommended monitoring and interventions, and formulate strategies for closing gaps in care. Propose modifications to a patient’s drug therapy regimen rooted in evidence-based algorithms for diabetes management. Recommend dietary interventions to support optimal glycemic control and weight loss (when indicated) in patients with diabetes. Analyze and interpret a patient’s self-monitoring of blood glucose results and use the results to identify needed changes in the diabetes management plan. Demonstrate proper technique for measuring blood pressure, administering injections, obtaining fingerstick samples for blood glucose monitoring, operating blood glucose meters, and performing monofilament foot testing. Integrate the varied aspects of comprehensive diabetes care into efficient, sensitive, respectful pharmacist–patient interactions that support optimal patient self-management. The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. TOTAL CPE CREDIT: 23 HOURS (2.3 CEUs) For a complete list of learning objectives, faculty and other CPE information, please visit www.pharmacist.com/ctp

Lance Boles, RPh, MBA GPhA 1st Vice Presidential Candidate

Liza Chapman GPhA 2nd Vice Presidential Candidate

Charles (Chuck) Wilson GPhA 2nd Vice Presidential Candidate

ance received his Bachelor of Science degree in 1999 from The University of Georgia College of Pharmacy. He spent the next three years working as a member of the GPhA staff before returning to earn his MBA from UGA’s Terry College of Business. Lance has been an independent pharmacy owner for ten years and currently owns two independent pharmacies - Hartwell Drugs in Hartwell, GA and Iva Drug Store located in Iva, SC. He currently serves as GPhA’s Second Vice President and as Chairman of the GPhA Transition Committee. He is a former President of GPhA’s Tenth Region and the 2013 recipient of the Mal T. Anderson Outstanding Region President Award. He is an alumnus of GPhA’s New Practitioner Leadership Conference and is a member of AIP, NCPA, and a PharmPAC contributor. n

iza received her doctor of pharmacy degree from Mercer University College of Pharmacy in 2002 and then went on to complete a community pharmacy residency with Mercer and Kroger Pharmacy. After her residency, Liza accepted a clinical pharmacist position with the Kroger Co. where she has been employed since 2003. During her Kroger career, Liza has served as a pharmacy manager, Immunization Coordinator, and her current roll as Clinical Coordinator for the past 7 years. She also serves as residency site coordinator and preceptor for the PGY1 Community Residency Programs with Mercer University and UGA Colleges of Pharmacy. Liza has served in various leadership roles for GPhA including: AEP Chair and Board of Director, Region 10 President, State at Large Member of the GPhA Board of Directors, and Annual Convention Planning Committee Chair. Liza and her husband Ronny are involved in their community and attend Gainesville First United Methodist. n

huck grew up in the Atlanta area attending Lakeside High School in DeKalb County and currently lives in Alpharetta, Georgia. He received his Pharmacy degree in 1982 from the University of Georgia. After receiving his degree, Chuck started his pharmacy career working with Thrift/Treasury Drug, a retail pharmacy chain owned by J.C. Penney. Over the next 14 years, he managed several drugstores in the Atlanta area. He has over 20 years of independent pharmacy and currently the pharmacist/pharmacy owner of The Medicine Shoppe of Dunwoody. His pharmacy specializes in compounding, immunizations and consultation in addition to traditional retail pharmacy business. Chuck is also an adjunct professor/preceptor for Mercer University, UGA and LECOM Pharmacy Schools and currently a member of AIP, GPhA, ASCP, PFOA, NCPA and IACP. He serves on the Governmental Affairs Committee of GPhA and is actively involved in year round GPhA events. n

L

L

C

WWW.PHARMACIST.COM/DIABETES-2014 SEATING IS LIMITED! REGISTER TODAY! ONLY $99

This program was developed by the American Pharmacists Association and is cosponsored by the American Association of Diabetes Educators. This offering is in partnership with the Georgia Pharmacy Association and supported by an independent educational grant from Novo Nordisk.

Nominations will remain open by petition through Noon on April 25, 2014.

Electronic Voting will begin Monday, June 16, 2014. A Paper Ballot may be requested at any time by calling Tei Muhammad at 404-419-8115.

The Election will close at 2:00 p.m. Saturday June 28, 2014. The Georgia Pharmacy Journal

7


M E M B E R

N E W S

GPhA 2014 Election Nominees

Lance Boles, RPh, MBA GPhA 1st Vice Presidential Candidate

Liza Chapman GPhA 2nd Vice Presidential Candidate

Charles (Chuck) Wilson GPhA 2nd Vice Presidential Candidate

ance received his Bachelor of Science degree in 1999 from The University of Georgia College of Pharmacy. He spent the next three years working as a member of the GPhA staff before returning to earn his MBA from UGA’s Terry College of Business. Lance has been an independent pharmacy owner for ten years and currently owns two independent pharmacies - Hartwell Drugs in Hartwell, GA and Iva Drug Store located in Iva, SC. He currently serves as GPhA’s Second Vice President and as Chairman of the GPhA Transition Committee. He is a former President of GPhA’s Tenth Region and the 2013 recipient of the Mal T. Anderson Outstanding Region President Award. He is an alumnus of GPhA’s New Practitioner Leadership Conference and is a member of AIP, NCPA, and a PharmPAC contributor. n

iza received her doctor of pharmacy degree from Mercer University College of Pharmacy in 2002 and then went on to complete a community pharmacy residency with Mercer and Kroger Pharmacy. After her residency, Liza accepted a clinical pharmacist position with the Kroger Co. where she has been employed since 2003. During her Kroger career, Liza has served as a pharmacy manager, Immunization Coordinator, and her current roll as Clinical Coordinator for the past 7 years. She also serves as residency site coordinator and preceptor for the PGY1 Community Residency Programs with Mercer University and UGA Colleges of Pharmacy. Liza has served in various leadership roles for GPhA including: AEP Chair and Board of Director, Region 10 President, State at Large Member of the GPhA Board of Directors, and Annual Convention Planning Committee Chair. Liza and her husband Ronny are involved in their community and attend Gainesville First United Methodist. n

huck grew up in the Atlanta area attending Lakeside High School in DeKalb County and currently lives in Alpharetta, Georgia. He received his Pharmacy degree in 1982 from the University of Georgia. After receiving his degree, Chuck started his pharmacy career working with Thrift/Treasury Drug, a retail pharmacy chain owned by J.C. Penney. Over the next 14 years, he managed several drugstores in the Atlanta area. He has over 20 years of independent pharmacy and currently the pharmacist/pharmacy owner of The Medicine Shoppe of Dunwoody. His pharmacy specializes in compounding, immunizations and consultation in addition to traditional retail pharmacy business. Chuck is also an adjunct professor/preceptor for Mercer University, UGA and LECOM Pharmacy Schools and currently a member of AIP, GPhA, ASCP, PFOA, NCPA and IACP. He serves on the Governmental Affairs Committee of GPhA and is actively involved in year round GPhA events. n

L

L

C

Nominations will remain open by petition through Noon on April 25, 2014.

Electronic Voting will begin Monday, May 12, 2014. A Paper Ballot may be requested at any time by calling Tei Muhammad at 404-419-8115 and must be returned by Monday, June 16, 2014.

The Election will close at 2:00 p.m. Saturday June 28, 2014. The Georgia Pharmacy Journal

7


M E M B E R

N E W S

M E M B E R

N E W S

Legislative Recap

“Politics” was played on a lot of important issues instead of doing what was best for the state. Andy Freeman

Director of Government Affiars

This session we learned how truly powerful the PBMs can be. The first part of this year they weren’t happy with some regulations that the Board of Pharmacy were having a hearing on. They took their complaints to a handful of legislators and some bureaucrats. Late in the session the PBMs had language added to a bill in the Senate Health Committee that would have exempted mail order from all rules and regulations

Richard Nixon once said, “A man is not finished when he’s defeated. He’s finished when he quits.” Yes we had a bad session but we are not throwing up our hands and quitting. Will you give to PharmPAC today to make sure that we have the resources to help those that fight PBMs for fairness and to help fund challengers to those that constantly side against us? Will you get a pharmacist to join GPhA so that we can be bigger and stronger next year? www.gpha.org of the Board of Pharmacy. With the help of pharmacists from across the state that contacted their legislators, GPhA was able to remove that language by a vote of 38-14 from the State Senate. With a few days left in the session, the PBMs struck again. The same Senator that added their language exempting them from the Boards’ rules added similar language to the Budget. This language says that no state dollars shall be used to require any mail order pharmacy to obtain a nonresident pharmacy permit. Even though language that is added to the budget is not legally binding, it is still troubling that the PBMs were able to

8

persuade a conference committee member to have this language added to the Budget. The last day of the Legislative Session we were working hard on adding language to various bills to address the issues of MAC pricing and expanding immunizations under protocol. Throughout the day, legislators were approaching the GPhA lobbying team and letting them know that they were receiving lots of emails and phone calls from pharmacists in their districts. Legislators were pledging their support to help us out when the bills came up in the House or Senate that were going to have our amendments added. We felt good about our chances to address both of these issues. Around 7:30 pm on the last night, a bill came up that was perfect to address MAC pricing. We had firm commitments from 5 of the 6 conference committee members that they were supporting our amendment. Before negotiations got started we learned that the Governor’s office was believing the lies of the PBMs that the Board of Pharmacy was a rogue board that was attempting to make rules over groups they had no legal authority to regulate. It became clear that any legislation that contained language addressing the MAC pricing problems that pharmacists constantly face would not become law. Next session we are not going to let the PBMs win. We are going to take the battle to them and we are going to be victorious. How many of you have had a State Representative or State Senator in your

The Georgia Pharmacy Journal

pharmacy? This summer we need you to invite your legislators to your pharmacy. We need you to talk to them about MAC pricing and make sure they understand how many times a day you are losing money when you are fi lling a prescription when the MAC pricing information used by the PBMs hasn’t been updated in months. If a majority of the legislators come to an AIP pharmacy between now and next session it won’t matter how much money the PBMs give to elected officials or what lies they tell, we will be victorious next session. Get to know your legislators and let them know our issues and we can’t be stopped! n

About The Georgia Pharmacy Association T

he Georgia Pharmacy Association strives to be the leading voice for pharmacy in the state of Georgia. We aggressively advocate for the profession by shaping public policy and scope of practice to enhance the value of pharmacy. We take pride in our prestigious history and value our membership for its diversity in all practice settings as well as its dedication to health care. GPhA provides its members with the resources and support needed to advance our profession. As healthcare changes, so do job responsibilities and career tracks may be refocused. GPhA is your career development partner as you address your future in pharmacy. Professional networking, skills training and continuing pharmacy education are key benefits of your GPhA membership. Whether you are a recent Pharmacy school grad or an established pharma-

The Georgia Pharmacy Journal

cist with years behind you, there is a fession and the citizens of Georgia. We keep members informed of important place for your voice at GPhA. The Georgia Pharmacy Association issues and frequently send out "calls to maintains a strong presence on the po- action" during the legislative session. litical scene, not only during the legis- The success of our Government Advocacy program depends lative session but also on the participation and throughout the year. involvement of you, the GPhA stays abreast of The Georgia member. We urge you current issues that could Pharmacy to seek out your repreimpact the profession of sentatives and introduce pharmacy. The associaAssociation yourself — talk about tion also works to build the profession and the relationships with polioffers you a voice important issues facing cy makers on a state and for the support pharmacy, which in turn national level, through affect Georgia patients. our grassroots program of pharmacy It's all about building reand also through the in the state. lationships and the most Government Advocacy important relationships staff and the Governbegin with you. ment Affairs committee. Join Us Today! GPhA's Government Over the years, GPhA Affairs staff is available has been a driving force behind important legislation to benefit to members to answer questions regardnot just the pharmacy profession, but ing pending or passed legislation and its also our patients. We have been at the effect on the profession. The Governforefront of cutting edge changes in the ment Affairs team is at the Capitol everyhealthcare delivery system. GPhA has day during the session representing and also been effective in freezing legisla- advocating on behalf of Georgia phartion that could be harmful to the pro- macists. n


M E M B E R

N E W S

M E M B E R

N E W S

Legislative Recap

“Politics” was played on a lot of important issues instead of doing what was best for the state. Andy Freeman

Director of Government Affiars

This session we learned how truly powerful the PBMs can be. The first part of this year they weren’t happy with some regulations that the Board of Pharmacy were having a hearing on. They took their complaints to a handful of legislators and some bureaucrats. Late in the session the PBMs had language added to a bill in the Senate Health Committee that would have exempted mail order from all rules and regulations

Richard Nixon once said, “A man is not finished when he’s defeated. He’s finished when he quits.” Yes we had a bad session but we are not throwing up our hands and quitting. Will you give to PharmPAC today to make sure that we have the resources to help those that fight PBMs for fairness and to help fund challengers to those that constantly side against us? Will you get a pharmacist to join GPhA so that we can be bigger and stronger next year? www.gpha.org of the Board of Pharmacy. With the help of pharmacists from across the state that contacted their legislators, GPhA was able to remove that language by a vote of 38-14 from the State Senate. With a few days left in the session, the PBMs struck again. The same Senator that added their language exempting them from the Boards’ rules added similar language to the Budget. This language says that no state dollars shall be used to require any mail order pharmacy to obtain a nonresident pharmacy permit. Even though language that is added to the budget is not legally binding, it is still troubling that the PBMs were able to

8

persuade a conference committee member to have this language added to the Budget. The last day of the Legislative Session we were working hard on adding language to various bills to address the issues of MAC pricing and expanding immunizations under protocol. Throughout the day, legislators were approaching the GPhA lobbying team and letting them know that they were receiving lots of emails and phone calls from pharmacists in their districts. Legislators were pledging their support to help us out when the bills came up in the House or Senate that were going to have our amendments added. We felt good about our chances to address both of these issues. Around 7:30 pm on the last night, a bill came up that was perfect to address MAC pricing. We had firm commitments from 5 of the 6 conference committee members that they were supporting our amendment. Before negotiations got started we learned that the Governor’s office was believing the lies of the PBMs that the Board of Pharmacy was a rogue board that was attempting to make rules over groups they had no legal authority to regulate. It became clear that any legislation that contained language addressing the MAC pricing problems that pharmacists constantly face would not become law. Next session we are not going to let the PBMs win. We are going to take the battle to them and we are going to be victorious. How many of you have had a State Representative or State Senator in your

The Georgia Pharmacy Journal

pharmacy? This summer we need you to invite your legislators to your pharmacy. We need you to talk to them about MAC pricing and make sure they understand how many times a day you are losing money when you are fi lling a prescription when the MAC pricing information used by the PBMs hasn’t been updated in months. If a majority of the legislators come to an AIP pharmacy between now and next session it won’t matter how much money the PBMs give to elected officials or what lies they tell, we will be victorious next session. Get to know your legislators and let them know our issues and we can’t be stopped! n

About The Georgia Pharmacy Association T

he Georgia Pharmacy Association strives to be the leading voice for pharmacy in the state of Georgia. We aggressively advocate for the profession by shaping public policy and scope of practice to enhance the value of pharmacy. We take pride in our prestigious history and value our membership for its diversity in all practice settings as well as its dedication to health care. GPhA provides its members with the resources and support needed to advance our profession. As healthcare changes, so do job responsibilities and career tracks may be refocused. GPhA is your career development partner as you address your future in pharmacy. Professional networking, skills training and continuing pharmacy education are key benefits of your GPhA membership. Whether you are a recent Pharmacy school grad or an established pharma-

The Georgia Pharmacy Journal

cist with years behind you, there is a fession and the citizens of Georgia. We keep members informed of important place for your voice at GPhA. The Georgia Pharmacy Association issues and frequently send out "calls to maintains a strong presence on the po- action" during the legislative session. litical scene, not only during the legis- The success of our Government Advocacy program depends lative session but also on the participation and throughout the year. involvement of you, the GPhA stays abreast of The Georgia member. We urge you current issues that could Pharmacy to seek out your repreimpact the profession of sentatives and introduce pharmacy. The associaAssociation yourself — talk about tion also works to build the profession and the relationships with polioffers you a voice important issues facing cy makers on a state and for the support pharmacy, which in turn national level, through affect Georgia patients. our grassroots program of pharmacy It's all about building reand also through the in the state. lationships and the most Government Advocacy important relationships staff and the Governbegin with you. ment Affairs committee. Join Us Today! GPhA's Government Over the years, GPhA Affairs staff is available has been a driving force behind important legislation to benefit to members to answer questions regardnot just the pharmacy profession, but ing pending or passed legislation and its also our patients. We have been at the effect on the profession. The Governforefront of cutting edge changes in the ment Affairs team is at the Capitol everyhealthcare delivery system. GPhA has day during the session representing and also been effective in freezing legisla- advocating on behalf of Georgia phartion that could be harmful to the pro- macists. n


S P R I N G PICKENS

MACON

E RS HAM

TON

BLE

LER

WILCOX

JEFF DAVIS

IRWIN

COFFEE

BRANTLEY

GLYNN

IER LAN

BROOKS

Region 1

Tuesday, April 15th Statesboro, GA President: Krista Stone ugarxgirl@gmail.com

Region 2

Tuesday, April 15th Albany, GA President: Ed Dozier eddozier@mediacombb.net

McINTOSH

PIERCE

CLINCH

CHARLTON

CAMDEN

ES

THOMAS

CHATHAM

LONG WAYNE

BACON

WARE

COOK

EFFINGHAM BRYAN

LIBERTY

ATKINSON

BERRIEN

GRADY

EVANS TATTNALL

APPLING

TIFT

COLQUITT

SCREVEN

BULLOCH

ND

DECATUR

CANDLE

TELFAIR HILL BEN HILL

TURNER WORTH

R

TLEN

TREU

MBS

MILLER

JENKINS

LAURENS

DODGE

BAKER MITCHELL

BURKE

JOHNSON

TOO

PULASKI

CRISP LEE

JEFFER -SON

EMANUEL Y KLE

C

US

HO DOOLY

DOUGHERTY

WASHINGTON

EE WH

CALHOUN

EARLY

SEMINOLE

Ahhh...

CLAY

GLA

TWIGGS

CH

RICHMOND

O SC

WILKINSON

PEA

COLUMBIA

CK

HANCOCK

WIN

BIBB

SUMTER

TERRELL

LN

MONTGOMERY

STER WEB

RANDOLPH

WA RR

EN

JONES

MONROE CRAWFORD

LEY SCH

MARION

CO

RO

AFER

TALI

BALD

TAYLOR

QUITMAN

GREENE

JASPER PUTNAM

UPSON

TALBOT

CHATTAHOOCHEE

LIN

WILKES

E

ON

R THE IWE MER

PIKE

MUSCOGEE

STEWART

ELBERT

IE UFF

E

HARRIS

EE

MORGAN NEWTON NEWTON

BUTTS

SPALDING

TROUP

HART

OGLETHORPE

HENRY

TT FAYE

COWETA

HEARD

CLAYTON

ON

RKE

McD

ON

FULT

CLA

OC

WALTON

ROCK

U

DO

CARROLL

DEKALB

IN

KL

AN

FR

MADISON

DAL

COBB S GLA

BARROW

GWINNETT GWINNETT

LAMA R

HARALSON

FORSYTH

ECHOLS

Region 3

We all know what that means.

T

he sun is shinning and the temps are warming. The flowers are blooming and the birds are chirping. The lawn needs mowing and of course the leadership of the Georgia Pharmacy Association are making their rounds throughout the state. It’s time for the GPhA Spring Region Meetings and you are invited! A lot has happened this year regarding the pharmacy profession and this is an opportunity for you to catch up, network, and earn continuing education hours. Check out your region dates here and for more information on locations and to register go to www.gpha.org or email your Region President. Grab a friend or an associate and we will see you there. n

10

M E E T I N G S

STEPHENS

BANKS

HALL

JACKSON

PAU LDIN G

POLK

ON

CHEROKEE

BARTOW

FLOYD

WHITE

HAB

GORDON

S P R I N G

M E E T I N G S

RABUN

UNION LUMPKIN

DA WS

LO W

MMUUR RRRAY AY

TFIE

LD

FANNIN GILMER

OFUNLT

DAD E

CHATTOOGA

FU LT

WHI

CATOOSA

WALKER

TOWNS

Tuesday, April 22nd Columbus, GA President: Renee Adamson radamson@eldercarepharmacy.org

Region 4

Thursday, May 1st Griffi n, GA President: Nicholas Bland blandn112@gmial.com

Region 5

Thursday, May 1st Norcross, GA President: Shelby Biagi sbiagi@aol.com

Region 6

Tuesday, April 22nd Macon, GA President: Sherri Moody sherri07@yahoo.com

Region 7

Thursday, May 1st Acworth, GA President: Tyler Mayotte tylermtt@gmail.com

Region 8

Tuesday, April 15th Waycross, GA President: Michael Lewis mikelewrph@gmail.com

Region 9

Tuesday, April 29th Blue Ridge, GA President: Amanda Westbrooks mandy.paisley@gmail.com

Region 10

Tuesday, April 29th Athens, GA President: Flynn Warren fwarren@rx.uga.edu

Region 11

Tuesday, April 29th Augusta, GA President: Kalen Manasco kmanasco@georgiahealth.edu

Region 12

Tuesday, April 22nd Dublin, GA President: Ken Eiland kenton.eiland@ga.gov

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

11


S P R I N G PICKENS

MACON

E RS HAM

TON

BLE

LER

WILCOX

JEFF DAVIS

IRWIN

COFFEE

BRANTLEY

GLYNN

IER LAN

BROOKS

Region 1

Tuesday, April 15th Statesboro, GA President: Krista Stone ugarxgirl@gmail.com

Region 2

Tuesday, April 15th Albany, GA President: Ed Dozier eddozier@mediacombb.net

McINTOSH

PIERCE

CLINCH

CHARLTON

CAMDEN

ES

THOMAS

CHATHAM

LONG WAYNE

BACON

WARE

COOK

EFFINGHAM BRYAN

LIBERTY

ATKINSON

BERRIEN

GRADY

EVANS TATTNALL

APPLING

TIFT

COLQUITT

SCREVEN

BULLOCH

ND

DECATUR

CANDLE

TELFAIR HILL BEN HILL

TURNER WORTH

R

TLEN

TREU

MBS

MILLER

JENKINS

LAURENS

DODGE

BAKER MITCHELL

BURKE

JOHNSON

TOO

PULASKI

CRISP LEE

JEFFER -SON

EMANUEL Y KLE

C

US

HO DOOLY

DOUGHERTY

WASHINGTON

EE WH

CALHOUN

EARLY

SEMINOLE

Ahhh...

CLAY

GLA

TWIGGS

CH

RICHMOND

O SC

WILKINSON

PEA

COLUMBIA

CK

HANCOCK

WIN

BIBB

SUMTER

TERRELL

LN

MONTGOMERY

STER WEB

RANDOLPH

WA RR

EN

JONES

MONROE CRAWFORD

LEY SCH

MARION

CO

RO

AFER

TALI

BALD

TAYLOR

QUITMAN

GREENE

JASPER PUTNAM

UPSON

TALBOT

CHATTAHOOCHEE

LIN

WILKES

E

ON

R THE IWE MER

PIKE

MUSCOGEE

STEWART

ELBERT

IE UFF

E

HARRIS

EE

MORGAN NEWTON NEWTON

BUTTS

SPALDING

TROUP

HART

OGLETHORPE

HENRY

TT FAYE

COWETA

HEARD

CLAYTON

ON

RKE

McD

ON

FULT

CLA

OC

WALTON

ROCK

U

DO

CARROLL

DEKALB

IN

KL

AN

FR

MADISON

DAL

COBB S GLA

BARROW

GWINNETT GWINNETT

LAMA R

HARALSON

FORSYTH

ECHOLS

Region 3

We all know what that means.

T

he sun is shinning and the temps are warming. The flowers are blooming and the birds are chirping. The lawn needs mowing and of course the leadership of the Georgia Pharmacy Association are making their rounds throughout the state. It’s time for the GPhA Spring Region Meetings and you are invited! A lot has happened this year regarding the pharmacy profession and this is an opportunity for you to catch up, network, and earn continuing education hours. Check out your region dates here and for more information on locations and to register go to www.gpha.org or email your Region President. Grab a friend or an associate and we will see you there. n

10

M E E T I N G S

STEPHENS

BANKS

HALL

JACKSON

PAU LDIN G

POLK

ON

CHEROKEE

BARTOW

FLOYD

WHITE

HAB

GORDON

S P R I N G

M E E T I N G S

RABUN

UNION LUMPKIN

DA WS

LO W

MMUUR RRRAY AY

TFIE

LD

FANNIN GILMER

OFUNLT

DAD E

CHATTOOGA

FU LT

WHI

CATOOSA

WALKER

TOWNS

Tuesday, April 22nd Columbus, GA President: Renee Adamson radamson@eldercarepharmacy.org

Region 4

Thursday, May 1st Griffi n, GA President: Nicholas Bland blandn112@gmial.com

Region 5

Thursday, May 1st Norcross, GA President: Shelby Biagi sbiagi@aol.com

Region 6

Tuesday, April 22nd Macon, GA President: Sherri Moody sherri07@yahoo.com

Region 7

Thursday, May 1st Acworth, GA President: Tyler Mayotte tylermtt@gmail.com

Region 8

Tuesday, April 15th Waycross, GA President: Michael Lewis mikelewrph@gmail.com

Region 9

Tuesday, April 29th Blue Ridge, GA President: Amanda Westbrooks mandy.paisley@gmail.com

Region 10

Tuesday, April 29th Athens, GA President: Flynn Warren fwarren@rx.uga.edu

Region 11

Tuesday, April 29th Augusta, GA President: Kalen Manasco kmanasco@georgiahealth.edu

Region 12

Tuesday, April 22nd Dublin, GA President: Ken Eiland kenton.eiland@ga.gov

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

11


2013 Recipients of the “Bowl of Hygeia” Award

M E M B E R

N E W S

2014 GPhA Convention Charles D. Sands III Alabama

Martie Lamont Alaska

Kathryn Labbe Arizona

Karrol Fowlkes Arkansas*

Vicki Fowlkes Arkansas*

Helen K Park California

Ronald Kennedy Colorado

Registration Now Open!

Gregory L Hancock Connecticut

Preliminary Schedule David W. Dryden Delaware

Leland Hanson Kansas

Judith Martin Riffee Florida

J Leon Claywell Kentucky

William Lee Prather Georgia

Selma Yamamoto Hawaii

Mark Johnston Idaho

Garry Moreland Illinois

Douglas Boudreaux Louisiana

Paul Chace Maine

Nancy J W Lewis Michigan

Harvey Buchholz Minnesota

Clarence DuBose Mississippi

Cheryl A Abel New Hampshire

Eileen Fishman New Jersey

Phil Griego New Mexico

James R. Schiffer New York

Wayne Kradjan Oregon

Edward Bechtel Pennsylvania

Daniel Mahiques-Nieves Puerto Rico

Linda A Carver Rhode Island

Dominic DeRose Utah

Angelo C. Voxakis Maryland

John R Reynolds Massachusetts

Carla Cobb Montana

Scott E Mambourg Nevada

Jean Douglas North Carolina

Laurel Haroldson North Dakota

Kenneth S. Alexander Ohio

Eric Winegardner Oklahoma

Linda Reid South Carolina

Ann M Cruse South Dakota

Kenneth Smith Tennessee

Leticia Van de Putte Texas

Janet Kusler Washington

Russell Jensen Wisconsin

Wednesday, June 25, 2014

Bernard Cremers Iowa

Kenneth W. Schafermeyer Missouri

The “Bowl of Hygeia”

Leo H Ross Virginia

Patrick Cashen Indiana

Timothy Seeley Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program. *husband and wife co-recipients

Ju n e 26 -29, 2014 Wyndham Bay Point Resort Panama City Beach, FL To register go to www.gpha.org and click on the Convention Banner or scan the code.

5:30 pm - 7:00 pm Board of Directors Meeting 9:00 pm - 10:00 pm Council of President’s Meeting with Coffee & Dessert Reception

Thursday, June 26, 2014 7:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am- 9:00 am Morning Coffee & Pastries Platinum Sponsor

8:00 am - 10:00 am Drug Abuse & Diversion: How You Can Play a Role in Prevention 8:00 am - 10:00 am Anticoagulation: Not Just Warfarin 10:15 am - 11:15 am The Busy Practitioners Guide to Effective Communication in Pharmacy Practice 10:15 am - 11:15 am Aromatherapy - An Introduction to Essential Oil and their Therapeutic Uses Gold Sponsor


2013 Recipients of the “Bowl of Hygeia” Award

M E M B E R

N E W S

2014 GPhA Convention Charles D. Sands III Alabama

Martie Lamont Alaska

Kathryn Labbe Arizona

Karrol Fowlkes Arkansas*

Vicki Fowlkes Arkansas*

Helen K Park California

Ronald Kennedy Colorado

Registration Now Open!

Gregory L Hancock Connecticut

Preliminary Schedule David W. Dryden Delaware

Leland Hanson Kansas

Judith Martin Riffee Florida

J Leon Claywell Kentucky

William Lee Prather Georgia

Selma Yamamoto Hawaii

Mark Johnston Idaho

Garry Moreland Illinois

Douglas Boudreaux Louisiana

Paul Chace Maine

Nancy J W Lewis Michigan

Harvey Buchholz Minnesota

Clarence DuBose Mississippi

Cheryl A Abel New Hampshire

Eileen Fishman New Jersey

Phil Griego New Mexico

James R. Schiffer New York

Wayne Kradjan Oregon

Edward Bechtel Pennsylvania

Daniel Mahiques-Nieves Puerto Rico

Linda A Carver Rhode Island

Dominic DeRose Utah

Angelo C. Voxakis Maryland

John R Reynolds Massachusetts

Carla Cobb Montana

Scott E Mambourg Nevada

Jean Douglas North Carolina

Laurel Haroldson North Dakota

Kenneth S. Alexander Ohio

Eric Winegardner Oklahoma

Linda Reid South Carolina

Ann M Cruse South Dakota

Kenneth Smith Tennessee

Leticia Van de Putte Texas

Janet Kusler Washington

Russell Jensen Wisconsin

Wednesday, June 25, 2014

Bernard Cremers Iowa

Kenneth W. Schafermeyer Missouri

The “Bowl of Hygeia”

Leo H Ross Virginia

Patrick Cashen Indiana

Timothy Seeley Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program. *husband and wife co-recipients

Ju n e 26 -29, 2014 Wyndham Bay Point Resort Panama City Beach, FL To register go to www.gpha.org and click on the Convention Banner or scan the code.

5:30 pm - 7:00 pm Board of Directors Meeting 9:00 pm - 10:00 pm Council of President’s Meeting with Coffee & Dessert Reception

Thursday, June 26, 2014 7:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am- 9:00 am Morning Coffee & Pastries Platinum Sponsor

8:00 am - 10:00 am Drug Abuse & Diversion: How You Can Play a Role in Prevention 8:00 am - 10:00 am Anticoagulation: Not Just Warfarin 10:15 am - 11:15 am The Busy Practitioners Guide to Effective Communication in Pharmacy Practice 10:15 am - 11:15 am Aromatherapy - An Introduction to Essential Oil and their Therapeutic Uses Gold Sponsor


M E M B E R

2014 GPhA Convention

Play the Course That Jack Built. 1

th

5

NUAL AN

10:15 am - 11:15 am Updates in Diabetes: Understanding the Standards of Medical Care in Type II Diabetes 1:00 pm - 3:30 pm First General Session: CPE Topic TBA 3:30 pm - 6:00 pm Exhibit Hall Open with Student Sponsor/VIP Lounge 7:30 pm Mercer Alumni Dinner 7:30 pm UGA Alumni Dinner

Friday, June 27, 2014 8:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am - 9:00 am Morning Coffee & Pastries 8:00 am GA Pharmacy Foundation/ Carlton Henderson Memorial Golf Tournament 9:00 am AEP Tennis Tournament 8:00 am - 9:00 am What You Always Wanted to Know About Teratogens, but were Afraid to Ask

Georgia Pharmacy Foundation

CARLTON HENDERSON MEMORIAL GOLF TOURNAMENT You work hard and you really care about your future in the pharmacy profession. That’s why you support The Georgia Pharmacy Association and attend the GPhA Convention. But you also deserve time to get out, enjoy one of the fantastic amenities at the convention and support a very worthy cause The Georgia Pharmacy Foundation Student Scholarship Program. Designed by the great Jack Nicklaus himself, this course is one of the best in Northwest Florida. So take a break and join us on the course that Jack built because as they say, “all work and no play makes Jack a dull boy.”

Friday, June 27, 2014 The Nicklaus Course at Bay Point Resort | Panama City Beach, FL

9:15 am - 10:15 am Hot Topics & Trends in Pharmacy Law

N E W S

8:00 am - 5:00 pm GPhA Registration

2:15 pm - 2:30 pm Tellers Committee Meeting

8:00 am - 10:00 am Hypertension 101: Clinical Pearls for the Community Pharmacist

2:30 pm - 3:30 pm Resolutions Committee Meeting

8:00 am - 10:00 am STAR Ratings 101 10:15 am - 12:15 pm Third General Session: CPE Topic TBA 12:30 pm - 1:45 pm ASA Luncheon & Annual Business Meeting

3:15 pm - 4:15 pm Issues of Cultural Competency in Pharmacy 3:15 pm - 4:15 pm Insulin Therapy: Optimizing the use of Insulin in Patients with Type II Diabetes 3:15 pm - 4:15 pm Compounding CPE

12:30 pm - 1:45 pm AIP Wholesaler Appreciation Luncheon

6:00 pm - 6:30 pm President’s Reception

12:30 pm - 1:45 pm ACP Luncheon & Business Meeting

6:30 pm - 11:00 pm President’s Banquet & Officer Installation. Dessert Reception & Dance

12:30 pm - 1:45 pm AEP Luncheon & Business Meeting 12:30 pm - 1:45 pm AHP Luncheon & Business Meeting 2:00 pm Election Closes

Sunday, June 29, 2014 8:00 am - 8:30 am Interfaith Sunrise Service 9:00 am - 9:30 am Annual Meeting

2:00 pm - 3:00 pm AIP CPE 2:00 pm - 3:00 pm 2014 Brown Bag Patient Counseling Competition 2:00 pm - 3:00 pm Asthma Management: Focus on Patient-Centered Care

9:30 am - 11:30 am New Drug Update 2014: A Formulary Approach 9:30 am - 10:30 am Update in the Management of Hyperlipidemia: Was it Worth the Wait? 10:00 am - 11:00 am 2014-2015 GPhA BOD Meeting

10:30 am - 12:30 pm Diabetes, Part II: Star-Rated Medications 10:30 am - 12:30 pm Immunization/OSHA Update CPE 2:00 pm - 3:30 pm Second General Session: CPE Topic TBA 3:30 pm - 6:00 pm Exhibit Hall Opens 6:00 pm - 7:00 pm PharmPAC Reception (by invitation)

Saturday, June 28, 2014 7:00 am - 8:00 am Compounding Breakfast 7:00 am - 9:00 am Morning Coffee & Pastries

The Georgia Pharmacy Journal

Representing pharmacists and pharmacies before the Georgia Pharmacy Board, GDNA and DEA. AREAS OF PRACTICE Professional Licensing Medicare and Medicaid Fraud and Reimbursement Criminal Defense

Administrative Law Healthcare Law Legal Advice for Licensed Professionals

WWW.FRANCULLEN.COM (404) 806-6771 • admin@francullen.com


M E M B E R

2014 GPhA Convention

Play the Course That Jack Built. 1

th

5

NUAL AN

10:15 am - 11:15 am Updates in Diabetes: Understanding the Standards of Medical Care in Type II Diabetes 1:00 pm - 3:30 pm First General Session: CPE Topic TBA 3:30 pm - 6:00 pm Exhibit Hall Open with Student Sponsor/VIP Lounge 7:30 pm Mercer Alumni Dinner 7:30 pm UGA Alumni Dinner

Friday, June 27, 2014 8:00 am - 5:00 pm GPhA Attendee & Exhibitor Registration 7:00 am - 9:00 am Morning Coffee & Pastries 8:00 am GA Pharmacy Foundation/ Carlton Henderson Memorial Golf Tournament 9:00 am AEP Tennis Tournament 8:00 am - 9:00 am What You Always Wanted to Know About Teratogens, but were Afraid to Ask

Georgia Pharmacy Foundation

CARLTON HENDERSON MEMORIAL GOLF TOURNAMENT You work hard and you really care about your future in the pharmacy profession. That’s why you support The Georgia Pharmacy Association and attend the GPhA Convention. But you also deserve time to get out, enjoy one of the fantastic amenities at the convention and support a very worthy cause The Georgia Pharmacy Foundation Student Scholarship Program. Designed by the great Jack Nicklaus himself, this course is one of the best in Northwest Florida. So take a break and join us on the course that Jack built because as they say, “all work and no play makes Jack a dull boy.”

Friday, June 27, 2014 The Nicklaus Course at Bay Point Resort | Panama City Beach, FL

9:15 am - 10:15 am Hot Topics & Trends in Pharmacy Law

N E W S

8:00 am - 5:00 pm GPhA Registration

2:15 pm - 2:30 pm Tellers Committee Meeting

8:00 am - 10:00 am Hypertension 101: Clinical Pearls for the Community Pharmacist

2:30 pm - 3:30 pm Resolutions Committee Meeting

8:00 am - 10:00 am STAR Ratings 101 10:15 am - 12:15 pm Third General Session: CPE Topic TBA 12:30 pm - 1:45 pm ASA Luncheon & Annual Business Meeting

3:15 pm - 4:15 pm Issues of Cultural Competency in Pharmacy 3:15 pm - 4:15 pm Insulin Therapy: Optimizing the use of Insulin in Patients with Type II Diabetes 3:15 pm - 4:15 pm Compounding CPE

12:30 pm - 1:45 pm AIP Wholesaler Appreciation Luncheon

6:00 pm - 6:30 pm President’s Reception

12:30 pm - 1:45 pm ACP Luncheon & Business Meeting

6:30 pm - 11:00 pm President’s Banquet & Officer Installation. Dessert Reception & Dance

12:30 pm - 1:45 pm AEP Luncheon & Business Meeting 12:30 pm - 1:45 pm AHP Luncheon & Business Meeting 2:00 pm Election Closes

Sunday, June 29, 2014 8:00 am - 8:30 am Interfaith Sunrise Service 9:00 am - 9:30 am Annual Meeting

2:00 pm - 3:00 pm AIP CPE 2:00 pm - 3:00 pm 2014 Brown Bag Patient Counseling Competition 2:00 pm - 3:00 pm Asthma Management: Focus on Patient-Centered Care

9:30 am - 11:30 am New Drug Update 2014: A Formulary Approach 9:30 am - 10:30 am Update in the Management of Hyperlipidemia: Was it Worth the Wait? 10:00 am - 11:00 am 2014-2015 GPhA BOD Meeting

10:30 am - 12:30 pm Diabetes, Part II: Star-Rated Medications 10:30 am - 12:30 pm Immunization/OSHA Update CPE 2:00 pm - 3:30 pm Second General Session: CPE Topic TBA 3:30 pm - 6:00 pm Exhibit Hall Opens 6:00 pm - 7:00 pm PharmPAC Reception (by invitation)

Saturday, June 28, 2014 7:00 am - 8:00 am Compounding Breakfast 7:00 am - 9:00 am Morning Coffee & Pastries

The Georgia Pharmacy Journal

Representing pharmacists and pharmacies before the Georgia Pharmacy Board, GDNA and DEA. AREAS OF PRACTICE Professional Licensing Medicare and Medicaid Fraud and Reimbursement Criminal Defense

Administrative Law Healthcare Law Legal Advice for Licensed Professionals

WWW.FRANCULLEN.COM (404) 806-6771 • admin@francullen.com


I N D U S T R Y

N E W S

I N D U S T R Y

Protect Health Information On Photocopier Hard Drives

Many pharmacies lease photocopiers and simply return the photocopier to

the leasing company to replace it with the latest model. However, most pharmacists are unaware that their old photocopier could subject their pharmacy to substantial fines and penalties as a result of violations of the Health Insurance Portability and Accountability Act. An insurance company recently negotiated a settlement with the United States Department of Health and Human Services in excess of one million dollars [$1,000,000.00] over its failure to erase Protected Health Information from leased photocopier hard drives, resulting in a breach of HIPAA. Commercial copiers have come a long way. Current digital copiers are smart machines that are used to copy, print, scan, fax and email documents. Digi-

tal copiers require hard disk drives to manage incoming jobs and workloads, and to increase the speed of production. Generally, commercial copiers have hard drives that store data about each documents that it copies, prints, scans, faxes or emails. If steps are not taken to protect that data and to remove it before the copier is returned to a leasing company, the data can be accessed from the hard drive by another user, resulting in a breach of Protected Health Information and a breach of HIPAA. Many copier manufacturers offer data security features for the copier machines, which typically involve encryp-

Most pharmacists are unaware their old photocopier could subject their pharmacy to substantial fines and penalties as a result to HIPAA.

Please Note:

Board of Pharmacy No Longer Mails Out Licenses As of June 1, 2012 the Georgia Board of Pharmacy will no longer mail out licenses. The Board will no longer print and/or mail courtesy hard copies of blue wall licenses and pocket cards to licensees free of charge. Statutes and board rules require some licensees to post a copy of their license at their place of business for inspection. To meet this requirement, the division will provide free of charge an electronic version of the professional license for the individual or business to obtain from our website at http://gadch.mylicense.com/PocketCards/. This change will apply to all license types and to the issuance of new, renewed, and reinstated licenses. A $25.00 charge will apply for all blue wall license/ pocket card orders. As always, someone seeking to verify the status of a professional license, you should use the real-time verification portal located at https:// gadch.mylicense.com/verification/Search.aspx?facility=N that contains the most accurate and up-to-date information on a licensee’s status. If you wish to check the status of your application please visit https:// gadch.mylicense.com/eGov/. n

16

tion and overwriting. Encryption methods protect information stored on the hard drive by scrambling the data using a code that can only be read by specific software. This ensures that the data stored on the hard drive cannot be retrieved by an outside user. Copier manufactures also offer overwriting protection. Overwriting consists of replacing existing data on the hard drive with random characters and making the files difficult to reconstruct. Another option for protecting data stored on hard drives involves locking the hard drive with a password. Manufacturers may also offer services upon the return of the copier to protect or secure the data stored on the hard drive. Many manufactures offer to remove the hard drive and return it to its previous user, so that the user can keep, dispose of or destroy the hard drive. The Omnibus Final Rule, which had a compliance date of September 23, 2013, presumes that all unauthorized uses or disclosures of PHI constitute a “breach” unless the covered entity or business associate demonstrates through a risk assessment that there is a “low probability that the PHI has been compromised. The Omnibus Final Rule identifies four “objective” factors that covered entities and business associates must consider when performing the required risk assessment: (1) What was the nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification? (2) Who was the unauthorized person who used the protected health information or to whom the disclosure was made? (3) Was the protected health information actually acquired or viewed?

The Georgia Pharmacy Journal

(4) To what extent was the risk to the protected health information mitigated? The U.S. Department of Health and Human Services’ move towards more objective factors is consistent with the increased enforcement efforts being undertaken across the board. With the increased penalties for a breach of HIPAA and the increased number of investigations conducted by the Department of Health and Human Services, it is critical to ensure that electronic Protected Health Information is properly managed at all times. The United States Department of Health and Human Services settlement is only one example of how Protected Health Information may be electronically stored in locations that are not easily apparent, and should serve as a motivator for every pharmacy to ensure that policies and procedures are in place regarding the return of photocopiers at the expiration of the lease term. Phar-

N E W S

macists should perform a risk analysis pursuant to HIPAA guidelines to ensure that every storage location of electronic Protected Health Information has been identified, including computers, scanners, flash drives and hard drives. Once the security risks of electronic Protected Health Information have been assessed, pharmacists must implement policies for the disposal of this Protected Health Information prior to the return or disposal of the equipment. Pharmacists should also ensure that each of its business associates have executed a Business Associate Agreement that requires the business associates to destroy all electronic Protected Health Information from devices before returning or discarding them. A breach of HIPPA can result in substantial fines, penalties and even a lack of patient confidence. By conducting a HIPAA risk analysis assessment on a regular basis, pharmacists can save time, money and

frustration, as well as avoid reputational damage in the health care community. n Stuart J. Oberman, Esq. handles a wide range of legal issues for the pharmacy profession including practice sales, real estate transactions, lease agreements, HIPAA and OSHA compliance, board complaints, employment law, and entity formation. For questions or comments regarding this article please call (770) 554-1400 or visit www.obermanlaw.com Please visit us at: Corporate Facebook: http://www.facebook.com/pages/Oberman-Law/246795745395840\ Twitter: http://twitter.com/#!/obermanlaw LinkedIn: http://www.linkedin.com/in/stuartobermanlaw Blog: http://obermanlawfirm.wordpress.com/


I N D U S T R Y

N E W S

I N D U S T R Y

Protect Health Information On Photocopier Hard Drives

Many pharmacies lease photocopiers and simply return the photocopier to

the leasing company to replace it with the latest model. However, most pharmacists are unaware that their old photocopier could subject their pharmacy to substantial fines and penalties as a result of violations of the Health Insurance Portability and Accountability Act. An insurance company recently negotiated a settlement with the United States Department of Health and Human Services in excess of one million dollars [$1,000,000.00] over its failure to erase Protected Health Information from leased photocopier hard drives, resulting in a breach of HIPAA. Commercial copiers have come a long way. Current digital copiers are smart machines that are used to copy, print, scan, fax and email documents. Digi-

tal copiers require hard disk drives to manage incoming jobs and workloads, and to increase the speed of production. Generally, commercial copiers have hard drives that store data about each documents that it copies, prints, scans, faxes or emails. If steps are not taken to protect that data and to remove it before the copier is returned to a leasing company, the data can be accessed from the hard drive by another user, resulting in a breach of Protected Health Information and a breach of HIPAA. Many copier manufacturers offer data security features for the copier machines, which typically involve encryp-

Most pharmacists are unaware their old photocopier could subject their pharmacy to substantial fines and penalties as a result to HIPAA.

Please Note:

Board of Pharmacy No Longer Mails Out Licenses As of June 1, 2012 the Georgia Board of Pharmacy will no longer mail out licenses. The Board will no longer print and/or mail courtesy hard copies of blue wall licenses and pocket cards to licensees free of charge. Statutes and board rules require some licensees to post a copy of their license at their place of business for inspection. To meet this requirement, the division will provide free of charge an electronic version of the professional license for the individual or business to obtain from our website at http://gadch.mylicense.com/PocketCards/. This change will apply to all license types and to the issuance of new, renewed, and reinstated licenses. A $25.00 charge will apply for all blue wall license/ pocket card orders. As always, someone seeking to verify the status of a professional license, you should use the real-time verification portal located at https:// gadch.mylicense.com/verification/Search.aspx?facility=N that contains the most accurate and up-to-date information on a licensee’s status. If you wish to check the status of your application please visit https:// gadch.mylicense.com/eGov/. n

16

tion and overwriting. Encryption methods protect information stored on the hard drive by scrambling the data using a code that can only be read by specific software. This ensures that the data stored on the hard drive cannot be retrieved by an outside user. Copier manufactures also offer overwriting protection. Overwriting consists of replacing existing data on the hard drive with random characters and making the files difficult to reconstruct. Another option for protecting data stored on hard drives involves locking the hard drive with a password. Manufacturers may also offer services upon the return of the copier to protect or secure the data stored on the hard drive. Many manufactures offer to remove the hard drive and return it to its previous user, so that the user can keep, dispose of or destroy the hard drive. The Omnibus Final Rule, which had a compliance date of September 23, 2013, presumes that all unauthorized uses or disclosures of PHI constitute a “breach” unless the covered entity or business associate demonstrates through a risk assessment that there is a “low probability that the PHI has been compromised. The Omnibus Final Rule identifies four “objective” factors that covered entities and business associates must consider when performing the required risk assessment: (1) What was the nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification? (2) Who was the unauthorized person who used the protected health information or to whom the disclosure was made? (3) Was the protected health information actually acquired or viewed?

The Georgia Pharmacy Journal

(4) To what extent was the risk to the protected health information mitigated? The U.S. Department of Health and Human Services’ move towards more objective factors is consistent with the increased enforcement efforts being undertaken across the board. With the increased penalties for a breach of HIPAA and the increased number of investigations conducted by the Department of Health and Human Services, it is critical to ensure that electronic Protected Health Information is properly managed at all times. The United States Department of Health and Human Services settlement is only one example of how Protected Health Information may be electronically stored in locations that are not easily apparent, and should serve as a motivator for every pharmacy to ensure that policies and procedures are in place regarding the return of photocopiers at the expiration of the lease term. Phar-

N E W S

macists should perform a risk analysis pursuant to HIPAA guidelines to ensure that every storage location of electronic Protected Health Information has been identified, including computers, scanners, flash drives and hard drives. Once the security risks of electronic Protected Health Information have been assessed, pharmacists must implement policies for the disposal of this Protected Health Information prior to the return or disposal of the equipment. Pharmacists should also ensure that each of its business associates have executed a Business Associate Agreement that requires the business associates to destroy all electronic Protected Health Information from devices before returning or discarding them. A breach of HIPPA can result in substantial fines, penalties and even a lack of patient confidence. By conducting a HIPAA risk analysis assessment on a regular basis, pharmacists can save time, money and

frustration, as well as avoid reputational damage in the health care community. n Stuart J. Oberman, Esq. handles a wide range of legal issues for the pharmacy profession including practice sales, real estate transactions, lease agreements, HIPAA and OSHA compliance, board complaints, employment law, and entity formation. For questions or comments regarding this article please call (770) 554-1400 or visit www.obermanlaw.com Please visit us at: Corporate Facebook: http://www.facebook.com/pages/Oberman-Law/246795745395840\ Twitter: http://twitter.com/#!/obermanlaw LinkedIn: http://www.linkedin.com/in/stuartobermanlaw Blog: http://obermanlawfirm.wordpress.com/


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Bronze Level

Members

$150 minimum pledge Monica Ali-Warren, R.Ph. 6/14 *Shane Bentley, Student *Robert Bowles *Rabun Deckle, R. Ph. Ashley Faulk, Pharm.D. 4/14 James Fetterman, Jr., Pharm.D. 4/14 *Larry Harkleroad, R.Ph. Winton Harris Jr., R.Ph. 6/14 *Amy Grimsley, Pharm. D *Thomas Jeter, R.Ph. *Henry Josey, R.Ph *Brenton Lake, R.Ph. *Tracie Lunde, Pharm.D. *Michael Lewis, Pharm.D. Max Mason, R.Ph. 6/14 *Susan McLeer, R.Ph. Judson Mullican, R.Ph. 11/14 *Natalie Nielsen, R.Ph. *Mark Niday, R. Ph. The Georgia Pharmacy Journal

No minimum pledge Claude Bates, R.Ph 6/14 Winston Brock, R.Ph. 6/14 David Carver, R.Ph. 6/14 Marshall Curtis, R.Ph. 6/14 Donley Dawson, Pharm.D. 12/14 John Drew, R.Ph. 6/14 James England, R.Ph. 6/14 Martin Grizzard, R.Ph. 12/14 Christopher Gurley, R. Ph 6/14 Lise Hennick 2/14 Marsha Kapiloff, R.Ph. 6/14 Charles Kovarik, R. Ph. 6/14 Carroll Lowery, R.Ph. 2/14 Ralph Marett, R.Ph. 6/14 Kenneth McCarthy, R.Ph. 6/14 Whitney Pickett, R.Ph. 11/14 Michael Reagan, R. Ph 6/14 Ola Reffell, R.Ph. 6/14 Leonard Reynolds, R.Ph. 6/14

Victor Serafy, R.Ph. 6/14 Terry Shaw, Pharm.D. 5/14 Harry Shurley, R.Ph 6/14 Amanda Stankiewicz, Student 6/14 Benjamin Stanley, R.Ph 6/14 Krista Stone, R.Ph 6/14 John Thomas, R.Ph. 11/14 William Thompson, R.Ph. 6/14 Carey Vaughan, Pharm.D. 6/14 Jonathon Williams R.Ph 8/14 *denotes sustaining members

NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incorrect. afreeman@gpha.org 404-419-8118

PharmPac Board of Directors

Eddie Madden, Chairman Dean Stone, Region 1 Keith Dupree, Region 2 Judson Mullican, Region 3 Bill McLeer, Region 4 Mahlon Davidson, Region 5 Mike McGee, Region 6 Jim McWilliams, Region 7 T.M. Bridges, Region 9 Mark Parris, Region 9 Chris Thurmond, Region 10 Stewart Flanagin, Region 11 Henry Josey, Region 12 Pam Marquess, Ex-Officio Jim Bracewell, Ex-Officio

19


*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.

Thanks to All Our Supporters Diamond Level

$4,800 minimum pledge *Scott Meeks, R.Ph. Bryan Scott, R.Ph. *Fred Sharpe, R.Ph

Titanium Level

$2,400 minimum pledge *Ralph Balchin, R.Ph. *Ben Cravey, R.Ph. *Michael Farmer, R.Ph. *David Graves, R.Ph. *Raymond Hickman, R.Ph. *Robert Ledbetter, R.Ph. *Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph. *Jeff Sikes, R.Ph. *Danny Smith, R.Ph. *Dean Stone, R.Ph. *Tommy Whitworth, R.Ph.

Platinum Level

$1,200 minimum pledge Thomas Bryan, Jr. 12/14 *Larry Braden, R.Ph. *William Cagle, R.Ph. *Hugh Chancy, R.Ph. *Keith Chapman, R.Ph. *Dale Coker, R.Ph. *Billy Conley, R.Ph. *Al Dixon Jr., R.Ph. *Ashley Dukes, R.Ph. Patrick Dunham, R.Ph. 3/15 *Jack Dunn Jr., R.Ph. *Neal Florence, R.Ph. *Andy Freeman 18

*Robert Hatton, Pharm.D. Ted Hunt, R.Ph.12/14 *Ira Katz, R.Ph. Thomas Lindsay, R.Ph. 5/14 Jeff Lurey, R.Ph. 4/14 *Eddie Madden, R.Ph. *Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D. *Kenneth McCarthy, R.Ph. *Ivey McCurdy, Pharm. D *Drew Miller, R.Ph. *Laird Miller, R.Ph. *Jay Mosley, R.Ph. *Sujal Patel, Pharm D *Mark Parris, Pharm.D. *Allen Partridge, R.Ph. *Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14 *Benjamin Stanley, Pharm.D. *Danny Toth, R.Ph. *Christopher Thurmond, Pharm.D. *Alex Tucker, Pharm.D. Lindsay Walker, R.Ph. 6/14 Henry Wilson, Pharm.D. 11/14

Gold Level

$600 minimum pledge James Bartling, Pharm.D. 6/14 *William Brewster, R.Ph. *Liza Chapman, Pharm.D. *Mahlon Davidson, R.Ph. *Angela DeLay, R.Ph. *Benjamin Dupree, Sr., R.Ph *Stewart Flanagin, R.Ph. *Kevin Florence, Pharm.D. *Kerry Griffin, R.Ph.

*Michael Iteogu, R.Ph. *Joshua Kinsey, Pharm.D. *Dan Kiser, R.Ph. *Allison Layne, C.Ph.T Lance LoRusso 6/14 *Sheila Miller, Pharm.D. *Robert Moody, R.Ph. *Sherri Moody, Pharm.D. *William Moye, R.Ph. *Anthony Ray, R.Ph. *Jeffrey Richardson, R.Ph. *Andy Rogers, R.Ph. Wade Scott, R.Ph. *Michael Tarrant *James Thomas, R.Ph. Zach Tomberlin, Pharm.D. 4/14 *Mark White, R.Ph. *Charles Wilson Jr., R.Ph.

Silver Level

$300 minimum pledge *Renee Adamson, Pharm.D. Larry Batten, R. Ph. 11/14 Lance Boles, R.Ph. 8/14 Robert Cecil, R.Ph. 3/15 Laura Coker, Pharm D 6/14 *Ed Dozier, R.Ph. *Greg Drake, R. Ph. *Terry Dunn, R.Ph. *Marshall Frost, Pharm.D. *Amanda Gaddy, R. Ph. *Johnathan Hamrick, Pharm.D. *Willie Latch, R.Ph *Hilary Mbadugha, Pharm.D. *Kalen Manasco, Pharm.D. Max Mason, R.Ph. The Georgia Pharmacy Journal

Highlight denotes new and increased contributors.

*William McLeer, R.Ph. *Sheri Mills, C.Ph.T. *Richard Noell, R.Ph. *Cynthia Piela, R.Ph. *Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14 *Kristy Pucylowski, Pharm.D. *Edward Reynolds, R.Ph. *Ashley Rickard, Pharm D. *Brian Rickard, Pharm D. Flynn Warren, R.Ph. 6/14 Steve Wilson, Pharm.D. 7/14 *William Wolfe, R.Ph. *Sharon Zerillo, R.Ph.

*Don Richie, R.Ph. *Amanda Paisley, Pharm.D. Rose Pinkstaff 1/14 *Alex Pinkston IV, R.Ph Don Richie, R.Ph. 11/14 *Corey Rieck Carlos Rodriguez-Feo, R.Ph. 12/14 *Laurence Ryan, Pharm.D. *Olivia Santoso, Pharm. D. James Stowe, R.Ph. 12/14 *Dana Strickland, R.Ph. G.H. Thurmond, R.Ph. 11/14 *Tommy Tolbert, R. Ph. *Austin Tull, Pharm.D.

Bronze Level

Members

$150 minimum pledge Monica Ali-Warren, R.Ph. 6/14 *Shane Bentley, Student *Robert Bowles *Rabun Deckle, R. Ph. Ashley Faulk, Pharm.D. 4/14 James Fetterman, Jr., Pharm.D. 4/14 *Larry Harkleroad, R.Ph. Winton Harris Jr., R.Ph. 6/14 *Amy Grimsley, Pharm. D *Thomas Jeter, R.Ph. *Henry Josey, R.Ph *Brenton Lake, R.Ph. *Tracie Lunde, Pharm.D. *Michael Lewis, Pharm.D. Max Mason, R.Ph. 6/14 *Susan McLeer, R.Ph. Judson Mullican, R.Ph. 11/14 *Natalie Nielsen, R.Ph. *Mark Niday, R. Ph. The Georgia Pharmacy Journal

No minimum pledge Claude Bates, R.Ph 6/14 Winston Brock, R.Ph. 6/14 David Carver, R.Ph. 6/14 Marshall Curtis, R.Ph. 6/14 Donley Dawson, Pharm.D. 12/14 John Drew, R.Ph. 6/14 James England, R.Ph. 6/14 Martin Grizzard, R.Ph. 12/14 Christopher Gurley, R. Ph 6/14 Lise Hennick 2/14 Marsha Kapiloff, R.Ph. 6/14 Charles Kovarik, R. Ph. 6/14 Carroll Lowery, R.Ph. 2/14 Ralph Marett, R.Ph. 6/14 Kenneth McCarthy, R.Ph. 6/14 Whitney Pickett, R.Ph. 11/14 Michael Reagan, R. Ph 6/14 Ola Reffell, R.Ph. 6/14 Leonard Reynolds, R.Ph. 6/14

Victor Serafy, R.Ph. 6/14 Terry Shaw, Pharm.D. 5/14 Harry Shurley, R.Ph 6/14 Amanda Stankiewicz, Student 6/14 Benjamin Stanley, R.Ph 6/14 Krista Stone, R.Ph 6/14 John Thomas, R.Ph. 11/14 William Thompson, R.Ph. 6/14 Carey Vaughan, Pharm.D. 6/14 Jonathon Williams R.Ph 8/14 *denotes sustaining members

NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incorrect. afreeman@gpha.org 404-419-8118

PharmPac Board of Directors

Eddie Madden, Chairman Dean Stone, Region 1 Keith Dupree, Region 2 Judson Mullican, Region 3 Bill McLeer, Region 4 Mahlon Davidson, Region 5 Mike McGee, Region 6 Jim McWilliams, Region 7 T.M. Bridges, Region 9 Mark Parris, Region 9 Chris Thurmond, Region 10 Stewart Flanagin, Region 11 Henry Josey, Region 12 Pam Marquess, Ex-Officio Jim Bracewell, Ex-Officio

19


SUPPORT BUDDY CARTER R.Ph FOR CONGRESS There is not a single Pharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/ With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES. Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle. PAID FOR BY BUDDY CARTER FOR CONGRESS CARLTON HODGES, TREASURER

continuing education for pharmacists Volume XXXII, No. 2

Vitamin D Deficiency and Treatment Melody L. Hartzler, R.Ph., PharmD, AE-C, BCACP, Assistant Professor of Pharmacy Practice and Tracy R. Frame, R.Ph., PharmD, BCACP, Assistant Professor of Pharmacy Practice, Cedarville University School of Pharmacy Drs. Melody Hartzler and Tracy Frame have no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on vitamin D deficiency and insufficiency including prevalence, epidemiology, screening, prevention, treatment recommendations, and the relationship to various diseases; as well as vitamin D supplements, dietary sources, and symptoms of toxicity. Objectives. At the completion of this activity, the participant will be able to: 1. identify clinical manifestations of vitamin D deficiency and insufficiency; 2. recognize the relationship of vitamin D deficiency to common disease states; 3. demonstrate an understanding of screening, prevention and treatment of vitamin D deficiencies, including vitamin D supplements and dietary sources; and 4. list signs and symptoms of vitamin D toxicity. Despite the lack of consensus on optimal levels of serum 25-hydroxyvitamin D [25(OH)D], vitamin D deficiency is most often defined as a level of less than 20 ng/mL, and insufficiency is defined as a serum 25(OH)D level of 20 to 29 ng/mL. The major source of vitamin D in the human body is produced in the skin by a UVB-mediated, photolytic, nonenzymatic reaction that converts 7-dehydrocholesterol to previtamin

The Georgia Pharmacy Journal

D3. Previtamin D3 then undergoes another conversion to vitamin D3 (cholecalciferol), which also occurs in the skin. Vitamin D3 can also be obtained from the diet via animal sources and supplements. Another form of vitamin D, vitamin D2 (ergocalciferol), is found in some plants and is commonly produced commercially by irradiation of yeast for supplementation and fortification in the food supply. Both of these forms of vitamin D undergo the same metabolism and are converted to 25(OH)D in the liver. Finally in the kidney, 25(OH)D is hydroxylated to 1,25 dihydroxyvitamin D [1,25(OH)2D], the biologically active form of vitamin D, which increases calcium absorption, and acts on the osteoblasts and osteoclasts in bone to mobilize calcium. This last step in the process is regulated primarily by serum parathyroid hormone (PTH), as well as low serum calcium or phosphorus levels. Research suggests vitamin D3 is a prohormone rather than a vitamin. In addition to increasing calcium absorption and mobilization, new information suggests the activated hormone 1,25(OH)2D plays other non-calcemic roles in intracellular biological reactions. The vitamin D receptor (VDR) is a phosphoprotein member of the nuclear receptor superfamily that can be affected by glucocorticoids, estrogens, retinoids, and cell proliferation rates. Vitamin D and VDR have shown important roles in immune, cardiovascular, reproductive systems and in hair growth. Serum 1,25(OH)2D has been found to

control more than 200 genes in the body that regulate cellular proliferation, differentiation, apoptosis, and angiogenesis. Some reports have estimated over a billion people worldwide have vitamin D deficiency or insufficiency. Data from National Health and Nutrition Examination Surveys (NHANES) report that from 2001 to 2006 an estimated one-quarter of Americans were at risk of vitamin D inadequacy [serum 25(OH)D of 30 to 49 nmol/L or 11 to 20 ng/mL], and 8 percent were at risk of vitamin D deficiency [serum 25(OH)D less than 30 nmol/L or less than 10 ng/mL]. The prevalence was lower in younger, male, or non-Hispanic white individuals. Among women, the prevalence was also lower in pregnant or lactating females. Risk factors for vitamin D deficiency include age greater than 65 years, babies breastfed exclusively without vitamin D supplementation, dark skin, insufficient sunlight exposure, medication use that alters vitamin D metabolism (such as anticonvulsants or glucocorticoids), obesity (BMI greater than 30 kg/m2), and a sedentary lifestyle. In light of this information, researchers have begun to ask the question, “Is vitamin D the reason for the racial disparities seen across a variety of disease states?” For example, the NHANES data from 2001 to 2006 suggest suboptimal vitamin D status may contribute to racial disparity in albuminuria due to an inverse relationship between 25(OH)D levels and albuminuria. Other observational stud-

21


SUPPORT BUDDY CARTER R.Ph FOR CONGRESS There is not a single Pharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/ With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES. Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle. PAID FOR BY BUDDY CARTER FOR CONGRESS CARLTON HODGES, TREASURER

continuing education for pharmacists Volume XXXII, No. 2

Vitamin D Deficiency and Treatment Melody L. Hartzler, R.Ph., PharmD, AE-C, BCACP, Assistant Professor of Pharmacy Practice and Tracy R. Frame, R.Ph., PharmD, BCACP, Assistant Professor of Pharmacy Practice, Cedarville University School of Pharmacy Drs. Melody Hartzler and Tracy Frame have no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on vitamin D deficiency and insufficiency including prevalence, epidemiology, screening, prevention, treatment recommendations, and the relationship to various diseases; as well as vitamin D supplements, dietary sources, and symptoms of toxicity. Objectives. At the completion of this activity, the participant will be able to: 1. identify clinical manifestations of vitamin D deficiency and insufficiency; 2. recognize the relationship of vitamin D deficiency to common disease states; 3. demonstrate an understanding of screening, prevention and treatment of vitamin D deficiencies, including vitamin D supplements and dietary sources; and 4. list signs and symptoms of vitamin D toxicity. Despite the lack of consensus on optimal levels of serum 25-hydroxyvitamin D [25(OH)D], vitamin D deficiency is most often defined as a level of less than 20 ng/mL, and insufficiency is defined as a serum 25(OH)D level of 20 to 29 ng/mL. The major source of vitamin D in the human body is produced in the skin by a UVB-mediated, photolytic, nonenzymatic reaction that converts 7-dehydrocholesterol to previtamin

The Georgia Pharmacy Journal

D3. Previtamin D3 then undergoes another conversion to vitamin D3 (cholecalciferol), which also occurs in the skin. Vitamin D3 can also be obtained from the diet via animal sources and supplements. Another form of vitamin D, vitamin D2 (ergocalciferol), is found in some plants and is commonly produced commercially by irradiation of yeast for supplementation and fortification in the food supply. Both of these forms of vitamin D undergo the same metabolism and are converted to 25(OH)D in the liver. Finally in the kidney, 25(OH)D is hydroxylated to 1,25 dihydroxyvitamin D [1,25(OH)2D], the biologically active form of vitamin D, which increases calcium absorption, and acts on the osteoblasts and osteoclasts in bone to mobilize calcium. This last step in the process is regulated primarily by serum parathyroid hormone (PTH), as well as low serum calcium or phosphorus levels. Research suggests vitamin D3 is a prohormone rather than a vitamin. In addition to increasing calcium absorption and mobilization, new information suggests the activated hormone 1,25(OH)2D plays other non-calcemic roles in intracellular biological reactions. The vitamin D receptor (VDR) is a phosphoprotein member of the nuclear receptor superfamily that can be affected by glucocorticoids, estrogens, retinoids, and cell proliferation rates. Vitamin D and VDR have shown important roles in immune, cardiovascular, reproductive systems and in hair growth. Serum 1,25(OH)2D has been found to

control more than 200 genes in the body that regulate cellular proliferation, differentiation, apoptosis, and angiogenesis. Some reports have estimated over a billion people worldwide have vitamin D deficiency or insufficiency. Data from National Health and Nutrition Examination Surveys (NHANES) report that from 2001 to 2006 an estimated one-quarter of Americans were at risk of vitamin D inadequacy [serum 25(OH)D of 30 to 49 nmol/L or 11 to 20 ng/mL], and 8 percent were at risk of vitamin D deficiency [serum 25(OH)D less than 30 nmol/L or less than 10 ng/mL]. The prevalence was lower in younger, male, or non-Hispanic white individuals. Among women, the prevalence was also lower in pregnant or lactating females. Risk factors for vitamin D deficiency include age greater than 65 years, babies breastfed exclusively without vitamin D supplementation, dark skin, insufficient sunlight exposure, medication use that alters vitamin D metabolism (such as anticonvulsants or glucocorticoids), obesity (BMI greater than 30 kg/m2), and a sedentary lifestyle. In light of this information, researchers have begun to ask the question, “Is vitamin D the reason for the racial disparities seen across a variety of disease states?” For example, the NHANES data from 2001 to 2006 suggest suboptimal vitamin D status may contribute to racial disparity in albuminuria due to an inverse relationship between 25(OH)D levels and albuminuria. Other observational stud-

21


ies have shown vitamin D levels to be lower in African Americans than White Americans with worse disease outcomes for those with cancer, cardiovascular disease, diabetes, end-stage renal disease, and all-cause mortality. It has been shown that African Americans have a mean serum 25(OH)D level of 16 ng/mL, while White Americans have a level of 26 ng/mL. The African American population has a higher rate of obesity. Because vitamin D is a fat-soluble vitamin, heavier individuals may require more, which could be a confounding explanation of the lower serum 25(OH)D levels. Additional data from NHANES III, as well as the mortality data from the National Death Index, has also been consistent with the hypothesis that vitamin D deficiency contributes to increased African American mortality from colorectal cancer. Although there is limited evidence, vitamin D may play a role in higher rates of preterm birth in the African American population due to the active form serving as a key modulator of immune response, and as a potent regulator of placental immunity. Lastly, there is a higher prevalence of hypertension among African American individuals versus Caucasians, and in a recent crosssectional analysis serum 25(OH)D levels explained one-quarter of the disparity in systolic blood pressure. It is important to recognize these racial disparities, especially among the African American population, in order to properly screen patients for deficiency.

Vitamin D Deficiency and Non-Skeletal Disease Diabetes Due to vitamin Dâ&#x20AC;&#x2122;s effect on more than 200 genes in the body, vitamin D has been linked to various non-skeletal diseases in multiple epidemiological studies. Data has established a link between vitamin D deficiency and an increased incidence of both type 1 and type 2 diabetes. Calcium intake has

22

evidence demonstrating an inverse relationship to incidence of metabolic syndrome and diabetes. There is evidence that suggests vitamin D influences beta cell function directly, and may make beta cells more resistant to types of cellular stress due to vitamin D receptors present on beta cells in the pancreas. A significant increased risk of type 2 diabetes has been reported among persons with serum 25(OH)D levels below 30 ng/mL (after adjustments for BMI and percent body fat.) A European study also showed evidence of vitamin D supplementation decreasing the risk of type 1 diabetes. Other small population studies in type 1 diabetic patients have shown supplementation improved glycemic control, although there is mixed evidence regarding improvement in type 2 diabetic patients. Other small trials have shown evidence for increased insulin secretion and decreased hemoglobin A1c (HbA1c) in patients supplemented with vitamin D. There are currently multiple on-going trials regarding this topic. In addition to glycemic control in diabetes, vitamin D has also been linked in one study to complications such as diabetic peripheral neuropathy. In this small study of 210 type 2 diabetic patients with or without diabetic peripheral neuropathy, vitamin D was assessed. Eighty-seven patients had diabetic peripheral neuropathy with a significantly longer duration of diabetes and higher HbA1c than those without. The mean serum 25(OH)D level was significantly lower in individuals with neuropathy, and there were significant correlations between serum 25(OH)D levels and total cholesterol, LDL-cholesterol and urine microalbumin:creatinine ratio. This data suggests vitamin D deficiency may be an independent risk factor for diabetic peripheral neuropathy.

been linked in epidemiological studies to vitamin D deficiency. A few studies in relation to endothelial dysfunction have shown statistically significant improvement in arterial stiffness compared to placebo when supplemented with vitamin D. Vitamin D supplementation has also been shown to have a beneficial effect on elastic properties of the arterial wall in a randomized placebo-controlled intervention study in post-menopausal women. Epidemiological studies also suggest that low levels of serum 25(OH)D are associated with an increased risk of CVD and mortality. There is expression of VDR in the heart and blood vessels, which suggests a role of vitamin D in the cardiovascular system. VDR-knockout mice suffer from CVD, and various experimental studies suggest cardiovascular protection by vitamin D. A retrospective, cross-sectional analysis report displayed increased rates of hypertension in individuals who tested for lower levels of 25(OH)D, which started at 40 ng/ mL. The odds ratio was 2.7 for vitamin D levels less than 15 ng/ mL, 2.0 from 15 to 30 ng/mL, and 1.3 for 30 to 39 ng/mL. A few randomized controlled trials (RCTs) looking at CVD events as a secondary outcome have found a moderate reduction in CVD risk (not shown to be statistically significant) using exclusive vitamin D supplementation. Further studies are being explored, such as the VITAL Study, in which researchers have enrolled 20,000 men and women across the U.S. to investigate whether taking daily dietary supplements of vitamin D3 (2,000 IU or placebo) or omega-3 fatty acids (OmacorÂŽ fish oil/EPA+DHA [1 gm/840 mg] or placebo) reduces the risk for developing cancer, heart disease, and stroke in persons who do not have a prior history of these illnesses.

Cardiovascular Disease Adding to the increased risk of metabolic syndrome and diabetes, cardiovascular disease (CVD) has

Depression Psychological conditions, such as depression and seasonal affective disorder (SAD), have also been

The Georgia Pharmacy Journal

linked to vitamin D deficiency. An RCT of overweight and obese patients with depression compared 20,000 IU or 40,000 IU of vitamin D supplementation with placebo weekly for one year. Both groups with vitamin D supplementation had improved BECK depression scores from baseline, but the placebo groups did not. This trial did exclude patients on antidepressant medications. Gloth et al. studied vitamin D deficiency in SAD, and in this small trial of 15 patients, eight received vitamin D therapy and seven received ultraviolet light therapy. All had improved vitamin D status (74 percent in the vitamin D group; 36 percent in the ultraviolet light therapy group). Vitamin D level improvements in this study were also significantly associated with improvements in depression scores. Available evidence does not definitively demonstrate that vitamin D deficiency is a cause of or risk for developing depression, or that vitamin D is an effective therapy for depression. Infectious Disease There is additional evidence that vitamin D is required for the expression of cathelicidin by macrophages, which is involved in killing bacteria. Most data about vitamin D and infectious disease surrounds tuberculosis (TB). A meta-analysis of seven observational studies found a higher risk of tuberculosis in those with the lowest vitamin D levels, although supplementation with vitamin D in one trial did not improve TB treatment outcomes. However, in this particular trial, the dose of 100,000 IU of vitamin D at zero, three and eight months may have been subtherapeutic in regard to treatment, since serum 25(OH)D levels did not differ from placebo. Ginde et al. also demonstrated that the prevalence of upper respiratory tract infections in the NHANES III population increased significantly as the serum 25(OH)D levels dropped, regardless of the season of the year, and was greatest during the winter when 25(OH)D levels were lowest.

The Georgia Pharmacy Journal

Asthma Evidence continues to reveal that vitamin D may also play a role in asthma. Vitamin D receptors are also located on lung bronchial smooth muscle cells, mast cells, dendritic cells and regulatory T-cells. Vitamin D then inhibits cytokine synthesis and release, decreases inflammation, and inhibits bronchial smooth muscle cell proliferation and remodeling. Vitamin D can also enhance interleukin-10 synthesis, which is a potent anti-inflammatory cytokine. In addition, evidence demonstrated that men and women with serum 25(OH)D levels above 35 ng/ mL had a 176 mL increase in forcedexpiratory volume in one second (FEV1). Children of women who had vitamin D deficiency during pregnancy were shown to be at an increased risk of wheezing illnesses. A small study of 86 children also revealed there were lower serum 25(OH)D levels in children with severe, therapy-resistant asthma, which were associated with increased airway smooth muscle masses, and worsened asthma control and lung function (p<0.001). Data on asthma in the literature is growing, and researchers have hypothesized that vitamin D supplementation may improve asthma control, but there are limited prospective studies to confirm this hypothesis. Cancer Carcinomas have also been linked to vitamin D deficiency and insufficiency in recent literature. A meta-analysis of case-control studies assessing serum 25(OH)D levels has shown for each 20 ng/mL increase in serum 25(OH)D levels, odds of colon cancer were reduced by more than 40 percent. One large RCT sought to determine if supplementation of 400 IU per day plus calcium had an effect on the incidence of colon cancer. There was no significant effect seen, as concentrations of serum 25(OH)D were measured at baseline but not during follow-up. Thus, it was difficult to determine if the dose even increased deficient levels.

Due to colon cancerâ&#x20AC;&#x2122;s long latency period, a trial length of only eight years could have been a significant limitation to the study. Other forms of cancer, such as breast cancer, have also been linked to vitamin D deficiency. A meta-analysis of vitamin D and the prevention of breast cancer found a 45 percent decrease in breast cancer for those in the highest quartile of circulating 25(OH)D of 60 nmol/L (about 24 ng/mL) compared with the lowest. A limitation with breast cancer and vitamin D research is that obesity can be a confounding factor that is difficult to separate. Other cancers, such as prostate cancer and pancreatic cancer, have been reviewed as well. The most recent meta-analysis for the U.S. Preventative Services Task Force suggests evidence is not sufficiently robust to draw conclusions regarding the benefit or harm of vitamin D supplementation for the prevention of cancer. Chronic Kidney Disease (CKD) Supplementation and treatment deficiency guidelines in CKD vary depending upon serum 25(OH)D levels and stage of CKD, and are discussed in the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. There have been recent reports demonstrating these guidelines may be outdated and not adequate. A recent review by Melamed et al. in the Clinical Journal of the American Society of Nephrology provides detailed information on recent studies done in CKD and ongoing studies in vitamin D therapy for CKD. Overall Mortality In addition to individual disease processes, the role of vitamin D deficiency in overall mortality has been studied and prospective observational data in older adults suggest a 45 percent lower risk of overall mortality in those with serum 25(OH)D levels greater than

23


ies have shown vitamin D levels to be lower in African Americans than White Americans with worse disease outcomes for those with cancer, cardiovascular disease, diabetes, end-stage renal disease, and all-cause mortality. It has been shown that African Americans have a mean serum 25(OH)D level of 16 ng/mL, while White Americans have a level of 26 ng/mL. The African American population has a higher rate of obesity. Because vitamin D is a fat-soluble vitamin, heavier individuals may require more, which could be a confounding explanation of the lower serum 25(OH)D levels. Additional data from NHANES III, as well as the mortality data from the National Death Index, has also been consistent with the hypothesis that vitamin D deficiency contributes to increased African American mortality from colorectal cancer. Although there is limited evidence, vitamin D may play a role in higher rates of preterm birth in the African American population due to the active form serving as a key modulator of immune response, and as a potent regulator of placental immunity. Lastly, there is a higher prevalence of hypertension among African American individuals versus Caucasians, and in a recent crosssectional analysis serum 25(OH)D levels explained one-quarter of the disparity in systolic blood pressure. It is important to recognize these racial disparities, especially among the African American population, in order to properly screen patients for deficiency.

Vitamin D Deficiency and Non-Skeletal Disease Diabetes Due to vitamin Dâ&#x20AC;&#x2122;s effect on more than 200 genes in the body, vitamin D has been linked to various non-skeletal diseases in multiple epidemiological studies. Data has established a link between vitamin D deficiency and an increased incidence of both type 1 and type 2 diabetes. Calcium intake has

22

evidence demonstrating an inverse relationship to incidence of metabolic syndrome and diabetes. There is evidence that suggests vitamin D influences beta cell function directly, and may make beta cells more resistant to types of cellular stress due to vitamin D receptors present on beta cells in the pancreas. A significant increased risk of type 2 diabetes has been reported among persons with serum 25(OH)D levels below 30 ng/mL (after adjustments for BMI and percent body fat.) A European study also showed evidence of vitamin D supplementation decreasing the risk of type 1 diabetes. Other small population studies in type 1 diabetic patients have shown supplementation improved glycemic control, although there is mixed evidence regarding improvement in type 2 diabetic patients. Other small trials have shown evidence for increased insulin secretion and decreased hemoglobin A1c (HbA1c) in patients supplemented with vitamin D. There are currently multiple on-going trials regarding this topic. In addition to glycemic control in diabetes, vitamin D has also been linked in one study to complications such as diabetic peripheral neuropathy. In this small study of 210 type 2 diabetic patients with or without diabetic peripheral neuropathy, vitamin D was assessed. Eighty-seven patients had diabetic peripheral neuropathy with a significantly longer duration of diabetes and higher HbA1c than those without. The mean serum 25(OH)D level was significantly lower in individuals with neuropathy, and there were significant correlations between serum 25(OH)D levels and total cholesterol, LDL-cholesterol and urine microalbumin:creatinine ratio. This data suggests vitamin D deficiency may be an independent risk factor for diabetic peripheral neuropathy.

been linked in epidemiological studies to vitamin D deficiency. A few studies in relation to endothelial dysfunction have shown statistically significant improvement in arterial stiffness compared to placebo when supplemented with vitamin D. Vitamin D supplementation has also been shown to have a beneficial effect on elastic properties of the arterial wall in a randomized placebo-controlled intervention study in post-menopausal women. Epidemiological studies also suggest that low levels of serum 25(OH)D are associated with an increased risk of CVD and mortality. There is expression of VDR in the heart and blood vessels, which suggests a role of vitamin D in the cardiovascular system. VDR-knockout mice suffer from CVD, and various experimental studies suggest cardiovascular protection by vitamin D. A retrospective, cross-sectional analysis report displayed increased rates of hypertension in individuals who tested for lower levels of 25(OH)D, which started at 40 ng/ mL. The odds ratio was 2.7 for vitamin D levels less than 15 ng/ mL, 2.0 from 15 to 30 ng/mL, and 1.3 for 30 to 39 ng/mL. A few randomized controlled trials (RCTs) looking at CVD events as a secondary outcome have found a moderate reduction in CVD risk (not shown to be statistically significant) using exclusive vitamin D supplementation. Further studies are being explored, such as the VITAL Study, in which researchers have enrolled 20,000 men and women across the U.S. to investigate whether taking daily dietary supplements of vitamin D3 (2,000 IU or placebo) or omega-3 fatty acids (OmacorÂŽ fish oil/EPA+DHA [1 gm/840 mg] or placebo) reduces the risk for developing cancer, heart disease, and stroke in persons who do not have a prior history of these illnesses.

Cardiovascular Disease Adding to the increased risk of metabolic syndrome and diabetes, cardiovascular disease (CVD) has

Depression Psychological conditions, such as depression and seasonal affective disorder (SAD), have also been

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linked to vitamin D deficiency. An RCT of overweight and obese patients with depression compared 20,000 IU or 40,000 IU of vitamin D supplementation with placebo weekly for one year. Both groups with vitamin D supplementation had improved BECK depression scores from baseline, but the placebo groups did not. This trial did exclude patients on antidepressant medications. Gloth et al. studied vitamin D deficiency in SAD, and in this small trial of 15 patients, eight received vitamin D therapy and seven received ultraviolet light therapy. All had improved vitamin D status (74 percent in the vitamin D group; 36 percent in the ultraviolet light therapy group). Vitamin D level improvements in this study were also significantly associated with improvements in depression scores. Available evidence does not definitively demonstrate that vitamin D deficiency is a cause of or risk for developing depression, or that vitamin D is an effective therapy for depression. Infectious Disease There is additional evidence that vitamin D is required for the expression of cathelicidin by macrophages, which is involved in killing bacteria. Most data about vitamin D and infectious disease surrounds tuberculosis (TB). A meta-analysis of seven observational studies found a higher risk of tuberculosis in those with the lowest vitamin D levels, although supplementation with vitamin D in one trial did not improve TB treatment outcomes. However, in this particular trial, the dose of 100,000 IU of vitamin D at zero, three and eight months may have been subtherapeutic in regard to treatment, since serum 25(OH)D levels did not differ from placebo. Ginde et al. also demonstrated that the prevalence of upper respiratory tract infections in the NHANES III population increased significantly as the serum 25(OH)D levels dropped, regardless of the season of the year, and was greatest during the winter when 25(OH)D levels were lowest.

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Asthma Evidence continues to reveal that vitamin D may also play a role in asthma. Vitamin D receptors are also located on lung bronchial smooth muscle cells, mast cells, dendritic cells and regulatory T-cells. Vitamin D then inhibits cytokine synthesis and release, decreases inflammation, and inhibits bronchial smooth muscle cell proliferation and remodeling. Vitamin D can also enhance interleukin-10 synthesis, which is a potent anti-inflammatory cytokine. In addition, evidence demonstrated that men and women with serum 25(OH)D levels above 35 ng/ mL had a 176 mL increase in forcedexpiratory volume in one second (FEV1). Children of women who had vitamin D deficiency during pregnancy were shown to be at an increased risk of wheezing illnesses. A small study of 86 children also revealed there were lower serum 25(OH)D levels in children with severe, therapy-resistant asthma, which were associated with increased airway smooth muscle masses, and worsened asthma control and lung function (p<0.001). Data on asthma in the literature is growing, and researchers have hypothesized that vitamin D supplementation may improve asthma control, but there are limited prospective studies to confirm this hypothesis. Cancer Carcinomas have also been linked to vitamin D deficiency and insufficiency in recent literature. A meta-analysis of case-control studies assessing serum 25(OH)D levels has shown for each 20 ng/mL increase in serum 25(OH)D levels, odds of colon cancer were reduced by more than 40 percent. One large RCT sought to determine if supplementation of 400 IU per day plus calcium had an effect on the incidence of colon cancer. There was no significant effect seen, as concentrations of serum 25(OH)D were measured at baseline but not during follow-up. Thus, it was difficult to determine if the dose even increased deficient levels.

Due to colon cancerâ&#x20AC;&#x2122;s long latency period, a trial length of only eight years could have been a significant limitation to the study. Other forms of cancer, such as breast cancer, have also been linked to vitamin D deficiency. A meta-analysis of vitamin D and the prevention of breast cancer found a 45 percent decrease in breast cancer for those in the highest quartile of circulating 25(OH)D of 60 nmol/L (about 24 ng/mL) compared with the lowest. A limitation with breast cancer and vitamin D research is that obesity can be a confounding factor that is difficult to separate. Other cancers, such as prostate cancer and pancreatic cancer, have been reviewed as well. The most recent meta-analysis for the U.S. Preventative Services Task Force suggests evidence is not sufficiently robust to draw conclusions regarding the benefit or harm of vitamin D supplementation for the prevention of cancer. Chronic Kidney Disease (CKD) Supplementation and treatment deficiency guidelines in CKD vary depending upon serum 25(OH)D levels and stage of CKD, and are discussed in the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. There have been recent reports demonstrating these guidelines may be outdated and not adequate. A recent review by Melamed et al. in the Clinical Journal of the American Society of Nephrology provides detailed information on recent studies done in CKD and ongoing studies in vitamin D therapy for CKD. Overall Mortality In addition to individual disease processes, the role of vitamin D deficiency in overall mortality has been studied and prospective observational data in older adults suggest a 45 percent lower risk of overall mortality in those with serum 25(OH)D levels greater than

23


Recommended Dosing for Prevention and Treatment

Table 1 Recommendations for vitamin D intake to prevent deficiency Age/ Condition 0-6 months 6-12 months 1-3 years 4-8 years 9-18 years 19-50 years 51-70 years >70 years Pregnancy Lactation

Institute of Medicine Recommended Upper Limit Intake (IU/day) (IU/day) 400 400 600 600 600 600 600 800 600 600

1,000 1,500 2,500 3,000 4,000 4,000 4,000 4,000 4,000 4,000

40 ng/mL compared with those less than 10 ng/mL (HR 0.55; 95 percent CI, 0.34-0.88). The NHANES III Database also shows an increase in adjusted all-cause mortality as serum 25(OH)D levels fall to less than 30 ng/mL, especially in women, as well as peak protection from death with a 25(OH)D level in the 35 to 40 ng/mL range. Most of the increase in all-cause mortality from this evidence can be accredited to cardiovascular deaths. Although epidemiological studies have shown links to vitamin D deficiency and insufficiency, this information must be taken lightly due to the fact there is no cause and effect relationship. It is not known whether the vitamin D deficiency happened first or second. Vitamin D may also be a surrogate marker for poor health status because it reflects an inability to get outdoors for ultraviolet B exposure due to comorbid conditions or poor exercise tolerance. A recent study by Dror et al. has suggested there might actually be a nonlinear association between vitamin D levels and cardiovascular mortality. They found that vitamin D levels in the 20 to 36 ng/mL range were associated with the lowest risk for mortality and morbidity, and the hazard ratio below and above this range increased significantly. This is controversial due to the popular belief that the more vitamin D, the better. Limitations to this study were the small sample size and a

24

Endocrinology Society Recommended Upper Limit Intake (IU/day) (IU/day) 400 400 600 600 600 600 600 800 600 600

2,000 2,000 4,000 4,000 4,000 10,000 10,000 10,000 10,000 10,000

primarily Israeli population. Continued interest in vitamin D and the non-calcemic mechanisms have led to trials such as the VITAL Study mentioned earlier. More information from both this study and other large scale studies will be needed to determine if supplementation can improve chronic disease states.

Screening for Vitamin D Deficiency

At the time of writing this lesson, screening for vitamin D deficiency is not recommended for everyone. Screening should only be performed in individuals thought to be at risk. Individuals at risk for vitamin D deficiency typically include those at risk for (1) bone disorders (rickets, osteomalacia, osteoporosis), (2) chronic kidney disease, (3) hepatic failure, (4) malabsorption syndromes, (5) hyperparathyroidism, (6) granuloma-forming disorders and (7) some lymphomas; (8) patients on certain medications (antiseizure medications, glucocorticoids, AIDS medications, antifungals, and cholestyramine), (9) African American and Hispanic children and adults, (10) pregnant and lactating women, (11) older adults with history of falls or nontraumatic fractures, (12) obese children and adults.

Proper prevention and treatment recommendations for patient populations are dependent upon age, disease states and conditions. To monitor vitamin D levels, most organizations recommend using the serum 25(OH)D. A serum 1,25(OH)2D level is not recommended unless there are certain conditions present, such as acquired and inherited disorders of vitamin D and phosphate metabolism. Serum 25(OH)D is considered the best measure of vitamin D status in patients at the time of writing this lesson due to serum 25(OH)Dâ&#x20AC;&#x2122;s half-life of approximately three weeks, and its ability to assess both nutritional intake and skin synthesis of vitamin D. Differing recommendations exist for the definition of serum 25(OH)D deficiency and insufficiency. The most recent clinical practice guidelines from the Endocrine Society in July 2011 state adequate serum 25(OH)D levels should be at or above 30 ng/mL. A serum 25(OH)D level below 20 ng/mL and between 21 and 29 ng/mL is defined as deficiency and insufficiency, respectively. The National Osteoporosis Foundation also recommends serum 25(OH)D levels be at the desired level of at least 30 ng/mL. On the other hand, the Institute of Medicine has recommended a serum 25(OH)D level above 20 ng/mL for good bone health, but has defined deficiency as serum 25(OH)D levels below 12 ng/mL and inadequate levels with serum 25(OH)D of 12 to 20 ng/mL. Table 1 includes recommendations of the Institute of Medicine and the Endocrinology Society for vitamin D dosing to prevent deficiency. Due to changes in society and occupational transformations over the past few decades, vitamin D deficiency today often results from lack of exposure to sunlight or decreased consumption of vitamin D-fortified milk. The dosage range for vitamin D supplementation recommendations differ among organizations and experts. Vitamin D deficiency and supplementation is a very expansive topic at this time with numerous

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studies and controversies. Therefore, in this lesson, the ranges discussed below are from recent guideline recommendations for prevention and treatment of vitamin D deficiency for pediatrics, adults, pregnant and lactating females, and obese adults. Infants and Children For prevention of deficiency, infants up to one year of age require at least 400 IU/day of vitamin D. Colostrum and human breast milk contain low amounts of vitamin D. Breastfed infants, even if being supplemented with formula, should be supplemented with 400 IU/day of vitamin D beginning in the first few days of life; this should continue until the infant is weaned to at least 1,000 mL/day of formula. Infants receiving >1,000 mL of formula per day should be receiving the recommended 400 IU/day of vitamin D in the formula; therefore, they do not need to be supplemented until formula intake falls below this threshold. As infants are weaned from breastfeeding or formula, vitamin D-fortified milk (after one year of age) or vitamin supplements should be encouraged to provide 400 IU/day of vitamin D. The recommendation for children one to 18 years of age is 600 IU/day of vitamin D. For treatment of deficiency in infants up to one year of age and children one to 18 years, the suggested dose is 2,000 IU/day of vitamin D for six weeks, or 50,000 IU once weekly for six weeks to achieve a serum 25(OH)D level above 30 ng/mL. After this level is achieved, maintenance therapy of 400 to 1,000 IU/ day of vitamin D to promote optimal bone health is recommended for infants up to one year of age, and 600 to 1,000 IU/day for children one to 18 years of age. Adults In adults, the recommended vitamin D intake to maximize bone health and muscle function is at least 600 IU/day and 800 IU/day for adults aged 19 to 70 and 70 or more years, respectively. The

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National Osteoporosis Foundation recommends a higher dosage of 800 to 1,000 IU/day for all adults aged 50 or older. Treatment recommendations for vitamin D deficiency in adults are 6,000 IU/ day of vitamin D or 50,000 IU once a week for eight weeks, to achieve a serum 25(OH)D level above 30 ng/mL. Once achieved, this should be maintained by using 1,500 to 2,000 IU/day of vitamin D. It has also been shown that 50,000 IU of vitamin D2 once every other week allowed serum 25(OH)D levels to be maintained at 35 to 50 ng/mL without toxicity. Nursing home residents have also used 50,000 IU of vitamin D2 three times per week for one month, or 100,000 IU every four months. Obese Individuals Due to the bodyâ&#x20AC;&#x2122;s ability to store the fat-soluble vitamin D in adipose tissue, the recommended dose of vitamin D for obese adults (BMI >30 kg/m2) should be at least two to three times the amount that is typically recommended for the individualâ&#x20AC;&#x2122;s age group. Previously, to prevent vitamin D deficiency in obese individuals, recommendations have been to provide 1,000 to 2,000 IU/day or 50,000 IU vitamin D every one, two or four weeks to achieve serum 25(OH)D levels of at least 30 ng/mL. Treatment of vitamin D deficiency could require at least 6,000 to 10,000 IU/day to maintain a serum 25(OH)D level above 30 ng/mL. Another treatment recommendation would be to provide 50,000 IU of vitamin D every week for eight to 12 weeks, and then repeat for another eight to 12 weeks if serum 25(OH)D is found to be less than 30 ng/mL. Pregnant and Lactating Women For pregnant and lactating females, vitamin D deficiency can be common, notably in high-risk women, including vegetarians, women with limited sun exposure, and ethnic minorities (especially with darker skin). Deficiency has also been shown to be linked to developing preeclampsia, gesta-

tional diabetes, and cesarean section delivery. Also, vitamin D deficiency in pregnant women has shown an increased risk of babies with lower birth weight for their gestational age and for development of disease in the future. Vitamin D supplementation is also very important to help prevent childhood rickets and osteomalacia in pregnant women. Recommendations for both pregnant and lactating females for vitamin D supplementation are at least 600 IU/day. Supplementing above the recommended 400 IU/day in most prenatal vitamins has not been studied extensively. There is insufficient evidence at this time to screen all pregnant women for vitamin D deficiency, unless there is concern. The Endocrine Society recommends that serum 25(OH)D levels should be maintained at 30 ng/mL or above, and that the 1,000 to 2,000 IU/day of vitamin D needed to reach this level is considered safe by most experts. A recent study by Hollis et al. concluded that for all women, regardless of race, 4,000 IU/day of vitamin D is a safe and effective way to raise 25(OH)D levels to achieve sufficiency. In this study, pregnant women were randomized to receive either placebo, 400 IU/day, 2,000 IU/ day, or 4,000 IU/day depending on baseline 25(OH)D levels. The primary outcome one month prior and at delivery was statistically different between each group, with the patients receiving 4,000 IU/day at the highest mean 25(OH)D level. Half of the mothers who received 400 IU/ day met a secondary outcome with serum 25(OH)D levels >32 ng/mL prior to delivery. In all groups, improvement of vitamin D status came without toxicity or adverse events. Women with serum 25(OH)D levels greater than 40 ng/mL at the initial visit were not included in the 4,000 IU/day group. Thus, it is difficult to extrapolate this data to all females without testing baseline serum 25(OH)D levels. Supplementation with vitamin D was not used during the first 12 weeks of gestation; thus data cannot speak to the safety of these regimens during the first tri-

25


Recommended Dosing for Prevention and Treatment

Table 1 Recommendations for vitamin D intake to prevent deficiency Age/ Condition 0-6 months 6-12 months 1-3 years 4-8 years 9-18 years 19-50 years 51-70 years >70 years Pregnancy Lactation

Institute of Medicine Recommended Upper Limit Intake (IU/day) (IU/day) 400 400 600 600 600 600 600 800 600 600

1,000 1,500 2,500 3,000 4,000 4,000 4,000 4,000 4,000 4,000

40 ng/mL compared with those less than 10 ng/mL (HR 0.55; 95 percent CI, 0.34-0.88). The NHANES III Database also shows an increase in adjusted all-cause mortality as serum 25(OH)D levels fall to less than 30 ng/mL, especially in women, as well as peak protection from death with a 25(OH)D level in the 35 to 40 ng/mL range. Most of the increase in all-cause mortality from this evidence can be accredited to cardiovascular deaths. Although epidemiological studies have shown links to vitamin D deficiency and insufficiency, this information must be taken lightly due to the fact there is no cause and effect relationship. It is not known whether the vitamin D deficiency happened first or second. Vitamin D may also be a surrogate marker for poor health status because it reflects an inability to get outdoors for ultraviolet B exposure due to comorbid conditions or poor exercise tolerance. A recent study by Dror et al. has suggested there might actually be a nonlinear association between vitamin D levels and cardiovascular mortality. They found that vitamin D levels in the 20 to 36 ng/mL range were associated with the lowest risk for mortality and morbidity, and the hazard ratio below and above this range increased significantly. This is controversial due to the popular belief that the more vitamin D, the better. Limitations to this study were the small sample size and a

24

Endocrinology Society Recommended Upper Limit Intake (IU/day) (IU/day) 400 400 600 600 600 600 600 800 600 600

2,000 2,000 4,000 4,000 4,000 10,000 10,000 10,000 10,000 10,000

primarily Israeli population. Continued interest in vitamin D and the non-calcemic mechanisms have led to trials such as the VITAL Study mentioned earlier. More information from both this study and other large scale studies will be needed to determine if supplementation can improve chronic disease states.

Screening for Vitamin D Deficiency

At the time of writing this lesson, screening for vitamin D deficiency is not recommended for everyone. Screening should only be performed in individuals thought to be at risk. Individuals at risk for vitamin D deficiency typically include those at risk for (1) bone disorders (rickets, osteomalacia, osteoporosis), (2) chronic kidney disease, (3) hepatic failure, (4) malabsorption syndromes, (5) hyperparathyroidism, (6) granuloma-forming disorders and (7) some lymphomas; (8) patients on certain medications (antiseizure medications, glucocorticoids, AIDS medications, antifungals, and cholestyramine), (9) African American and Hispanic children and adults, (10) pregnant and lactating women, (11) older adults with history of falls or nontraumatic fractures, (12) obese children and adults.

Proper prevention and treatment recommendations for patient populations are dependent upon age, disease states and conditions. To monitor vitamin D levels, most organizations recommend using the serum 25(OH)D. A serum 1,25(OH)2D level is not recommended unless there are certain conditions present, such as acquired and inherited disorders of vitamin D and phosphate metabolism. Serum 25(OH)D is considered the best measure of vitamin D status in patients at the time of writing this lesson due to serum 25(OH)Dâ&#x20AC;&#x2122;s half-life of approximately three weeks, and its ability to assess both nutritional intake and skin synthesis of vitamin D. Differing recommendations exist for the definition of serum 25(OH)D deficiency and insufficiency. The most recent clinical practice guidelines from the Endocrine Society in July 2011 state adequate serum 25(OH)D levels should be at or above 30 ng/mL. A serum 25(OH)D level below 20 ng/mL and between 21 and 29 ng/mL is defined as deficiency and insufficiency, respectively. The National Osteoporosis Foundation also recommends serum 25(OH)D levels be at the desired level of at least 30 ng/mL. On the other hand, the Institute of Medicine has recommended a serum 25(OH)D level above 20 ng/mL for good bone health, but has defined deficiency as serum 25(OH)D levels below 12 ng/mL and inadequate levels with serum 25(OH)D of 12 to 20 ng/mL. Table 1 includes recommendations of the Institute of Medicine and the Endocrinology Society for vitamin D dosing to prevent deficiency. Due to changes in society and occupational transformations over the past few decades, vitamin D deficiency today often results from lack of exposure to sunlight or decreased consumption of vitamin D-fortified milk. The dosage range for vitamin D supplementation recommendations differ among organizations and experts. Vitamin D deficiency and supplementation is a very expansive topic at this time with numerous

The Georgia Pharmacy Journal

studies and controversies. Therefore, in this lesson, the ranges discussed below are from recent guideline recommendations for prevention and treatment of vitamin D deficiency for pediatrics, adults, pregnant and lactating females, and obese adults. Infants and Children For prevention of deficiency, infants up to one year of age require at least 400 IU/day of vitamin D. Colostrum and human breast milk contain low amounts of vitamin D. Breastfed infants, even if being supplemented with formula, should be supplemented with 400 IU/day of vitamin D beginning in the first few days of life; this should continue until the infant is weaned to at least 1,000 mL/day of formula. Infants receiving >1,000 mL of formula per day should be receiving the recommended 400 IU/day of vitamin D in the formula; therefore, they do not need to be supplemented until formula intake falls below this threshold. As infants are weaned from breastfeeding or formula, vitamin D-fortified milk (after one year of age) or vitamin supplements should be encouraged to provide 400 IU/day of vitamin D. The recommendation for children one to 18 years of age is 600 IU/day of vitamin D. For treatment of deficiency in infants up to one year of age and children one to 18 years, the suggested dose is 2,000 IU/day of vitamin D for six weeks, or 50,000 IU once weekly for six weeks to achieve a serum 25(OH)D level above 30 ng/mL. After this level is achieved, maintenance therapy of 400 to 1,000 IU/ day of vitamin D to promote optimal bone health is recommended for infants up to one year of age, and 600 to 1,000 IU/day for children one to 18 years of age. Adults In adults, the recommended vitamin D intake to maximize bone health and muscle function is at least 600 IU/day and 800 IU/day for adults aged 19 to 70 and 70 or more years, respectively. The

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National Osteoporosis Foundation recommends a higher dosage of 800 to 1,000 IU/day for all adults aged 50 or older. Treatment recommendations for vitamin D deficiency in adults are 6,000 IU/ day of vitamin D or 50,000 IU once a week for eight weeks, to achieve a serum 25(OH)D level above 30 ng/mL. Once achieved, this should be maintained by using 1,500 to 2,000 IU/day of vitamin D. It has also been shown that 50,000 IU of vitamin D2 once every other week allowed serum 25(OH)D levels to be maintained at 35 to 50 ng/mL without toxicity. Nursing home residents have also used 50,000 IU of vitamin D2 three times per week for one month, or 100,000 IU every four months. Obese Individuals Due to the bodyâ&#x20AC;&#x2122;s ability to store the fat-soluble vitamin D in adipose tissue, the recommended dose of vitamin D for obese adults (BMI >30 kg/m2) should be at least two to three times the amount that is typically recommended for the individualâ&#x20AC;&#x2122;s age group. Previously, to prevent vitamin D deficiency in obese individuals, recommendations have been to provide 1,000 to 2,000 IU/day or 50,000 IU vitamin D every one, two or four weeks to achieve serum 25(OH)D levels of at least 30 ng/mL. Treatment of vitamin D deficiency could require at least 6,000 to 10,000 IU/day to maintain a serum 25(OH)D level above 30 ng/mL. Another treatment recommendation would be to provide 50,000 IU of vitamin D every week for eight to 12 weeks, and then repeat for another eight to 12 weeks if serum 25(OH)D is found to be less than 30 ng/mL. Pregnant and Lactating Women For pregnant and lactating females, vitamin D deficiency can be common, notably in high-risk women, including vegetarians, women with limited sun exposure, and ethnic minorities (especially with darker skin). Deficiency has also been shown to be linked to developing preeclampsia, gesta-

tional diabetes, and cesarean section delivery. Also, vitamin D deficiency in pregnant women has shown an increased risk of babies with lower birth weight for their gestational age and for development of disease in the future. Vitamin D supplementation is also very important to help prevent childhood rickets and osteomalacia in pregnant women. Recommendations for both pregnant and lactating females for vitamin D supplementation are at least 600 IU/day. Supplementing above the recommended 400 IU/day in most prenatal vitamins has not been studied extensively. There is insufficient evidence at this time to screen all pregnant women for vitamin D deficiency, unless there is concern. The Endocrine Society recommends that serum 25(OH)D levels should be maintained at 30 ng/mL or above, and that the 1,000 to 2,000 IU/day of vitamin D needed to reach this level is considered safe by most experts. A recent study by Hollis et al. concluded that for all women, regardless of race, 4,000 IU/day of vitamin D is a safe and effective way to raise 25(OH)D levels to achieve sufficiency. In this study, pregnant women were randomized to receive either placebo, 400 IU/day, 2,000 IU/ day, or 4,000 IU/day depending on baseline 25(OH)D levels. The primary outcome one month prior and at delivery was statistically different between each group, with the patients receiving 4,000 IU/day at the highest mean 25(OH)D level. Half of the mothers who received 400 IU/ day met a secondary outcome with serum 25(OH)D levels >32 ng/mL prior to delivery. In all groups, improvement of vitamin D status came without toxicity or adverse events. Women with serum 25(OH)D levels greater than 40 ng/mL at the initial visit were not included in the 4,000 IU/day group. Thus, it is difficult to extrapolate this data to all females without testing baseline serum 25(OH)D levels. Supplementation with vitamin D was not used during the first 12 weeks of gestation; thus data cannot speak to the safety of these regimens during the first tri-

25


mester. Overall, vitamin D supplementation above the recommended dosage during pregnancy should be individualized until further studies are done, especially during the first 12 weeks of pregnancy.

Vitamin D Supplements and Dietary Sources

The two forms of vitamin D supplements available are vitamin D2 (ergocalciferol, plant-derived) and vitamin D3 (cholecalciferol, fishderived). Vitamin D3 is the natural form of vitamin D and is chemically similar to what is produced by the skin during sun exposure. Some evidence has shown vitamin D3 to be superior in raising vitamin D levels to sufficient concentrations due to slower metabolism. Another study reports vitamin D2 and D3 to be equally effective in maintaining vitamin D levels. Dosage forms of vitamin D2 and D3 supplements are available in strengths of 400 IU, 800 IU, 1,000 IU, 2,000 IU, 5,000 IU, 8,000 IU, 10,000 IU, and 50,000 IU as capsules, solutions, drops, gummies, and tablets. Few foods provide the needed source of vitamin D, with most averaging vitamin D content between 100 to 200 IU. Dietary sources that are vitamin D-fortified include milk, orange juice, yogurt, margarine, cheeses, some bread products and cereal. Other dietary sources of vitamin D include swordfish, salmon, tuna, sardines, liver, and egg yolk.

Vitamin D Toxicity

Toxicity is always a concern with any supplement or medication. Vitamin D toxicity can cause hypercalcemia, hypercalciuria, vascular and soft tissue calcification, nephrolithiasis, and retarded growth and hypercalcemia in infants. There is also emerging evidence that toxicity can contribute to all-cause mortality, selected cancers, cardiovascular risks, falls and fractures. Hypercalcemia is usually the sign of acute toxicity with vitamin D, and has been seen with doses that exceed 10,000 IU/ day and 25(OH)D levels above 150

26

continuing education quiz

ng/mL. Signs of vitamin D toxicity include headache, metallic taste, nephrocalcinosis or vascular calcinosis, pancreatitis, nausea, and vomiting. The tolerable upper level daily intake set by the Institute of Medicine is 1,000 IU/ day for infants up to six months of age, 1,500 IU/day for infants six to 12 months, 2,500 IU/day for one- to three-year-olds, 3,000 IU/day for four- to eight-year-olds, and 4,000 IU/day for anyone nine years of age or older, including pregnant and lactating females. The Endocrine Society Practice Guidelines set the upper tolerable level at 2,000 IU/ day for infants up to 12 months, 4,000 IU/day for children one- to 18-years-old, and 10,000 IU/day for all persons aged 19 and over (including pregnant and lactating women).

Vitamin D Deficiency and Treatment

1. Which of the following is the biologically active form of vitamin D? a. Ergocalciferol c. 25(OH)D b. Cholecalciferol d. 1,25(OH)2D 2. Data from National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2006 report what percentage of Americans were at risk for vitamin D deficiency with a 25(OH)D level less than 10 ng/mL? a. 5 percent c. 15 percent b. 8 percent d. 30 percent

Conclusion

Vitamin D deficiency, insufficiency, and supplementation have been making headlines worldwide. The body of literature seems to be expanding on a daily basis regarding vitamin D deficiency and treatment. This lesson certainly cannot include all available information regarding vitamin D deficiency, insufficiency, and treatment available. Although much of the information is based on epidemiological information, there is reason to believe vitamin D may be the missing key for disease states seemingly unrelated to bone and calcemic mechanisms, once thought to be vitamin D’s only role in the human body.

[a] [a] [a] [a] [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] 6. [a] [d] 7. [a] [d] 8. [a] [d] 9. [a] [d] 10. [a]

[b] [b] [b] [b] [b]

[c] [c] [d] [c] [d] [c] [d]

11. [a] 12. [a] 13. [a] 14. [a] 15. [a]

[b] [b] [b] [b] [b]

[c] [d] [c] [d] [c] [d] [c] [d]

 I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association. 1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor) 2. Did it meet each of its objectives?  yes  no If no, list any unmet_______________________________ 3. Was the content balanced and without commercial bias?  yes  no 4. Did the program meet your educational/practice needs?  yes  no 5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

CE Hours: 1.5 (0.15 CEU) The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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City, State, Zip______________________________________ Email_______________________________________________ NABP e-Profile ID____________Birthdate_________

(MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990

8. What is the recommended daily intake of vitamin D for a 6-year-old? a. 200 IU c. 600 IU b. 400 IU d. 800 IU

1. 2. 3. 4. 5.

Release date: 2-15-14 Expiration date: 2-15-17

Address_____________________________________________

4. Which of the following statements is true regarding racial disparities and vitamin D? a. African Americans have a higher serum 25(OH)D level than White Americans. b. Suboptimal vitamin D status may contribute to racial disparity in albuminuria. c. Preterm birth rates have never been associated with decreased vitamin D levels. d. White Americans have a higher rate of hypertension vs. African Americans which could be related to 25(OH)D levels.

Completely fill in the lettered box corresponding to your answer.

Program 0129-0000-14-002-H01-P

Name________________________________________________

7. Cancers with potential links to vitamin D deficiency include all of the following EXCEPT: a. breast cancer. c. thyroid cancer. b. colon cancer.

6. Ginde et al. demonstrated that the prevalence of upper respiratory tract infections increased significantly as the serum 25(OH)D levels dropped, regardless of the season of the year. a. True b. False

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

Program 0129-0000-14-002-H01-P 0.15 CEU

3. Risk factors for vitamin D deficiency include all of the following EXCEPT: a. obesity. c. insufficient sunlight exposure. b. age >65 years. d. light skin.

5. Which of the following is true regarding vitamin D and diabetes? a. Vitamin D deficiency has only been linked to type 2 diabetes. b. In a small study, mean vitamin D levels were found to be significantly higher in those with extensive peripheral neuropathy. c. Evidence suggests vitamin D influences beta cell function directly and may make beta cells more resistant to types of cellular stress. d. There is no established relationship between vitamin D and diabetes.

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

Please print.

The Georgia Pharmacy Journal

9. Most of the data regarding all-cause mortality and vitamin D can be accredited to which of the following? a. Cardiovascular deaths b. Diabetes complication deaths c. End-stage renal disease d. Asthma deaths 10. All of the following individuals could be at risk for vitamin D deficiency and should be screened EXCEPT those: a. with chronic kidney disease. b. on glucocorticoids. c. who are obese. d. with hypoparathyroidism. 11. How much vitamin D supplementation is required per day for a three-month-old receiving both breast milk and approximately 600 mL of formula? a. 200 IU c. 600 IU b. 400 IU d. 800 IU 12. Because vitamin D is fat soluble and stored in adipose tissue, the recommended dose for individuals with BMIs >30 kg/m2 is how much greater than typically required for that individual’s age group? a. Should be the same c. Three to four times b. Four to five times d. Two to three times 13. All pregnant women should be screened for vitamin D deficiency. a. True b. False 14. Which of the following is NOT a dietary source of vitamin D? a. Swordfish c. Chicken b. Egg yolk d. Liver 15. Which of the following is NOT a sign of vitamin D toxicity? a. Tachycardia c. Vascular calcinosis b. Metallic taste d. Pancreatitis

To receive CE credit, your quiz must be received no later than February 15, 2017. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to opa@ohiopharmacists.org.

february 2014

27


mester. Overall, vitamin D supplementation above the recommended dosage during pregnancy should be individualized until further studies are done, especially during the first 12 weeks of pregnancy.

Vitamin D Supplements and Dietary Sources

The two forms of vitamin D supplements available are vitamin D2 (ergocalciferol, plant-derived) and vitamin D3 (cholecalciferol, fishderived). Vitamin D3 is the natural form of vitamin D and is chemically similar to what is produced by the skin during sun exposure. Some evidence has shown vitamin D3 to be superior in raising vitamin D levels to sufficient concentrations due to slower metabolism. Another study reports vitamin D2 and D3 to be equally effective in maintaining vitamin D levels. Dosage forms of vitamin D2 and D3 supplements are available in strengths of 400 IU, 800 IU, 1,000 IU, 2,000 IU, 5,000 IU, 8,000 IU, 10,000 IU, and 50,000 IU as capsules, solutions, drops, gummies, and tablets. Few foods provide the needed source of vitamin D, with most averaging vitamin D content between 100 to 200 IU. Dietary sources that are vitamin D-fortified include milk, orange juice, yogurt, margarine, cheeses, some bread products and cereal. Other dietary sources of vitamin D include swordfish, salmon, tuna, sardines, liver, and egg yolk.

Vitamin D Toxicity

Toxicity is always a concern with any supplement or medication. Vitamin D toxicity can cause hypercalcemia, hypercalciuria, vascular and soft tissue calcification, nephrolithiasis, and retarded growth and hypercalcemia in infants. There is also emerging evidence that toxicity can contribute to all-cause mortality, selected cancers, cardiovascular risks, falls and fractures. Hypercalcemia is usually the sign of acute toxicity with vitamin D, and has been seen with doses that exceed 10,000 IU/ day and 25(OH)D levels above 150

26

continuing education quiz

ng/mL. Signs of vitamin D toxicity include headache, metallic taste, nephrocalcinosis or vascular calcinosis, pancreatitis, nausea, and vomiting. The tolerable upper level daily intake set by the Institute of Medicine is 1,000 IU/ day for infants up to six months of age, 1,500 IU/day for infants six to 12 months, 2,500 IU/day for one- to three-year-olds, 3,000 IU/day for four- to eight-year-olds, and 4,000 IU/day for anyone nine years of age or older, including pregnant and lactating females. The Endocrine Society Practice Guidelines set the upper tolerable level at 2,000 IU/ day for infants up to 12 months, 4,000 IU/day for children one- to 18-years-old, and 10,000 IU/day for all persons aged 19 and over (including pregnant and lactating women).

Vitamin D Deficiency and Treatment

1. Which of the following is the biologically active form of vitamin D? a. Ergocalciferol c. 25(OH)D b. Cholecalciferol d. 1,25(OH)2D 2. Data from National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2006 report what percentage of Americans were at risk for vitamin D deficiency with a 25(OH)D level less than 10 ng/mL? a. 5 percent c. 15 percent b. 8 percent d. 30 percent

Conclusion

Vitamin D deficiency, insufficiency, and supplementation have been making headlines worldwide. The body of literature seems to be expanding on a daily basis regarding vitamin D deficiency and treatment. This lesson certainly cannot include all available information regarding vitamin D deficiency, insufficiency, and treatment available. Although much of the information is based on epidemiological information, there is reason to believe vitamin D may be the missing key for disease states seemingly unrelated to bone and calcemic mechanisms, once thought to be vitamin D’s only role in the human body.

[a] [a] [a] [a] [a]

[b] [b] [b] [b] [b]

[c] [c] [c] [c] [c]

[d] 6. [a] [d] 7. [a] [d] 8. [a] [d] 9. [a] [d] 10. [a]

[b] [b] [b] [b] [b]

[c] [c] [d] [c] [d] [c] [d]

11. [a] 12. [a] 13. [a] 14. [a] 15. [a]

[b] [b] [b] [b] [b]

[c] [d] [c] [d] [c] [d] [c] [d]

 I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association. 1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor) 2. Did it meet each of its objectives?  yes  no If no, list any unmet_______________________________ 3. Was the content balanced and without commercial bias?  yes  no 4. Did the program meet your educational/practice needs?  yes  no 5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

CE Hours: 1.5 (0.15 CEU) The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

The Georgia Pharmacy Journal

City, State, Zip______________________________________ Email_______________________________________________ NABP e-Profile ID____________Birthdate_________

(MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA, 2674 Federated Blvd, Columbus, OH 43235-4990

8. What is the recommended daily intake of vitamin D for a 6-year-old? a. 200 IU c. 600 IU b. 400 IU d. 800 IU

1. 2. 3. 4. 5.

Release date: 2-15-14 Expiration date: 2-15-17

Address_____________________________________________

4. Which of the following statements is true regarding racial disparities and vitamin D? a. African Americans have a higher serum 25(OH)D level than White Americans. b. Suboptimal vitamin D status may contribute to racial disparity in albuminuria. c. Preterm birth rates have never been associated with decreased vitamin D levels. d. White Americans have a higher rate of hypertension vs. African Americans which could be related to 25(OH)D levels.

Completely fill in the lettered box corresponding to your answer.

Program 0129-0000-14-002-H01-P

Name________________________________________________

7. Cancers with potential links to vitamin D deficiency include all of the following EXCEPT: a. breast cancer. c. thyroid cancer. b. colon cancer.

6. Ginde et al. demonstrated that the prevalence of upper respiratory tract infections increased significantly as the serum 25(OH)D levels dropped, regardless of the season of the year. a. True b. False

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

Program 0129-0000-14-002-H01-P 0.15 CEU

3. Risk factors for vitamin D deficiency include all of the following EXCEPT: a. obesity. c. insufficient sunlight exposure. b. age >65 years. d. light skin.

5. Which of the following is true regarding vitamin D and diabetes? a. Vitamin D deficiency has only been linked to type 2 diabetes. b. In a small study, mean vitamin D levels were found to be significantly higher in those with extensive peripheral neuropathy. c. Evidence suggests vitamin D influences beta cell function directly and may make beta cells more resistant to types of cellular stress. d. There is no established relationship between vitamin D and diabetes.

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

Please print.

The Georgia Pharmacy Journal

9. Most of the data regarding all-cause mortality and vitamin D can be accredited to which of the following? a. Cardiovascular deaths b. Diabetes complication deaths c. End-stage renal disease d. Asthma deaths 10. All of the following individuals could be at risk for vitamin D deficiency and should be screened EXCEPT those: a. with chronic kidney disease. b. on glucocorticoids. c. who are obese. d. with hypoparathyroidism. 11. How much vitamin D supplementation is required per day for a three-month-old receiving both breast milk and approximately 600 mL of formula? a. 200 IU c. 600 IU b. 400 IU d. 800 IU 12. Because vitamin D is fat soluble and stored in adipose tissue, the recommended dose for individuals with BMIs >30 kg/m2 is how much greater than typically required for that individual’s age group? a. Should be the same c. Three to four times b. Four to five times d. Two to three times 13. All pregnant women should be screened for vitamin D deficiency. a. True b. False 14. Which of the following is NOT a dietary source of vitamin D? a. Swordfish c. Chicken b. Egg yolk d. Liver 15. Which of the following is NOT a sign of vitamin D toxicity? a. Tachycardia c. Vascular calcinosis b. Metallic taste d. Pancreatitis

To receive CE credit, your quiz must be received no later than February 15, 2017. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to opa@ohiopharmacists.org.

february 2014

27


GET THE APP! THE GEORGIA PHARMACY ASSOCIATION

2013-2014

Board of Directors The GPhA Mobile App.

Name

Position

Robert M. Hatton

Chair of the Board

Pamala S. Marquess

President

Robert B. Moody President-Elect Thomas H. Whitworth

First Vice President

Lance P. Boles

Second Vice President

Liza Chapman

State At Large

Terry Forshee

State At Large

David Graves

State At Large

Joshua D. Kinsey

State At Large

Eddie Madden

State At Large

Laird Miller

State At Large

Chris Thurmond

State At Large

Krista Stone

1st Region President

Ed S. Dozier

2nd Region President

Renee D. Adamson

3rd Region President

Nicholas O. Bland

4th Region President

Shelby Biagi

5th Region President

Sherri S. Moody

6th Region President

Renew your membership - join the Association.

Tyler Mayotte

7th Region President

Michael Lewis

8th Region President

Receive Association reminders and updates.

Amanda Westbrooks

9th Region President

Flynn Warren

10th Region President

Kalen Manasco

11th Region President

Ken Von Eiland

12th Region President

Ted Hunt

ACP Chair

Sharon B. Zerillo

AEP Chair

John Drew

AHP Chair

Drew Miller

AIP Chair

Michelle Hunt

APT Chair

Leah Stowers

ASA Chair

John T. Sherrer

Foundation Chair

Al McConnell

Board of Pharmacy Chair

Megan Freeman

GSHP President

Amy C. Grimsley

Mercer Faculty Representative

Rusty Fetterman

South Faculty Representative

Lindsey Welch

UGA Faculty Representative

Contact Association Staff. Share this App with a friend. Association and Industry News. Check out Association events and register.

Connect with the GPhA on facebook. Learn about GPhA services. Connect with friends and associates. Important Advocacy links.

We’re going mobile, leveraging mobile technology to meet member’s communication, education, advocacy, and engagement needs. Available anywhere and anytime you need it.

Search gpha using the App Store or Google Play. Download and You’ve Got the App!

IT’S FREE!

Android

Apple

Tyler Bryant

Thanks ... ...to the many members who support the Georgia Pharmacy Association’s Academy of Independent Pharmacy. We pledge to continue to defend and protect the profession to the best of our ability and we pledge to continue to fight for the economic viability of Independent Pharmacy. AIP Mission Statement: To advance the concept of pharmacy care. To ensure the economic viability and security of Independent Pharmacy; To provide a forum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; To address the unique business and professional issues of independent pharmacies; To develop and implement marketing opportunities for members of the Academy with emphasis on the third party prescription drug program/benefit market; To provide educational programs designed to enhance the managerial skills of Independent Pharmacy Owners and Managers; and, To establish and implement programs and services designed to assist Independent Pharmacy Owners and Managers.

ASP, Mercer University

Tiffany Galloway

ASP, South University

Jessica Kupstas

ASP, UGA

Jim Bracewell

Executive Vice President

The Georgia Pharmacy Journal

THE GEORGIA PHARMACY ASSOCIATION 50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.org


GET THE APP! THE GEORGIA PHARMACY ASSOCIATION

2013-2014

Board of Directors The GPhA Mobile App.

Name

Position

Robert M. Hatton

Chair of the Board

Pamala S. Marquess

President

Robert B. Moody President-Elect Thomas H. Whitworth

First Vice President

Lance P. Boles

Second Vice President

Liza Chapman

State At Large

Terry Forshee

State At Large

David Graves

State At Large

Joshua D. Kinsey

State At Large

Eddie Madden

State At Large

Laird Miller

State At Large

Chris Thurmond

State At Large

Krista Stone

1st Region President

Ed S. Dozier

2nd Region President

Renee D. Adamson

3rd Region President

Nicholas O. Bland

4th Region President

Shelby Biagi

5th Region President

Sherri S. Moody

6th Region President

Renew your membership - join the Association.

Tyler Mayotte

7th Region President

Michael Lewis

8th Region President

Receive Association reminders and updates.

Amanda Westbrooks

9th Region President

Flynn Warren

10th Region President

Kalen Manasco

11th Region President

Ken Von Eiland

12th Region President

Ted Hunt

ACP Chair

Sharon B. Zerillo

AEP Chair

John Drew

AHP Chair

Drew Miller

AIP Chair

Michelle Hunt

APT Chair

Leah Stowers

ASA Chair

John T. Sherrer

Foundation Chair

Al McConnell

Board of Pharmacy Chair

Megan Freeman

GSHP President

Amy C. Grimsley

Mercer Faculty Representative

Rusty Fetterman

South Faculty Representative

Lindsey Welch

UGA Faculty Representative

Contact Association Staff. Share this App with a friend. Association and Industry News. Check out Association events and register.

Connect with the GPhA on facebook. Learn about GPhA services. Connect with friends and associates. Important Advocacy links.

We’re going mobile, leveraging mobile technology to meet member’s communication, education, advocacy, and engagement needs. Available anywhere and anytime you need it.

Search gpha using the App Store or Google Play. Download and You’ve Got the App!

IT’S FREE!

Android

Apple

Tyler Bryant

Thanks ... ...to the many members who support the Georgia Pharmacy Association’s Academy of Independent Pharmacy. We pledge to continue to defend and protect the profession to the best of our ability and we pledge to continue to fight for the economic viability of Independent Pharmacy. AIP Mission Statement: To advance the concept of pharmacy care. To ensure the economic viability and security of Independent Pharmacy; To provide a forum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; To address the unique business and professional issues of independent pharmacies; To develop and implement marketing opportunities for members of the Academy with emphasis on the third party prescription drug program/benefit market; To provide educational programs designed to enhance the managerial skills of Independent Pharmacy Owners and Managers; and, To establish and implement programs and services designed to assist Independent Pharmacy Owners and Managers.

ASP, Mercer University

Tiffany Galloway

ASP, South University

Jessica Kupstas

ASP, UGA

Jim Bracewell

Executive Vice President

The Georgia Pharmacy Journal

THE GEORGIA PHARMACY ASSOCIATION 50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.org


THE GEORGIA PHARMACY ASSOCIATION

50 Lenox Pointe, NE Atlanta, GA 30324

139 th GPh A C on v en tion Ju n e 26 -29, 2014 Wy n dh a m Bay Poi n t R e sort - Pa na m a Cit y Be ach, F L

As healthcare changes, so do job responsibilities and career tracks. The Georgia Pharmacy Association is your development partner as you address your future in pharmacy. Professional networking, skills training and continuing education are key benefits of your GPhA membership. Plan to attend this year’s Convention and take advantage of all the educational and networking opportunities available. Whether you’re a seasoned professional or a first year student, there’s something for you at the GPhA Convention. We’re looking forward to seeing you there.

Go to www.gpha.org and click on the Convention Banner or scan the code below.

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