Page 1

December 2012

from the Team at the Georgia Pharmacy Association

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3


Endorsed by:**

December 2012 Editor: Jim Bracewell jbracewell@gpha.org The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2012, 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. 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. 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.

Guarantee a better

Quality of Life for your family.

Life Insurance can provide for your loved ones by:

• Providing coverage for final medical and funeral expenses • Paying outstanding debts • Creating an estate for those you care about • Providing college funding

Life insurance solutions from The Pharmacists Life Insurance Company. For more information, contact your local representative:

Hutton Madden

800.247.5930 ext. 7149 678.714.9198 www.phmic.com * This is not a claims reporting site. You cannot electronically report a claim to us. To report a claim, call 800.247.5930. ** Compensated endorsement. Not all products available in every state. The Pharmacists Life is licensed in the District of Columbia and all states except AK, FL, HI, MA, ME, NH, NJ, NY and VT. Check with your representative or the company for details on coverages and carriers.

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. 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.

CONTENTS

2 4 5 6 11 12 16 18 21

Message From Robert Hatton.........................................................

Message From Jim Bracewell..........................................................

Welcome New GPhA Members......................................................

Assessing Impact and Patient Satisfaction of Immunization Services................................................................

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor...................... Georgia State Board of Pharmacy Compounding Pharmacies and Pharmacists Advisory........................................................................................

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

Call for GPhA Award Entrees..................................................

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.

PharmPAC Supporters...............................................................

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

gpha.org

Continuing Education for Pharmacists..................................

*

1 PO Box 370 • Algona Iowa 50511

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

1


Endorsed by:**

December 2012 Editor: Jim Bracewell jbracewell@gpha.org The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2012, 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. 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. 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.

Guarantee a better

Quality of Life for your family.

Life Insurance can provide for your loved ones by:

• Providing coverage for final medical and funeral expenses • Paying outstanding debts • Creating an estate for those you care about • Providing college funding

Life insurance solutions from The Pharmacists Life Insurance Company. For more information, contact your local representative:

Hutton Madden

800.247.5930 ext. 7149 678.714.9198 www.phmic.com * This is not a claims reporting site. You cannot electronically report a claim to us. To report a claim, call 800.247.5930. ** Compensated endorsement. Not all products available in every state. The Pharmacists Life is licensed in the District of Columbia and all states except AK, FL, HI, MA, ME, NH, NJ, NY and VT. Check with your representative or the company for details on coverages and carriers.

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. 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.

CONTENTS

2 4 5 6 11 12 16 18 21

Message From Robert Hatton.........................................................

Message From Jim Bracewell..........................................................

Welcome New GPhA Members......................................................

Assessing Impact and Patient Satisfaction of Immunization Services................................................................

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor...................... Georgia State Board of Pharmacy Compounding Pharmacies and Pharmacists Advisory........................................................................................

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

Call for GPhA Award Entrees..................................................

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.

PharmPAC Supporters...............................................................

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

gpha.org

Continuing Education for Pharmacists..................................

*

1 PO Box 370 • Algona Iowa 50511

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

1


MESSAGE from Robert Hatton W

ow! It is hard to believe that the holidays are here! It feels like we just finished the convention in Hilton Head when in reality we are well into the year here at GPhA. December is usually a relatively quiet month for the Executive Committee. We have the normal EC meeting and a Christmas dinner, but important issues, such as legislative Robert Hatton agendas are usually fairly well defined by now. GPhA President Given that we have a chance to reflect before heading into busy January, I would like to remind us of a few things for which we can be thankful. We are in a profession that allows us to help people while being able to support our loved ones. We do have some challenges ahead, but I know of no other group of professionals better poised to make the impact needed to be successful in a changing environment. I “Here’s wishing will remind you that the current economic climate has compromised many occupations and we have not been singled out. The ever increasing you a safe demand combined with a limited amount of resources, has caused inand happy creased market pressures in almost every area. I, for one, believe that the holiday season. changes will cause us to discover and develop new niches for our profession and force us to do some things that we have been talking about for Merry years. Increasing our participating immunizing pharmacies, expanding Christmas our role in MTM and advancing our specialty in compounding are just and Happy a few ways we can look to the future. I would be remiss if I didn’t, once again, remind you of VIP day, FebruNew Year!” ary 14th. A chance to influence your legislators and dialogue with your colleagues. Please mark your calendars and plan to be there. Any December article would be wanting without a wish-list for Santa... so here goes. 1. PBM legislation that truly helps our profession control its destiny. 2. New members eager to advance the role of their profession at the local, state and national level. 3. Wisdom for GPhA leadership to deal with the changing environment in an effective manner. 4. A new truck for Robert ‘cause he has worn his out driving to Atlanta. There!

All Georgia Pharmacists must now present verifiable documentation. Amendments to O.C.G.A. § 50-36-1 became effective January 1, 2012.

Georgia law now requires all applicants for licensure, and all those applying for renewal of an existing license to submit secure and verifiable documentation with their application that will be reviewed by the Board. Examples of secure and verifiable documents are driver’s license, U.S. passport, or green card; however, a complete list of the approved Secure and Verifiable Documents may be found on the Professional Licensing Board’s webpage.

All Pharmacists are encouraged to submit their renewal applications early to avoid delays! Pharmacists may submit their renewal online in minutes just follow these quick and easy steps: • Visit the Georgia Online Licensing site at www.sos.ga.gov/plb (Free internet access is available at every Georgia Public Library) • Click on the License Renewal link to begin the renewal process. • Step-by-Step instructions can be found here: www.sos.ga.gov/plb/renewal_process.htm • Update address, phone number, e-mail address and answer the renewal questions. • Pay renewal fee(s) using a American Express, Mastercard, or Visa on our secure server. • Upload your secure and verifiable document. • Print the receipt of payment. • Verify the renewal online by the end of the next business day. • Receive the renewed license in the mail. If pharmacists choose not to renew online and would like to request a renewal form that will be mailed to your address on file with board, please call (404)463-1100. Please note that renewing by mail may take up to 4 weeks to process after the completed renewal form is received. A licensee cannot practice after their license expiration date.

2

The Georgia Pharmacy Journal

AVOID ADDITIONAL DELAY & LATE FEES BY RENEWING NOW!


MESSAGE from Robert Hatton W

ow! It is hard to believe that the holidays are here! It feels like we just finished the convention in Hilton Head when in reality we are well into the year here at GPhA. December is usually a relatively quiet month for the Executive Committee. We have the normal EC meeting and a Christmas dinner, but important issues, such as legislative Robert Hatton agendas are usually fairly well defined by now. GPhA President Given that we have a chance to reflect before heading into busy January, I would like to remind us of a few things for which we can be thankful. We are in a profession that allows us to help people while being able to support our loved ones. We do have some challenges ahead, but I know of no other group of professionals better poised to make the impact needed to be successful in a changing environment. I “Here’s wishing will remind you that the current economic climate has compromised many occupations and we have not been singled out. The ever increasing you a safe demand combined with a limited amount of resources, has caused inand happy creased market pressures in almost every area. I, for one, believe that the holiday season. changes will cause us to discover and develop new niches for our profession and force us to do some things that we have been talking about for Merry years. Increasing our participating immunizing pharmacies, expanding Christmas our role in MTM and advancing our specialty in compounding are just and Happy a few ways we can look to the future. I would be remiss if I didn’t, once again, remind you of VIP day, FebruNew Year!” ary 14th. A chance to influence your legislators and dialogue with your colleagues. Please mark your calendars and plan to be there. Any December article would be wanting without a wish-list for Santa... so here goes. 1. PBM legislation that truly helps our profession control its destiny. 2. New members eager to advance the role of their profession at the local, state and national level. 3. Wisdom for GPhA leadership to deal with the changing environment in an effective manner. 4. A new truck for Robert ‘cause he has worn his out driving to Atlanta. There!

All Georgia Pharmacists must now present verifiable documentation. Amendments to O.C.G.A. § 50-36-1 became effective January 1, 2012.

Georgia law now requires all applicants for licensure, and all those applying for renewal of an existing license to submit secure and verifiable documentation with their application that will be reviewed by the Board. Examples of secure and verifiable documents are driver’s license, U.S. passport, or green card; however, a complete list of the approved Secure and Verifiable Documents may be found on the Professional Licensing Board’s webpage.

All Pharmacists are encouraged to submit their renewal applications early to avoid delays! Pharmacists may submit their renewal online in minutes just follow these quick and easy steps: • Visit the Georgia Online Licensing site at www.sos.ga.gov/plb (Free internet access is available at every Georgia Public Library) • Click on the License Renewal link to begin the renewal process. • Step-by-Step instructions can be found here: www.sos.ga.gov/plb/renewal_process.htm • Update address, phone number, e-mail address and answer the renewal questions. • Pay renewal fee(s) using a American Express, Mastercard, or Visa on our secure server. • Upload your secure and verifiable document. • Print the receipt of payment. • Verify the renewal online by the end of the next business day. • Receive the renewed license in the mail. If pharmacists choose not to renew online and would like to request a renewal form that will be mailed to your address on file with board, please call (404)463-1100. Please note that renewing by mail may take up to 4 weeks to process after the completed renewal form is received. A licensee cannot practice after their license expiration date.

2

The Georgia Pharmacy Journal

AVOID ADDITIONAL DELAY & LATE FEES BY RENEWING NOW!


MESSAGE from Jim Bracewell O

Jim Bracewell

Executive Vice President

ne of the things I am most thankful for this holiday season is the great team we have at GPhA. As we all sit around and enjoy the many bowl games, we recognize that all teams have players who want to play and win but at the end of the season only a few have winning seasons. Those that have winning seasons are the teams that have recruited the best and most talented team members. The GPhA Team is a winning team and they are getting better each month. December, we will have a new member join our team, Kim McNeely who comes to us from an international association with great experience in membership development. Please plan to welcome her to GPhA. The November issue of James Magazine published by Internet News Agency and one of the most widely read magazines that focuses on the politics of Georgia government named Andy Freeman, GPhA Director of Government Affairs, one of the top fifteen lobbyists for associations in Georgia. Andy, we congratulate you and I am proud to have you on our GPhA Team. One of the easiest winning teams that you can be part of is the Million Hearts Team. See the information below and become a member of the effort to teach patients to take control of their blood pressure. You are already a member of the GPhA nation. You can also be a member of a great winning national team.

Team Up. Pressure Down. Coaching Patients to Take Control. A Free One Hour (0.1 CEU) On Demand CPE Activity

WELCOME New GPhA Members Pharmacy School Students Stephen Lee PCOM Alpharetta, GA

James Gay Mercer University Richmond Hills, GA

About GPhA

The Georgia Pharmacy Association is the collective voice of the pharmacy profession, aggressively advocating for the profession in the shaping of public policy, encouraging ethical health care practices, advancing educational leadership while ensuring the profession’s future is economically prosperous.

Scott Welborn UGA Duluth, GA

New Graduate

Amy Knaperek, Pharm.D. (1st year) Mills River, NC

The members of GPhA would like to welcome all our new members and encourage them to take advantage of all the benefits membership offers.

Active Pharmacist Elsie Hester, R. Ph. Marietta, GA

Available At:

www.GoToCEI.org Citing strong evidence of effectiveness, the U.S. Preventive Services Task Force in May 2012 recommended team-based care -- uniting the efforts of physicians, pharmacists, nurses and other health care professionals -- to improve blood pressure control. Participate in a free, one hour On Demand CPE activity to learn more about Team Up. Pressure Down. Coaching Patients to Take Control., a Million Hearts™ educational program that offers support and resources for health care professionals working to help Americans improve medication adherence and more effectively manage their blood pressure.

The Collaborative Education Institute is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. UAN 107-999-12-078-H04-P 0.1 CEU/1.0 Hr (For complete CPE information, go to www.GoToCEI.org)

THANK YOU FOR YOUR MEMBERSHIP! Georgia Pharmacy Association

This CPE activity is FREE to participating pharmacists through the Million Hearts™ initiative.

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

gpha.org

The Georgia Pharmacy Journal

5


MESSAGE from Jim Bracewell O

Jim Bracewell

Executive Vice President

ne of the things I am most thankful for this holiday season is the great team we have at GPhA. As we all sit around and enjoy the many bowl games, we recognize that all teams have players who want to play and win but at the end of the season only a few have winning seasons. Those that have winning seasons are the teams that have recruited the best and most talented team members. The GPhA Team is a winning team and they are getting better each month. December, we will have a new member join our team, Kim McNeely who comes to us from an international association with great experience in membership development. Please plan to welcome her to GPhA. The November issue of James Magazine published by Internet News Agency and one of the most widely read magazines that focuses on the politics of Georgia government named Andy Freeman, GPhA Director of Government Affairs, one of the top fifteen lobbyists for associations in Georgia. Andy, we congratulate you and I am proud to have you on our GPhA Team. One of the easiest winning teams that you can be part of is the Million Hearts Team. See the information below and become a member of the effort to teach patients to take control of their blood pressure. You are already a member of the GPhA nation. You can also be a member of a great winning national team.

Team Up. Pressure Down. Coaching Patients to Take Control. A Free One Hour (0.1 CEU) On Demand CPE Activity

WELCOME New GPhA Members Pharmacy School Students Stephen Lee PCOM Alpharetta, GA

James Gay Mercer University Richmond Hills, GA

About GPhA

The Georgia Pharmacy Association is the collective voice of the pharmacy profession, aggressively advocating for the profession in the shaping of public policy, encouraging ethical health care practices, advancing educational leadership while ensuring the profession’s future is economically prosperous.

Scott Welborn UGA Duluth, GA

New Graduate

Amy Knaperek, Pharm.D. (1st year) Mills River, NC

The members of GPhA would like to welcome all our new members and encourage them to take advantage of all the benefits membership offers.

Active Pharmacist Elsie Hester, R. Ph. Marietta, GA

Available At:

www.GoToCEI.org Citing strong evidence of effectiveness, the U.S. Preventive Services Task Force in May 2012 recommended team-based care -- uniting the efforts of physicians, pharmacists, nurses and other health care professionals -- to improve blood pressure control. Participate in a free, one hour On Demand CPE activity to learn more about Team Up. Pressure Down. Coaching Patients to Take Control., a Million Hearts™ educational program that offers support and resources for health care professionals working to help Americans improve medication adherence and more effectively manage their blood pressure.

The Collaborative Education Institute is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. UAN 107-999-12-078-H04-P 0.1 CEU/1.0 Hr (For complete CPE information, go to www.GoToCEI.org)

THANK YOU FOR YOUR MEMBERSHIP! Georgia Pharmacy Association

This CPE activity is FREE to participating pharmacists through the Million Hearts™ initiative.

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

gpha.org

The Georgia Pharmacy Journal

5


Assessing Impact and Patient Satisfaction of Immunization Services

Provided by a Student Facilitated Community Health Fair  

Authors and Affiliations: Meagan S. Barbee, PharmD1 Jill Augustine, PharmD2 Christina Gonzalez, PharmD Candidate3 J. Grady Strom, Jr., PhD, RPh3 1 Emory Healthcare 2 University of Arizona College of Pharmacy 3 Mercer University College of Pharmacy and Health Sciences Corresponding Author: Meagan Barbee 4333 Dunwoody Park #2214 Dunwoody, GA 30338 404-545-1582 meg.barbee@gmail.com Conflict of Interest: Authors do not have any conflicts of interest or financial interest in any product or service discussed in the manuscript, including grants, employment, gifts, stock holdings, or options, honoraria, consultancies, expert testimony, patients, and royalties. Funding: This study was funded by a Student Incentive Grant for Innovation in Immunization Practices from the American Pharmacists Association Foundation Knowlton Center for Pharmacist-Based Health Solutions.  Abstract (200-250 words): Objective(s): The objective of the survey was to assess whether participants gained knowledge about abilities of pharmacists to provide vaccination services and the likeliness of participants to receive vaccination services from a pharmacy/pharmacist in the future. Design: The study was a nonrandomized, cross-sectional survey of patients. Setting: Immunization services were provid-

6

ed at a community-based health fair targeted at underserved populations. Patients: Immunization services were available to eligible patients who attended the health fair, and the survey was open to patients who received an immunization. Main outcome measure(s): Patients’ agreement with survey statements based on a four-point Likert scale. Results: Twenty-nine vaccinations were provided to 27 patients. Twenty-four patients completed the survey (88.9%). All patients agreed or strongly agreed that the service taught them that pharmacists could provide immunization services. Participants were also more likely to seek immunization services from a pharmacy/pharmacist in the future (100% strongly agreed or agreed). Patients reported that they were more likely to seek education regarding vaccine-preventable diseases from a pharmacy/pharmacists in the future (100% strongly agreed or agreed). Most participants reported that prior to the health fair, they were planning on receiving a pneumococcal vaccination (87.5% strongly agree or agreed) or a tetanus/diphtheria/ pertussis vaccination (70.2% strongly agreed or agreed). Conclusions: Student pharmacists were able to provide underserved patients immunizations in a community health fair. Educating patients that pharmacists and student pharmacists can provide immunization services may lead patients to seek pharmacists for such services in the future. Keywords: immunization, pharmacist, patient satisfaction, student pharmacist

Introduction

Immunizations save over 30,000 lives annually and prevent 14 million cases of disease each year.1 In 2007, 1.2 million people in the United States were hospitalized with pneumonia, and more than 52,000 peopled died from the disease.1 In the Healthy People 2020 campaign, the Department of Health and Human Services has set a goal of reducing or eliminating the cases of vaccine-preventable diseases, including tetanus, diphtheria, pertussis, and pneumonia.1 Part of this goal includes vaccinating 90% of noninstitutionalized adults age 64 years and older and 60% of noninstitutionalized adults aged 18 to 64 years against pneumococcal disease. 1 According to the National Immunization Survey (NIS), current vaccination rates from 2007 are well below these goals.2 Rates of pneumococcal immunizations among African Americans and Hispanic patients over the age of 65 years are approximately 10% lower than the national average.2 Due to these alarming rates as well as the threat of other emerging diseases, health care professionals, including pharmacists, will need to be capable of providing preventative health care to a growing and diverse population and responding to new, emerging threats. Immunization programs organized, developed, and implemented by pharmacists and student pharmacists have increased the percentage of immunized patients in the community.3-6 Community pharmacies have a number of aspects that facilitate delivery of immunizations. Convenient locations and long hours of operation make it attractive for patients, parents, and caregivers to have immunizations administered by local community pharmacies.7 Patients have also reported overall satisfaction with pharmacist-based immunization clinics, when considering professionalism, access to vaccinations, and communication by the pharmacist.8 Vaccine administration in hard-toreach populations has not received attention in the published literature.9 Hard-to-reach populations, while not

The Georgia Pharmacy Journal

uniformly defined, have include undocumented immigrants, substance users, homeless patients, and homebound elderly.9 Activities that have been proposed to increase immunization rates in these populations include community-based educational campaigns, education of providers, broadening the provider base to include nurses and pharmacists to give vaccinations, and promoting a wider availability and access to the vaccines.9 No previous research has examined programs that provide immunizations to underserved populations in order to increase their immunization rate.

Objectives

The objectives of this study were to assess whether participants gained knowledge about the immunization abilities of pharmacists through a community health fair, whether participants who received an immunization were satisfied with the services they received, whether the healthfair provided a service that would have not otherwise been sought by participants, and the likeliness of participants to receive vaccination services from a pharmacy/pharmacist in the future.

Methods

Participants who entered the health fair were approached about receiving a vaccination. If participants did not speak English as a first language, an on-site translator was used to facilitate communication. Student pharmacists explained the risk and benefits of receiving the tetanus/diphtheria/pertussis and pneumococcal vaccinations and obtained consent to receive a vaccination from participants who were interested. Potential participants were screened using a questionnaire to determine whether the inclusion criteria were met to receive the vaccination or whether the potential participants had any exclusion criteria. The respective Vaccine Information Statements (VIS) were given to the participant, and the participant was permitted to ask questions regarding the vaccination. After receiving the vaccination, participants were approached to participate in a brief, anonymous survey regarding the vaccination services they received. Surveyors were instructed to allow the participants to complete the

The Georgia Pharmacy Journal

survey on their own but were nearby to answer any questions from participants. The survey portion of this project was approved by the University Institutional Review Board as a minimal risk study and authorization was waived for participation.

Patients

Participants were eligible to receive a tetanus/diphtheria/pertussis or pneumococcal vaccination if they signed and completed the immunization administration questionnaire and consent form and did not meet any of the exclusion criteria. Participants were excluded from receiving a tetanus/diphtheria/ pertussis vaccine if they reported any of the following: age less than 18 years, encephalopathy not attributed to another identifiable cause within 7 days following previous dose of diphtheria, tetanus, with pertussis (DTwP); diphtheria, tetanus, and pertussis (DTaP); or tetanus, diphtheria, and acellular pertussis (Tdap), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylaxis) to a previous vaccine dose or component, immunosuppression including drug-induced immunosuppression, recent or current chemotherapy, progressive or unstable neurological disorder, Guillain-Barre syndrome within 6 weeks following previous dose of tetanus-containing vaccine, history of arthus-type hypersensitivity reaction following previous dose of tetanus-containing vaccine, or receipt of vaccination or booster in the last 5 years.10,11 Participants were excluded from receiving a pneumococcal vaccine if they reported any of the following: age less than 18 years, age of 18-64 years of age without chronic disease state (diabetes, heart disease, COPD, liver disease, alcoholism, or kidney disease including dialysis), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylaxis) to a previous vaccine dose or component, immunosuppression including drug-induced immunosuppression, recent or current chemotherapy, receipt of vaccination or booster in the last 5 years, or receipt of two doses of vaccine in lifetime.12,13 Participants were eligible for inclusion in the survey study if they received a vaccination.

Outcomes

The outcomes of this study were the proportion of participants who were satisfied with the services they received, who received a service they were not originally intending to receive, who were taught about pharmacy services they were originally unaware of, and who were likely to seek a pharmacy or pharmacist for similar services in the future.

Statistics

Survey results are represented in frequencies and percent response for each question is also reported.

Results

Thirty participants expressed interest in receiving a vaccination, answered the immunization administration questionnaire, and were screened and consented. Three participants were excluded (one current pregnancy, one with receipt of vaccination within five years, and one receiving chemotherapy). Twenty-seven participants received 29 total vaccinations, where two participants received pneumococcal and 27 participants received a tetanus/diphtheria/pertussis vaccination. Of the 27 participants who received at least one vaccination, 24 completed the immunization survey. Vaccination services were provided in Spanish and English only. Most patients agreed or strongly agreed with the survey statements. All participants at least agreed that the health fair taught them that pharmacists can provide immunization vaccination services (66.7% strongly agreed, 33.3% agreed). Further, all patients were satisfied with the services they received at the health fair regarding the vaccinations/ immunizations (75% strongly agreed, 25% agreed). The survey results showed that because of the health fair, participants were more likely to seek immunization/vaccination services from a pharmacist or pharmacy in the future (45.8% strongly agreed and 54.2% agreed). Also, participants noted that in the future, they were likely to seek a pharmacist or pharmacy to provide immunization / vaccination services and to seek education regarding vaccine-preventable diseases from a pharmacist or pharmacy (54.2% strongly agreed, 45.8% agreed on both survey statements). On average, however, participants reported that prior

7


Assessing Impact and Patient Satisfaction of Immunization Services

Provided by a Student Facilitated Community Health Fair  

Authors and Affiliations: Meagan S. Barbee, PharmD1 Jill Augustine, PharmD2 Christina Gonzalez, PharmD Candidate3 J. Grady Strom, Jr., PhD, RPh3 1 Emory Healthcare 2 University of Arizona College of Pharmacy 3 Mercer University College of Pharmacy and Health Sciences Corresponding Author: Meagan Barbee 4333 Dunwoody Park #2214 Dunwoody, GA 30338 404-545-1582 meg.barbee@gmail.com Conflict of Interest: Authors do not have any conflicts of interest or financial interest in any product or service discussed in the manuscript, including grants, employment, gifts, stock holdings, or options, honoraria, consultancies, expert testimony, patients, and royalties. Funding: This study was funded by a Student Incentive Grant for Innovation in Immunization Practices from the American Pharmacists Association Foundation Knowlton Center for Pharmacist-Based Health Solutions.  Abstract (200-250 words): Objective(s): The objective of the survey was to assess whether participants gained knowledge about abilities of pharmacists to provide vaccination services and the likeliness of participants to receive vaccination services from a pharmacy/pharmacist in the future. Design: The study was a nonrandomized, cross-sectional survey of patients. Setting: Immunization services were provid-

6

ed at a community-based health fair targeted at underserved populations. Patients: Immunization services were available to eligible patients who attended the health fair, and the survey was open to patients who received an immunization. Main outcome measure(s): Patients’ agreement with survey statements based on a four-point Likert scale. Results: Twenty-nine vaccinations were provided to 27 patients. Twenty-four patients completed the survey (88.9%). All patients agreed or strongly agreed that the service taught them that pharmacists could provide immunization services. Participants were also more likely to seek immunization services from a pharmacy/pharmacist in the future (100% strongly agreed or agreed). Patients reported that they were more likely to seek education regarding vaccine-preventable diseases from a pharmacy/pharmacists in the future (100% strongly agreed or agreed). Most participants reported that prior to the health fair, they were planning on receiving a pneumococcal vaccination (87.5% strongly agree or agreed) or a tetanus/diphtheria/ pertussis vaccination (70.2% strongly agreed or agreed). Conclusions: Student pharmacists were able to provide underserved patients immunizations in a community health fair. Educating patients that pharmacists and student pharmacists can provide immunization services may lead patients to seek pharmacists for such services in the future. Keywords: immunization, pharmacist, patient satisfaction, student pharmacist

Introduction

Immunizations save over 30,000 lives annually and prevent 14 million cases of disease each year.1 In 2007, 1.2 million people in the United States were hospitalized with pneumonia, and more than 52,000 peopled died from the disease.1 In the Healthy People 2020 campaign, the Department of Health and Human Services has set a goal of reducing or eliminating the cases of vaccine-preventable diseases, including tetanus, diphtheria, pertussis, and pneumonia.1 Part of this goal includes vaccinating 90% of noninstitutionalized adults age 64 years and older and 60% of noninstitutionalized adults aged 18 to 64 years against pneumococcal disease. 1 According to the National Immunization Survey (NIS), current vaccination rates from 2007 are well below these goals.2 Rates of pneumococcal immunizations among African Americans and Hispanic patients over the age of 65 years are approximately 10% lower than the national average.2 Due to these alarming rates as well as the threat of other emerging diseases, health care professionals, including pharmacists, will need to be capable of providing preventative health care to a growing and diverse population and responding to new, emerging threats. Immunization programs organized, developed, and implemented by pharmacists and student pharmacists have increased the percentage of immunized patients in the community.3-6 Community pharmacies have a number of aspects that facilitate delivery of immunizations. Convenient locations and long hours of operation make it attractive for patients, parents, and caregivers to have immunizations administered by local community pharmacies.7 Patients have also reported overall satisfaction with pharmacist-based immunization clinics, when considering professionalism, access to vaccinations, and communication by the pharmacist.8 Vaccine administration in hard-toreach populations has not received attention in the published literature.9 Hard-to-reach populations, while not

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uniformly defined, have include undocumented immigrants, substance users, homeless patients, and homebound elderly.9 Activities that have been proposed to increase immunization rates in these populations include community-based educational campaigns, education of providers, broadening the provider base to include nurses and pharmacists to give vaccinations, and promoting a wider availability and access to the vaccines.9 No previous research has examined programs that provide immunizations to underserved populations in order to increase their immunization rate.

Objectives

The objectives of this study were to assess whether participants gained knowledge about the immunization abilities of pharmacists through a community health fair, whether participants who received an immunization were satisfied with the services they received, whether the healthfair provided a service that would have not otherwise been sought by participants, and the likeliness of participants to receive vaccination services from a pharmacy/pharmacist in the future.

Methods

Participants who entered the health fair were approached about receiving a vaccination. If participants did not speak English as a first language, an on-site translator was used to facilitate communication. Student pharmacists explained the risk and benefits of receiving the tetanus/diphtheria/pertussis and pneumococcal vaccinations and obtained consent to receive a vaccination from participants who were interested. Potential participants were screened using a questionnaire to determine whether the inclusion criteria were met to receive the vaccination or whether the potential participants had any exclusion criteria. The respective Vaccine Information Statements (VIS) were given to the participant, and the participant was permitted to ask questions regarding the vaccination. After receiving the vaccination, participants were approached to participate in a brief, anonymous survey regarding the vaccination services they received. Surveyors were instructed to allow the participants to complete the

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survey on their own but were nearby to answer any questions from participants. The survey portion of this project was approved by the University Institutional Review Board as a minimal risk study and authorization was waived for participation.

Patients

Participants were eligible to receive a tetanus/diphtheria/pertussis or pneumococcal vaccination if they signed and completed the immunization administration questionnaire and consent form and did not meet any of the exclusion criteria. Participants were excluded from receiving a tetanus/diphtheria/ pertussis vaccine if they reported any of the following: age less than 18 years, encephalopathy not attributed to another identifiable cause within 7 days following previous dose of diphtheria, tetanus, with pertussis (DTwP); diphtheria, tetanus, and pertussis (DTaP); or tetanus, diphtheria, and acellular pertussis (Tdap), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylaxis) to a previous vaccine dose or component, immunosuppression including drug-induced immunosuppression, recent or current chemotherapy, progressive or unstable neurological disorder, Guillain-Barre syndrome within 6 weeks following previous dose of tetanus-containing vaccine, history of arthus-type hypersensitivity reaction following previous dose of tetanus-containing vaccine, or receipt of vaccination or booster in the last 5 years.10,11 Participants were excluded from receiving a pneumococcal vaccine if they reported any of the following: age less than 18 years, age of 18-64 years of age without chronic disease state (diabetes, heart disease, COPD, liver disease, alcoholism, or kidney disease including dialysis), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylaxis) to a previous vaccine dose or component, immunosuppression including drug-induced immunosuppression, recent or current chemotherapy, receipt of vaccination or booster in the last 5 years, or receipt of two doses of vaccine in lifetime.12,13 Participants were eligible for inclusion in the survey study if they received a vaccination.

Outcomes

The outcomes of this study were the proportion of participants who were satisfied with the services they received, who received a service they were not originally intending to receive, who were taught about pharmacy services they were originally unaware of, and who were likely to seek a pharmacy or pharmacist for similar services in the future.

Statistics

Survey results are represented in frequencies and percent response for each question is also reported.

Results

Thirty participants expressed interest in receiving a vaccination, answered the immunization administration questionnaire, and were screened and consented. Three participants were excluded (one current pregnancy, one with receipt of vaccination within five years, and one receiving chemotherapy). Twenty-seven participants received 29 total vaccinations, where two participants received pneumococcal and 27 participants received a tetanus/diphtheria/pertussis vaccination. Of the 27 participants who received at least one vaccination, 24 completed the immunization survey. Vaccination services were provided in Spanish and English only. Most patients agreed or strongly agreed with the survey statements. All participants at least agreed that the health fair taught them that pharmacists can provide immunization vaccination services (66.7% strongly agreed, 33.3% agreed). Further, all patients were satisfied with the services they received at the health fair regarding the vaccinations/ immunizations (75% strongly agreed, 25% agreed). The survey results showed that because of the health fair, participants were more likely to seek immunization/vaccination services from a pharmacist or pharmacy in the future (45.8% strongly agreed and 54.2% agreed). Also, participants noted that in the future, they were likely to seek a pharmacist or pharmacy to provide immunization / vaccination services and to seek education regarding vaccine-preventable diseases from a pharmacist or pharmacy (54.2% strongly agreed, 45.8% agreed on both survey statements). On average, however, participants reported that prior

7


Immunization Services to the health fair, they were planning on receiving a pneumococcal vaccination (29.2% strongly agreed, 58.3% agreed, 8.33% disagreed, and 4.17% strongly disagreed) or a tetanus/diphtheria vaccination (41.7% strongly agreed, 37.5% agreed, and 20.8% disagreed). Table 1. Survey Results

Discussion

Student pharmacists immunized 27 participants against preventable diseases of pneumonia, tetanus, diphtheria, and pertussis. While demographic information was not collected for this study, the survey was administered at a health fair that targeted underserved Hispanic population in a metropolitan city. As evident in the literature2, the Hispanic population has immunization rates below those of other populations, includ-

ing Caucasian and African American. Through health fairs which target providing immunization services, immunization rates of the underserved have the potential to improve. Additionally, all of the participants stated that they were favorable to seeking a pharmacist or pharmacy in the future for immunizations or vaccinations. With the education of patients about the abilities of pharmacists, patients and their families may seek pharmacies to provide vaccination services, including travel, childhood, and annual immunizations as well as other services. Through this education, pharmacies also have the ability to develop clinics and programs that are targeted at providing vaccinations. Over the past several years, pharmacists have been encouraged to increase

Table 1

the number and types of services that they can offer to patients. This study has shown that pharmacists and student pharmacists can provide satisfactory vaccinations and immunization services to patients who might not have otherwise received these services. Pharmacists have the ability to educate patients about vaccinations that cover a wide variety of diseases and increase access to such services. With an increased number of patients seeking immunization services, pharmacists and pharmacies can increase the number of immunizations offered and provide access to immunization services to populations that have low overall immunization rates.

Limitations

With a small sample size and targeted population, the conclusions of this study

n (%)

Survey Statement

Strongly Agree

Agree

Disagree

Strongly Disagree

N/A

Total

THIS health fair taught me that pharmacists provide immunization and vaccination services.

16 (66.7%)

8 (33.3%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

18 (75%)

6 (25%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

Prior to today, I was planning on receiving the PNEUMOCOCCAL (pneumonia) vaccine in the future.

7 (29.2%)

14 (58.3%)

2 (8.33%)

1 (4.17%)

0 (0%)

24 (100%)

Prior to today, I was planning on receiving the TETANUS/ DIPTHERIA vaccine in the future.

10 (41.7%)

9 (37.5%)

5 (20.8%)

0 (0%)

0 (0%)

24 (100%)

I am satisfied with the service I received at this health fair regarding the vaccination / immunization.

Because of this health fair, I am MORE LIKELY to seek immunization / vaccination services from a pharmacist or pharmacy in the future. In the future, I AM LIKELY to seek a pharmacist or pharmacy to provide my immunization / vaccination services. In the future, I AM LIKELY to seek education regarding vaccinepreventable diseases from a pharmacist or pharmacy.

8

Immunization Services are not universal. As a baseline survey was not gathered, the true effect of the health fair and services rendered on patient perspectives of pharmacist- and student pharmacist-provided vaccination services was not able to be assessed. The survey did not assess the likelihood of patients to approach a pharmacy or pharmacist for immunization services or related education prior to receiving their vaccination at the health fair. As with all survey studies, an inherent limitation of the current study was the reliance on a self-report method of data collection. Although efforts were made to

minimize response bias, there is always a potential in survey studies that this type of bias is present.

Conclusion

The results of this study support the findings of other studies favoring pharmacist-facilitated immunization services. With student pharmacists able to perform activities under the supervision of a pharmacist, this could increase the abilities of pharmacies to facilitate immunization services, especially to underserved populations. In the current study, student pharmacists provided

satisfactory immunization services to an underserved population in a community setting. Educating patients that pharmacists and student pharmacists can provide immunization services may lead patients to seek pharmacists for such services in the future. We would like to acknowledge that the study was supported by the Student Incentive Grants for Innovation in Immunization Practices from the American Pharmacists Association Foundation (APhA Foundation) Knowlton Center for Pharmacist-Based Health Solutions.

References: 1. Healthy People 2020. United States Department of Health and Human Services. http://www.healthypeople.gov/2020/default.aspx. Accessed November 10, 2011. 2. National Immunization Survey-Adult, 2007. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/stats-surv/nis/downloads/nis-adult-summer-2007.pdf. Accessed November 10, 2011. 3. Taitel M, Cohen E, Duncan I, Pegus C. Pharmacists as providers: targeting pneumococcal vaccination to high risk populations. Vaccine. 2011;29(45):8073-6. 4. Loughlin SM, Mortazavi A, Garey KW, Rick GK, Birtcher KK. Pharmacist-managed vaccination program increased influenza vaccination rate in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27(5):729-33. 5. Ragucci KR, Pearson WS, Mainous AG. The role of pharmacists in the delivery of influenza vaccinations. Vaccine. 2004;22(8):1001-6. 6. Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved influenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy. 2001;21(9):1115-22. 7. Ndiaye SM, Madhavan S, Washington ML, et al. The use of pharmacy immunization services in rural communities. Public Health. 2003;117(2):88-97. 8. Bounthavong M, Christopher ML, Mendes MA, et al. Measuring patient satisfaction in the pharmacy specialty immunization clinic: a pharmacist-run immunization clinic at the Veterns Affairs San Diego Healthcare System. Int J Pharm Pract. 2010;18(2):100-7. 9. Valhov D, Coady MD, Ompad DC, Galea S. Strategies for improving influenza immunization rates among hard-to-reach populations. J Urban Health. 2007;84(4):615-31. 10. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60 (No. 1): 13-15. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm 11. Boostrix® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011. 12. Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-8): 1-25. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr4608.pdf 13. Pneumovax® 23 [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2011. 14. Pneumonia. Centers for Disease Control and Prevention. http://www.cdc.gov/Features/Pneumonia/. Accessed December 15, 2011.

Division of Display Options, Inc.

Compounding Labs Pharmacy Planning & Design

11 (45.8%)

13 (54.2%)

13 (54.2%)

11 (45.8%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

24 (100%)

Rx Planning Specialist

Patient Consultation Areas

Roland Thomas

Stocking Lozier Distributor

experience in over 2,000 pharmacies.

Full line of Pharmacy Fixtures Custom Wood Work Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

13 (54.2%)

11 (45.8%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

The Georgia Pharmacy Journal

1-800-321-4344 www.displayoptions.com www � .displayoptions.com �


Immunization Services to the health fair, they were planning on receiving a pneumococcal vaccination (29.2% strongly agreed, 58.3% agreed, 8.33% disagreed, and 4.17% strongly disagreed) or a tetanus/diphtheria vaccination (41.7% strongly agreed, 37.5% agreed, and 20.8% disagreed). Table 1. Survey Results

Discussion

Student pharmacists immunized 27 participants against preventable diseases of pneumonia, tetanus, diphtheria, and pertussis. While demographic information was not collected for this study, the survey was administered at a health fair that targeted underserved Hispanic population in a metropolitan city. As evident in the literature2, the Hispanic population has immunization rates below those of other populations, includ-

ing Caucasian and African American. Through health fairs which target providing immunization services, immunization rates of the underserved have the potential to improve. Additionally, all of the participants stated that they were favorable to seeking a pharmacist or pharmacy in the future for immunizations or vaccinations. With the education of patients about the abilities of pharmacists, patients and their families may seek pharmacies to provide vaccination services, including travel, childhood, and annual immunizations as well as other services. Through this education, pharmacies also have the ability to develop clinics and programs that are targeted at providing vaccinations. Over the past several years, pharmacists have been encouraged to increase

Table 1

the number and types of services that they can offer to patients. This study has shown that pharmacists and student pharmacists can provide satisfactory vaccinations and immunization services to patients who might not have otherwise received these services. Pharmacists have the ability to educate patients about vaccinations that cover a wide variety of diseases and increase access to such services. With an increased number of patients seeking immunization services, pharmacists and pharmacies can increase the number of immunizations offered and provide access to immunization services to populations that have low overall immunization rates.

Limitations

With a small sample size and targeted population, the conclusions of this study

n (%)

Survey Statement

Strongly Agree

Agree

Disagree

Strongly Disagree

N/A

Total

THIS health fair taught me that pharmacists provide immunization and vaccination services.

16 (66.7%)

8 (33.3%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

18 (75%)

6 (25%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

Prior to today, I was planning on receiving the PNEUMOCOCCAL (pneumonia) vaccine in the future.

7 (29.2%)

14 (58.3%)

2 (8.33%)

1 (4.17%)

0 (0%)

24 (100%)

Prior to today, I was planning on receiving the TETANUS/ DIPTHERIA vaccine in the future.

10 (41.7%)

9 (37.5%)

5 (20.8%)

0 (0%)

0 (0%)

24 (100%)

I am satisfied with the service I received at this health fair regarding the vaccination / immunization.

Because of this health fair, I am MORE LIKELY to seek immunization / vaccination services from a pharmacist or pharmacy in the future. In the future, I AM LIKELY to seek a pharmacist or pharmacy to provide my immunization / vaccination services. In the future, I AM LIKELY to seek education regarding vaccinepreventable diseases from a pharmacist or pharmacy.

8

Immunization Services are not universal. As a baseline survey was not gathered, the true effect of the health fair and services rendered on patient perspectives of pharmacist- and student pharmacist-provided vaccination services was not able to be assessed. The survey did not assess the likelihood of patients to approach a pharmacy or pharmacist for immunization services or related education prior to receiving their vaccination at the health fair. As with all survey studies, an inherent limitation of the current study was the reliance on a self-report method of data collection. Although efforts were made to

minimize response bias, there is always a potential in survey studies that this type of bias is present.

Conclusion

The results of this study support the findings of other studies favoring pharmacist-facilitated immunization services. With student pharmacists able to perform activities under the supervision of a pharmacist, this could increase the abilities of pharmacies to facilitate immunization services, especially to underserved populations. In the current study, student pharmacists provided

satisfactory immunization services to an underserved population in a community setting. Educating patients that pharmacists and student pharmacists can provide immunization services may lead patients to seek pharmacists for such services in the future. We would like to acknowledge that the study was supported by the Student Incentive Grants for Innovation in Immunization Practices from the American Pharmacists Association Foundation (APhA Foundation) Knowlton Center for Pharmacist-Based Health Solutions.

References: 1. Healthy People 2020. United States Department of Health and Human Services. http://www.healthypeople.gov/2020/default.aspx. Accessed November 10, 2011. 2. National Immunization Survey-Adult, 2007. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/stats-surv/nis/downloads/nis-adult-summer-2007.pdf. Accessed November 10, 2011. 3. Taitel M, Cohen E, Duncan I, Pegus C. Pharmacists as providers: targeting pneumococcal vaccination to high risk populations. Vaccine. 2011;29(45):8073-6. 4. Loughlin SM, Mortazavi A, Garey KW, Rick GK, Birtcher KK. Pharmacist-managed vaccination program increased influenza vaccination rate in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27(5):729-33. 5. Ragucci KR, Pearson WS, Mainous AG. The role of pharmacists in the delivery of influenza vaccinations. Vaccine. 2004;22(8):1001-6. 6. Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved influenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy. 2001;21(9):1115-22. 7. Ndiaye SM, Madhavan S, Washington ML, et al. The use of pharmacy immunization services in rural communities. Public Health. 2003;117(2):88-97. 8. Bounthavong M, Christopher ML, Mendes MA, et al. Measuring patient satisfaction in the pharmacy specialty immunization clinic: a pharmacist-run immunization clinic at the Veterns Affairs San Diego Healthcare System. Int J Pharm Pract. 2010;18(2):100-7. 9. Valhov D, Coady MD, Ompad DC, Galea S. Strategies for improving influenza immunization rates among hard-to-reach populations. J Urban Health. 2007;84(4):615-31. 10. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60 (No. 1): 13-15. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm 11. Boostrix® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011. 12. Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-8): 1-25. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr4608.pdf 13. Pneumovax® 23 [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2011. 14. Pneumonia. Centers for Disease Control and Prevention. http://www.cdc.gov/Features/Pneumonia/. Accessed December 15, 2011.

Division of Display Options, Inc.

Compounding Labs Pharmacy Planning & Design

11 (45.8%)

13 (54.2%)

13 (54.2%)

11 (45.8%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

24 (100%)

Rx Planning Specialist

Patient Consultation Areas

Roland Thomas

Stocking Lozier Distributor

experience in over 2,000 pharmacies.

Full line of Pharmacy Fixtures Custom Wood Work Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

13 (54.2%)

11 (45.8%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

The Georgia Pharmacy Journal

1-800-321-4344 www.displayoptions.com www � .displayoptions.com �


NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE April 26-28, 2013 Legacy Lodge & Conference Center Lake Lanier Islands Resort Lake Lanier Islands, GA

The 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference. Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria: (1) Leadership potential; (2) Involvement in college student activities and/or professional organizations; (3) Community activities; (4) Clarity and vision in response to application questions. I would like to nominate the following individual to attend the 2013 New Practitioner Leadership Conference: (Please Print) Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For:

______________________________________________________________________________________

Preferred Mailing Address: _____________________________________________________________________________ _

_______________________________________________________________________________

This address is [ ] Home [ ] Work

_______________________________________________ State: ______ ZIP: _____________

Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________

E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________ Address:

[ ] Home or [ ] Work?________________________________________________________________________________

_________________________________________________________ Tel. (____) __________________

20th Year

State: _______

Zip: ___________________

E-mail: ___________________________________________________________

Please return this Nomination Form to: Georgia Pharmacy Foundation Attn: Regena Banks 50 Lenox Pointe, NE Atlanta, GA 30324

Please return by January 18, 2013

Or, you may FAX this Nomination Form to: 404.237.8435 Or, submit online at WWW.GPHA.ORG If you have questions, please contact Regena Banks at GPhF: 404.231.5074  Email: rbanks@gpha.org

10

The Georgia Pharmacy Journal

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor CPE Monitor™ integration is well underway and soon all Accreditation Council for Pharmacy Education (ACPE)-accredited providers will require pharmacists and pharmacy technicians to submit their NABP e-Profile ID and date of birth (MMDD) in order to obtain ACPE-accredited continuing pharmacy education (CPE) credit. In fact, many providers have already integrated their systems and are requiring this information. As of press time, more than: • 950,000 CPE activity records are now stored in the CPE Monitor system • 120 ACPE-accredited providers are actively transmitting CPE data electronically • 188,000 pharmacists have created e-Profiles • 103,500 pharmacy technicians have created e-Profiles CPE Monitor is a national collaborative service from NABP, ACPE, and ACPE providers that will allow licensees to track their completed CPE credits electronically. It is anticipated that in 2013 the boards of pharmacy will be able to request reports on their

- CORRECTION In the November edition of the Georgia Pharmacy Journal, Bent Gay’s name was spelled incorrectly. We sincerely apologize and again would like to congratulate Mr. Gay on being named the Next Generation Long-term Care Pharmacist of the Year. The Georgia Pharmacy Journal

licensees, eventually eliminating the need for printed statements of credit for ACPE-accredited CPE. To obtain an e-Profile ID, licensees may visit www.MyCPEmonitor.net, create an e-Profile, and register for CPE Monitor.

Reprinted with permission from The National Association of Boards of Pharmacy® (NABP®), October 2012 issue of the NABP Newsletter: ©2012, National Association of Boards of Pharmacy®, Mount Prospect, Illinois.

Melvin M. Goldstein, P.C. A T T O R N E___ Y AT

LAW

248 Roswell Street Marietta, Georgia 30060 Telephone 770/427-7004 Fax 770/426-9584 www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency n Former Administrative Law Judge for the Office of State Administrative Hearings


NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE April 26-28, 2013 Legacy Lodge & Conference Center Lake Lanier Islands Resort Lake Lanier Islands, GA

The 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference. Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria: (1) Leadership potential; (2) Involvement in college student activities and/or professional organizations; (3) Community activities; (4) Clarity and vision in response to application questions. I would like to nominate the following individual to attend the 2013 New Practitioner Leadership Conference: (Please Print) Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For:

______________________________________________________________________________________

Preferred Mailing Address: _____________________________________________________________________________ _

_______________________________________________________________________________

This address is [ ] Home [ ] Work

_______________________________________________ State: ______ ZIP: _____________

Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________

E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________ Address:

[ ] Home or [ ] Work?________________________________________________________________________________

_________________________________________________________ Tel. (____) __________________

20th Year

State: _______

Zip: ___________________

E-mail: ___________________________________________________________

Please return this Nomination Form to: Georgia Pharmacy Foundation Attn: Regena Banks 50 Lenox Pointe, NE Atlanta, GA 30324

Please return by January 18, 2013

Or, you may FAX this Nomination Form to: 404.237.8435 Or, submit online at WWW.GPHA.ORG If you have questions, please contact Regena Banks at GPhF: 404.231.5074  Email: rbanks@gpha.org

10

The Georgia Pharmacy Journal

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor CPE Monitor™ integration is well underway and soon all Accreditation Council for Pharmacy Education (ACPE)-accredited providers will require pharmacists and pharmacy technicians to submit their NABP e-Profile ID and date of birth (MMDD) in order to obtain ACPE-accredited continuing pharmacy education (CPE) credit. In fact, many providers have already integrated their systems and are requiring this information. As of press time, more than: • 950,000 CPE activity records are now stored in the CPE Monitor system • 120 ACPE-accredited providers are actively transmitting CPE data electronically • 188,000 pharmacists have created e-Profiles • 103,500 pharmacy technicians have created e-Profiles CPE Monitor is a national collaborative service from NABP, ACPE, and ACPE providers that will allow licensees to track their completed CPE credits electronically. It is anticipated that in 2013 the boards of pharmacy will be able to request reports on their

- CORRECTION In the November edition of the Georgia Pharmacy Journal, Bent Gay’s name was spelled incorrectly. We sincerely apologize and again would like to congratulate Mr. Gay on being named the Next Generation Long-term Care Pharmacist of the Year. The Georgia Pharmacy Journal

licensees, eventually eliminating the need for printed statements of credit for ACPE-accredited CPE. To obtain an e-Profile ID, licensees may visit www.MyCPEmonitor.net, create an e-Profile, and register for CPE Monitor.

Reprinted with permission from The National Association of Boards of Pharmacy® (NABP®), October 2012 issue of the NABP Newsletter: ©2012, National Association of Boards of Pharmacy®, Mount Prospect, Illinois.

Melvin M. Goldstein, P.C. A T T O R N E___ Y AT

LAW

248 Roswell Street Marietta, Georgia 30060 Telephone 770/427-7004 Fax 770/426-9584 www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency n Former Administrative Law Judge for the Office of State Administrative Hearings


ADVISORY Georgia State Board of Pharmacy Compounding Pharmacies and Pharmacists October 30, 2012

The Georgia State Board of Pharmacy reminds pharmacies, pharmacists and medical

practitioners who engage in compounding in this state that Board Rule 480-11 requires that all actions be performed in accordance with United States Pharmacopeia (USP) Standards. USP<795> addresses the practice for Non-Sterile Compounding and USP Standard <797> addresses the practice for Sterile Compounding Preparations. Georgia Pharmacies, Pharmacists and Practitioners are also reminded that Georgia law (O.C.G.A. Title 26, Chapter 4, Section 80) and Georgia State Board of Pharmacy Rules and Regulations (Chapter 480) require that medications can only be dispensed pursuant to the receipt of a valid prescription from an authorized practitioner for a spe“Medications can cific patient. This prescription must be valid as defined under Georgia only be dispensed laws, rules and regulations. Additionally, if any pharmacy, pharmacist, or practitioner is in receipt pursuant to the of medication which has been dispensed and labeled for a specific pareceipt of a valid tient, that medication cannot be lawfully utilized, administered, or disprescription from pensed to any patient except the one whose name appears on the prescription label (O.C.G.A. 16-13, 26-4). an authorized Further, Georgia laws (O.C.G.A. 26-4-113, 115) and Rules (480-7, -11) practitioner for a prohibit compounding pharmacies from distributing bulk compounded specific patient.” medications to other health care providers without having a drug wholesale permit. These same laws and rules prohibit any pharmacy or medical practitioner in this state from purchasing drugs from any firm except one licensed in Georgia as a Drug Wholesaler and/or Manufacturer. Board licensees are advised to review USP standards and Board Rule Chapter 480-11 to assure that compounding pharmacy practice is conducted in accordance with state and federal laws and regulations, as required by The Georgia Pharmacy Practice Act (O.C.G.A. 26-4) and Board Rules and Regulations (Chapter 480-5). The Board advises that all compounding pharmacies and pharmacists should obtain and complete the respective USP Gap Analysis Tool(s) (®International Journal of Pharmaceutical Compounding) for USP <795> and <797> as provided below, to determine preliminary compliance with the above-referenced USP standards. http://www.ijpc.com/USP/ The Board appreciates your prompt attention to this important advisory.

The North Carolina Association of Pharmacists presents

CE & Ski

Winterfest Weekend Save the Date: January 25 - 27, 2013 Chetola Mountain Resort, Blowing Rock, NC Join us in the mountains for a unique CE opportunity. Are you ready for some skiing, fun with family, exploring the Blowing Rock Winterfest Celebration, and 6 hours of ACPE approved live education? Then save the date and book your room now at Chetola Resort. Call 1-800-CHETOLA and let them know you are with the NC Association of Pharmacists. Two night minimum stay is required and the cut-off date to reserve your room is January 4, 2013. Rooms range from $153 to $170. Online registration for CE & Ski will be available soon. Cost: $220.00 for NCAP members or partnering state association members, $315 for non-members. Questions? Call NCAP at 919-967-2237

Indulge. Pharmacy Leadership Weekend

Southeastern Girls of

January 11- 13, 2013 Grove Park Inn, Asheville, NC Register today at www.scrx.org

12

The Georgia Pharmacy Journal


ADVISORY Georgia State Board of Pharmacy Compounding Pharmacies and Pharmacists October 30, 2012

The Georgia State Board of Pharmacy reminds pharmacies, pharmacists and medical

practitioners who engage in compounding in this state that Board Rule 480-11 requires that all actions be performed in accordance with United States Pharmacopeia (USP) Standards. USP<795> addresses the practice for Non-Sterile Compounding and USP Standard <797> addresses the practice for Sterile Compounding Preparations. Georgia Pharmacies, Pharmacists and Practitioners are also reminded that Georgia law (O.C.G.A. Title 26, Chapter 4, Section 80) and Georgia State Board of Pharmacy Rules and Regulations (Chapter 480) require that medications can only be dispensed pursuant to the receipt of a valid prescription from an authorized practitioner for a spe“Medications can cific patient. This prescription must be valid as defined under Georgia only be dispensed laws, rules and regulations. Additionally, if any pharmacy, pharmacist, or practitioner is in receipt pursuant to the of medication which has been dispensed and labeled for a specific pareceipt of a valid tient, that medication cannot be lawfully utilized, administered, or disprescription from pensed to any patient except the one whose name appears on the prescription label (O.C.G.A. 16-13, 26-4). an authorized Further, Georgia laws (O.C.G.A. 26-4-113, 115) and Rules (480-7, -11) practitioner for a prohibit compounding pharmacies from distributing bulk compounded specific patient.” medications to other health care providers without having a drug wholesale permit. These same laws and rules prohibit any pharmacy or medical practitioner in this state from purchasing drugs from any firm except one licensed in Georgia as a Drug Wholesaler and/or Manufacturer. Board licensees are advised to review USP standards and Board Rule Chapter 480-11 to assure that compounding pharmacy practice is conducted in accordance with state and federal laws and regulations, as required by The Georgia Pharmacy Practice Act (O.C.G.A. 26-4) and Board Rules and Regulations (Chapter 480-5). The Board advises that all compounding pharmacies and pharmacists should obtain and complete the respective USP Gap Analysis Tool(s) (®International Journal of Pharmaceutical Compounding) for USP <795> and <797> as provided below, to determine preliminary compliance with the above-referenced USP standards. http://www.ijpc.com/USP/ The Board appreciates your prompt attention to this important advisory.

The North Carolina Association of Pharmacists presents

CE & Ski

Winterfest Weekend Save the Date: January 25 - 27, 2013 Chetola Mountain Resort, Blowing Rock, NC Join us in the mountains for a unique CE opportunity. Are you ready for some skiing, fun with family, exploring the Blowing Rock Winterfest Celebration, and 6 hours of ACPE approved live education? Then save the date and book your room now at Chetola Resort. Call 1-800-CHETOLA and let them know you are with the NC Association of Pharmacists. Two night minimum stay is required and the cut-off date to reserve your room is January 4, 2013. Rooms range from $153 to $170. Online registration for CE & Ski will be available soon. Cost: $220.00 for NCAP members or partnering state association members, $315 for non-members. Questions? Call NCAP at 919-967-2237

Indulge. Pharmacy Leadership Weekend

Southeastern Girls of

January 11- 13, 2013 Grove Park Inn, Asheville, NC Register today at www.scrx.org

12

The Georgia Pharmacy Journal


GEORGIA PHARMACY FOUNDATION ANNUAL GIVING CAMPAIGN

50 LENOX POINTE, NE ATLANTA, GA 30324 404.231.5074 WWW.GPHA.ORG

The Georgia Pharmacy Foundation began its 11th Annual Giving Campaign on September 1st. Since 2002, the Foundation’s Annual Giving Campaigns have raised more than $118,000. Thank you to everyone who has made a difference with their gifts. Each year, these resources make it possible for the Foundation to:    

Provide financial aid through scholarships to deserving Georgia student pharmacists Provide training for future pharmacy leaders through our New Practitioner Leadership Conference Provide continuing education opportunities for pharmacists and pharmacy technicians Explore other opportunities for the benefit of our members

By giving to the Annual Campaign you are contributing to the continuity of the pharmacy profession, in turn strengthening the future of pharmacy. These gifts are vitally important to the continued success of the Foundation because they offer the flexibility to support emerging opportunities and unmet needs when often no other source of funding is available. Acknowledging the difference that pharmacy has made in your life will ensure that the profession remains the place where thinkers become leaders. If you have not yet made your tax-deductible* gift for the current campaign, please do so today. Your support, at any level, is important. It will have an impact! Remember, many companies will match your contribution, doubling or even tripling the value of your gift! The success of our fundraising depends on donations and grants from foundations, government, corporations, and many generous individuals. Often contributions are made “In Memory/Honor” of someone or for a Special Occasion in lieu of sending flowers. Contributions are acknowledged with a Charitable Donation receipt for tax purposes, and names will appear on our website. Checks should be made payable to the Georgia Pharmacy Foundation, a 501(c)(3) organization. (*As provided by law)

Giving back is the best way to keep our profession going forward! Yes! I want to help support the good work of the Georgia Pharmacy Foundatio n by contributing to the 11 t h Annual Giving Campaign with my pledge of: [ ] President’s Circle = $5,000 or more [ ] Gold Partner = $500 - $999 [ ] Partner = $____ - $99

[ ] Eagle = $2,500 - $4,999 [ ] Silver Partner = $250 - $499

[ ] Centurion = $1,000 - $2,499 [ ] Bronze Partner = $100 - $249

Name (Please Print): ____________________________________________________________________________________________________ Company (if applicable): ______________________________________________________________________________________ Address: _____________________________________________________________________________________________________________ City: ______________________________________________________________________ ST _________ Zip _________________ Telephone: (_____) ___________________ Email: __________________________________________________________ [ ] Please check here if you prefer to be listed as an Anonymous contributor. Please indicate if you would like to make your donation a gift “In Memory or Honor of.” If so, please provide name and address where the gift card/notification should be sent: (Please Print) [ ] In Memory of _______________________________________________________________________________ [ ] In Honor of _________________________________________________________________________________ Send notification to: __________________________________________________________________________________________ Address: __________________________________________________________________________________________ __________________________________________________________________________________________ DON’T FORGET, you can also make your gift online at WWW.GPHA.ORG. Please apply my contribution as indicated:

[ ] Unrestricted Funds – Foundation to determine where funds are most needed. [ ] Foundation Scholarships (Please, minimum of $50.00 for this selection. Thank you.)

[ ] Enclosed is check payable to Georgia Pharmacy Foundation for $__________ OR [ ] Bill my credit card for $____________ (If you prefer to pay by installments, please indicate which one: [ ] Monthly or [ ] Quarterly. A separate form will be sent to you for completion.) Please circle one: AmEx Visa M/C Disc.)

Card #:_____________________________________________

Security

#: _____

Exp.Date: _____

If name on credit card and/or the billing address are different from above, please provide that information below: Name ______________________________________________________________________________________________________________________

o t r o w c o k H

Enroll At RxAlly, we believe that personalized pharmacist care can lead to better health outcomes. You are a pivotal player in the health of patients, particularly those facing chronic illnesses and taking multiple medications. RxAlly offers you the opportunity to: • Enhance your role as a health care provider • Access market opportunities through a national network • Participate in clinical service programs • Expand into new patient care niches • Be compensated for an array of professional services • Transform pharmacy practice in the U.S. RxAlly has brought together the nation’s leading independent pharmacy organizations, regional chains and Walgreens, to form a performance network of community pharmacies nationwide.

How do I Enroll? • Go to www.rxAlly.com/enroll. • Enter your contact information. • Select your role as “Pharmacy owner/officer”. Enter your NCPDP number. • Then, you will see another box with your affiliation(s) listed. If you have more than one affiliation, select “AIP”. • Click “submit” button. • Review and confirm your acceptance of the Pharmacy Network Agreement by checking the box at the bottom of the agreement and clicking the “confirm” button. • You will see a Network Enrollment Confirmation screen indicating that you have successfully enrolled. • Within a few days you will receive an enrollment confirmation email that includes your pharmacy name, NCPDP number and selected affiliation.

It’s good for your patients, and good for your business. Join the revolution today at www.rxAlly.com/enroll

Address: _______________________________________________________ City: _______________________________ St:______ Zip: __________ Signature: ________________________________________________________________________

14

Today’s Date: ______________

The Georgia Pharmacy Journal

Visit RxAlly.com

Email network@RxAlly.com

Call 1-855-RxAlly-1

©2012 RxAlly, Inc. All rights reserved. RxAlly, the RxAlly logo, and other trademarks, service marks, and designs are registered or unregistered trademarks of RxAlly. 3/12


GEORGIA PHARMACY FOUNDATION ANNUAL GIVING CAMPAIGN

50 LENOX POINTE, NE ATLANTA, GA 30324 404.231.5074 WWW.GPHA.ORG

The Georgia Pharmacy Foundation began its 11th Annual Giving Campaign on September 1st. Since 2002, the Foundation’s Annual Giving Campaigns have raised more than $118,000. Thank you to everyone who has made a difference with their gifts. Each year, these resources make it possible for the Foundation to:    

Provide financial aid through scholarships to deserving Georgia student pharmacists Provide training for future pharmacy leaders through our New Practitioner Leadership Conference Provide continuing education opportunities for pharmacists and pharmacy technicians Explore other opportunities for the benefit of our members

By giving to the Annual Campaign you are contributing to the continuity of the pharmacy profession, in turn strengthening the future of pharmacy. These gifts are vitally important to the continued success of the Foundation because they offer the flexibility to support emerging opportunities and unmet needs when often no other source of funding is available. Acknowledging the difference that pharmacy has made in your life will ensure that the profession remains the place where thinkers become leaders. If you have not yet made your tax-deductible* gift for the current campaign, please do so today. Your support, at any level, is important. It will have an impact! Remember, many companies will match your contribution, doubling or even tripling the value of your gift! The success of our fundraising depends on donations and grants from foundations, government, corporations, and many generous individuals. Often contributions are made “In Memory/Honor” of someone or for a Special Occasion in lieu of sending flowers. Contributions are acknowledged with a Charitable Donation receipt for tax purposes, and names will appear on our website. Checks should be made payable to the Georgia Pharmacy Foundation, a 501(c)(3) organization. (*As provided by law)

Giving back is the best way to keep our profession going forward! Yes! I want to help support the good work of the Georgia Pharmacy Foundatio n by contributing to the 11 t h Annual Giving Campaign with my pledge of: [ ] President’s Circle = $5,000 or more [ ] Gold Partner = $500 - $999 [ ] Partner = $____ - $99

[ ] Eagle = $2,500 - $4,999 [ ] Silver Partner = $250 - $499

[ ] Centurion = $1,000 - $2,499 [ ] Bronze Partner = $100 - $249

Name (Please Print): ____________________________________________________________________________________________________ Company (if applicable): ______________________________________________________________________________________ Address: _____________________________________________________________________________________________________________ City: ______________________________________________________________________ ST _________ Zip _________________ Telephone: (_____) ___________________ Email: __________________________________________________________ [ ] Please check here if you prefer to be listed as an Anonymous contributor. Please indicate if you would like to make your donation a gift “In Memory or Honor of.” If so, please provide name and address where the gift card/notification should be sent: (Please Print) [ ] In Memory of _______________________________________________________________________________ [ ] In Honor of _________________________________________________________________________________ Send notification to: __________________________________________________________________________________________ Address: __________________________________________________________________________________________ __________________________________________________________________________________________ DON’T FORGET, you can also make your gift online at WWW.GPHA.ORG. Please apply my contribution as indicated:

[ ] Unrestricted Funds – Foundation to determine where funds are most needed. [ ] Foundation Scholarships (Please, minimum of $50.00 for this selection. Thank you.)

[ ] Enclosed is check payable to Georgia Pharmacy Foundation for $__________ OR [ ] Bill my credit card for $____________ (If you prefer to pay by installments, please indicate which one: [ ] Monthly or [ ] Quarterly. A separate form will be sent to you for completion.) Please circle one: AmEx Visa M/C Disc.)

Card #:_____________________________________________

Security

#: _____

Exp.Date: _____

If name on credit card and/or the billing address are different from above, please provide that information below: Name ______________________________________________________________________________________________________________________

o t r o w c o k H

Enroll At RxAlly, we believe that personalized pharmacist care can lead to better health outcomes. You are a pivotal player in the health of patients, particularly those facing chronic illnesses and taking multiple medications. RxAlly offers you the opportunity to: • Enhance your role as a health care provider • Access market opportunities through a national network • Participate in clinical service programs • Expand into new patient care niches • Be compensated for an array of professional services • Transform pharmacy practice in the U.S. RxAlly has brought together the nation’s leading independent pharmacy organizations, regional chains and Walgreens, to form a performance network of community pharmacies nationwide.

How do I Enroll? • Go to www.rxAlly.com/enroll. • Enter your contact information. • Select your role as “Pharmacy owner/officer”. Enter your NCPDP number. • Then, you will see another box with your affiliation(s) listed. If you have more than one affiliation, select “AIP”. • Click “submit” button. • Review and confirm your acceptance of the Pharmacy Network Agreement by checking the box at the bottom of the agreement and clicking the “confirm” button. • You will see a Network Enrollment Confirmation screen indicating that you have successfully enrolled. • Within a few days you will receive an enrollment confirmation email that includes your pharmacy name, NCPDP number and selected affiliation.

It’s good for your patients, and good for your business. Join the revolution today at www.rxAlly.com/enroll

Address: _______________________________________________________ City: _______________________________ St:______ Zip: __________ Signature: ________________________________________________________________________

14

Today’s Date: ______________

The Georgia Pharmacy Journal

Visit RxAlly.com

Email network@RxAlly.com

Call 1-855-RxAlly-1

©2012 RxAlly, Inc. All rights reserved. RxAlly, the RxAlly logo, and other trademarks, service marks, and designs are registered or unregistered trademarks of RxAlly. 3/12


Call for GPhA Awards!

The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA

138th Annual Convention in 2013. A brief description and criteria of each award is included below. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 1, 2013. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at GPhA’s 138th Annual Convention at the Omni Amelia Island Plantation on Amelia Island, FL.

Bowl of Hygeia Award

Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has an outstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist Award

Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of GPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate in association and community activities, and 2) To annually

recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programs or activities and community service projects.

Distinguished Young Pharmacist

This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.

Generation Rx Champions Award

This award is presented annually to a pharmacist who has demonstrated work with prescription drug abuse. This award gives honor the recipient with a plaque and a $500 to the charity of the recipients choice. Selection Criteria: 1) Nominee must a have demonstrated a committed effort to reduce prescription drug abuse 2) Nominee must be a licensed Georgia Pharmacist. 3) Nominee must be a member of the Georgia Pharmacy Association in the year of the selection.

Innovative Pharmacy Practice

Nominee’s Full Name Home Address

Generation Rx Champions

Nickname City

State

Zip

Practice Site Work Address

City

State

Zip

College/School of Pharmacy List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:

Supporting information:

Thursday, February 14, 2013 The Georgia Railroad Freight Depot - Freight Room (Across from the Capitol Building)

65 Martin Luther King Drive, SE, Atlanta, GA 30335

- Schedule of Events -

*Note: Schedule of events is tentative. We will continue to update you as it becomes permanent.

6:00 am - Registration and Exhibit Hall Opens with Coffee 6:30 am - GPhA Attendee Orientation 7:00 am - Breakfast with Your Legislator(s) 8:00 am - Presentation of GPhA Legislator of the Year Award and Closing Remarks 9:15 am - Group Photo on the Capitol Steps 10:00 am - Tour of the Georgia Capitol Building Special GPhA Recognitions to Be Made by Georgia House and Senate Members Plan to wear white coat and make your presence known at the Capitol. Parking directions available online.

Submitted by (optional):

Registration Coming Soon!

Submit this form completed by March 1, 2013 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

16

VIP Day

Innovative Pharmacy Practice Award

2013 Awards Nomination Form Bowl of Hygeia

Join Us For

The Georgia Pharmacy Journal


Call for GPhA Awards!

The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA

138th Annual Convention in 2013. A brief description and criteria of each award is included below. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 1, 2013. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at GPhA’s 138th Annual Convention at the Omni Amelia Island Plantation on Amelia Island, FL.

Bowl of Hygeia Award

Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has an outstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist Award

Created in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one of GPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate in association and community activities, and 2) To annually

recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programs or activities and community service projects.

Distinguished Young Pharmacist

This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.

Generation Rx Champions Award

This award is presented annually to a pharmacist who has demonstrated work with prescription drug abuse. This award gives honor the recipient with a plaque and a $500 to the charity of the recipients choice. Selection Criteria: 1) Nominee must a have demonstrated a committed effort to reduce prescription drug abuse 2) Nominee must be a licensed Georgia Pharmacist. 3) Nominee must be a member of the Georgia Pharmacy Association in the year of the selection.

Innovative Pharmacy Practice

Nominee’s Full Name Home Address

Generation Rx Champions

Nickname City

State

Zip

Practice Site Work Address

City

State

Zip

College/School of Pharmacy List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:

Supporting information:

Thursday, February 14, 2013 The Georgia Railroad Freight Depot - Freight Room (Across from the Capitol Building)

65 Martin Luther King Drive, SE, Atlanta, GA 30335

- Schedule of Events -

*Note: Schedule of events is tentative. We will continue to update you as it becomes permanent.

6:00 am - Registration and Exhibit Hall Opens with Coffee 6:30 am - GPhA Attendee Orientation 7:00 am - Breakfast with Your Legislator(s) 8:00 am - Presentation of GPhA Legislator of the Year Award and Closing Remarks 9:15 am - Group Photo on the Capitol Steps 10:00 am - Tour of the Georgia Capitol Building Special GPhA Recognitions to Be Made by Georgia House and Senate Members Plan to wear white coat and make your presence known at the Capitol. Parking directions available online.

Submitted by (optional):

Registration Coming Soon!

Submit this form completed by March 1, 2013 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

16

VIP Day

Innovative Pharmacy Practice Award

2013 Awards Nomination Form Bowl of Hygeia

Join Us For

The Georgia Pharmacy Journal


Thanks To All Our Supporters

New Contributors are Highlighted in Yellow.

Diamond Level

$4,800 minimum pledge Cynthia K. Moon

Titanium Level

$2,400 minimum pledge T.M. Bridges, R.Ph. Ben Cravey, R.Ph. Michael E. Farmer, R.Ph. David B. Graves, R.Ph. Raymond G Hickman, R.Ph. Ted M. Hunt, R.Ph. Robert A. Ledbetter, R.Ph. Jeffrey L. Lurey, R.Ph. Marvin O. McCord, R.Ph. Scott Meeks, R.Ph. Judson Mullican, R.Ph. Mark Parris, Pharm.D. Loren B. Pierce, R.Ph. Fred F. Sharpe, R.Ph. Jeff Sikes, R.Ph. Dean Stone, R.Ph., CDM

Platinum Level

$1,200 minimum pledge Ralph W. Balchin, R.Ph. Robert Bowles, Jr., R.Ph., CDM, Cfts Jim R. Bracewell Thomas E. Bryan Jr., R.Ph. William G. Cagle, R.Ph. Hugh M. Chancy, R.Ph. Keith E. Chapman, R.Ph. Dale M. Coker, R.Ph., FIACP John Ashley Dukes, R.Ph. Jack Dunn, Jr. R.Ph. 18

Neal Florence, R.Ph. Andy Freeman Martin T. Grizzard, R.Ph. Robert M. Hatton, Pharm.D. Ted Hunt, R.Ph. Alan M. Jones, R.Ph. Ira Katz, R.Ph. Hal M. Kemp, Pharm.D. George B. Launius, R.Ph. Brandall S. Lovvorn, Pharm.D. Eddie M. Madden, R.Ph. Jonathan Marquess, Pharm.D., CDE, CPT Pam Marquess, Pharm.D. Kenneth A. McCarthy, R.Ph. Drew Miller, R.Ph., CDM Laird Miller, R.Ph. Jay Mosley, R.Ph. Allen Partridge, R.Ph. Houston Lee Rogers, Pharm.D., CDM Tim Short, R.Ph. Benjamin Lake Stanley, Pharm.D. Danny Toth, R.Ph. Christopher Thurmond, Pharm.D. Tommy Whitworth, R.Ph.,CDM

Gold Level

$600 minimum pledge James Bartling, Pharm.D., ADC, CACII William F. Brewster, R.Ph. Bruce L. Broadrick, Sr., R.Ph. Liza G. Chapman, Pharm.D.

Craig W. Cocke, R.Ph. J. Ernie Culpepper, R.Ph. Mahlon Davidson, R.Ph., CDM Benjamin Keith Dupree, Sr., R.Ph Kevin M. Florence, Pharm.D. Kerry A. Griffin, R.Ph. James Jordan, Pharm.D. Ed Kalvelage John D. Kalvelage Steve D. Kalvelage Marsha C. Kapiloff, R.Ph. Earl W. Marbut, R.Ph. John W. McKinnon, Jr., R.Ph. Robert B. Moody, R.Ph. Sherri S. Moody, Pharm.D. William A. Moye, R.Ph. Anthony Boyd Ray, R.Ph. Jeffrey Grady Richardson, R.Ph. Andy Rogers, R.Ph. Daniel C. Royal, Jr., R.Ph. John Thomas Sherrer, R.Ph. Sharon Mills Sherrer, Pharm.D. Michael T. Tarrant Mark H. White, R.Ph. Henry Dallas Wilson, III, Pharm.D.

Silver Level

$300 minimum pledge Renee D. Adamson, Pharm.D. Ed Stevens Dozier, R.Ph. Terry Dunn, R.Ph. Charles Alan Earnest, R.Ph. Marshall L. Frost, Pharm.D. Johnathan Wyndell Hamrick, Pharm.D. James A. Harris, Jr., R.Ph. The Georgia Pharmacy Journal

Michael O. Iteogu, Pharm.D. Joshua D. Kinsey, Pharm.D. Willie O. Latch, R.Ph. Kalen Porter Manasco, Pharm.D. Michael L. McGee, R.Ph. William J. McLeer, R.Ph. Sheri D. Mills, C.Ph.T. Richard Noell, R.Ph. Leslie Ernest Ponder, R.Ph. William Lee Prather, R.Ph. Kristy Lanford Pucylowski, Pharm.D. Ola Reffell, R.Ph. Edward Franklin Reynolds, R.Ph. Sukhmani Kaur Sarao, Pharm.D. David J. Simpson, R.Ph. James N. Thomas, R.Ph. Archie R. Thompson, Jr., R.Ph. Alex S. Tucker, Pharm.D. William H. Turner, R.Ph. Flynn W. Warren, M.S., R.Ph. Walter Alan White, R.Ph. Charles W. Wilson, Jr., R.Ph. Steve Wilson, Pharm.D. William T. Wolfe, R.Ph. Sharon Zerillo, R.Ph.

Bronze Level

$150 minimum pledge Sylvia Ann Davis Adams,R.Ph. Monica M. Ali-Warren, R.Ph. Julie Wickman Bierster, Pharm.D. Nicholas O. Bland, Pharm.D. Lance P. Boles, R.Ph. Michael A. Crooks, Pharm.D. William Crowley, R.Ph. Rabun E. Deckle, Pharm.D. Helen DuBiner, Pharm.D. Charles Alan Earnest, R.Ph. Vaspar Eddings, R.Ph. Randall W. Ellison, R.Ph. The Georgia Pharmacy Journal

Mary Ashley Faulk, Pharm.D. James W. Fetterman, Jr., Pharm.D. Amanda R. Gaddy, R.Ph. Charles C. Gass, R.Ph. Winton C. Harris, Jr., R.Ph. Lura Elizabeth Jarrett, Pharm.D. Anabelle D. Keohane, Pharm.D. Brenton Lake, R.Ph. Allison L. Layne, C.Ph.T. William E. Lee, R.Ph. Tracie D. Lunde, Pharm.D. Michael Lewis, Pharm.D. Ashley Sherwood London Shad Jason Sutherland Max A. Mason, R.Ph. Amanda McCall, Pharm.D. Susan W. McLeer, R.Ph. Sheila D. Miller, R.Ph. Natalie Nielsen Amanda Rose Paisley, Pharm.D. Rose Pinkstaff, R.Ph. Sara W. Reece Pharm.D., BC-ADM, CDE Leonard Franklin Reynolds, R.Ph. Don K. Richie, R.Ph. Laurence Neil Ryan, Pharm.D. Richard Brian Smith, R.Ph. Benjamin Lake Stanley, Pharm.D. Dana E. Strickland, R.Ph. Charles Storey, III, R.Ph. Archie Thompson, Jr., R.Ph. William C. Thompson, R.Ph. G.H. Thurmond, R.Ph. Carrie-Anne Wilson Max Wilson Sharon B. Zerillo, R.Ph. Christy Zwygart, Pharm.D.

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Members

No minimum pledge G.M. Atkinson, R.Ph. 19


Thanks To All Our Supporters

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Michael O. Iteogu, Pharm.D. Joshua D. Kinsey, Pharm.D. Willie O. Latch, R.Ph. Kalen Porter Manasco, Pharm.D. Michael L. McGee, R.Ph. William J. McLeer, R.Ph. Sheri D. Mills, C.Ph.T. Richard Noell, R.Ph. Leslie Ernest Ponder, R.Ph. William Lee Prather, R.Ph. Kristy Lanford Pucylowski, Pharm.D. Ola Reffell, R.Ph. Edward Franklin Reynolds, R.Ph. Sukhmani Kaur Sarao, Pharm.D. David J. Simpson, R.Ph. James N. Thomas, R.Ph. Archie R. Thompson, Jr., R.Ph. Alex S. Tucker, Pharm.D. William H. Turner, R.Ph. Flynn W. Warren, M.S., R.Ph. Walter Alan White, R.Ph. Charles W. Wilson, Jr., R.Ph. Steve Wilson, Pharm.D. William T. Wolfe, R.Ph. Sharon Zerillo, R.Ph.

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$150 minimum pledge Sylvia Ann Davis Adams,R.Ph. Monica M. Ali-Warren, R.Ph. Julie Wickman Bierster, Pharm.D. Nicholas O. Bland, Pharm.D. Lance P. Boles, R.Ph. Michael A. Crooks, Pharm.D. William Crowley, R.Ph. Rabun E. Deckle, Pharm.D. Helen DuBiner, Pharm.D. Charles Alan Earnest, R.Ph. Vaspar Eddings, R.Ph. Randall W. Ellison, R.Ph. The Georgia Pharmacy Journal

Mary Ashley Faulk, Pharm.D. James W. Fetterman, Jr., Pharm.D. Amanda R. Gaddy, R.Ph. Charles C. Gass, R.Ph. Winton C. Harris, Jr., R.Ph. Lura Elizabeth Jarrett, Pharm.D. Anabelle D. Keohane, Pharm.D. Brenton Lake, R.Ph. Allison L. Layne, C.Ph.T. William E. Lee, R.Ph. Tracie D. Lunde, Pharm.D. Michael Lewis, Pharm.D. Ashley Sherwood London Shad Jason Sutherland Max A. Mason, R.Ph. Amanda McCall, Pharm.D. Susan W. McLeer, R.Ph. Sheila D. Miller, R.Ph. Natalie Nielsen Amanda Rose Paisley, Pharm.D. Rose Pinkstaff, R.Ph. Sara W. Reece Pharm.D., BC-ADM, CDE Leonard Franklin Reynolds, R.Ph. Don K. Richie, R.Ph. Laurence Neil Ryan, Pharm.D. Richard Brian Smith, R.Ph. Benjamin Lake Stanley, Pharm.D. Dana E. Strickland, R.Ph. Charles Storey, III, R.Ph. Archie Thompson, Jr., R.Ph. William C. Thompson, R.Ph. G.H. Thurmond, R.Ph. Carrie-Anne Wilson Max Wilson Sharon B. Zerillo, R.Ph. Christy Zwygart, Pharm.D.

Robert C. Ault, R.Ph. Mary S. Bates, R.Ph. Fred W. Barber, R.Ph. Lucinda F. Burroughs, R.Ph. Henry Cobb, III, R.Ph., CDM Jean N. Courson, R.Ph. Guy Anderson Cox, R.Ph. Carleton C. Crabill, R.Ph. Wendy A. Dorminey, Pharm.D., CDM James Fetterman, Jr., Pharm.D. Charles A. Fulmer, R.Ph. Thomas Bagby Garner Jr., R.Ph. Kimberly Dawn Grubbs, R.Ph. Christopher Gurley, Pharm.D. Fred C. Gurley, R.Ph. Keith Herist, Pharm.D., AAHIVE, CPA William “Woody” Hunt, Jr., RPh Carey B. Jones, R.Ph. Susan M Kane, R.Ph. Randall T. Maret, R.Ph. Ralph K. Marett, R.Ph.,M.S. Darby R. Norman, R.Ph. Christopher Brown Painter, R.Ph. Whitney B. Pickett, R.Ph. Robert J. Probst, Jr. Pharm.D. Terry Donald Shaw, Pharm.D. Negin Sovaidi - Moon Charles Iverson Storey III, R.Ph. James E. Stowe, Jr., R.Ph. James R. Strickland, R.Ph. Carey Austin Vaughan, Pharm.D. Erica Lynn Veasley, R.Ph. William D. Whitaker, R.Ph. Jonathon Williams, Pharm.D. Rogers W. Wood, R.Ph.

Members

No minimum pledge G.M. Atkinson, R.Ph. 19


Association Plans Are DIFFERENT

continuing education for pharmacists Volume XXX, No. 10

Adult Community-Acquired Pneumonia Mona T. Thompson, R.Ph., PharmD

(between ordinary and extraordinary)

Georgia Pharmacy Association proudly sponsors Meadowbrook Insurance Group for your Worker’s Compensation insurance needs.

10%

Workers’ Compensation dividends paid to GPhA members in 2012 For more information about this program, please contact: Ruth Ann McGehee p 404-419-8173 f 404-237-8435 email: rmcgehee@gpha.org

Experience the difference with us... Chosen by your association AM Best “A” rating Dividend plans for members* Superior claims handling Personal customer service representative Free Safety Gear Package Free Safety Meeting Library CD Access to Loss Control Services and much more!

Put our expertise to work for you! *Members must meet eligibility requirements

Dr. Mona T. Thompson has no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide a review of adult community-acquired pneumonia (CAP) to include a disease state overview, outpatient treatment recommendations, and vaccine prevention information. Objectives. At the completion of

this activity, the participant will be able to: 1. demonstrate an understanding of basic pathophysiology of pneumonia and the pathogens that are most often responsible for CAP; 2. list antibiotics prescribed for empiric outpatient treatment of CAP; and identify key patient counseling points associated with them; 3. recognize measures that may be taken to reduce the risk of pneumonia, including vaccines; and 4. compare and contrast pneumococcal vaccines and recommendations for use in adults.

Definition of Pneumonia

Pneumonia, an infection of the lung parenchyma, is generally divided into three major types. The classification is important as it defines the likely pathogens causing disease and influences the treatment course. Community-acquired pneumonia (CAP) is defined as pneumonia that is diagnosed in patients living independently in the community. It also encompasses patients who were hospitalized for other medical reasons for less than

The Georgia Pharmacy Journal

48 hours before the development of respiratory symptoms, because it is likely that pathogen exposure occurred prior to admission. The other two types of pneumonia are considered to be hospital-acquired. Healthcare-associated pneumonia (HCAP) is reserved for patients who have been previously hospitalized for at least two days within 90 days before infection; patients from nursing homes who received intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days; and patients from hemodialysis centers. The third type, ventilator-associated pneumonia (VAP), is designated for patients who develop disease more than 48 hours after placement of endotracheal intubation and mechanical ventilation. The remainder of this lesson will focus on adult CAP and outpatient management.

Epidemiology

Community-acquired pneumonia is the seventh leading cause of death in the U.S., as well as the leading cause of death from infectious disease. Most cases of CAP are managed in the outpatient setting. Mortality rates range from less than 5 percent in mild cases to greater than 12 percent in hospitalized patients. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia, and more than 50,000 people died from the disease. The majority of these deaths occurred in elderly or immunosuppressed patients. The incidence of pneumonia is expected to increase as the percentage of the population older than

age 65 years continues to rise. The number of individuals taking immunosuppressive drugs is also on the rise and contributory.

Pathophysiology

Healthy lungs are extremely resistant to infection and virtually sterile due to numerous innate host defenses. This is evident as approximately 10,000 liters of air containing hundreds to thousands of microorganisms per cubic meter pass through the respiratory tract daily and fail to cause disease. Host defenses include an epithelial barrier and cough and laryngeal reflexes that prevent the introduction of pathogens, as well as phagocytes that respond by removing pathogens and their products from the lungs. The development of clinical pneumonia requires a failure in host defenses, along with the presence of virulent organisms, followed by the introduction of these organisms into the lungs. If the infectious organism reaches the alveoli and begins replicating, a series of host immune responses occurs that lead to the development of clinical pneumonia. In patients who have weak host defenses, only a minimal challenge is needed to develop pneumonia. Microaspiration of oropharyngeal contents during sleep, in otherwise healthy individuals, is a common mechanism for inoculating the lungs with pathogenic organisms. Streptococcus pneumoniae is the most common aerobic organism found in the mouth. It is often colonized in the oral pharynx and, thus, has the potential to infect the lungs. S. pneumoniae is the most

21


Association Plans Are DIFFERENT

continuing education for pharmacists Volume XXX, No. 10

Adult Community-Acquired Pneumonia Mona T. Thompson, R.Ph., PharmD

(between ordinary and extraordinary)

Georgia Pharmacy Association proudly sponsors Meadowbrook Insurance Group for your Worker’s Compensation insurance needs.

10%

Workers’ Compensation dividends paid to GPhA members in 2012 For more information about this program, please contact: Ruth Ann McGehee p 404-419-8173 f 404-237-8435 email: rmcgehee@gpha.org

Experience the difference with us... Chosen by your association AM Best “A” rating Dividend plans for members* Superior claims handling Personal customer service representative Free Safety Gear Package Free Safety Meeting Library CD Access to Loss Control Services and much more!

Put our expertise to work for you! *Members must meet eligibility requirements

Dr. Mona T. Thompson has no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide a review of adult community-acquired pneumonia (CAP) to include a disease state overview, outpatient treatment recommendations, and vaccine prevention information. Objectives. At the completion of

this activity, the participant will be able to: 1. demonstrate an understanding of basic pathophysiology of pneumonia and the pathogens that are most often responsible for CAP; 2. list antibiotics prescribed for empiric outpatient treatment of CAP; and identify key patient counseling points associated with them; 3. recognize measures that may be taken to reduce the risk of pneumonia, including vaccines; and 4. compare and contrast pneumococcal vaccines and recommendations for use in adults.

Definition of Pneumonia

Pneumonia, an infection of the lung parenchyma, is generally divided into three major types. The classification is important as it defines the likely pathogens causing disease and influences the treatment course. Community-acquired pneumonia (CAP) is defined as pneumonia that is diagnosed in patients living independently in the community. It also encompasses patients who were hospitalized for other medical reasons for less than

The Georgia Pharmacy Journal

48 hours before the development of respiratory symptoms, because it is likely that pathogen exposure occurred prior to admission. The other two types of pneumonia are considered to be hospital-acquired. Healthcare-associated pneumonia (HCAP) is reserved for patients who have been previously hospitalized for at least two days within 90 days before infection; patients from nursing homes who received intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days; and patients from hemodialysis centers. The third type, ventilator-associated pneumonia (VAP), is designated for patients who develop disease more than 48 hours after placement of endotracheal intubation and mechanical ventilation. The remainder of this lesson will focus on adult CAP and outpatient management.

Epidemiology

Community-acquired pneumonia is the seventh leading cause of death in the U.S., as well as the leading cause of death from infectious disease. Most cases of CAP are managed in the outpatient setting. Mortality rates range from less than 5 percent in mild cases to greater than 12 percent in hospitalized patients. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia, and more than 50,000 people died from the disease. The majority of these deaths occurred in elderly or immunosuppressed patients. The incidence of pneumonia is expected to increase as the percentage of the population older than

age 65 years continues to rise. The number of individuals taking immunosuppressive drugs is also on the rise and contributory.

Pathophysiology

Healthy lungs are extremely resistant to infection and virtually sterile due to numerous innate host defenses. This is evident as approximately 10,000 liters of air containing hundreds to thousands of microorganisms per cubic meter pass through the respiratory tract daily and fail to cause disease. Host defenses include an epithelial barrier and cough and laryngeal reflexes that prevent the introduction of pathogens, as well as phagocytes that respond by removing pathogens and their products from the lungs. The development of clinical pneumonia requires a failure in host defenses, along with the presence of virulent organisms, followed by the introduction of these organisms into the lungs. If the infectious organism reaches the alveoli and begins replicating, a series of host immune responses occurs that lead to the development of clinical pneumonia. In patients who have weak host defenses, only a minimal challenge is needed to develop pneumonia. Microaspiration of oropharyngeal contents during sleep, in otherwise healthy individuals, is a common mechanism for inoculating the lungs with pathogenic organisms. Streptococcus pneumoniae is the most common aerobic organism found in the mouth. It is often colonized in the oral pharynx and, thus, has the potential to infect the lungs. S. pneumoniae is the most

21


Continuing Education microorganisms. These pathogens include Mycobacterium tuberculosis, Legionella pneuPatient Population Etiology mophila, Yersinia pestis (plague), and Outpatient Streptococcus pneumoniae Bacillus anthracis Mycoplasma pneumoniae (anthrax). Viral Haemophilus influenzae Chlamydophila pneumoniae pneumonia is also Respiratory viruses** transmitted in this way. The preInpatient (non-ICU) Streptococcus pneumoniae dominant respiraMycoplasma pneumoniae tory viruses include Chlamydophila pneumoniae various influenza Haemophilus influenzae viruses and respiraLegionella species tory syncytial virus Aspiration (RSV). In addition, Respiratory viruses** viral infections of Inpatient (ICU) Streptococcus pneumoniae the respiratory tract Staphylococcus aureus may destroy the Legionella species epithelial barrier Gram-negative bacilli and predispose the Haemophilus influenzae lungs to secondary bacterial infection. *listed by decreasing frequency of occurrence The increased risk of **Influenza A and B, adenovirus, RSV, and parainfluenza bacterial pneumonia From IDSA/ATS Guidelines for CAP in Adults 2007 following influenza infection is well established. (See Table 1.) common blood culture isolate in all There are also specific epidemiCAP studies. Staphylococci, Haeologic conditions and/or risk factors mophilus sp, Moraxella catarrhalis, that have been found to be related and Neisseria sp are also aerobic to specific pathogens in CAP. For organisms found in the mouth. instance, patients with alcoholBacteroides and Fusobacterium spp ism are commonly infected with are the most common anaerobic S. pneumoniae, oral anaerobes, organisms. Klebsiella pneumoniae, AcinetoAlternatively, gross aspiration bacter species, and Mycobacterium may occur in patients with altered tuberculosis. Pathogens associated levels of consciousness (i.e., intoxiwith patients who smoke or have cation, stroke, seizure, and anesCOPD are Haemophilus influenzae, thesia) due to suppressed protecPseudomonas aeruginosa, Legioneltive airway reflexes. Interventions la species, S. pneumoniae, Moraxelthat bypass the usual defenses, la catarrhalis, and Chlamydophila such as endotracheal intubation, pneumoniae. Correlations have also nasogastric intubation, and respibeen made in patients with HIV, ratory therapy devices, also predisrecent travel, or exposure to certain pose the lower tract to infection. animals (e.g., bats, birds, rabbits, Hospitalized patients with or other farm animals). severe CAP are more likely to be infected with pathogens other Symptoms and Diagnosis of than S. pneumoniae, including S. Pneumonia aureus, P. aeruginosa, and other The classical symptoms seen with gram-negative bacilli. acute CAP are cough, dyspnea and The second most common fever. Other symptoms include mechanism for lung infections sputum production and pleuritic is the inhalation of small aerochest pain. In addition to suggessolized droplets that may contain tive clinical features, an infiltrate

Table 1 Most common etiologies of community-acquired pneumonia*

22

Continuing Education by chest radiograph or other imaging technique is needed to confirm a diagnosis of pneumonia. Upon physical examination, rales or bronchial breath sounds may be heard, but are not specific to a diagnosis of pneumonia. Elderly patients often present with confusion and nonspecific findings. Additional diagnostic testing such as blood and sputum cultures is optional when treating outpatients. However, guidelines established by the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) specify testing to be conducted in hospitalized patients, and is most strongly indicated in those with severe CAP. Testing for influenza is logical when the symptoms are present during the proper season and in the company of an epidemic. Influenza testing is justifiable considering availability of point of care diagnostic testing and antiviral therapies. Clinicians utilize the initial assessment of the severity of disease to consider whether the patient diagnosed with CAP should be treated as an outpatient or inpatient. Tools such as the CURB-65 (confusion, uremia, respiratory rate, low blood pressure, and 65 years or greater) or Pneumonia Severity Index (PSI) can be used to identify patients who are candidates for outpatient treatment. In addition to these objective measurement tools, physicians considering outpatient treatment must also consider the patient’s ability to take oral medication and the availability of outpatient support resources.

Outpatient Treatment of Community-Acquired Pneumonia

The following empirical treatment recommendations are based on IDSA/ATS Consensus Guidelines on the Management of CommunityAcquired Pneumonia in Adults (Table 2). These recommendations are written by class of antibiotics rather than for a specific drug, unless outcome data clearly favors

The Georgia Pharmacy Journal

Table 2 Empirical outpatient treatment of CAP* Previously healthy and no risk factors for DRSP infection: 1. A macrolide (azithromycin, clarithromycin, or erythromycin) or 2. Doxycycline Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous three months (in which case an alternative from a different class should be selected); or other risk factors for DRSP infection: 1. A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin 750mg) or 2. A beta-lactam plus a macrolide (amoxicillin 1 gram three times a day or amoxicillin-clavulanate 2 grams two times a day is preferred; alternatives include ceftriaxone, cefpodoxime, and cefuroxime). Doxycycline is an alternative to the macrolide. *Chart adapted from IDSA/ATS Guidelines for CAP in Adults 2007

one drug. For outpatient CAP, the recommendations were established based on the presence or absence of drug resistant S. pneumoniae (DRSP). While drug-resistant pneumococcal isolates are well documented, the resistance patterns vary by geography. Therefore, practitioners should be aware of their local resistance patterns when selecting antibiotic therapy. In addition, in this 2007 guideline document, IDSA/ATS state that resistance to penicillin and cephalosporins may be decreasing, while macrolide resistance continues to rise. In regions with a high rate (>25 percent) of infection with high-level (MIC>16 mcg/mL) macrolide-resistant S. pneumoniae, the alternative agents are recommended for all patients, including those who do not have comorbidities. According to the IDSA/ATS

The Georgia Pharmacy Journal

guidelines, patients with CAP should be treated for a minimum of five days, should be afebrile for 48 to 72 hours, and should have no more than one CAP-associated sign of instability (stability measured by assessing various vital signs, ability to maintain oral intake, and normal mental status) before discontinuing therapy. A longer duration may be needed if initial therapy was not active against the pathogen, or if therapy was complicated by an extrapulmonary infection. The guidelines also recognize that most patients are treated for seven to 10 days, or even longer as few well-controlled trials have evaluated the most favorable length of treatment. Azithromycin has a long half-life at respiratory sites of infection, and it is given for only one to five days.

Review of Select Antibiotics Commonly Prescribed for the Treatment of CAP

Macrolides are commonly prescribed for CAP due to their activity against S. pneumoniae and the atypical pathogens (M. pneumoniae, C. pneumoniae, Legionella pneumophila). This class includes erythromycin, clarithromycin, and azithromycin. Erythromycin is the least expensive, but is not often used due to gastrointestinal intolerance and lack of activity against H. influenzae. Azithromycin is preferred for outpatients with comorbidities such as COPD because of its activity against H. influenzae. All three antibiotics in this class have been associated with QT prolongation and should be used with caution in patients with an increased risk of arrhythmia or taking multiple medications that can prolong the QT interval. For CAP, azithromycin is commonly prescribed as a Z-pak® which is a regimen consisting of 500mg on day 1, followed by 250mg on days 2 to 5. Alternatively, extended-release suspension formulation (Zmax®) is also approved as a 2 gram single dose. While the 250mg and 500mg tablets are

bioequivalent and interchangeable, the 2 gram extended-release suspension is not, and should not be substituted for tablets. The tablets may be administered without regard to food. The oral suspension should be taken on an empty stomach (at least one hour before or two hours following a meal). Azithromycin does not generally require dosing adjustments in the presence of renal impairment. Specific guidelines are not available for dosing in hepatic impairment; however, rare hepatotoxicity has occurred. It is classified as pregnancy Category B. Azithromycin does enter breastmilk and should be used with caution. Limited literature reports indicate that the amount excreted is minimal and has not resulted in adverse events. The recommended regimen for clarithromycin (Biaxin®) when treating CAP due to C. pneumoniae, M. pneumoniae, and S. pneumoniae is 250mg (immediate-release tablet) every 12 hours for seven to 14 days or 1000mg (extendedrelease tablet) once daily for seven days. For H. influenzae, either formulation may be used and treatment is needed for seven days only. When treating H. parainfluenzae and M. catarrhalis, 1000mg (extended-release tablet) once daily for seven days is approved. The immediate-release tablets and oral suspension may be given with or without food, and should be given every 12 hours rather than twice daily to avoid peak and trough concentration variations. The extended-release tablets should be given with food, and should not be crushed or chewed. Renal dosing adjustments are required when the creatinine clearance (CrCl) is <30mL/min (or less than 60mL/min when given in combination with atazanavir or ritonavir). Clarithromycin is a strong CYP3A4 inhibitor and has several major drug interactions rendering a thorough medication profile review when it is prescribed. It is classified as pregnancy Category C, and should be used with caution with breastfeeding as excretion is unknown.

23


Continuing Education microorganisms. These pathogens include Mycobacterium tuberculosis, Legionella pneuPatient Population Etiology mophila, Yersinia pestis (plague), and Outpatient Streptococcus pneumoniae Bacillus anthracis Mycoplasma pneumoniae (anthrax). Viral Haemophilus influenzae Chlamydophila pneumoniae pneumonia is also Respiratory viruses** transmitted in this way. The preInpatient (non-ICU) Streptococcus pneumoniae dominant respiraMycoplasma pneumoniae tory viruses include Chlamydophila pneumoniae various influenza Haemophilus influenzae viruses and respiraLegionella species tory syncytial virus Aspiration (RSV). In addition, Respiratory viruses** viral infections of Inpatient (ICU) Streptococcus pneumoniae the respiratory tract Staphylococcus aureus may destroy the Legionella species epithelial barrier Gram-negative bacilli and predispose the Haemophilus influenzae lungs to secondary bacterial infection. *listed by decreasing frequency of occurrence The increased risk of **Influenza A and B, adenovirus, RSV, and parainfluenza bacterial pneumonia From IDSA/ATS Guidelines for CAP in Adults 2007 following influenza infection is well established. (See Table 1.) common blood culture isolate in all There are also specific epidemiCAP studies. Staphylococci, Haeologic conditions and/or risk factors mophilus sp, Moraxella catarrhalis, that have been found to be related and Neisseria sp are also aerobic to specific pathogens in CAP. For organisms found in the mouth. instance, patients with alcoholBacteroides and Fusobacterium spp ism are commonly infected with are the most common anaerobic S. pneumoniae, oral anaerobes, organisms. Klebsiella pneumoniae, AcinetoAlternatively, gross aspiration bacter species, and Mycobacterium may occur in patients with altered tuberculosis. Pathogens associated levels of consciousness (i.e., intoxiwith patients who smoke or have cation, stroke, seizure, and anesCOPD are Haemophilus influenzae, thesia) due to suppressed protecPseudomonas aeruginosa, Legioneltive airway reflexes. Interventions la species, S. pneumoniae, Moraxelthat bypass the usual defenses, la catarrhalis, and Chlamydophila such as endotracheal intubation, pneumoniae. Correlations have also nasogastric intubation, and respibeen made in patients with HIV, ratory therapy devices, also predisrecent travel, or exposure to certain pose the lower tract to infection. animals (e.g., bats, birds, rabbits, Hospitalized patients with or other farm animals). severe CAP are more likely to be infected with pathogens other Symptoms and Diagnosis of than S. pneumoniae, including S. Pneumonia aureus, P. aeruginosa, and other The classical symptoms seen with gram-negative bacilli. acute CAP are cough, dyspnea and The second most common fever. Other symptoms include mechanism for lung infections sputum production and pleuritic is the inhalation of small aerochest pain. In addition to suggessolized droplets that may contain tive clinical features, an infiltrate

Table 1 Most common etiologies of community-acquired pneumonia*

22

Continuing Education by chest radiograph or other imaging technique is needed to confirm a diagnosis of pneumonia. Upon physical examination, rales or bronchial breath sounds may be heard, but are not specific to a diagnosis of pneumonia. Elderly patients often present with confusion and nonspecific findings. Additional diagnostic testing such as blood and sputum cultures is optional when treating outpatients. However, guidelines established by the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) specify testing to be conducted in hospitalized patients, and is most strongly indicated in those with severe CAP. Testing for influenza is logical when the symptoms are present during the proper season and in the company of an epidemic. Influenza testing is justifiable considering availability of point of care diagnostic testing and antiviral therapies. Clinicians utilize the initial assessment of the severity of disease to consider whether the patient diagnosed with CAP should be treated as an outpatient or inpatient. Tools such as the CURB-65 (confusion, uremia, respiratory rate, low blood pressure, and 65 years or greater) or Pneumonia Severity Index (PSI) can be used to identify patients who are candidates for outpatient treatment. In addition to these objective measurement tools, physicians considering outpatient treatment must also consider the patient’s ability to take oral medication and the availability of outpatient support resources.

Outpatient Treatment of Community-Acquired Pneumonia

The following empirical treatment recommendations are based on IDSA/ATS Consensus Guidelines on the Management of CommunityAcquired Pneumonia in Adults (Table 2). These recommendations are written by class of antibiotics rather than for a specific drug, unless outcome data clearly favors

The Georgia Pharmacy Journal

Table 2 Empirical outpatient treatment of CAP* Previously healthy and no risk factors for DRSP infection: 1. A macrolide (azithromycin, clarithromycin, or erythromycin) or 2. Doxycycline Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous three months (in which case an alternative from a different class should be selected); or other risk factors for DRSP infection: 1. A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin 750mg) or 2. A beta-lactam plus a macrolide (amoxicillin 1 gram three times a day or amoxicillin-clavulanate 2 grams two times a day is preferred; alternatives include ceftriaxone, cefpodoxime, and cefuroxime). Doxycycline is an alternative to the macrolide. *Chart adapted from IDSA/ATS Guidelines for CAP in Adults 2007

one drug. For outpatient CAP, the recommendations were established based on the presence or absence of drug resistant S. pneumoniae (DRSP). While drug-resistant pneumococcal isolates are well documented, the resistance patterns vary by geography. Therefore, practitioners should be aware of their local resistance patterns when selecting antibiotic therapy. In addition, in this 2007 guideline document, IDSA/ATS state that resistance to penicillin and cephalosporins may be decreasing, while macrolide resistance continues to rise. In regions with a high rate (>25 percent) of infection with high-level (MIC>16 mcg/mL) macrolide-resistant S. pneumoniae, the alternative agents are recommended for all patients, including those who do not have comorbidities. According to the IDSA/ATS

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guidelines, patients with CAP should be treated for a minimum of five days, should be afebrile for 48 to 72 hours, and should have no more than one CAP-associated sign of instability (stability measured by assessing various vital signs, ability to maintain oral intake, and normal mental status) before discontinuing therapy. A longer duration may be needed if initial therapy was not active against the pathogen, or if therapy was complicated by an extrapulmonary infection. The guidelines also recognize that most patients are treated for seven to 10 days, or even longer as few well-controlled trials have evaluated the most favorable length of treatment. Azithromycin has a long half-life at respiratory sites of infection, and it is given for only one to five days.

Review of Select Antibiotics Commonly Prescribed for the Treatment of CAP

Macrolides are commonly prescribed for CAP due to their activity against S. pneumoniae and the atypical pathogens (M. pneumoniae, C. pneumoniae, Legionella pneumophila). This class includes erythromycin, clarithromycin, and azithromycin. Erythromycin is the least expensive, but is not often used due to gastrointestinal intolerance and lack of activity against H. influenzae. Azithromycin is preferred for outpatients with comorbidities such as COPD because of its activity against H. influenzae. All three antibiotics in this class have been associated with QT prolongation and should be used with caution in patients with an increased risk of arrhythmia or taking multiple medications that can prolong the QT interval. For CAP, azithromycin is commonly prescribed as a Z-pak® which is a regimen consisting of 500mg on day 1, followed by 250mg on days 2 to 5. Alternatively, extended-release suspension formulation (Zmax®) is also approved as a 2 gram single dose. While the 250mg and 500mg tablets are

bioequivalent and interchangeable, the 2 gram extended-release suspension is not, and should not be substituted for tablets. The tablets may be administered without regard to food. The oral suspension should be taken on an empty stomach (at least one hour before or two hours following a meal). Azithromycin does not generally require dosing adjustments in the presence of renal impairment. Specific guidelines are not available for dosing in hepatic impairment; however, rare hepatotoxicity has occurred. It is classified as pregnancy Category B. Azithromycin does enter breastmilk and should be used with caution. Limited literature reports indicate that the amount excreted is minimal and has not resulted in adverse events. The recommended regimen for clarithromycin (Biaxin®) when treating CAP due to C. pneumoniae, M. pneumoniae, and S. pneumoniae is 250mg (immediate-release tablet) every 12 hours for seven to 14 days or 1000mg (extendedrelease tablet) once daily for seven days. For H. influenzae, either formulation may be used and treatment is needed for seven days only. When treating H. parainfluenzae and M. catarrhalis, 1000mg (extended-release tablet) once daily for seven days is approved. The immediate-release tablets and oral suspension may be given with or without food, and should be given every 12 hours rather than twice daily to avoid peak and trough concentration variations. The extended-release tablets should be given with food, and should not be crushed or chewed. Renal dosing adjustments are required when the creatinine clearance (CrCl) is <30mL/min (or less than 60mL/min when given in combination with atazanavir or ritonavir). Clarithromycin is a strong CYP3A4 inhibitor and has several major drug interactions rendering a thorough medication profile review when it is prescribed. It is classified as pregnancy Category C, and should be used with caution with breastfeeding as excretion is unknown.

23


Continuing Education Doxycycline is a cost-effective alternative to a macrolide and is prescribed as 100mg twice daily. When administered with food, absorption may be decreased by up to 20 percent, but administration on an empty stomach is not recommended due to gastrointestinal intolerance. Doxycycline is classified as pregnancy Category D (may cause fetal harm), and is not recommended with breastfeeding. Patients should be advised to avoid prolonged exposure to sunlight or use of tanning beds since photosensitivity reactions may occur. Renal dosing adjustments are not necessary. Amoxicillin, a beta-lactam antibiotic, is dosed at 1 gram three times a day when treating CAP. It may be taken with food, and should be administered every eight hours to reduce fluctuations in the peak and trough concentrations. Renal dosing adjustments are necessary with CrCl <30mL/min. It is classified as pregnancy Category B, and is considered compatible with breastfeeding by the American Academy of Pediatrics (AAP) and World Health Organization (WHO). While a minimal amount is excreted into breastmilk, the concentration is not considered clinically significant. The recommended dose of amoxicillin-clavulanate (Augmentin®) for CAP is 2 grams (extended-release tablet) orally every 12 hours for seven to 10 days. The extended-release tablet should be taken with food to increase absorption and minimize stomach upset. It should not be used in patients with CrCl <30mL/min. Similar to amoxicillin, it is classified as pregnancy Category B, and is considered compatible with breastfeeding according to WHO. However, infants should be monitored for dose-dependent gastrointestinal side effects (thrush, diarrhea) or allergic reactions. Cefpodoxime (Vantin®) is a third generation cephalosporin. The recommended dose is 200mg orally every 12 hours for 14 days, and may be taken with food. In

24

patients with CrCl <30mL/min, the medication should be reduced to 200mg every 24 hours. It is classified as pregnancy Category B, and is not recommended with breastfeeding as small amounts of drug are excreted into milk and infant risk has not been ruled out. Cefdinir (Omnicef®), also a third generation cephalosporin, is prescribed as 300mg twice daily (every 12 hours) for 10 days. Cefdinir may be administered with or without food. The manufacturer recommends that it be separated from antacids or iron supplements by two hours. In patients with CrCl <30mL/min, the dose is reduced to 300mg once daily. No adjustments are required in the presence of hepatic impairment. It is classified as pregnancy Category B, and the excretion into breast milk is unknown. Cefuroxine (Ceftin®) is a second generation cephalosporin that has been effective in treating CAP. It is dosed at 500mg twice daily. Renal dosing adjustments are necessary when the CrCl is less than 10mL/min. It is also classified as pregnancy Category B. It has been found to enter into breastmilk and should be used with caution. The respiratory fluoroquinolones that are recommended for CAP include moxifloxacin, gemifloxacin, and levofloxacin. All three of these have also been associated with QT prolongation, tendon inflammation and/or tendon rupture, and the development of serious hypoglycemia. They are all classified as pregnancy Category C, and are not recommended with breastfeeding. Moxifloxacin (Avelox®) is prescribed as 400mg orally once daily for seven to 14 days. It may be taken without regard to food, but should be given either four hours before or eight hours after products containing magnesium, aluminum, iron, or zinc. Renal and hepatic dosage adjustments are not necessary. Caution should be exercised in patients with hepatic impairment due to the risk of QT prolongation.

Continuing Education Gemifloxacin (Factive®) is dosed as 320mg orally once daily for five to seven days (seven days recommended for multi-drug resistant S. pneumoniae (MDRSP), K. pneumoniae, or M. catarrhalis). Patients with CrCl <40mL/ min or on dialysis should receive only 160mg once daily. No dosage adjustments are required in the presence of hepatic impairment. Gemifloxacin may be taken with or without food, milk, or calcium supplements. It should be taken three hours before or two hours after supplements containing iron, zinc, or magnesium. Levofloxacin (Levaquin®) for CAP may be prescribed as 500mg every 24 hours for seven to 14 days, or 750mg every 24 hours for five days (five-day regimen for MDRSP not established). Product information should be referred to for renal dosing recommendations when CrCl <50mL/min. Levofloxacin tablets may be taken without regard to meals. It should be taken two hours before or two hours after products containing magnesium, aluminum, iron, or zinc. The use of fluoroquinolones to treat outpatients without comorbid conditions or risk factors for DRSP is discouraged due to concern that widespread use may lead to the development of resistance. Many trials and meta-analyses have been conducted comparing fluoroquinolones to standard antibiotics which have resulted in either non-compelling superiority or inconsistent data. Therefore, it is suggested that antibiotic selection be based on side-effects, patient preferences, availability, and cost. Telithromycin (Ketek®) is the first of the ketolide antibiotics, which is derived from the macrolide family. It is active against S. pneumoniae that is resistant to other antibiotics often used for CAP. Trials have demonstrated equivalency to amoxicillin and clarithromycin. However, it has been associated with postmarketing reports of life-threatening hepatotoxicity. This antibiotic was not included in the IDSA/

The Georgia Pharmacy Journal

ATS guidelines since, at the time of publishing, the committee was awaiting further safety evaluation from FDA. It is currently approved for CAP and dosed at 800mg once daily for seven to 10 days. The dose should be reduced to 600mg once daily when CrCl <30mL/min. When renal impairment is accompanied by hepatic impairment, the dose should be further reduced to 400mg once daily. It may be taken with or without food. Telithromycin is also a strong CYP3A4 inhibitor associated with select drug interactions, and may prolong the QT interval. Life-threatening respiratory failure has occurred in patients with myasthenia gravis. It is classified as pregnancy Category C, and excretion in breast milk is unknown.

Prevention of Pneumonia

Several measures may be taken to reduce the risk of lung infection. These include smoking cessation; avoidance of illicit drugs or excess alcohol consumption (may impair consciousness); and optimizing nutritional status, as distinctly underweight or obese patients are also at an increased risk. Following good hygiene practices, such as hand washing, cleaning of surfaces that are touched often, and coughing or sneezing into a tissue or into an elbow or sleeve can also help prevent the spread of respiratory infections. Preventing and treating chronic conditions such as diabetes and HIV/AIDS can also reduce pneumonia risk. In the U.S., there are several vaccines available that prevent bacterial or viral infections that may cause pneumonia. While the remainder of this lesson will focus on the pneumococcal vaccine, other vaccines include influenza (flu), H. influenzae (Hib), pertussis (whooping cough), varicella (chickenpox), and measles.

Pneumococcal Disease Vaccine Prevention

In addition to pneumococcal pneumonia (caused by Streptococcus pneumoniae), this bacterium is also

The Georgia Pharmacy Journal

capable of causing invasive disease such as meningitis or bacteremia. Bacteremia occurs in 25 to 30 percent of patients with pneumococcal pneumonia. Pneumococci cause 13 to 19 percent of all cases of bacterial meningitis in the U.S. While there are over 90 serotypes of pneumococci, the 10 most common types cause over 60 percent of invasive disease. Some pneumococci are encapsulated with a complex polysaccharide surface enabling them to be pathogenic to humans. Protective type specific antibodies are produced in response to the capsular polysaccharide. These antibodies may cross-react with related types, as well as other bacteria, providing protection against additional serotypes. Pneumococcal Polysaccharide Vaccine. The pneumococcal polysaccharide vaccine (PPSV) is made of purified preparations of pneumococcal capsular. The first U.S. vaccine was licensed in 1977 and contained antigen from 14 different types of pneumococcal bacteria. In 1983, the 23-valent polysaccharide vaccine (PPSV23) was licensed and replaced the 14-valent vaccine. The U.S. vaccine is marketed as Pneumovax®-23 by Merck and contains 25mcg of each antigen per 0.5ml dose which is administered either intramuscularly or subcutaneously. More than 80 percent of healthy adults who receive PPSV23 develop antibodies against the serotypes within two to three weeks of vaccination. However, older adults and persons with chronic illnesses or immunodeficiency may not respond as well. The antibodies remain elevated in healthy adults for at least five years, but may decline faster in persons with certain underlying disease. The efficacy may vary based on underlying illnesses, but is overall 60 to 70 percent effective in preventing invasive disease. While it provides protection from invasive pneumonia complications, it has not demonstrated protection against pneumococcal pneumonia. Hence, it should not be referred to as the

“pneumonia vaccine.” Pneumococcal polysaccharide vaccine is recommended for all adults who are 65-years-old and older. It is also recommended for adults age 19 years and older who smoke cigarettes; and for persons between the age of two and 64 years who have chronic illnesses specifically associated with increased risk from pneumococcal infection or who are candidates for or recipients of a cochlear implant. Chronic illnesses include cardiovascular disease, pulmonary disease (including asthma in adults age 19 years and older), diabetes mellitus, alcoholism, cirrhosis, or cerebrospinal fluid leaks. In addition, persons with asymptomatic or symptomatic HIV infection and immunocompromised adults with chronic illnesses specifically associated with increased risk from pneumocccal infection (splenic dysfunction, anatomic asplenia, Hodgkin’s disease, lymphoma, multiple myeloma, chronic renal failure, nephrotic syndrome, or organ transplantation) should receive the vaccine. Lastly, residents of nursing homes or long-term care facilities should also be vaccinated. It is not recommended for patients who have recurrent acute upper respiratory tract infections such as otitis media and sinusitis. The vaccine should not be withheld if the immunization record is unobtainable or patient’s verbal history is uncertain. Persons with uncertain or unknown vaccination status should be vaccinated. Because the relationship between antibody titers and protection from invasive disease is uncertain, the need for revaccination based on serology is inadequate. Also, there is lack of evidence to support improved protection with multiple doses of pneumococcal vaccine. Consequently, the Advisory Committee on Immunization Practices (ACIP) has established the following recommendations for revaccination: routine revaccination of immunocompetent persons is not recommended; a single revaccination five or more years after

25


Continuing Education Doxycycline is a cost-effective alternative to a macrolide and is prescribed as 100mg twice daily. When administered with food, absorption may be decreased by up to 20 percent, but administration on an empty stomach is not recommended due to gastrointestinal intolerance. Doxycycline is classified as pregnancy Category D (may cause fetal harm), and is not recommended with breastfeeding. Patients should be advised to avoid prolonged exposure to sunlight or use of tanning beds since photosensitivity reactions may occur. Renal dosing adjustments are not necessary. Amoxicillin, a beta-lactam antibiotic, is dosed at 1 gram three times a day when treating CAP. It may be taken with food, and should be administered every eight hours to reduce fluctuations in the peak and trough concentrations. Renal dosing adjustments are necessary with CrCl <30mL/min. It is classified as pregnancy Category B, and is considered compatible with breastfeeding by the American Academy of Pediatrics (AAP) and World Health Organization (WHO). While a minimal amount is excreted into breastmilk, the concentration is not considered clinically significant. The recommended dose of amoxicillin-clavulanate (Augmentin®) for CAP is 2 grams (extended-release tablet) orally every 12 hours for seven to 10 days. The extended-release tablet should be taken with food to increase absorption and minimize stomach upset. It should not be used in patients with CrCl <30mL/min. Similar to amoxicillin, it is classified as pregnancy Category B, and is considered compatible with breastfeeding according to WHO. However, infants should be monitored for dose-dependent gastrointestinal side effects (thrush, diarrhea) or allergic reactions. Cefpodoxime (Vantin®) is a third generation cephalosporin. The recommended dose is 200mg orally every 12 hours for 14 days, and may be taken with food. In

24

patients with CrCl <30mL/min, the medication should be reduced to 200mg every 24 hours. It is classified as pregnancy Category B, and is not recommended with breastfeeding as small amounts of drug are excreted into milk and infant risk has not been ruled out. Cefdinir (Omnicef®), also a third generation cephalosporin, is prescribed as 300mg twice daily (every 12 hours) for 10 days. Cefdinir may be administered with or without food. The manufacturer recommends that it be separated from antacids or iron supplements by two hours. In patients with CrCl <30mL/min, the dose is reduced to 300mg once daily. No adjustments are required in the presence of hepatic impairment. It is classified as pregnancy Category B, and the excretion into breast milk is unknown. Cefuroxine (Ceftin®) is a second generation cephalosporin that has been effective in treating CAP. It is dosed at 500mg twice daily. Renal dosing adjustments are necessary when the CrCl is less than 10mL/min. It is also classified as pregnancy Category B. It has been found to enter into breastmilk and should be used with caution. The respiratory fluoroquinolones that are recommended for CAP include moxifloxacin, gemifloxacin, and levofloxacin. All three of these have also been associated with QT prolongation, tendon inflammation and/or tendon rupture, and the development of serious hypoglycemia. They are all classified as pregnancy Category C, and are not recommended with breastfeeding. Moxifloxacin (Avelox®) is prescribed as 400mg orally once daily for seven to 14 days. It may be taken without regard to food, but should be given either four hours before or eight hours after products containing magnesium, aluminum, iron, or zinc. Renal and hepatic dosage adjustments are not necessary. Caution should be exercised in patients with hepatic impairment due to the risk of QT prolongation.

Continuing Education Gemifloxacin (Factive®) is dosed as 320mg orally once daily for five to seven days (seven days recommended for multi-drug resistant S. pneumoniae (MDRSP), K. pneumoniae, or M. catarrhalis). Patients with CrCl <40mL/ min or on dialysis should receive only 160mg once daily. No dosage adjustments are required in the presence of hepatic impairment. Gemifloxacin may be taken with or without food, milk, or calcium supplements. It should be taken three hours before or two hours after supplements containing iron, zinc, or magnesium. Levofloxacin (Levaquin®) for CAP may be prescribed as 500mg every 24 hours for seven to 14 days, or 750mg every 24 hours for five days (five-day regimen for MDRSP not established). Product information should be referred to for renal dosing recommendations when CrCl <50mL/min. Levofloxacin tablets may be taken without regard to meals. It should be taken two hours before or two hours after products containing magnesium, aluminum, iron, or zinc. The use of fluoroquinolones to treat outpatients without comorbid conditions or risk factors for DRSP is discouraged due to concern that widespread use may lead to the development of resistance. Many trials and meta-analyses have been conducted comparing fluoroquinolones to standard antibiotics which have resulted in either non-compelling superiority or inconsistent data. Therefore, it is suggested that antibiotic selection be based on side-effects, patient preferences, availability, and cost. Telithromycin (Ketek®) is the first of the ketolide antibiotics, which is derived from the macrolide family. It is active against S. pneumoniae that is resistant to other antibiotics often used for CAP. Trials have demonstrated equivalency to amoxicillin and clarithromycin. However, it has been associated with postmarketing reports of life-threatening hepatotoxicity. This antibiotic was not included in the IDSA/

The Georgia Pharmacy Journal

ATS guidelines since, at the time of publishing, the committee was awaiting further safety evaluation from FDA. It is currently approved for CAP and dosed at 800mg once daily for seven to 10 days. The dose should be reduced to 600mg once daily when CrCl <30mL/min. When renal impairment is accompanied by hepatic impairment, the dose should be further reduced to 400mg once daily. It may be taken with or without food. Telithromycin is also a strong CYP3A4 inhibitor associated with select drug interactions, and may prolong the QT interval. Life-threatening respiratory failure has occurred in patients with myasthenia gravis. It is classified as pregnancy Category C, and excretion in breast milk is unknown.

Prevention of Pneumonia

Several measures may be taken to reduce the risk of lung infection. These include smoking cessation; avoidance of illicit drugs or excess alcohol consumption (may impair consciousness); and optimizing nutritional status, as distinctly underweight or obese patients are also at an increased risk. Following good hygiene practices, such as hand washing, cleaning of surfaces that are touched often, and coughing or sneezing into a tissue or into an elbow or sleeve can also help prevent the spread of respiratory infections. Preventing and treating chronic conditions such as diabetes and HIV/AIDS can also reduce pneumonia risk. In the U.S., there are several vaccines available that prevent bacterial or viral infections that may cause pneumonia. While the remainder of this lesson will focus on the pneumococcal vaccine, other vaccines include influenza (flu), H. influenzae (Hib), pertussis (whooping cough), varicella (chickenpox), and measles.

Pneumococcal Disease Vaccine Prevention

In addition to pneumococcal pneumonia (caused by Streptococcus pneumoniae), this bacterium is also

The Georgia Pharmacy Journal

capable of causing invasive disease such as meningitis or bacteremia. Bacteremia occurs in 25 to 30 percent of patients with pneumococcal pneumonia. Pneumococci cause 13 to 19 percent of all cases of bacterial meningitis in the U.S. While there are over 90 serotypes of pneumococci, the 10 most common types cause over 60 percent of invasive disease. Some pneumococci are encapsulated with a complex polysaccharide surface enabling them to be pathogenic to humans. Protective type specific antibodies are produced in response to the capsular polysaccharide. These antibodies may cross-react with related types, as well as other bacteria, providing protection against additional serotypes. Pneumococcal Polysaccharide Vaccine. The pneumococcal polysaccharide vaccine (PPSV) is made of purified preparations of pneumococcal capsular. The first U.S. vaccine was licensed in 1977 and contained antigen from 14 different types of pneumococcal bacteria. In 1983, the 23-valent polysaccharide vaccine (PPSV23) was licensed and replaced the 14-valent vaccine. The U.S. vaccine is marketed as Pneumovax®-23 by Merck and contains 25mcg of each antigen per 0.5ml dose which is administered either intramuscularly or subcutaneously. More than 80 percent of healthy adults who receive PPSV23 develop antibodies against the serotypes within two to three weeks of vaccination. However, older adults and persons with chronic illnesses or immunodeficiency may not respond as well. The antibodies remain elevated in healthy adults for at least five years, but may decline faster in persons with certain underlying disease. The efficacy may vary based on underlying illnesses, but is overall 60 to 70 percent effective in preventing invasive disease. While it provides protection from invasive pneumonia complications, it has not demonstrated protection against pneumococcal pneumonia. Hence, it should not be referred to as the

“pneumonia vaccine.” Pneumococcal polysaccharide vaccine is recommended for all adults who are 65-years-old and older. It is also recommended for adults age 19 years and older who smoke cigarettes; and for persons between the age of two and 64 years who have chronic illnesses specifically associated with increased risk from pneumococcal infection or who are candidates for or recipients of a cochlear implant. Chronic illnesses include cardiovascular disease, pulmonary disease (including asthma in adults age 19 years and older), diabetes mellitus, alcoholism, cirrhosis, or cerebrospinal fluid leaks. In addition, persons with asymptomatic or symptomatic HIV infection and immunocompromised adults with chronic illnesses specifically associated with increased risk from pneumocccal infection (splenic dysfunction, anatomic asplenia, Hodgkin’s disease, lymphoma, multiple myeloma, chronic renal failure, nephrotic syndrome, or organ transplantation) should receive the vaccine. Lastly, residents of nursing homes or long-term care facilities should also be vaccinated. It is not recommended for patients who have recurrent acute upper respiratory tract infections such as otitis media and sinusitis. The vaccine should not be withheld if the immunization record is unobtainable or patient’s verbal history is uncertain. Persons with uncertain or unknown vaccination status should be vaccinated. Because the relationship between antibody titers and protection from invasive disease is uncertain, the need for revaccination based on serology is inadequate. Also, there is lack of evidence to support improved protection with multiple doses of pneumococcal vaccine. Consequently, the Advisory Committee on Immunization Practices (ACIP) has established the following recommendations for revaccination: routine revaccination of immunocompetent persons is not recommended; a single revaccination five or more years after

25


Continuing Education the first dose is recommended for persons age two years and older who are at the highest risk of serious pneumococcal infection; and persons aged 65 years and older if they received the first dose more than five years previously and were younger than 65 years of age at the time it was given. Pneumococcal Conjugate Vaccine. The first pneumococcal conjugate vaccine (PCV7) was licensed in the U.S. in 2000, and was comprised of purified capsular polysaccharide of seven serotypes of S. pneumoniae conjugated to a nontoxic variant of diphtheria toxin. In 2010, Prevnar 13® (PCV13) was approved for children six weeks of age through five years as a threedose primary series, followed by a fourth dose booster. This vaccine replaced the previous version as this product contains the same seven serotypes, in addition to six more which are all conjugated. According to 2008 data from the Active Bacterial Core Surveillance (ABCS), 61 percent of the invasive pneumococcal disease cases in children younger than five years were attributable to the serotypes in PCV13, while PCV7 serotypes caused less than 2 percent. On December 30, 2011, the Food and Drug Administration (FDA) expanded approval of PCV13 for prevention of pneumonia and invasive disease among adults aged 50 years and older. However, it was not until June 2012 that ACIP adopted vaccination recommendations for PCV13 in adults. At the time of writing this lesson, however, the ACIP recommendation is considered “provisional.” The recommendations will become official when published in CDC’s (Centers for Disease Control and Prevention) Morbidity and Mortality Weekly Report. The proposal advises that PCV13 should be administered to adults aged 19 years or older who are at a high risk of invasive pneumococcal disease, which includes those who are immunosuppressed. If these patients have never received a pneumococcal vaccine, ACIP is recommend-

ing that PCV13 be administered first, followed by PPSV eight weeks later, and then PPSV five years later. If the high risk patient has already received PPSV, providers should wait one year after the last PPSV dose before giving PCV13, to avoid interference between the vaccines. Pharmacists are encouraged to visit the CDC website (www. cdc.gov) for the most up-to-date information regarding PCV13 and PPSV recommendations for initial and revaccination, as well as updated vaccine information sheets (VISs). Federal law requires that VISs be distributed to the adult recipient or the child’s parent/legal guardian when certain vaccines are administered. Pfizer is conducting the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), a trial involving more than 84,000 subjects, 65 years of age and older, designed to determine if PCV13 is effective in preventing the first episode of CAP caused by one of the 13 serotypes in the vaccine. Pfizer will share the results with ACIP, in order to consider a recommendation for routine use of Prevnar 13® in adults aged 50 years and older. It is estimated that the primary outcome measures for this event-driven study will be available in 2013. The most common adverse reactions to both vaccines are local. For PPSV, 30 to 50 percent of recipients report pain, swelling, or erythema at the site of injection, which may persist for 48 hours. The local reactions have been reported more frequently after the second dose. Fewer than 1 percent of patients report moderate systemic reactions such as fever or myalgia. For PCV13, local reactions are reported in 5 to 49 percent of those vaccinated, and 8 percent may be severe. A fever within seven days of vaccination was reported in 24 to 35 percent of children receiving their primary three-dose series. Severe reactions are rare for both vaccines. Anaphylaxis is a contraindica-

Continuing Education tion for further doses. Persons with moderate to severe illness should not be vaccinated until their condition improves. Minor illnesses (upper respiratory infections) are not a contraindication to vaccination. Patient populations eligible for both the pneumococcal vaccine and influenza vaccine often overlap. Both of these vaccines are important for optimal protection, and may be given at the same time, but should be administered at different sites. Unlike pneumococcal vaccine which may be given year round, the influenza vaccine is recommended only during the influenza season.

Summary

CAP is a leading cause of death due to infectious disease in the United States. Treatment guidelines have been established for proper antibiotic selection. Pharmacists play a crucial role in identifying key safety and administration counseling information to patients initiating antibiotic therapy. In addition, pharmacists can be vaccination advocates by encouraging patients who are candidates for pneumococcal vaccination to obtain it, thus reducing the risk of pneumonia complications and invasive disease. Recommendations and guidelines change; pharmacists are encouraged to keep current. The author, 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. This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.

continuing education quiz

Please print.

Adult Community-Acquired Pneumonia

Address_____________________________________________

1. CAP is defined as pneumonia diagnosed in patients: a. who received IV antibiotics in nursing homes. b. who live independently in the community. c. who come from hemodialysis centers.

City, State, Zip______________________________________

2. Host defenses that prevent development of pneumonia include all of the following EXCEPT: a. epithelial barrier. c. laryngeal reflex. b. cough reflex. d. esophageal spasm.

*Obtain NABP e-Profile number at www.MyCPEmonitor.net.

3. The most common blood culture isolate in CAP is: a. S. pneumoniae. c. M. catarrhalis. b. H. influenzae. d. S. aureus. 4. Risk factors related to specific CAP pathogens include all of the following EXCEPT: a. alcoholism. c. COPD. b. gout. d. HIV.

Release date: 10-15-12

Expiration date: 10-15-15

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.

Name________________________________________________

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. Macrolides are associated with: a. hypoglycemia. c. QT prolongation. b. tendon rupture. 9. The recommended regimen for treating CAP with extended-release clarithromycin is: a. 250mg daily for 7 days. c. 500mg daily for 7 days. b. 750mg daily for 7 days. d. 1000mg daily for 7 days.

5. Which of the following is needed to confirm a diagnosis of pneumonia? a. Cough b. Pleuritic chest pain c. Infiltrate by chest radiograph d. Rales

10. Which of the following antibiotics is classified as pregnancy Category D and not recommended with breastfeeding? a. Clarithromycin c. Amoxicillin b. Doxycycline d. Cefdinir

6. According to IDSA/ATS guidelines, previously healthy patients with no risk factors for DRSP infection may be treated with which of the following for CAP? a. Moxifloxacin c. Amoxicillin b. Ceftriaxone d. Azithromycin

11. Which of the following antibiotics is a strong CYP3A4 inhibitor associated with select drug interactions? a. Amoxicillin c. Telithromycin b. Doxycycline d. Levofloxacin

7. The 2007 IDSA/ATS guidelines document states that: a. resistance to penicillin and cephalosporins may be decreasing. b. resistance to penicillin and cephalosporins may be increasing.

12. The risk of lung infection can be reduced with all of the following EXCEPT:

Completely fill in the lettered box corresponding to your answer. 1. 2. 3. 4. 5.

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

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

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

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

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

[c] [d]

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

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

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

 I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

Program 0129-0000-12-010-H01-P

Program 0129-0000-12-010-H01-P 0.15 CEU

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.

a. good hygiene. b. smoking cessation.

c. optimizing nutritional status. d. antibiotic prophylaxis.

13. Persons with uncertain or unknown pneumococcal vaccination status should not be vaccinated. a. True b. False 14. ACIP recommends pneumococcal revaccination with PPSV in which of the following circumstances? a. Immunocompetent persons b. Persons age two and older with previous pneumococcal infection c. Persons aged 65 years and older if they received the first dose more than 5 years ago and were younger than 65 years of age at the time 15. Pneumococcal and influenza vaccines may be administered at the same time. a. True b. False

To receive CE credit, your quiz must be received no later than October 15, 2015. A passing grade of 80% must be attained. All quizzes received after July 1, 2012 will be uploaded to the CPE Monitor Program and a statement of credit will not be mailed. Send inquiries to opa@ohiopharmacists.org.

october 2012

26

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

27


Continuing Education the first dose is recommended for persons age two years and older who are at the highest risk of serious pneumococcal infection; and persons aged 65 years and older if they received the first dose more than five years previously and were younger than 65 years of age at the time it was given. Pneumococcal Conjugate Vaccine. The first pneumococcal conjugate vaccine (PCV7) was licensed in the U.S. in 2000, and was comprised of purified capsular polysaccharide of seven serotypes of S. pneumoniae conjugated to a nontoxic variant of diphtheria toxin. In 2010, Prevnar 13® (PCV13) was approved for children six weeks of age through five years as a threedose primary series, followed by a fourth dose booster. This vaccine replaced the previous version as this product contains the same seven serotypes, in addition to six more which are all conjugated. According to 2008 data from the Active Bacterial Core Surveillance (ABCS), 61 percent of the invasive pneumococcal disease cases in children younger than five years were attributable to the serotypes in PCV13, while PCV7 serotypes caused less than 2 percent. On December 30, 2011, the Food and Drug Administration (FDA) expanded approval of PCV13 for prevention of pneumonia and invasive disease among adults aged 50 years and older. However, it was not until June 2012 that ACIP adopted vaccination recommendations for PCV13 in adults. At the time of writing this lesson, however, the ACIP recommendation is considered “provisional.” The recommendations will become official when published in CDC’s (Centers for Disease Control and Prevention) Morbidity and Mortality Weekly Report. The proposal advises that PCV13 should be administered to adults aged 19 years or older who are at a high risk of invasive pneumococcal disease, which includes those who are immunosuppressed. If these patients have never received a pneumococcal vaccine, ACIP is recommend-

ing that PCV13 be administered first, followed by PPSV eight weeks later, and then PPSV five years later. If the high risk patient has already received PPSV, providers should wait one year after the last PPSV dose before giving PCV13, to avoid interference between the vaccines. Pharmacists are encouraged to visit the CDC website (www. cdc.gov) for the most up-to-date information regarding PCV13 and PPSV recommendations for initial and revaccination, as well as updated vaccine information sheets (VISs). Federal law requires that VISs be distributed to the adult recipient or the child’s parent/legal guardian when certain vaccines are administered. Pfizer is conducting the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), a trial involving more than 84,000 subjects, 65 years of age and older, designed to determine if PCV13 is effective in preventing the first episode of CAP caused by one of the 13 serotypes in the vaccine. Pfizer will share the results with ACIP, in order to consider a recommendation for routine use of Prevnar 13® in adults aged 50 years and older. It is estimated that the primary outcome measures for this event-driven study will be available in 2013. The most common adverse reactions to both vaccines are local. For PPSV, 30 to 50 percent of recipients report pain, swelling, or erythema at the site of injection, which may persist for 48 hours. The local reactions have been reported more frequently after the second dose. Fewer than 1 percent of patients report moderate systemic reactions such as fever or myalgia. For PCV13, local reactions are reported in 5 to 49 percent of those vaccinated, and 8 percent may be severe. A fever within seven days of vaccination was reported in 24 to 35 percent of children receiving their primary three-dose series. Severe reactions are rare for both vaccines. Anaphylaxis is a contraindica-

Continuing Education tion for further doses. Persons with moderate to severe illness should not be vaccinated until their condition improves. Minor illnesses (upper respiratory infections) are not a contraindication to vaccination. Patient populations eligible for both the pneumococcal vaccine and influenza vaccine often overlap. Both of these vaccines are important for optimal protection, and may be given at the same time, but should be administered at different sites. Unlike pneumococcal vaccine which may be given year round, the influenza vaccine is recommended only during the influenza season.

Summary

CAP is a leading cause of death due to infectious disease in the United States. Treatment guidelines have been established for proper antibiotic selection. Pharmacists play a crucial role in identifying key safety and administration counseling information to patients initiating antibiotic therapy. In addition, pharmacists can be vaccination advocates by encouraging patients who are candidates for pneumococcal vaccination to obtain it, thus reducing the risk of pneumonia complications and invasive disease. Recommendations and guidelines change; pharmacists are encouraged to keep current. The author, 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. This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.

continuing education quiz

Please print.

Adult Community-Acquired Pneumonia

Address_____________________________________________

1. CAP is defined as pneumonia diagnosed in patients: a. who received IV antibiotics in nursing homes. b. who live independently in the community. c. who come from hemodialysis centers.

City, State, Zip______________________________________

2. Host defenses that prevent development of pneumonia include all of the following EXCEPT: a. epithelial barrier. c. laryngeal reflex. b. cough reflex. d. esophageal spasm.

*Obtain NABP e-Profile number at www.MyCPEmonitor.net.

3. The most common blood culture isolate in CAP is: a. S. pneumoniae. c. M. catarrhalis. b. H. influenzae. d. S. aureus. 4. Risk factors related to specific CAP pathogens include all of the following EXCEPT: a. alcoholism. c. COPD. b. gout. d. HIV.

Release date: 10-15-12

Expiration date: 10-15-15

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.

Name________________________________________________

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. Macrolides are associated with: a. hypoglycemia. c. QT prolongation. b. tendon rupture. 9. The recommended regimen for treating CAP with extended-release clarithromycin is: a. 250mg daily for 7 days. c. 500mg daily for 7 days. b. 750mg daily for 7 days. d. 1000mg daily for 7 days.

5. Which of the following is needed to confirm a diagnosis of pneumonia? a. Cough b. Pleuritic chest pain c. Infiltrate by chest radiograph d. Rales

10. Which of the following antibiotics is classified as pregnancy Category D and not recommended with breastfeeding? a. Clarithromycin c. Amoxicillin b. Doxycycline d. Cefdinir

6. According to IDSA/ATS guidelines, previously healthy patients with no risk factors for DRSP infection may be treated with which of the following for CAP? a. Moxifloxacin c. Amoxicillin b. Ceftriaxone d. Azithromycin

11. Which of the following antibiotics is a strong CYP3A4 inhibitor associated with select drug interactions? a. Amoxicillin c. Telithromycin b. Doxycycline d. Levofloxacin

7. The 2007 IDSA/ATS guidelines document states that: a. resistance to penicillin and cephalosporins may be decreasing. b. resistance to penicillin and cephalosporins may be increasing.

12. The risk of lung infection can be reduced with all of the following EXCEPT:

Completely fill in the lettered box corresponding to your answer. 1. 2. 3. 4. 5.

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

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

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

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

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

[c] [d]

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

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

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

 I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

Program 0129-0000-12-010-H01-P

Program 0129-0000-12-010-H01-P 0.15 CEU

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.

a. good hygiene. b. smoking cessation.

c. optimizing nutritional status. d. antibiotic prophylaxis.

13. Persons with uncertain or unknown pneumococcal vaccination status should not be vaccinated. a. True b. False 14. ACIP recommends pneumococcal revaccination with PPSV in which of the following circumstances? a. Immunocompetent persons b. Persons age two and older with previous pneumococcal infection c. Persons aged 65 years and older if they received the first dose more than 5 years ago and were younger than 65 years of age at the time 15. Pneumococcal and influenza vaccines may be administered at the same time. a. True b. False

To receive CE credit, your quiz must be received no later than October 15, 2015. A passing grade of 80% must be attained. All quizzes received after July 1, 2012 will be uploaded to the CPE Monitor Program and a statement of credit will not be mailed. Send inquiries to opa@ohiopharmacists.org.

october 2012

26

The Georgia Pharmacy Journal

The Georgia Pharmacy Journal

27


Georgia Pharmacy Association

AIP Spring Meeting – March 10, 2012 – Atlanta, GA

2012-2013 BOARD OF DIRECTORS Name

Position

L. Jack Dunn Robert M. Hatton Pamala S. Marquess Robert B. Moody Thomas H. Whitworth Hugh M. Chancy Liza G. Chapman Keith N. Herist Joshua D. Kinsey Tracie D. Lunde Eddie M. Madden Jonathan G. Marquess Christine Somers Ed S. Dozier Renee D. Adamson Nicholas O. Bland Julie W. Bierster Sherri S. Moody Amanda McCall Michael Lewis Kristy L. Pucylowski Lance P. Boles Ashley London Ken Von Eiland Thomas R. Jeter Sharon B. Zerillo Archie R. Thompson Drew Miller Linda Gail Lowney Robert Bentley John T. Sherrer Michael E. Farmer Bill Prather

Chairman of the Board President President-Elect First Vice President Second Vice President State At Large State At Large State At Large State At Large State At Large State At Large State At Large 1st Region President 2nd Region President 3rd Region President 4th Region President 5th Region President 6th Region President 7th Region President 8th Region President 9th Region President 10th Region President 11th Region President 12th Region President ACP Chairman AEP Chairman AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Georgia Board of Pharmacy Chariman Georgia Society of Health Systems Pharmacists Mercer Faculty Representative South Faculty Representative UGA Faculty Representative ASP, Mercer University ASP, South University ASP President, UGA Executive Vice President

Kenneth G Jozefcyk Amy C. Grimsley Rusty Fetterman Sukhmani K. Sarao Negin Sovaidi Moon Amanda Brown James William Spence Jim Bracewell

28

Build Store Traffic, Build Profits: Front-End Overhaul One Day Intensive Presented by: Gabe Trahan (NCPA) 8.5 hours (7.5 hours of CE Credit with 2 hours of non-CE)

Pharmacists Need Time for Financial Planning This ad entitles you to:

This hands-on, one day seminar is full of walk-away-tools and is specifically designed to capitalize on the strengths of the community pharmacy. Community pharmacies are unparalleled in their customer focus and connection, but without the corporate machine available to the chain competition for merchandising, advertising, store layout, and external curb appeal, a large segment of local pharmacy patients may not know of the superior experience that awaits them in a community pharmacy. This program is designed to deliver the tools and knowledge the pharmacy owner needs to change the picture and create more pharmacy traffic and more profit. Topics: Creating Curb Appeal; OTC Basic to Advanced; Inventory: What, How Many and How Much; Moving Private Label ; Getting the Word Out – Message and Medium; Effective Signage; Trade Secrets: Stores Talking to Stores.

Price and location to be determined. Please call or email Verouschka Betancourt-Whigham at vbwhigham@gpha.org to receive additional information.

A cup of coffee, and a second opinion. You’re welcome to schedule a time to come in or talk via conference call about your financial concerns and what your portfolio is intended to do for you and your family. I’ll review it with you and give you my opinion – without obligation.

T J

Either way, the coffee is on me.

Keeping Independents Independent

Michael T. Tarrant

Dear Jeff, Jennie and I want to thank you for your recent intervention

• Independent Financial Planner since 1992 • Focusing on Pharmacy since 2002 • PharmPAC Supporter • Speaker & Author

Financial Network Associates

1117 Perimeter Center West, Suite N-307 Atlanta, GA 30338 ● 770-350-2455 mike@fnaplanners.com www.fnaplanners.com ♦

Securities, certain advisory services and insurance products are offered through INVEST Financial Corporation (INVEST), member FINRA/SIPC, a federally registered Investment Adviser, and affiliated insurance agencies. INVEST is not affiliated with Financial Network Associates, Inc. Other advisory services may be offered through Financial Network Associates, Inc., a registered investment adviser.

Do you want to work for an Independent Pharmacy?

to help us retire and to keep our pharmacy independent. When we made our decision to sell Warwick Drugs, you were our first contact. You acted quickly and professionally to find a buyer in 5 days!

Do you want to own your own pharmacy?

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 jlurey@gpha.org

We joined AIP at its inception. We have participated in its programs, utilized the extensive information network and treasured our relationships with exceptional people, like you. We wish the best for all of you and the role you all play in our healthcare future. If we can ever be of assistance, please call on us. Thanks again; our best regards to all. Sincerely yours, Cliff Hilliard, RPH, PHD


Georgia Pharmacy Association

AIP Spring Meeting – March 10, 2012 – Atlanta, GA

2012-2013 BOARD OF DIRECTORS Name

Position

L. Jack Dunn Robert M. Hatton Pamala S. Marquess Robert B. Moody Thomas H. Whitworth Hugh M. Chancy Liza G. Chapman Keith N. Herist Joshua D. Kinsey Tracie D. Lunde Eddie M. Madden Jonathan G. Marquess Christine Somers Ed S. Dozier Renee D. Adamson Nicholas O. Bland Julie W. Bierster Sherri S. Moody Amanda McCall Michael Lewis Kristy L. Pucylowski Lance P. Boles Ashley London Ken Von Eiland Thomas R. Jeter Sharon B. Zerillo Archie R. Thompson Drew Miller Linda Gail Lowney Robert Bentley John T. Sherrer Michael E. Farmer Bill Prather

Chairman of the Board President President-Elect First Vice President Second Vice President State At Large State At Large State At Large State At Large State At Large State At Large State At Large 1st Region President 2nd Region President 3rd Region President 4th Region President 5th Region President 6th Region President 7th Region President 8th Region President 9th Region President 10th Region President 11th Region President 12th Region President ACP Chairman AEP Chairman AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Georgia Board of Pharmacy Chariman Georgia Society of Health Systems Pharmacists Mercer Faculty Representative South Faculty Representative UGA Faculty Representative ASP, Mercer University ASP, South University ASP President, UGA Executive Vice President

Kenneth G Jozefcyk Amy C. Grimsley Rusty Fetterman Sukhmani K. Sarao Negin Sovaidi Moon Amanda Brown James William Spence Jim Bracewell

28

Build Store Traffic, Build Profits: Front-End Overhaul One Day Intensive Presented by: Gabe Trahan (NCPA) 8.5 hours (7.5 hours of CE Credit with 2 hours of non-CE)

Pharmacists Need Time for Financial Planning This ad entitles you to:

This hands-on, one day seminar is full of walk-away-tools and is specifically designed to capitalize on the strengths of the community pharmacy. Community pharmacies are unparalleled in their customer focus and connection, but without the corporate machine available to the chain competition for merchandising, advertising, store layout, and external curb appeal, a large segment of local pharmacy patients may not know of the superior experience that awaits them in a community pharmacy. This program is designed to deliver the tools and knowledge the pharmacy owner needs to change the picture and create more pharmacy traffic and more profit. Topics: Creating Curb Appeal; OTC Basic to Advanced; Inventory: What, How Many and How Much; Moving Private Label ; Getting the Word Out – Message and Medium; Effective Signage; Trade Secrets: Stores Talking to Stores.

Price and location to be determined. Please call or email Verouschka Betancourt-Whigham at vbwhigham@gpha.org to receive additional information.

A cup of coffee, and a second opinion. You’re welcome to schedule a time to come in or talk via conference call about your financial concerns and what your portfolio is intended to do for you and your family. I’ll review it with you and give you my opinion – without obligation.

T J

Either way, the coffee is on me.

Keeping Independents Independent

Michael T. Tarrant

Dear Jeff, Jennie and I want to thank you for your recent intervention

• Independent Financial Planner since 1992 • Focusing on Pharmacy since 2002 • PharmPAC Supporter • Speaker & Author

Financial Network Associates

1117 Perimeter Center West, Suite N-307 Atlanta, GA 30338 ● 770-350-2455 mike@fnaplanners.com www.fnaplanners.com ♦

Securities, certain advisory services and insurance products are offered through INVEST Financial Corporation (INVEST), member FINRA/SIPC, a federally registered Investment Adviser, and affiliated insurance agencies. INVEST is not affiliated with Financial Network Associates, Inc. Other advisory services may be offered through Financial Network Associates, Inc., a registered investment adviser.

Do you want to work for an Independent Pharmacy?

to help us retire and to keep our pharmacy independent. When we made our decision to sell Warwick Drugs, you were our first contact. You acted quickly and professionally to find a buyer in 5 days!

Do you want to own your own pharmacy?

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 jlurey@gpha.org

We joined AIP at its inception. We have participated in its programs, utilized the extensive information network and treasured our relationships with exceptional people, like you. We wish the best for all of you and the role you all play in our healthcare future. If we can ever be of assistance, please call on us. Thanks again; our best regards to all. Sincerely yours, Cliff Hilliard, RPH, PHD


Georgia Pharmacy Association

50 Lenox Point NE Atlanta, GA 30324

December GPhA Journal 2012