The Kentucky Pharmacist Vol. 9, No. 4

Y K C U T N E K THE T S I C A M R A PH Vol. 9, No. 4 July 2014

2014-15 KPhA President Bob Oakley with his family — daughter, Lauren; wife, Janice; son, Rob and his wife, Amanda.

Get Involved—Stay Involved Membership Matters in YOUR KPhA News & Information for Members of the Kentucky Pharmacists Association

Table of Contents

July 2014

Table of Contents Table of Contents— Oath— Mission Statement President’s Perspective KPhA 2014 Professional Awards From your Executive Director KPERF Golf Scramble 136th KPhA Annual Meeting and Convention 136th KPhA Annual Meeting and Convention Sponsors 136th KPhA Annual Meeting and Convention Exhibitors APSC After Banquet Party Technician Review July 2014 CE — Hypertension Management July Pharmacist/Pharmacy Tech Quiz

2 3 4 6 8 9 12 13 14 15 16 17 24

Continuing Education Changes KPhA Emergency Preparedness Meet the New Dean of SUCOP KPhA Mid-Year Conference on Legislative Priorities KPhA Open House KPPAC/KPhA Government Affairs Contribution Forms Kentucky Renaissance Pharmacy Museum KPhA New and Returning Members KPhA wins Bowl of Hygeia Fundraising Contest Pharmacy Law Brief Pharmacy Policy Issues Pharmacists Mutual Cardinal Health KPhA Board of Directors 50 Years Ago/Frequently Called and Contacted

25 27 28 29 30 31 34 36 38 40 42 44 45 46 47

Oath of a Pharmacist At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Kentucky Pharmacists Association The mission of the Kentucky Pharmacists Association is to promote the profession of pharmacy, enhance the practice standards of the profession, and demonstrate the value of pharmacist services within the health care system.

Editorial Office: © Copyright 2014 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association.

Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email ssisco@kphanet.org.

Website http://www.kphanet.org.

The Kentucky Pharmacy Education and Research Foundation (KPERF), established in 1980 as a non-profit subsidiary corporation of the Kentucky Pharmacists Association (KPhA), fosters educational activities and research projects in the field of pharmacy including career counseling, student assistance, post-graduate education, continuing and professional development and public health education and assistance.

It is the goal of KPERF to ensure that pharmacy in Kentucky and throughout the nation may sustain the continuing need for sufficient and adequately trained pharmacists. KPERF will provide a minimum of 15 continuing pharmacy education hours. In addition, KPERF will provide at least three educational interventions through other mediums — such as webinars — to continuously improve healthcare for all.

Programming will be determined by assessing the gaps between actual practice and ideal practice, with activities designed to narrow those gaps using interaction, learning assessment, and evaluation. Additionally, feedback from learners will be used to improve the overall programming designed by KPERF. 2

THE KENTUCKY PHARMACIST

President’s Perspective

July 2014 and KPhA). I became a Board member of JCAP and became president in 1992. I was then asked to run for President of KPhA in 1995. I lost, but it did not bother me that I lost. I remained involved and stay involved in all of my professional associations. I lost to Anne Policastri who was a great President for KPhA. In 2001, Dwaine Green, Executive VP of KSHP asked if I would like to run for president. It occurred to me to ask him who I was running against and he told me Anne Policastri. I respectfully declined to run at that time; however, I was elected president-elect of KSHP in 2003. In 2012, I was appointed to the KPhA Board of Directors. In 2013, I was elected President-Elect of KPhA and here I am. It is all because I got involved and stay involved. My goal was not to achieve any elected office; it was to serve the profession.

PRESIDENT’S PERSPECTIVE Robert Oakley KPhA President 2014-2015 Adapted from President Oakley’s address at the 2014 Ray Wirth Banquet

Get Involved — Stay Involved

For the students, you may be asking yourselves why get involved in the first place? What’s in it for me? There is significant benefit for you personally, your career and your profession. I will review what I consider to be three of the most important reasons, but these are by no means the only reasons to get involved and stay involved. The first benefit is networking. Yes, you can get all of the CE you need these days on-line, but there is no substitute for opportunities such as this meeting to meet and talk to your peers. You will learn as much (or more) from networking with your peers and discussing the challenges you have in work every day and learning ways to deal with those challenges. Another benefit of networking is job opportunities.

There are now over 14,000 graduates per year from pharmacy schools. Networking gives you a leg up on the competition.

I would like to thank everyone for the opportunity to serve as President of YOUR KPhA. It is an honor and a privilege to be in this position. There have been many excellent pharmacists who have preceded me in this role. I would like to recognize all of the past presidents of KPhA for their years of service to the profession. Next, I would like to recognize all of the students that are attended the KPhA Annual Meeting and Convention. I would like for everyone to pay close attention to this group. Look closely and you will see in this group several future Presidents of KPhA. This group represents the future of our organization and our profession.

So, how did I get here? One theory is that I just don’t know how to say “no” when asked. I would prefer to think of it another way. I chose to get involved and stay involved in professional organizations, throughout my career. It started in pharmacy school and it continued long after graduation.

There are many others in this room who also have chosen to get involved and stay involved throughout their careers.

If we can do it, all of the students in this room can do so as well. You also do not have to limit yourself to just one professional organization to be a member of. I am also an active member of KSHP, ASHP, JCAP and Kappa Psi. It doesn’t matter where you live or where you work, get involved and stay involved. This is a theme that Duane Parsons discussed in his September article in the KPhA Journal.

The second benefit is service. Service to the profession, your patients and to yourself. Those of you reading this article chose to get involved when you started in pharmacy school so why would you not continue to stay involved after graduation? Being active in your professional organizations is a means of providing service to the profession.

The third benefit is promotion of the profession. Laws and regulations define the scope of pharmacy practice. The only way you can change the scope of practice and your profession is through the efforts of organizations such as KPhA and yourself. If you are not involved, changes will happen to you and the profession. You may not like these changes because they will be decisions made by others During my career, I have practiced pharmacy in Florida, Virginia and Kentucky. I was an active member of the asso- outside of our profession that will have a significant impact on our profession. KPhA, in addition to its role as the primaciations in each of these states and I was fortunate to be treasurer of VSHP and President of the Southside Pharma- ry professional organization of pharmacy in the state, is cist Association in Virginia. When I returned to Kentucky in 1988, I rejoined the Kentucky Associations (JCAP, KSHP

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136th KPhA Annual Meeting and Convention

July 2014

2014 KPhA Professional Awards Jerry White, Russellville, Bowl of Hygeia Award sponsored by the American Pharmacists Association Foundation and the National Alliance of State Pharmacy Associations with support from Boehringer Ingelheim. Pictured with his partner and nominator Donnie Riley and KPhA 2014-15 Chair Duane Parsons.

KPhA Distinguished Service Award

William Grise Lexington

Judy Minogue Louisville

Christopher Harlow Louisville KPhA Distinguished Young Pharmacist of the Year, Sponsored

by Pharmacists Mutual Insurance.

Tracy Curtis presented for Pharmacists Mutual.

Jill Rhodes, Louisville KPhA Pharmacist of the Year 4

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136th KPhA Annual Meeting and Convention

July 2014

Cassandra Beyerle Louisville KPhA Professional Promotion Award

Brooke Hudspeth, Lexington, KPhA Excellence in Innovation Award sponsored by Upsher-Smith Laboratories, Inc. Don Carpenter, Morehead, KPhA Technician of the Year

Amber Cann, Louisville, Cardinal Health Generation Rx Award, presented by Todd Wright, Cardinal Health Retail Sales Manager

KPhA Meritorious Service Award Senator Tom Buford (R-Nicholasville) and David Switzer

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From Your Executive Director

July 2014

MESSAGE FROM YOUR

EXECUTIVE DIRECTOR Robert “Bob” McFalls Roamey Marches On—Traverses the Commonwealth Since his appearance about a year ago, Roamey has really enjoyed meeting and making so many acquaintances across the Commonwealth, roaming far and wide to promote Membership Matters in YOUR KPhA! He has attended state and national conventions and also has studied pharmacy topics with the brightest students at the UK College of Pharmacy and at Sullivan University College of Pharmacy. And, as many of you are aware, he loves having his photo taken when he is roaming to local pharmacies where he quickly befriends pharmacists, technicians and patients alike. As Roamey continues to build his legacy, like you — our members — he seeks to make a difference for others every day. Edward Everett Hale said, "I am only one, but I am one. I cannot do everything, but I can do something. And I will not let what I cannot do interfere with what I can do." Keep up the great work. The value of YOUR actions is recognized by the public and has significant outcomes in terms of both short-term recovery and in long term living results for your patients.

tunity to purchase their personally engraved KPhA Membership Matters Roamey for $25 delivered to your pharmacy or home. If you would like to purchase your very own Roamey, please let me or any KPhA staff member know.

In mid June, President Bob Oakley, Jill Rhodes and I were privileged to attend a Ceremonial Bill Signing on the Parity for Oral Chemotherapy legislation (HB 125) with Governor Steve Beshear, bill sponsors Senator Tom Buford and Representative Bob Damron, along with several cancer survivors and other supportDuring late spring and throughout the summer, Kentucky ers and partners. These papharmacists ranks were again strengthened with graduatients were very involved in advocating for this legislation tion ceremonies and licensure achievement. Congratulations to our newest members of the Kentucky pharma- which will become effective in January. Having lost two dear family members to cancer this year, I am personally cist family of professionals. In a similar endeavor, Roamey has found the power to be cloned. Past President honored to have been involved with KPhA in advancing this Duane W. Parsons presented each of the 2013-2014 Direc- important issue. Along with Jill Rhodes, I also want to thank tors and staff with her/his own personalized Roamey at the members Jeff Mills and Anne Policastri for their participaton KPhA Annual Meeting & Convention in recognition of their and assistance in advancing this issue. service to YOUR KPhA. Roamey can now be found living Also, I am pleased to report that KPhA is finalizing its apat more than 25 geographic locations throughout Kentucky, pointment of the Pharmacy Technical Advisory Committee and he looks forward to receiving even more photos of ento Medicaid. Ten well-qualified individuals were nominated gagement with local pharmacies with this expansion to add from all practice settings to serve on the Pharmacy TAC. to his growing photo gallery on KPhA's web site. In addiWhile only five can be appointed, the interest and engagetion, Roamey has visited 28 pharmacies in six counties this ment in helping advance pharmacist and pharmacy issues summer, bringing his total face-to-face visits to 129 for the with Medicaid is made all the stronger with this level of inpast year. If he has not come to see you yet, he will! And, volvement. We salute and thank all of our nominees. he is honored when he is requested to visit as well as when members "like" his posts on Facebook. Thank you for your I also am pleased to update you that conversations are continuing with the Department of Insurance on ways to reception and support of Roamey! In addition, due to his strengthen our PBMTransparency for Drug Reimbursement popularity, KPhA is pleased to offer members the oppor6

THE KENTUCKY PHARMACIST

From Your Executive Director

July 2014

Gov. Steve Beshear signs HB 125, which included language for Oral Chemotherapy Parity. KPhA President Bob Oakley, member Jill Rhodes and Executive Director Robert McFalls attended the ceremony in mid-June.

(or MAC) legislation (often referred to as Senate Bill 107).

We will be providing an educational session on this topic at KPhA's Mid-Year Conference on November 14 as well along with related webinar educational opportunities. Look for additional details in your weekly KPhA eNews. Along these lines, I also want to encourage you to save the date and calendar your participation in the 137th KPhA Annual

Meeting and Convention for June 25-28, 2015 which will be in Bowling Green at the Holiday Inn University Plaza/ Slone Convention Center.

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macy will be revolutionized if this passes! If you get involved and stay involved, you can help make this happen.

Roamey, his friends and I look forward to seeing you at your place of employment and at one or all of these venues very soon!

also the primary group that lobbies on behalf of the profession in Frankfort. The past couple of years have been very successful legislatively for the profession thanks to the efforts of Bob McFalls and Jan Gould. There were many bills passed that benefited our patients and profession. Unfortunately this year, the BIG one got away. The effort to change the collaborative care agreement section of the pharmacy practice act (SB 76) was not passed by the Kentucky House. This will be one of our top legislative priorities for the 2015 session; however, it will not be the only one.

There are many other issues out there currently facing our profession that will need to be addressed as well. For us to be successful, it will take the efforts of everyone in this room and more. There is also legislation on the federal level introduced by Representative Brett Guthrie of Kentucky to recognize pharmacists as providers under Medicare.

This has huge potential impact for the profession and it needs everyone’s support. Think how the practice of phar7

In conclusion, I have been blessed in my personal life because of my wife Janice who has supported me these many years and our children (Rob and Lauren), professionally for the career opportunities that I have had and the patients I have served, the people that I have had the opportunity to work with over the years and my service to the profession of pharmacy through my work in organizations such as KPhA. You never know where the paths we choose in life will take us until you follow them. Who knows, you could wind up a few years from now giving a speech tonight like me.

For the students, let us know what you would like to get from YOUR KPhA and help make it happen and next time bring a friend! For the current members of KPhA, I would like to see you do the same. For all of you, get involved to shape your future and stay involved to protect your future.

Thank you.

THE KENTUCKY PHARMACIST

2014 KPERF Golf Scramble

July 2014

2014 KPERF Golf Scramble

First Place: Eric Pitts, Ryan Russell, Nevin Goebel, Jamie Ferrell

Closest To the Pin: Lewis Wilkerson

Save the Date KPERF Golf Scramble June 25, 2015

Second Place: Terry Seiter, Jim Geil, Ron Nieporte, Tim Kroger

Longest Drive: Tim Wilson

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Crosswinds Golf Course Bowling Green Not Pictured: Last Place: Jan Gould, Cheryl Gould, Gay Dwyer, Mike Burleson

THE KENTUCKY PHARMACIST

136th KPhA Annual Meeting and Convention

July 2014

The KPhA Annual Meeting

Q&A with a 4th Year Pharmacy Student By: Laurel Taylor

As much as I hate to admit it, this was my first year attending the Annual Meeting. I regret this because I’ve missed out on three years of learning, networking and becoming part of the family that is OUR KPhA. I wanted to take this opportunity to let others know the importance of attending this event and what a great value it is to your present and future practice as a pharmacist.

There also is ample time to network and socialize with old friends. You might possibly even meet a future employer or coworker. I was able to meet my preceptors for many of my upcoming rotations and also learn more about them from students currently on the rotation.

Q: What types of events occur at these meetings?

A: There are preconference events, such as the Delivering Medication Therapy Management Services certificate training program. There is programming on current and relevant issues for the pharmacy profession that will meet the needs of students, residents, pharmacists and technicians. Some special events this year consisted of the Kentucky Mobile Pharmacy Unit display and a financial planning seminar for new practitioners and student pharmacists. There also was a post conference event on adult immunization training.

To give a little background about myself, I am a 4th year pharmacy student at the University of Kentucky College of Pharmacy. During the time of the Annual Meeting, I was on a pharmacy organization management rotation that correlated perfectly with assisting in the preparations for the Annual Meeting. Luckily, I was able to spend one day at the KPhA office in Frankfort helping them prepare for the event.

While I was only able to see a small part of the preparation, I can’t sing enough praises for the hardworking staff at KPhA for all the effort they put into organizing this meeting.

For those of you who haven’t been able to experience the KPhA Annual Meeting in the past, I hope the answers to the following questions will persuade you into attending!

Q: What will I gain from attending the meeting?

A: Everyone always can benefit from a little networking, and this is a great meeting to be able to accomplish this because there are pharmacists from a variety of settings.

Whether you are interested in hospital or health systems, Q: Why should I attend the KPhA Annual Meeting? community, retail, consultant or long term care pharmacy, A: This meeting incorporates programming and events for there are individuals you can speak to concerning each of everyone involved in the pharmacy profession; whether you these areas. There were 87 pharmacists, 75 students, 11 are a student, resident, pharmacist or technician, there is pharmacy technicians and 10 guests in attendance, so something for you! I particularly enjoyed the Drugs of there was never a shortage of people to talk to about any Abuse in Kentucky presentation by Van Ingram, and based subject! For those practicing pharmacists, this is a great on the many thought-provoking questions afterward, others place to obtain CPE Credits that are relevant to current seemed to appreciate it as well. The update on Pharmapharmacy issues. Attending these events also helps update cists Provider Status by Rebecca Snead, Executive Vice you on current events, changing practices, and, last but not President & CEO of the National Alliance of State Pharmaleast, assists you in being the best student or practitioner cy Associations, was interesting for everyone, as it has possible. many implications on the future of our practice. I found that Q: What is your favorite part of the meeting? my fellow students and I were very interested in attending the CMS Medicare Star Ratings presentation by Cathy Hanna because it is very relevant to current practice but isn’t something we get much exposure to in the classroom setting. Some other presentations that people look forward to from year-to-year are the New Drugs presentation by Trish Freeman and the Kentucky Legislative and Law Update by Ralph Bouvette. There is also a technician track that included programming like Inventory Management and Calculations for Technicians by Don Carpenter. As you can see, you shouldn’t be worried you won’t find something to interest you!

A: My favorite part of the meeting was being able to learn things I wasn’t taught in school. For example, I didn’t know much about CMS Medicare Star Ratings other than the few passing comments made in the classroom, but this was a fantastic opportunity to learn this information.

Q: What are the other “perks” from attending the meeting?

A: I can’t believe I haven’t mentioned the incredible food

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136th KPhA Annual Meeting and Convention

Continued from Page 9

July 2014

Suggestions are always welcome for future programming and events as well!

and snacks served at the meeting, but you will definitely never be hungry. There are also luncheons, preconference events and post conference events. It all ended with the Ray Wirth Banquet, a Gatsby Themed Party where costumes were encouraged!

All in all, this was an incredible first experience attending the KPhA Annual Meeting. It was a great atmosphere and, despite not knowing many people, I felt welcomed by everyone as soon as I arrived. It was such a nice touch that they included the United We Stand ribbons which further Q: How can I participate? unified this tight-knit group of people. I expanded my pharA: Students are encouraged to participate in the Student macy knowledge more than you could imagine, and many Pharmacist Self-Care Championship which always ends up of these things I know I will use on my upcoming rotations. being a nice refresher course in pharmacy and a great, en- In addition, I was able to meet my future preceptors, learn tertaining way to end the first day of programming. I also more about my upcoming rotations and also learn more know the staff at KPhA will always welcome those who about my future career interests. I highly encourage everywant to lend a helping hand in the meeting preparation. one to attend this meeting. You will not regret it!

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THE KENTUCKY PHARMACIST

136th KPhA Annual Meeting and Convention

July 2014

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THE KENTUCKY PHARMACIST

136th KPhA Annual Meeting and Convention

July 2014

KPhA Would Like to Thank Our 2014 Sponsors Event Sponsors

KPERF Golf Hole Sponsors

American Pharmacy Services Corporation

AmerisourceBergen

Humana

Booneville Discount Drug

Jefferson County Academy of Pharmacists

The Clifton Family

KPhA District 1

George Hammons, Frankie Abner & Tom Houchens

Kroger Corporation

Harrod & Associates

Northern Kentucky Pharmacists Association

Medica Pharmacy and Wellness Center,

Pharmacists Mutual Co. Insurance

Bardstown-Shepherdsville-Bloomfield

Poole’s Pharmacy Care

Pharmacists Mutual Co. Insurance

Rx Therapy Management

Poole’s Pharmacy Care

University of Kentucky College of Pharmacy

Sponsoring Pharmacy’s Future Cardinal Health Customers in Kentucky

National Association of Chain Drug Stores

Matt Carrico

Bob Oakley

Kimberly Croley

Duane W. Parsons

Brian Fingerson

Clay & Jill Rhodes

Humana

Donnie Riley

Kentucky Heart Disease & Stroke and Diabetes Prevention & Control Programs—Department for Public Health

Richard & Zena Slone

Medica Pharmacy and Wellness Center

Wellcare of Kentucky

Bardstown-ShepherdsvilleBloomfield

Sam Willett

Sullivan University College of Pharmacy Tolliver Management Group Lewis Wilkerson

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Republic Bank & Trust Rite Aid Rx Discount Pharmacy The Save-Rite Family of Pharmacies Sullivan University College of Pharmacy—INCAPS Tolliver Management Group Warner Medical Wayne’s Pharmacy

Annual Meeting Supporters Rx Systems, Inc. Samford University McWhorter School of Pharmacy

THE KENTUCKY PHARMACIST

136th KPhA Annual Meeting and Convention

July 2014

… and our 2014 Exhibitors American Pharmacy Cooperative, Inc.

QS/1

AmerisourceBergen

R&S Northeast.com

American Pharmacy Services Corp.

Rite Aid

Astrazeneca

Samuels Products, Inc.

Cardinal Health

Smith Drug Company

Dr. Comfort

SUCOP Student Organizations

EPIC Pharmacies

UK COP Experiential Ed/ CAPP

HD Smith

UK Student Organizations

Kentucky Cabinet for Health & Family Services (KASPER)

Walgreens Warner Medical

Kentucky Renaissance Pharmacy Museum

Save the Date

Kentucky Heart Disease & Stroke Kentucky Diabetes Prevention & Control Programs—Department for Public Health KHELPS Kirby Lester

137th KPhA Annual Meeting & Convention June 25-28, 2015

McKesson Corporation Merck Miami Luken

Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

Morris & Dickson Noven Pharmaceuticals Passport Health Plan/Magellan Pharmacists Mutual Companies 13

THE KENTUCKY PHARMACIST

American Pharmacy Services Corporation

July 2014

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THE KENTUCKY PHARMACIST

136th KPhA Annual Meeting and Convention

July 2014

A GRAND TIME BANQUET AFTER-PARTY

Following the Ray Wirth Banquet, attendees partied into the night to benefit the Kentucky Renaissance Pharmacy Museum. Costumes were encouraged and the Museum sold hats and headbands for those who needed an extra accessory. Make sure you mark your calendar for June 25-28, 2015 so you don’t miss out on the fun! On to Bowling Green!

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Technician Review

July 2014

Technician Review From the KPhA Academy of Technicians KPhA members,

responsibility for technicians or have suggestions for needed changes, please let us know. We developed a set of The KPhA Pharmacy Technician Academy invites all KPhA proposals that would help guide our profession in the fumembers to get involved with the Academy. Only techniture. The pharmacy profession is changing. In fact, the only cians may become members, but we hope the KPhA pharthing in pharmacy that does not change is the fact that we macists will increase their involvement also. The Academy are always changing. As providers struggle to grasp the is devoted to the improvement of the pharmacy technician new era of healthcare, pharmacists have the opportunity to profession; we can be a strong foundation for our pharma- fill that void. The Academy is here to help technicians by cists to work with and help improve patient care. being a voice for all technicians. If you are interested in learning more about the Academy, please visit the AcadePharmacists, please encourage your technicians to bemy webpage through the KPhA website or contact Don come involved with KPhA and the Academy to help Carpenter at dacarpenter@st-claire.org. strengthen our voice. If you would like to see increased

KPhA Member Pharmacy Technicians

FREE CE

KPhA Technician members are eligible for Free CE modeled on PTCB standards by becoming a member of the KPhA Pharmacy Technician Academy. All KPhA Technician Members are eligible for Academy Membership at no additional cost.

The mission of the KPhA Academy of Pharmacy Technicians is: To unite the pharmacy technicians throughout the Commonwealth to have one voice toward the advancement of our profession.

To follow what is currently happening with your profession please read our newsletter articles and become involved.

For more information contact Don Carpenter via email at dacarpenter@st-claire.org

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July 2014 CE — Hypertension Management

July 2014

Hypertension Management: New Guidelines and Recommendations By: Brett Smith, PharmD, Jessica Everitt, PharmD and Deborah Minor, PharmD; G.V. (Sonny) Montgomery VA Medical Center Department of Pharmacy and The University of Mississippi Medical Center, Departments of Pharmacy and Medicine, Jackson, Mississippi Reprinted with permission of the authors and the Mississippi Pharmacists Association where this article originally appeared.

This activity may appear in other state pharmacy association journals. There are no financial relationships that could be perceived as real or apparent conflicts of interest.

KPERF offers all CE Universal Activity # 0143-9999-14-007-H01-P&T 1.5 Contact Hour (0.15 CEU) Goal: The purpose of this review is to increase the awareness and understanding of recent recommendations for the treatment and management of hypertension among pharmacy practitioners.

articles to members online at www.kphanet.org

Objectives At the conclusion of this article, the reader should be able to: 1.

2.

3.

4.

Review recent guideline updates and recommendations for the treatment and management of hypertension.

Identify changes in blood pressure goals and thresholds for treatment in reference to specific patient populations.

Discuss recommendations for treatment of hypertension based on race or concurrent disease states.

Describe the influence of lifestyle modifications on hypertension prevention and treatment.

After a gap of more than 10 years, we now have new recommendations in the United States for the treatment of hypertension. Within a matter of days, two different guidelines were released by members of the Eighth Joint National Committee (JNC 8) and the American and International Societies of Hypertension (ASH/ISH). Because hypertension is such a significant global public health problem and the most common chronic condition for which people seek health care in the United States, the release of updated recommendations has been anxiously awaited. The National Heart, Lung and Blood Institute (NHLBI) publication of “JNC-Wait” or “-Late,” as some have referred to the overdue guidelines, was delayed and then abruptly cancelled in June 2013 when the agency announced that it was no longer going to release guidelines. Subsequently, panel members of the development committee elected to release their recommendations independently, as JNC 8. Within days of the JNC 8 release, the ASH/ISH also released its hypertension guidelines. Both guidelines were released in December 2013, and later published in January 2014.

rates for cardiovascular disease (CVD) mortality. Hypertension is typically defined as systolic blood pressure of > 140 mmHg or diastolic blood pressure of > 90 mmHg or taking antihypertensive medication. The prevalence of hypertension does not vary significantly by gender but is significantly and independently associated with increasing age, increasing body mass index (BMI, kg/m 2), being AfricanAmerican and having less education.

From the initial gathering of the JNC 8 committee, the charge was clear: to utilize recent literature to produce evidence-based guidelines. The JNC 8 committee based its research and resultant recommendations on three core questions which addressed blood pressure thresholds for therapy initiation, blood pressure goals and the effect of antihypertensive regimens on health outcomes. Unlike the JNC 7 authors, who reviewed any peer-reviewed literature relevant to critical concepts, the JNC 8 committee solely included randomized controlled trials (RCTs) of good quality with a defined population size and follow-up outcomes.

Studies from 1966-2009 were reviewed, with large multiThe burden of hypertension is significant primarily due to its center trials after 2009 meeting other criteria added in a place as a major modifiable risk factor for cardiovascular bridge review. For treatment recommendations, JNC 8 only and kidney disease. Approximately one third of United considered RCTs that compared a member of one drug States adults have hypertension. Kentucky has one of the class to another class, rather than to placebo. Though the highest prevalence rates of hypertension (35.6 percent ver- result is clearly more evidence-based and focused than sus 29.1 percent nationally) along with one of the highest predecessors, five of the nine listed recommendations were 17

THE KENTUCKY PHARMACIST

July 2014 CE — Hypertension Management consensus-based for the ultimate panel decision. The full evidence reviews and statements are included in a 300page online supplemental review.

Authors of the ASH/ISH recommendations acknowledge that there is insufficient clinical data to develop purely evidence-based guidelines for hypertension. Rather, the goal of their publication was to serve as a broad curriculum of recommendations for practical use based on both literature and expert opinion. The authors emphasize the importance of individual patient care environments and clinical judgment as the driving forces behind ultimate hypertension therapy decisions. JNC 8 and the ASH/ISH guidelines contain important similarities and differences. The purpose of this review is to increase the awareness and understanding of these recent recommendations for the treatment and management of hypertension among pharmacy practitioners.

RECOMMENDATIONS FOR BLOOD PRESSURE THRESHOLDS AND GOALS

July 2014 goals for patients > 80 years of age.

Both guidelines note that while their recommendations and definitions are based on the evidence to date, there is an absence of evidence regarding the benefits of treatment for much of the population. More research is needed to identify optimal goals. For example, there are no good quality RCTs evaluating the benefits of treating elevated diastolic blood pressure in adults younger than 30 years, hence the recommendations are based on opinion. In contrast, there is moderate to high quality evidence (Grade A) to support the JNC 8 recommendation of < 150/90 mmHg in the general population aged 60 years and older, and also some evidence that setting a lower goal in this age group provides no additional benefit. Despite this evidence, this recommendation was highly debated among the ASH panel.

Some members expressed concern that raising the goal for this general population (from < 140 mmHg) would inadvertently influence hypertension management for many patients that may benefit from a lower blood pressure. For high-risk groups, including blacks, those with CVD, and those with multiple risk factors, there is insufficient evidence of the lack of benefit with the lower target. Because of this, a corollary recommendation was added to the primary recommendation for this age group. The panel acknowledged that there are many hypertensive patients with systolic blood pressures of < 140 mmHg and treatment need not be adjusted if there are no adverse effects on health or quality of life. In a subsequent January 2014 publication, five of the JNC 8 authors further elaborated on their cause of disagreement with the differential age goals.

They detailed the major clinical and public health implications associated with adoption of this recommendation and the lack of sufficient evidence for increasing the systolic blood pressure target.

In general, thresholds for treatment and blood pressure goals recommended for adults in the 2014 guidelines are more consistent across the population and relaxed than those recommended in previous guidelines. In contrast to JNC 7, the JNC 8 and ASH/ISH guidelines identify blood pressure goals primarily based on age and do not designate lower goals for patients with specific comorbidities such as diabetes and chronic kidney disease (CKD). The included table highlights and compares thresholds, goals and selected considerations for treatment of hypertension according to the JNC 8 and ASH/ISH guidelines, as well as the 2014 American Diabetes Association (ADA) recommendations. Of note, other disease-focused guidelines (e.g., heart failure, acute management) may include recommendations for alternative blood pressure goals, in the presThe ASH/ISH age recommendation is based on clinical ence of concurrent conditions. trials in the aged 80 and older population, where achieving a systolic blood pressure of < 150 mmHg was associated Blood Pressure Goals – General Population with strong cardiovascular and stroke protection.

JNC 8 separates the thresholds for treatment of hypertension between younger adults and those aged 60 years and Blood Pressure Goals – Diabetes above, while ASH/ISH does the same but at 80 years or The JNC 8 and ASH/ISH guidelines both recommend that a older. For the younger population (< 60 or 80 years, repatient with diabetes should be treated to a systolic goal of spectively), treatment should be initiated when systolic < 140 mmHg and a diastolic goal of < 90 mmHg. Despite blood pressure is 140 mmHg or higher or diastolic blood the evidence-based direction, this recommendation is pripressure is 90 mmHg or higher, with a goal of treating to marily based on expert opinion. There is a moderate below this threshold. amount of evidence to support a systolic blood pressure goal of < 150 mmHg, while the < 140 mmHg goal is solely For those > 60 years, JNC 8 recommends initiating pharsupported by ACCORD-BP. Both guidelines note that there macologic treatment to lower blood pressure at a systolic is insufficient evidence to recommend the previous JNC 7 blood pressure of 150 mmHg or higher or diastolic blood diastolic goal of < 80 mmHg. pressure of 90 mmHg or higher, and treating to < 150/90 For many years, ADA recommended a systolic blood presmmHg. ASH/ISH recommend these same thresholds and 18

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2014 Hypertension Treatment Guidelines Joint National Committee (JNC ) 8

Blood Pressure Thresholds for Treatment (i.e., >) and Goals (mm/Hg)

American/ International Society of Hypertension

<140/90, <60 years

<140/90, < 80 years

<150/90, ≥60 years

<150/90, ≥80 years; optional <140/90 with CKD or diabetes

CKD: <140/90

American Diabetes Association

<140/80, <130/80 optional (e.g., younger patients)

CKD w/ albuminuria: consider <130/80

Diabetes: <140/90

Initial Treatment by Race* Nonblack Black

Thiazide, CCB, ACEI, or ARB Thiazide or CCB

<60 years: ACEI or ARB ≥60 years: CCB or thiazide CCB or thiazide

No race-specific recommendations

Initial Treatment by Selected Concurrent Disease States*

Chronic Kidney Disease (CKD)

Diabetes Stroke Coronary Artery Disease Symptomatic Heart Failure

ACEI or ARB as initial or add-on; thiazide or CCB also an option in those >75 years.

For black patients without proteinuria, thiazide, CCB, ACEI or ARB for initial.

As per recommendations by race.

-

ACEI or ARB; CCB or thiazide acceptable in black patients ACEI or ARB B-blocker + ARB or ACEI

-

ACEI or ARB

-

ARB or ACEI + B-blocker + diuretic + spironolactone Selected Recommendations

In those ≥60 years and BP <150/90, no need to adjust medications to increase BP if no adverse events.

Regimen to include ACEI or ARB

-

Lifestyle modifications for BP lowering can be attempted for 6-12 months in patients with stage 1 HTN and no evidence of abnormal cardiovascular findings.

Promptly initiate drug therapy along with lifestyle modifications when BP > 140/80.

Administer one or more antihypertensives at bedtime. *Medication classes recommended for initial add-on therapy include ACEIs, ARBs, CCBs, or thiazides. Other classes (e.g., B-blockers, aldosterone antagonists, centrally acting agents) may be needed for specific conditions or subsequent therapy. sure goal of < 130 mmHg and a diastolic goal of < 80 mmHg for patients with diabetes, consistent with JNC 7 recommendations. The ADA Standards of Care 2013 revised this goal by modifying the systolic goal to < 140 mmHg (based on ACCORD-BP), while retaining the diastolic goal of < 80 mmHg. The 2014 ADA guidelines maintained these recommendations, noting that a systolic goal of < 130 mmHg may be appropriate for younger patients or those at less risk of falls due to treatment-induced hypotension.

Blood Pressure Goals - Chronic Kidney Disease Consistent with recommendations from the National Kidney Foundation, JNC 7 recommended a blood pressure goal of < 130 mmHg systolic and < 80 mmHg diastolic for patients with CKD. In contrast, JNC 8 recommends a goal of < 140 mmHg systolic and < 90 mmHg diastolic. Based on their review, the panel reports that there is evidence of no benefit on kidney disease progression associated with the previously recommended lower goal. They also note that a lower goal is not necessary for patients with albuminuria, 19

THE KENTUCKY PHARMACIST

July 2014 CE — Hypertension Management based on the evidence. The ASH/ISH guidelines also recommend a general blood pressure goal of < 140/90 mmHg in patients with CKD but acknowledge that some experts promote a goal of < 130/80 mmHg when albuminuria is present.

From another perspective, Sarafidis and Ruilope evaluated the effects of blood pressure reduction in patients with CKD. They concluded that blood pressure goals in this population should be based on the type of CKD (diabetic versus nondiabetic) and the degree of proteinuria. Goals of < 125/75 mmHg were suggested for nondiabetic patients with proteinuria greater than 1 gram/day. A blood pressure goal of < 130/80 mmHg was justifiable, according to their review, if proteinuria was between 0.25 grams and 1 gram/ day. The recommendation for diabetic patients without proteinuria was a diastolic blood pressure of < 80 mmHg and systolic target between 130 and 140 mmHg, to provide optimal cardioprotective benefits of blood pressure lowering.

These recommendations are not consistent with those of JNC 8 and ASH/ISH and reflect the differences in methodology, review criteria and levels of evidence.

July 2014 to start with one drug and then add a second drug, in lieu of up-titration of the first drug. A third approach would be to begin with two drugs, particularly when systolic blood pressure is > 20 mmHg and/or diastolic blood pressure is > 10 mmHg above goal, then add a third drug if needed. In selection of a treatment strategy, consideration should be given to the individual patient circumstances, clinician and patient preferences and drug tolerability.

The clearest departure from previous guidelines is the lack of inclusion of beta-adrenergic blockers (BBs) for the initial treatment of hypertension. With the availability of newer classes [i.e., diuretic, ACE-I, ARB, CCB] and evidence of more favorable outcomes, BBs are no longer a preferred initial class for treatment of hypertension. Historically, BBs have been widely used as antihypertensive agents and remain among the most commonly prescribed medications. A meta-analysis of 13 trials comparing BBs to other antihypertensives or placebo revealed a higher risk of stroke and no difference in myocardial infarction in patients taking BBs. BBs remain indicated and are considered standard of care for many of the cardiovascular conditions that often accompany hypertension, including heart failure, atrial fibrilRECOMMENDATIONS FOR TREATMENT lation and coronary artery disease. Evidence clearly supOF HYPERTENSION ports the value of BBs in reducing morbidity and mortality Unlike JNC 7, the JNC 8 guidelines do not highly emphaamong patients with a history of myocardial infarction or size medication selection based on compelling indications. heart failure. While BBs may not be first line for hypertenAlong with the streamlined blood pressure goals, populasion, most patients with these other cardiovascular condition-specific treatment recommendations in JNC 8 are pritions have hypertension as a concurrent or contributing risk marily based on race (nonblack and black) and whether the factor. patient has CKD or diabetes. The guidelines by ASH/ISH Treatment of Hypertension – Nonblack Population recommend treatment based on race, age and concurrent conditions.

For all nonblack patients, JNC 8 recommends initiating medication therapy with either an ACE-I, ARB, CCB or thiaBoth JNC 8 and ASH/ISH guidelines recommend angiotenzide-type diuretic. The authors do not differentiate the order sin-converting enzyme inhibitors (ACE-I), angiotensin reof treatment for these drug classes, and all four are considceptor blockers (ARB), calcium channel blockers (CCB) or ered equally reasonable as a first line option unless there is thiazide-type diuretics for the initial treatment of hypertenconsideration for other conditions. sion. As most patients will require more than one drug to achieve and maintain blood pressure control, additional The initial drug choice recommended in nonblack patients drug therapy should be selected from within the classes varies by age group in the ASH/ISH guidelines. For pasuggested. An exception to this is the combination of an tients < 60 years of age, an ACE-I or ARB is recommendACE-I and ARB, which should not be used together. All ed, while a CCB or thiazide-type diuretic is recommended patients should have a thorough evaluation before starting in those > 60 years, with a CCB generally preferred. treatment for hypertension. Evaluation should optimally Treatment of Hypertension – Black Population include personal history, physical examination and selecJNC 8 recommends thiazide-type diuretics or CCBs as first tive testing and laboratory assessments. Both JNC 8 and ASH/ISH guidelines identify general dosing suggestions for line therapy for the general black population. This recomindividual agents in the recommended classes of drugs as mendation is supported by the ALLHAT study, which demonstrated better cerebrovascular, heart failure and carwell as acceptable strategies for medication initiation and dosing. Therapy may be initiated with one drug, with subse- diovascular outcomes with a thiazide-type diuretic compared to an ACE-I in black patients. In this population, quent titration to a maximum dose, and then addition of another drug if needed. An alternative approach would be ACE-Is also were associated with a higher rate of stroke 20

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July 2014 CE — Hypertension Management

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and less effective blood pressure control than CCBs. Though the CCB was less effective than the diuretic in preventing heart failure in the black ALLHAT population, there were no differences in other outcomes. Per JNC 8 authors, this recommendation for thiazide diuretics and CCBs applies to black patients with diabetes as well, though this is considered a weak recommendation. The ASH/ISH recommendations for initial drug treatment for the black population align with those from JNC 8, again with a CCB generally preferred over a thiazide-type diuretic.

Treatment of Hypertension – With Chronic Kidney Disease

The ASH/ISH guidelines recommend that most patients with heart failure should receive an ACE-I or ARB, BB, diuretic and spironolactone regardless of blood pressure due to the benefits in heart failure outcomes. Dihydropyridine CCBs can be added if needed to achieve blood pressure goals.

LIFESTYLE MODIFICATIONS Lifestyle interventions or modifications are pivotal in the management of hypertension and should be the foundation of treatment. Appropriate modification of lifestyle factors can directly influence blood pressure and other cardiovascular risk factors. Weight loss, increased physical activity and sodium restriction are recommended for all patients with hypertension and as the initial approach to treating most patients with prehypertension. Limitations on alcohol intake and smoking cessation also can positively impact cardiovascular risk. Even more far-reaching than the value in the treatment of established hypertension is the potential for disease prevention.

For the treatment of hypertension in all patients with CKD, JNC 8 and ASH/ISH recommend utilizing an ACE-I or ARB as initial or add-on therapy. These recommendations are unchanged from JNC 7. These classes of medications have been shown to improve renal outcomes and slow the progression to end-stage renal disease; however, there is less evidence to support improved cardiovascular outcomes compared to other classes. JNC 8 also lists thiazide While a review of lifestyle modifications effective for hyper-type diuretics and CCBs as options for initial therapy in tension management was not conducted by the authors of those > 75 years of age, as well as for black patients withJNC 8, the guidelines do promote a healthy diet, weight out proteinuria. control and regular exercise in order to improve blood pressure control and potentially reduce the need for medicaTreatment of Hypertension – With Diabetes tions. The ASH/ISH guidelines also highlight effective lifeJNC 8 makes no specific recommendations for the pharmastyle interventions. For specific recommendations on lifecologic treatment of hypertension in patients with diabetes style modifications shown to improve blood pressure conbut states therapy should follow the race-based recommentrol, the JNC 8 authors refer readers to the recommendadations. A review of trials including those with diabetes tions of the NHLBI 2013 Lifestyle Work Group. This group showed no difference in major cardiovascular or cerebroreviewed and assessed evidence related to dietary patvascular outcomes from those in the general population terns, nutrient intake and physical activity for prevention and no strong evidence that one particular class leads to and treatment of CVD through modifiable risk factors, inbetter outcomes. cluding blood pressure.

The ASH/ISH guidelines suggest use of an ACE-I or ARB, Healthy Diet particularly if the patient also has CKD, but also list CCBs The Work Group recommends a dietary pattern that emand thiazide diuretics as acceptable alternatives in black patients with diabetes. The ADA guidelines suggest the use phasizes the consumption of vegetables, fruits and whole of an ACE-I or ARB in the hypertension treatment regimen grains. The diet should include low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils and nuts, while of patients with diabetes and make no recommendations sweets, sugar-sweetened beverages and red meat should for therapy based on race. be limited. Plans that follow this pattern include the Dietary Treatment of Hypertension – With Heart Failure Approaches to Stop Hypertension (DASH) diet, United States Department of Agriculture (USDA) Food Pattern and JNC 7 guidelines specified heart failure as a compelling the American Heart Association Diet. Evidence shows that indication for which ACE-I, ARB and BBs were recommended as optimal therapy. JNC 8 suggests that heart fail- following the DASH diet decreased blood pressure by 5 – ure alone does not require alternate therapy options. There 6/3 mmHg compared to the typical American diet. This effect was seen regardless of gender, race, age or presence is some evidence that supports better heart failure outof a hypertension diagnosis. These dietary-related effects comes with ACE-Is compared to CCBs, but the panel determined that alternative classes could also be acceptable on blood pressure are independent of changes in weight and sodium intake. This degree of blood pressure reduction first line agents.

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July 2014 CE â&#x20AC;&#x201D; Hypertension Management

July 2014

is sufficient to prevent progression to hypertension from prehypertension, promote blood pressure lowering in patients with hypertension and supplement pharmacologic therapy.

CONCLUSIONS

The Work Group also promotes a decrease in sodium intake to lower blood pressure. Reducing sodium to less than 2,400 mg per day has been shown to lower blood pressure.

For maximum blood pressure lowering, sodium intake should be reduced to less than 1,500 mg per day. Again, the benefits of blood pressure lowering due to decreased sodium intake are seen regardless of age, gender, race or hypertension diagnosis. In adults 22 to 80 years of age with blood pressures of 120-159/80-95 mmHg, combining sodium reduction with the DASH diet decreased blood pressure more than reduced sodium intake alone. In addition, a reduction in daily sodium consumption by at least 1,000 mg may reduce overall risk of CVD events and is recommended even if goal sodium intake is not yet achieved.

Weight Control The relationship between weight and blood pressure is clear. Over 70 percent of adults with hypertension are overweight or obese, with the prevalence of high blood pressure increasing progressively with increasing BMI. In the Framingham Heart Study, 70 percent of the new cases of hypertension were attributable to excess body weight and for every 10-pound weight gain, systolic blood pressure increased an average of 4.5 mmHg. Obesity, specifically excess body weight, is the single most important cause of primary hypertension. Obesity also is recognized as an epidemic and independent risk factor for CVD that is strongly associated with other risk factors. Weight loss or prevention of excess weight gain is the most obvious approach to preventing hypertension.

The treatment of hypertension is challenging for patients and health care providers alike. The link between CVD and hypertension is well established. Goals for treatment and therapeutic decisions for hypertension management should be based on a constellation of factors. The new guidelines for management of hypertension offer recommendations and guidance and should meet the clinical needs of most patients. In deciding the application of particular recommendations, clinical judgment and the individual characteristics and circumstances of each patient must be considered.

Therapeutic decisions should be based on identification of known causes of high blood pressure, age of the patient, potential for adverse effects, response to therapy and identification of other cardiovascular risk factors or concomitant disorders that may define prognosis and guide treatment.

Undoubtedly debate will continue regarding ideal blood pressure goals and recommendations for the population as a whole. Further evidence will contribute to our existing gaps in knowledge.

Pharmacists encounter patients with hypertension on a daily basis. We are in a unique position to influence patient care and decisions, particularly in the areas of medication use and selection. By understanding current recommendations for therapy, we can effectively impact disease management and outcomes for many patients with hypertension.

REFERENCES

1. James PA, Oparil S, Carter BL, et al.: 2014 evidencebased guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

JAMA 2014, 311(5):507-520.

Weight reductions of as little as 5-10 percent can improve 2. Weber MA, Schiffrin EL, White WB, et al.: Clinical pracblood pressure and amplify the pharmacologic treatment for tice guidelines for the management of hypertension in hypertension, potentially reducing the amount of medicathe community: a statement by the American Society of tions needed to reach goals. Several studies demonstrate Hypertension and the International Society of Hypertenthat weight loss lowers blood pressure in obese subjects sion. J Clin Hypertens 2014, 16(1):14-26. and may prevent hypertension even when compared to sodium reduction. Patients should be encouraged that even 3. Chobanian AV, Bakris GL, Black HR, et al.: The seventh report of the Joint National Committee on Prevenmodest weight loss can lead to blood pressure reduction. tion, Detection, Evaluation, and Treatment of High Regular Exercise Blood Pressure: the JNC report. JAMA 2003, 289:2560 Physical inactivity is associated with hypertension. The -2572. combination of exercise with weight reduction may have 4. Ong KL, Cheung BM, Man YB, et al.: Prevalence, additive effects on blood pressure reduction. The Lifestyle awareness, treatment, and control of hypertension Work Group recommends a goal for all adults to accumuamong United States adults 1999-2004. Hypertension late approximately 160 minutes of moderate to vigorous 2007, 49(1):69-75. physical activity per week (over three to four sessions, av5. Wright JT, Fine LJ, Lackland DT, et al.: Evidence superage 40 minutes).

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July 2014

porting a systolic blood pressure goal of less than 150 mm in patients aged 60 years or older: the minority view. Ann Intern Med 2014, 160(7):499-503.

care in diabetes-2014. Diabetes Care 2014, 37 Suppl 1:S14-80.

6. Lithovius R, Harjutsalo V, Forsblom C, et al.: Antihypertensive treatment and resistant hypertension in patients with type 1 diabetes by stages of diabetic nephropathy.

Diabetes Care 2014, 37(3):709-17.

7. American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care 2013, 36 Suppl 1:S11-66.

8. American Diabetes Association. Standards of medical

9. Sarafidis PA, Ruilope LM. Aggressive blood pressure reduction and renin-angiotensin system blockade in chronic kidney disease: time for re-evaluation. Kidney Int 2014, 85(3):536-46.

10. Eckel RH, Jakicic JM, Ard JD, et al.: 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol Epub 2013.

July 2014 â&#x20AC;&#x201D; Hypertension Management: New Guidelines and Recommendations 1. The following risk factors are independently associated with development of hypertension: a. Increasing age. b. Increasing BMI. c. African American race. d. Lower education level. e. All of the above.

2. The blood pressure goal for the general population aged 60 years and older according to JNC 8 is: a. < 120/80 mmHg. b. < 130/80 mmHg. c. < 140/90 mmHg. d. < 150/90 mmHg. 3. The blood pressure goal for patients with diabetes according to JNC 8 and ASH/ISH is: a. < 130/80 mmHg. b. < 140/80 mmHg. c. < 140/90 mmHg. d. < 150/90 mmHg.

6. Beta blockers have been shown to reduce morbidity and mortality in patients with a history of: a.

Hypertension. b.

Myocardial infarction. c.

Heart failure. d.

Both B & C. 7. According to JNC 8 ACE-Is are an appropriate first-line treatment for the general black population. a. True b. False 8. JNC 8 lists thiazide-type diuretics and CCBs as initial therapy options for CKD patients with hypertension who: a. Are > 75 years old. b. Are black without proteinuria. c. Are black with proteinuria. d. Both A & B.

9. In people with hypertension, the recommended daily sodium intake for maximal blood pressure lowering is: 4. All of the following medication classes are a. 1,500 mg. recommended by new guidelines as first line treatment b. 2,400 mg. options for the general nonblack population EXCEPT: c. 3,000 mg. a.

Angiotensin-converting enzyme inhibitors. d. 3,500 mg. b.

Angiotensin receptor blockers. c.

Beta blockers.

10. A weight reduction of at least 20 percent is d.

Calcium channel blockers. necessary for blood pressure reduction. e.

Thiazide-type diuretics. a. True b. False 5. The following should be considered when selecting a medication regimen for treatment of hypertension: a.

Patient preference. b.

Clinician preference. c.

Drug tolerability. d.

All of the above.

The August 2014 Continuing Education Article will appear in the September issue of The

Kentucky Pharmacist.

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This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South, Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

Expiration Date: July 31, 2017 Successful Completion: Score of 80% will result in 1.5 contact hour or 0.15 CEU. Participants who score less than 80% will be notified and permitted one re-examination.

TECHNICIANS ANSWER SHEET. July 2014 — Hypertension Management: New Guidelines and Recommendations (1.5 contact hours) Universal Activity # 0143-9999-14-007-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 3. A B C D 5. A B C D 2. A B C D 4. A B C D E 6. A B C D

7. A B 8. A B C D

9. A B C D 10. A B

Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature _________________________________________________ Date _________________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) PHARMACISTS ANSWER SHEET July 2014 — Hypertension Management: New Guidelines and Recommendations (1.5 contact hours) Universal Activity # 0143-9999-14-007-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D E 3. A B C D 5. A B C D 2. A B C D 4. A B C D E 6. A B C D

7. A B 8. A B C D

9. A B C D 10. A B

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature _________________________________________________ Date _________________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.

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Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

THE KENTUCKY PHARMACIST

July 2014

Continuing Education Changes

YOUR KPhA wants YOU to be informed

Continuing Education changes that YOU need to know By: Scott Sisco, Director of Communications and Continuing Education You should have noticed several changes in continuing pharmacy education over the past few years. Many of these changes were necessitated with the new credit tracking mechanism, CPE Monitor.

Tips for Successful CE  

CPE Monitor was developed through collaboration between the Accreditation Council for Pharmacy Education (ACPE) and the National Association of Boards of Pharmacy (NABP) to create an electronic system for pharmacists and pharmacy technicians to track completed continuing education credits. The Kentucky Pharmacy Education and Research Foundation (KPERF) implemented CPE Monitor in September 2012, and all ACPE Accredited Providers were required to implement the service by Jan. 1, 2013.

The biggest change that you have probably noticed by now is that you no longer receive certificates for your credit.

All credit is uploaded through the CPE Monitor program to your profile. ACPE does not recognize any credit outside of CPE Monitor. When you log into your profile at www.mycpemonitor.net, you can check your credit and print statements. It is recommended that you do print a copy of your credit, though the Board of Pharmacy has access to check your credit through CPE Monitor.

Timing Issues and Completion Dates In April 2014, ACPE released a few updates on CPE Monitor. Beginning May 1, ACPE enabled a 60-day submission rule for activities. What does this mean for you? Probably not much for live activities, such as the ones at the KPhA Annual Meeting and Convention and the Mid-Year Conference. YOUR KPERF Administrator (that would be Scott Sisco, KPhA Director of Communications and Continuing Education) must have activities uploaded to CPE Monitor within 60 days of the activity. On home activities (the CE articles in these pages each issue), activities must be uploaded within 60 days of the completion date. So make sure you send in your quizzes soon after you complete them.

Always include your CORRECT NABP eProfile ID and Birthdate (MONTH AND DAY).

Write legibly.



Check your date of participation to make sure it is within the year you are seeking credit.



Be aware of deadlines for certification or registration.



Don’t procrastinate.



Include an email address and/or a phone number in case there is an issue with your CE submission.



Copy the quizzes you send in in case they are lost in the mail.



Check your CPE Monitor profile to make sure all of your credit has been applied to your account.

date on a quiz in December 2014, but mail it to KPhA for credit in January 2015, it will count toward your total for 2014.

The expiration date for home-based CE programs remains the same as it always has. Programs are valid for three years after the release date. KPERF lists the expiration date at the top of the page of answer sheets. You can still complete CE activities from past years for current year credit, as long as the program hasn’t expired. All KPERF CE articles are available online for KPhA members under the Education tab on www.kphanet.org.

Pharmacy Technician Changes Technicians who are certified through the Pharmacy Technician Certification Board (PTCB) have seen several changes this year as well. In addition to the 1 hour of law requirement, technicians now also must complete 1 hour of patient safety CE as part of the 20 hours per two-year period. PTCB also requires technician specific CE. Universal Activity Number

One question that we get quite often is how do you tell if a program is law or patient safety. It’s all in the numbers – In regards to the completion date for home activities, which is next to your signature on the answer sheets for the the ACPE Universal Activity Number to be precise. This is CE quizzes, ACPE considers this date to determine when the number under the article name in the answer sheets for the credit for the activity is valid. So, if you put a completion journal articles or under the title of a live presentation on 25

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Continuing Education Changes

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the evaluation sheet and announcement. It has six parts.

Here’s a sample: 0143-0000-14-006-H01-P&T. The 0143 is the ACPE Accredited Provider number (KPERF). All activities that begin with 0143 are accredited by KPERF. The next part, 0000 shows that this is a KPERF activity. The other option for this area is 9999, which shows that another organization is presenting this activity, but KPERF is still accrediting the program as a joint provider (a new term ACPE adopted in June 2014).

The third section (14) is the year the activity was accredited, and the fourth section (006) is the sequence of the activity. This is the sixth activity accredited for 2014 by KPERF.

Questions?

The fifth part (H01) is the important one for determining the type of the activity. The “H” shows that this is a homebased activity. If it were a live activity, this would be an “L”.

The 01 is the topic designator. ACPE has five topic designators for CE: 01 - Drug therapy related, 02 - AIDS therapy related, 03 - Law topics, 04 - General Pharmacy Topics, 05 - Patient Safety. Most of KPERF’s topics are Drug Therapy Related or General Pharmacy Topics, but we are working to add patient safety topics. The January 2014 article about changes to HIPAA is designated as a Law topic.

The final part of the UAN designates this credit either for

pharmacists (P) or pharmacy technicians (T). This designation is why we have two answer sheets in the journal for each article and separate evaluation sheets for live activies. For most of KPERF articles, the objectives for technicians and pharmacists are the same, but some articles have separate objectives. For live activities, pharmacists and technicians have separate sheets. Often the only difference is this section of the UAN. But this is a very important designation. If the administrator entering the credit doesn’t know the participants, pharmacists could end up with technician credit on their CPE Monitor profile and vice versa.

NABP Customer Service is available to answer your questions about CPE Monitor at custserv@nabp.net or on the telephone Monday through Friday 9 a.m. to 5 p.m. Central Time at 847-391-4406. If you have trouble logging in to your profile or forget your user name or password, they can help you with those issues.

If you have any other questions about continuing education or if you are interested in writing a CE article or presenting a CE topic at a meeting, let Scott Sisco know. KPERF is YOUR trusted source for quality continuing pharmacy education.

YOUR KPhA Needs YOU! Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines The following broad guidelines should guide an author to completing a continuing education article for publication in The Kentucky Pharmacist.  

 



Include a quiz over the material. Usually between 10 to 12 multiple choice questions.



Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers.

Average length is 4-10 typed pages in a word processing document (Microsoft Word is preferred). 

When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article.

Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not pertinent to technicians, that needs to be stated clearly Articles should address topics designed to narrow at the beginning of the article. gaps between actual practice and ideal practice in Article should begin with the goal or goals of the pharmacy. Please see the KPhA website overall program – usually a few sentences. (www.kphanet.org) under the Education link to see Include 3 to 5 objectives using SMART and meas- previously published articles. urable verbs.



Articles must be submitted electronically to the KPhA director of communications and continuing education Feel free to include graphs or charts, but please submit them separately, not embedded in the text (ssisco@kphanet.org) by the first of the month preceding publication. of the article.

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KPhA Pharmacy Emergency Preparedness

July 2014

Emergency Preparedness begins at home Before you can help others, you should make sure you and your family are prepared in case of an emergency. Here are some tips to get you started: - Don't run out of your medications! * Have an extra supply of medications on hand. * Check with health care providers on proper storage of medications during a power outage.

-Have a 'Grab and Go' bag on hand. * Includes extra medications, including over-the counter in waterproof zippered bags. * Keep each medication in its original container. * Check for expired and discontinued medications twice a year. * Include pet medications and records.

- Make a kit for your home * Flashlight, water (1 gallon per person), radio and batteries, first aid kit, whistle, plastic bags, toilet paper, canned food, peanut butter, crackers, duct tape, blankets.

- Things to grab and go *Car keys, house keys, identification, family files, eye glasses, medicine, hearing aid, batteries. *List of phone numbers *Doctor, school, poison control hot line, emergency phone numbers, local police/state police.

Pharmacy Personnel Training Program KPhA Director of Pharmacy Emergency Preparedness Leah Tolliver, PharmD, is developing a training program for Pharmacy Personnel on preparing for a disaster, both in the pharmacy and at home. Watch the KPhA eNews and the calendar on www.kphanet.org for dates and more information.

KPhA Pharmacy Emergency Preparedness Initiative Interest Form Name: ______________________

Status (Pharmacist, Technician, Other): ___________________

Email: ______________________________ Phone: ___________________________ For Pharmacists: Interest in serving as a volunteer: Yes____ No _____ If yes, please go to KHELPS link on KPhA Website to register (www.kphanet.org under Resources) Please send this information to Leah Tolliver, KPhA Director of Pharmacy Emergency Preparedness via email at ltolliver@kphanet.org, fax to 502-227-2258 or mail at KPhA, 1228 US 127 South, Frankfort, KY 40601.

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THE KENTUCKY PHARMACIST

Getting to Know Dr. Cindy Stowe

July 2014

Getting To Know Dr. Cindy Stowe: The New Dean of Sullivan University College of Pharmacy By: Heather M. Bryan, PharmD candidate and Irina Yaroshenko, PharmD candidate, Sullivan University College of Pharmacy (SUCOP) Class of 2015 Dr. Cindy Stowe is a graduate of the University of Kentucky College of Pharmacy, where she also completed a general clinical residency and a pediatric specialty residency. Following residency, she finished a pediatric pharmacotherapy research fellowship at LeBonheur Children’s Medical Center in Memphis, Tenn. Dr. Stowe was a member of the medical staff at Arkansas Children’s Hospital from 19962014 and has extensive teaching experience at both the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy and Dr. Cindy Stowe visits with KPhA Chair Duane Parsons the College of Medicine. While at UAMS, she served as at the 136th KPhA Annual Meeting and Convention. Dr. Associate Dean of Academic Affairs, Associate Dean for Stowe was introduced at the KPhA Awards Luncheon.

Professional Education. In the two years prior to joining Sullivan, she held the title of Associate Dean for Adminiswas a plus and definitely a positive. trative & Academic Affairs.

What interests you in the Dean position at SUCOP? What is your favorite part of the pharmacy profession?

I had a good fortune to work for an excellent Dean at While practicing, my favorite part of the profession was UAMS and that position gave me the confidence to do this. working with the other members of health care team. I en- I like challenges and I want to make a difference, so when I joyed direct patient care, but the aspect that I liked the learned about Sullivan University, the Sullivan family and most is working with other health care providers, both as a what they believe in, it seemed right. I like learning new collaborator and educator. things and making a difference so this was a perfect opportunity for me. When I interviewed at SUCOP, what imWhat made you decide to choose a career in academpressed me the most was the faculty and students. The ia? faculty is young and enthusiastic and really committed to As a child, I always wanted to be a teacher. I did not think the profession, while the student body is diverse and drivabout pharmacy as a profession until I got into high school. en. My on-site visit confirmed that this would be a great Once I decided to go through residency, going into acaplace for me. demia just made sense. Being a faculty member was not What goals do you have for SUCOP? something that I envisioned early on in my career because I envisioned my role would be educating patients and other Initially, my goal is to get to know Sullivan, the faculty and health care providers, not necessarily being in academic staff, students and people externally – build relationships. pharmacy. Having done a residency and fellowship preIn terms of long-term goals, my main focus is for SUCOP pared me to take on a faculty position. to be structurally sound then dream big. We have some strong faculty that are well prepared, and we need to figure Why did you decide to return to the state of Kentucky? out our niche, create an identity for ourselves and make I was at the point of my career when I was looking for other clear goals for the College. opportunities and new challenges. The next logical step What is your outlook on provider status for pharmawas deanship and the opening at Sullivan got my attention. cists?

I did my homework and learned what Sullivan was all about and the rest is history. Getting to return to Kentucky Provider status is a topic that never goes away because 28

THE KENTUCKY PHARMACIST

2014 KPhA Mid-Year Conference on Legislative Priorities we haven't been successful at achieving it. Sometimes you may not achieve your end result, but what you do achieve is still beneficial for the profession. As a Dean, it is my job to help support initiatives that move the profession forward.

I think there are a lot of barriers to earn provider status, and we just have to continue to work toward that end result. I am hopeful that with healthcare reform, there will be expanded opportunities for pharmacists, one of them provider status.

How do you think the pharmacy field will change in the next 10 years and why?

I believe the pharmacy field will be drastically different in the next 10 years, driven by healthcare reform to achieve access to quality healthcare at a reasonable cost. I believe

July 2014

payment models will drive a shift to a service-based model with less emphasis on dispensing a product. Pharmacists will continue to become more dependent on technology and this should include access to the entire medical record regardless of location. The role of pharmacy technicians will continue to evolve to support direct patient care.

What advice can you give to new pharmacy graduates?

Innovate, innovate, innovate! It is an awesome time to be a new graduate. New graduates hold the key to the future because you are better prepared for the new practice models than my generation. Finally, I hope every graduate finds their place in practice where they get to do what they love each day. I feel like I have been blessed to have found a career where I get to do just that – it’s a great deal of fun!

Save the Date!

Nov. 14-15, 2014 Griffin Gate Marriott, Lexington, KY 

CE



PBM Transparency Update



Networking



MTM Certification Program



Legislative Presentations



Immunization Training

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THE KENTUCKY PHARMACIST

2014 KPhA Open House

July 2014

YOU’RE INVITED! KPhA Open House to celebrate National/Kentucky Pharmacists Month 1 p.m. Thursday, Oct. 2, 2014 at KPhA Headquarters at 1228 US 127 South Frankfort, KY

Nominate your peers for a new feature in The Kentucky Pharmacist We are looking for members to profile in coming editions of The Kentucky Pharmacist who are making the world a better place.

Do you know someone who goes above and beyond the “above and beyond the call of duty”?

Let us know!

Email Scott Sisco at ssisco@kphanet.org with a brief description of the story or to schedule a time to discuss.

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THE KENTUCKY PHARMACIST

Government Affairs/KPPAC

July 2014

KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________

Email: ______________________________________________________________ Address: _____________________________________________________________ City: ___________________________________________ State: _________ Zip: ____________ Phone: ________________ Fax: __--_______________ E-Mail: ______________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)

Mail to: Kentucky Pharmacists Association, 1228 US Highway 127 South, Frankfort, KY 40601

Kentucky Pharmacists Political Advocacy Contribution Form Name: _________________________________ Pharmacy: ___________________________ Address: _______________________ City: ________________ State: _____ Zip: ________ Phone: ________________ Fax: __--_______________ E-Mail: __________________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)

Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601

CONTRIBUTION LIMITS The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election.

Individuals may contribute no more than $1,500 per year to all PACs in the aggregate.

In-kind contributions are subject to the same limits as monetary contributions.

Cash Contributions: $50 per contributor, per election. Contributions by cashierâ&#x20AC;&#x2122;s check or money order are limited to $50 per election unless the instrument identifies the payor and payee. KRS 121.150(4) Anonymous Contributions: $50 per contributor, per election, maximum total of $1,000 per election.

(This information is in accordance with KRS 121. 150)

The Kentucky Pharmacist is online!

Go to www.kphanet.org, click on Communications and then on The Kentucky Pharmacist link.

Would you rather receive the journal electronically?

Email ssisco@kphanet.org to be placed on the Green list for electronic delivery.

Once the journal is published, you will receive an email with a link to the online version.

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THE KENTUCKY PHARMACIST

Treasures of Kentucky Pharmacy History

July 2014

Treasures of Kentucky Pharmacy History: Currently Collecting Dust and Seeking Hope By: Lauren VanHook UK APPE 2 As a part of my second advanced pharmacy practice experience rotation at Laurel Heights Nursing Home in London, Ky., I had the opportunity to visit the KPhA office in Frankfort and the great honor of meeting the one and only Gloria Doughty. She is the chairperson and founder of the Kentucky Renaissance Pharmacy Museum and Fountain, a not for profit organization. The highlight of my day was sitting down with this amazing woman to listen to stories about her life and how the dream of a museum came to be a reality. I discovered she was truly a trailblazer for women in the profession as she was the first female member of the Kentucky Board of Pharmacy, and she was one of only two women in her pharmacy graduating class. As we talked, I could see that her passion for history burned just as brightly as her passion for the profession of pharmacy. forward as a profession and between long work weeks, continuing education and the general obligations of life, Today, the museum’s vast collection of pharmaceutical pharmacists and pharmacy students alike are just trying to trinkets, treasures and artifacts lies packed away in cardkeep up. In the race to stay up-to-date, it’s easy to dismiss board in the very basement Gloria and I talked in. Regretwhat has come before us. To most of us the history of tably, the museum was recently forced to relocate from its pharmacy sits in the back of our minds covered in a heavy previous location in the old Fayette County courthouse. layer of dust just like the boxes in There was just one small probthe KPhA office basement in Franklem; they had no location to relo“A generation which fort, but how can we ever hope to cate to. With limited resources to better ourselves as a profession if dedicate to locating and securing ignores history has no we abandon pharmacy’s past? a new home for the museum, past: and no future” the only option left was to store it Kentucky has one of the most (if not temporarily at the KPhA office. I the most) extensive collection of Lazarus Long was only able to get glimpses of historical pharmacy artifacts, and it a couple pieces when Gloria acneeds immediate help in the form of companied me into a back room to explore and admire. dedication and passion from the very profession it represents. It is our obligation as pharmacists to be responsible One item that stood out to me in particular was a shadow for maintaining our history. We owe it to the generations of box filled with pins, medals and ribbons from some of the pharmacists and druggists that have come before us to very first annual pharmacy meetings. As a fourth year stupreserve their story. It was through their efforts and profesdent at the University of Kentucky College of Pharmacy sionalism that pharmacy has become the respected proI’ve had the opportunity to travel to many of the same anfession it is today. So what are you going to do? Be apanual meetings with fellow pharmacy classmates and prothetic and let these Smithsonian worthy items collect dust fessionals where we too collected 21st century versions of or take action so that these treasures can once again see the aged memorabilia protected under the glass. It was a the light of day? Join KPhA in its mission and contact simple connection, but an important one…a personal one.

KPhA staff or Museum representatives (see next page) In a science based career such as pharmacy, it is easy to today to see what you can do to help find a permanent forget about history amongst the chemistry, physiology and home for the Kentucky Renaissance Pharmacy Museum biology we work with daily. Pharmacy is constantly moving and Fountain.

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THE KENTUCKY PHARMACIST

Treasures of Kentucky Pharmacy History

July 2014

The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's leading preservation organization for pharmacy.

While contributions of any size are greatly appreciated, the following levels of annual giving have been established for your consideration.

Friend of the Museum $100  Proctor Society $250 Damien Society $500 Galen Society $1,000 Name______________________________________ Specify gift amount________________________ Address ____________________________________ City____________________Zip______________ Phone H____________________W________________ Email___________________________________ Employer name_____________________________________________________for possible matching gift.

Tributes in honor or memory of_____________________________________________________ Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax deductible contributions will be mailed to you annually.

Questions: Contact Lynn Harrelson @ 502-425-8642 or Lharrelsonky@aol.com

For more information on the museum, see www.pharmacymuseumky.org or contact Gloria Doughty at g.doughty@twc.com or Lynn Harrelson at lharrelsonky@aol.com.

Pharmacists Mutual Insurance offers Medicare Surety Bond In 2009 the Centers for Medicare and Medicaid Services (CMS) implemented Surety Bond Requirements for suppliers of Durable Medical Equipment, Prosthetics and Supplies (CMS-6006-F). This ruling requires that each existing supplier must have a $50,000 surety bond to CMS. Pharmacists Mutual Insurance Company, through its subsidiary Pro Advantage Services, Inc. d/b/a Pharmacists Insurance Agency (in California), led the way to meet this requirement by negotiating the price of the bond from $1,500 down to $250 for qualifying risks.

To see if you qualify for a $250 Medicare Surety Bond, or would like information regarding our other products, please contact us:    

Call 800.247.5930 Extension 4260 E-mail medbond@phmic.com Contact a Pharmacists Mutual Field Representative or Sales Associate http://www.phmic.com/phmc/ services/ibs/Pages/Home.aspx In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815 or Tracy Curtis at 800.247.5930 ext. 7103 or 270.799.8756.

2014 Mid-Year Conference on Legislative Priorities Nov. 14-15, 2014 Griffin Gate Marriott Resort, Lexington, KY 33

THE KENTUCKY PHARMACIST

KPhA Board of Directors

July 2014

Welcome to the New Directors of the KPhA Board of Directors Secretary Brooke Hudspeth (pictured at right) is a clinical diabetes care pharmacist for Kroger Pharmacy and serves as the Program Coordinator for Kroger’s American Diabetes Association– recognized Diabetes Self-Management Education Program. She received her doctor of pharmacy degree from the University of Kentucky College of Pharmacy in 2007. Upon graduation, Dr. Hudspeth completed a postgraduate (PGY1) residency with an emphasis in community care with the University of Kentucky and Kroger Pharmacy. Dr. Hudspeth’s practice interests include medication therapy management and disease state management, particularly diabetes.

In addition to her clinical practice activities, Dr. Hudspeth is Assistant Professor at the University of Kentucky College of Pharmacy. She serves as a preceptor for the University of Kentucky College of Outgoing Chair Kim Croley with re-elected Director Richard Slone, SUCOP Pharmacy/Kroger Community Pharmacy Student Representative Christian Polen, Secretary Brooke Hudspeth and Residency Program. She also is on the UKCOP Student Representative Mallory Megee. faculty of the American Pharmacists AsPharmacy and has been the Director of Operations for Med sociation’s certificate training program The Pharmacist and Care Pharmacy in Florence since 2007. Prior to that, he Patient-Centered Diabetes Care. was a pharmacy manager for Kroger in Louisville. In 2013, Director Tony Esterly graduated from he joined the Board of Directors for the Northern Kentucky the University of Kentucky College of Pharmacist Association and has been on the Government Pharmacy in 2006 where he served a Affairs committee for KPhA the last two years. year as Regent for the Upsilon chapter of University of Kentucky College of Pharmacy Student Kappa Psi. He has worked in a broad Representative Mallory Megee (pictured above) is currange of pharmacy settings (some overrently a third year student pharmacist at the University of lapping) which include retail at Kroger, Kentucky College of Pharmacy. She graduated from the compounding with University of Kentucky in 2012 with a Bachelors of Science Wickliffe Veterinary Compounding, in Biology before moving across the street to the College of managed care at Humana and his own Pharmacy. She is actively involved in the Kentucky Alliconsulting business. Today he is emance of Pharmacy Students (KAPS), Phi Lambda Sigma ployed as a contracting consultant for (PLS) and PediaKats. During her free time, she enjoys Humana Trade Relations. reading and volunteering at the College of Pharmacy.

Director Matt Foltz is a 2003 graduate Sullivan University College of Pharmacy Representaof University of Kentucky College of tive Christian Polen (pictured above) is from Bowling 34

THE KENTUCKY PHARMACIST

KPhA Board of Directors

July 2014

Green, Ky. He graduated from the University of Kentucky in 2012 with a B.S. in Biology, and in 2013 enrolled as a student at Sullivan University College of Pharmacy (SUCOP).

At SUCOP, he was elected President of the SUCOP chapter of the American Pharmacists Association- Academy of Student Pharmacists (APhA-ASP). As President of APhAASP, he enjoys working with an incredible executive committee to implement and participate in various community outreach programs in the city of Louisville. In the Fall, he will enter the dual degree program at SUCOP, and will pursue an MBA along with a PharmD. At this time, he does not know what he wants to do after graduation, but he does know that he wants to remain in the great state of Kentucky.

Past President Representative Ray Bishop is married to

Joan and has five children, Karen, Lisa, Ray, Jean Marie and Brian. He graduated from St. Xavier High School and Mercer Pharmacy School. Ray retired after more than 40 years of practice. His career included Director of Pharmacy for Taylor Drug Stores and finishing his career at Rite Aid. He also has been very active in pharmacy associations having served as president of both Jefferson County Academy of Pharmacy and Kentucky Pharmacists Association in 1990. He is a member of Kappa Psi Graduate Chapter and is Secretary/Treasurer of the Veteran Drug Club and presently serves as Past President Representative on the KPhA Board of Directors.

Directors Richard Slone and Chris Killmeier were re-elected to three-year terms. Director Tony Esterly was appointed to fill a two year term vacated when Chris Clifton was elected President-Elect.

Special Thank Yous

2014-15 Chair Duane Parsons presents outgoing chair Kim Croley with the Chairâ&#x20AC;&#x2122;s Plaque for her dedicated service.

Trish Freeman is recognized for serving as KPhAâ&#x20AC;&#x2122;s delegate to USP.

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THE KENTUCKY PHARMACIST

KPhA New and Returning Members

July 2014

KPhA Welcomes New and Renewing Members May-June 2014 Cathy Adams Pineville

Richard Brooks Louisville

Heather Daniels Hazard

Andrew Goble Louisa

Diane Akin Bowling Green

Benjamin Brown Louisville

Alan Daniels Georgetown

Sherry Goeing Melvin

Katelyn Alexander Johnson City, Tenn.

Greg Browning Louisville

Floyd Davis Louisville

Charles “Len” Gore Nicholasville

Christina Amburgey Nicholasville

Dianna Bryant Hartford

Steven Dawson McDowell

Ben Gower Henderson

Jeffrey Arnold Florence

John Bushong Tompkinsville

Dave Dickerson Morehead

Dwaine Green The Villages, Fla.

Rosana Aydt Villa Hills

Robert Cain Hanson

James Dixon Barbourville

Scott Greenwell Prospect

Terri Bailey Elizabethtown

Breanna Capps Middlesboro

Anna Lee DuPont Louisville

Charles Gross Hazard

Jeffrey Baize Louisville

Paulette Caron-Turner Louisville

Margret Easterling Jenkins

Larry Hadley Frankfort

Jason Baker Louisville

Thomas Carter Lexington

Michael Eastridge Lebanon

Thomas Hall Martin

Jennifer Baker Louisville

Wayne Carter The Villages, Fla.

Joseph Elmes Louisville

Matthew Harman Dublin, Ohio

Greg Baker Louisville

Jessika Chinn Beaver Dam

Kevin Emberton Edmonton

Kin Harmon Louisville

James Ball Elizabethtown

Margaret Christopher Winchester

Chad Evans Maysville

Jim Harned Louisville

Larry Barnett South Williamson

Aimee Cloud Louisville

John Evans Henderson

Billy Hart Frankfort

Margaret Beeler Lebanon Junction

Arica Collins Albany

Lorie Evans Quincy

Pamela Hays McKee

Crystal Belt Annville

Teresa Collison Summersville

Justin Fink Fort Wright

Gregory Hines Bowling Green

Mike Berry Maysville

Erin Conkright Owensboro

Alan Flener Glasgow

Chrystyanna Hoefler Brooksville

John Beville Shelbyville

Susan Conn Forest Hills

Patricia Freeman Lexington

Tom Houchens London

Cindy Biecker Edgewood

Paul Cooper Morehead

Mary Fricke Corbin

Jan Houchens London

Stefani Billington Mayfield

Robert Croley Corbin

Donald Fritts Morganfield

Reymonda Howard London

Joshua Blackwell Hazard

Kimberly Croley Corbin

Dennis Gawronski Prestonsburg

James Howard Fountain Run

David Bowman Columbia

Sue Dailey Lexington

Susan Gibson Lexington

Joseph Huff Hodgenville

Debra Brock Wallins Creek

Johnnie Dando Liberty

Misty Glin Louisville

Jennifer Jaber Louisville

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THE KENTUCKY PHARMACIST

KPhA New and Returning Members

July 2014

Tim Jenkins Louisville

Janet Mills Louisville

Gary Rice Corbin

Brittany Sullivan Melber

Mason Kash Winchester

Dan Minogue Louisville

Christine Richardson Louisville

Patricia Sullivan Louisa

Dana Kays Bardstown

Judy Minogue Louisville

Amber Riesselman Louisville

Lisa Terry Elizabethtown

William Keck Corbin

Christy Mulberry Alexandria

Hanson Roberts Staffordsville

Gene Thomas Owenton

Christi Keckley Shelbyville

James Murphy Whitley City

Frank Romanelli Lexington

Marla Tolley Ashland

Paul Koenig Louisville

Chanin Nelson Middlesboro

Helen Rose Kevil

Leah Tolliver Lexington

Mike Leake Danville

Brad Newcomb Paducah

Ann Rule Newark, Del.

Danny Tsai Louisville

Ken Lewis Louisville

Patrick Noonan Louisville

Thomas Runge Union

Clifford Tsuboi Lexington

Carlos Lopez Leal Lexington

Mark Nybo Crescent Springs

Jessica Salmons Hazard

John Turner Paintsville

Rick Loudermelt Williamsburg

Jamie Otte Florence

Anthony Schmid Grand Rapids, Mich.

Melissa Vice Dry Ridge

Robert Lucas Flatwoods

Thomas Parker Pikeville

Lisa Schwartz Crestview Hills

Samuel Waddell Sitka

Christopher Mack Simpsonville

Jarred Patrick Greenup

Craig Seither Ludlow

Jason Wallace Dry Ridge

Richard Manuel Frankfort

Brittany Pauly Union

Harold Shields Ashland

Virgil Webb Bellevue

Thomas Mason Fairfield

Michael Perdue Catlettsburg

David Shipley Henderson

Brian Wells Owensboro

Joey Mattingly Baltimore, Md.

Brookes Pickard Louisville

Jennifer Shugars Liberty

Leonard Westbay Louisville

William McConnell Kuttawa

Hilary Pohn Prospect

Sarah Slabaugh Louisville

Tonya Westmoreland Lowmansville

Jill McIntosh Louisville

Richard Potter Bowling Green

Kelly Smith Lexington

Lenville White Irvine

Brittany McQueary Russell Springs

Carmel Powell Clarkson

Marla Smoot Crittenden

Kerri Woods Hamilton, N.Y.

Laurie Meeks Lexington

Amanda Powers Boaz

Stephanie Southern Paducah

Grady Wright Georgetown

Mike Menard Mt. Sterling

Richard Preece Ashland

Scott Spille Edgewood

Michael Wyant Finchville

Florence Merrifield Louisville

Mary Probst Louisville

William Spoo Louisville

Mark Milburn Louisville

John Rasche Bonnyman

Michael Stephens Columbia

Jeffry Mills Louisville

Megan Reynolds Louisville

Paula Straub Louisville

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MEMBERSHIP MATTERS: To YOU, To YOUR Patients To YOUR Profession!

THE KENTUCKY PHARMACIST

Bowl of Hygeia Challenge

July 2014

Kentucky is No. 1!

KPhA wins the 2013-14 Bowl of Hygeia Challenge Thanks to the generosity of several KPhA members, Kentucky blew away the competition in the APhA Foundation Bowl of Hygeia Challenge 2.0. We raised $9,660.00 during the campaign.

KPhA kicked off year two of the challenge with a bang thanks to 2013 Kentucky Bowl of Hygeia winner Leon Claywellâ&#x20AC;&#x2122;s pledge to match up to $5,000 in contributions toward the campaign.

The APhA Foundation is raising funds to make sure this award continues to be awarded each year. Each state pharmacy organization was asked to raise $5,000, and thanks to the donors from Kentucky, we nearly doubled that.

KPhA thanks each of the donors who made this victory possible.

KPhA acknowledges all of the donors to the APhA Bowl of Hygeia Endowment Fund, including those in attendance at the KPhA Annual Meeting and Convention in June.

$9,660.00!

Leon and Margaret Claywell with the Bowl of Hygeia at the 2014 Bowl of Hygeia Reception at the APhA Annual Meeting.

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2012 KPhA Bowl of Hygeia recipient George Hammons makes inaugural gift and chairs Kentucky's Campaign in Year 1 of the APhA Foundation State Pharmacy Association Challenge .

THE KENTUCKY PHARMACIST

Bowl of Hygeia Challenge

July 2014

Kentucky Donors

                       

American Pharmacy Services Corp.

Cassandra Beyerle Booneville Discount Drugs Kenneth Calvert Mike Cayce Cayce's Pharmacy, Inc. Leon & Margaret Claywell Brian Fingerson Charles Fletcher Dwaine Green George Hammons Tom Houchens Chris Killmeier Philip Losch Matthew & Aleshea Martin Robert McFalls Medica Pharmacy and Wellness Center Bob Oakley Duane Parsons Donald Riley Patricia Thornbury Tolliver Management Group Jerry White Simon Wolf

Above: Executive Director Robert McFalls presents Margaret & Leon Claywell with the KPhA Trailblazer Award, Leading KPhA to be No. 1 in the 2014 APhA Foundation Bowl of Hygeia Challenge at the 2014 Ray Wirth Banquet during the 136th KPhA Annual Meeting and Convention. Leon was the 2013 KPhA Bowl of Hygeia winner, and pledged to match up to $5,000 in contributions from Kentucky donors for the Bowl of Hygeia campaign.

Below: Kentucky was presented with a Certificate of Recognition in recognition of YOUR KPhA leading the way among all state pharmacy associations in Year 2 of the Bowl of Hygeia State Association Challenge.

Mindy D. Smith, RPh, Executive Director of the APhA Foundation with Bob McFalls at the 2014 Bowl of Hygeia Reception at the APhA Annual Meeting.

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THE KENTUCKY PHARMACIST

Pharmacy Law Brief

July 2014

Pharmacy Law Brief:

The Federal False Claims Act Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: I continually see mention of a federal law known as the Federal False Claims Act and, in association with that, read strange phrases and words such as “Quit Tam Action” and “Relator.” What is all that?

Submit Questions: jfink@uky.edu Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief discussion of an issue or topic for educational or discussion purposes can adequately and fully address the multifaceted and often complex issues that arise in the course of professional practice. It is always the best advice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intricacies of a specific situation, and render advice in accordance with the full information.

Response: The Federal False Claims Act (FCA) is a federal statute that creates potential criminal and civil liability for those who would defraud the federal government.

This can apply either to individuals or to companies. The contemporary statute traces its origins to the Civil War when a variety of vendors sold defective or adulterated products to the federal government. Enactment of this statute during the administration of President Lincoln has resulted in this sometimes being referred to as the “Lincoln Law.” It can be found at 31 U.S.C. §3729.

One unusual feature of the statute is that it permits or authorizes individuals having no affiliation with the federal government to initiate legal actions on behalf of the government when they have knowledge of nefarious activities that might run afoul of the law. These people are sometimes referred to as “whistleblowers” and the resultant filings are called whistleblower lawsuits.

time. During the Civil War the transgressions that first led to enactment of the statute primarily related to sales of materiel to the federal government for prosecuting the war. That focus on military-related purchase continued for quite some time. In fact, during World War II the statute was enacted to reduce the share of proceeds directed to the relator. Up through the 1980s the activities of defense contractors continued to be a principle focus of FCA-related activities. It is noteworthy, however, that by the late 1990s that focus had shifted to health care fraud. It is reported that false claims related to provision of health care goods and services now comprise a majority of cases filed under the statute.

If the lawsuit is successful the person who filed the suit, referred to by the title “relator,” can be rewarded with 15-30 percent of the amount recovered. This provision authorizing an individual to file the lawsuit on behalf of the federal government and creating the entitlement to a portion of the amount recovered is called the qui tam provision. Those two words are a key portion of a long legal phrase in Latin that essentially means “he who sues in this matter for the The pharmaceutical industry, pharmacy chains and individual pharmacies have all come under scrutiny using the Fedking as well as for himself.” eral False Claims Act. During recent years GlaxoSmithKline Two of the key provisions in the False Claims Act serve to entered into a $750 million settlement with federal governprohibit [1] knowingly presenting, or causing to be presentment under the False Claims Act and Ranbaxy Pharmaceued, a false claim for approval or payment, and [2] knowingly ticals paid a $500 million settlement, both for allegedly remaking, using or causing to be made or used, a false recleasing adulterated medications into interstate commerce. ord or statement materials to a false or fraudulent claim. So The Department of Justice reports that the pharmaceutical either making the false claim or crafting documents to justiindustry was one of the largest contributors to settlements, fy or support that false submission can run afoul of the law. with the predominant violation being alleged off-label proIt should be borne in mind that the statute mandates treble motional activities. Advent of Part D of Medicare with more damages plus the court can impose additional penalties of direct, expanded federal payment for pharmaceuticals and between $5,500 and $11,000 per false claim. pharmacy services has increased potential exposure in this There have been interesting shifts with the statute over area.

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THE KENTUCKY PHARMACIST

24th Annual UKCOP Alumni & Friends Scholarship Golf Outing Between 2009 and 2012 the federal government recovered $9.5 billion under this statute. In FY 2013 alone the U.S. Department of Justice recovered $3.8 billion in civil settlements and judgments under the FCA. Of that total, $2.9 billion was recovered through qui tam actions. There were 752 qui tam actions filed during FY 2013, over 100 more than during the previous year.

Member Update Amber Cann, Louisville, was selected as the AACP chairelect for the TiPEL (technology in pharmacy education and learning) special interest group.

July 2014

September 15, 2014 Champion Trace Golf Club Golf Registration begins at 10 a.m.

Lunch available at 11 a.m.

Shotgun Start at Noon Followed by Dinner, Awards Ceremony & Auction Registration available at www.ukalumni.net/pharmgolf2014 For more information on Sponsorship Opportunities or Individual/Team Registration, please contact Amber Bowling at 859.218.1305, amber.bowling@uky.edu

Are you connected to YOUR KPhA? Join us online!

Facebook.com/KyPharmAssoc

@KyPharmAssoc @KPhAGrassroots

KPhA Company Page

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THE KENTUCKY PHARMACIST

Pharmacy Policy Issues

July 2014

PHARMACY POLICY ISSUES: The Implementation of iPLEDGE™ to Manage Serious Risks Author: Allie E. Curlin is a second professional year PharmD student at the University of Kentucky College of Pharmacy and is concurrently pursuing the degree Master of Business Administration at the Gatton College of Business and Economics. She completed her pre-professional academic work at the University of Kentucky and is a native of Fulton, Ky. Issue: FDA approval of pharmaceuticals for marketing involves balancing risk versus benefit. Is there an example of extremely serious risks being outweighed by the anticipated benefits from use of the product? This issue might arise more frequently in the context of seriously ill patients in the hospital but how about in community pharmacy practice?

How can a manufacturer keep a product with horrific side effects on the market and meet the burdens that arise from risk management programs?

Discussion: Thirty years ago, Roche Pharmaceuticals introduced the first medication for severe recalcitrant nodular acne known as Accutane™. Isotretinoin (Accutane™) is still considered the top acne drug by many today but is unfortunately the cause of many horrific side effects, most specifically teratogenicity. In response to the serious contraindications, Hoffman-La Roche, Inc. created several programs to reduce pregnancy exposure to allow isotretinoin to remain on the market.1 This ultimately led to the program known today as iPLEDGE™.

ly required that a medication guide be included with each prescription dispensed.5

Unfortunately, with increased security measures have come increased complaints. According to the article, “Ethical Challenges of Pregnancy Prevention Programs,” the iPLEDGE™ program and other pregnancy prevention programs are so cumbersome they create ethical issues.6 The authors of the article claim that the programs interrupt the usual relationship between the prescriber, patient and pharmacist. In many cases it creates a barrier between the In 2005, the FDA approved iPLEDGE™ under its regulapatient and the medication due to overwhelming qualification 21 CFR §314, Subpart H, a regulation governing tion procedures.6 The stipulations also create an ethical “Accelerated Approval of New Drugs for Serious or Lifebarrier by requiring patients to report and share their perThreatening Illnesses.” Specifically, iPLEDGE™ falls under sonal information.6 Many healthcare providers commend 21 CFR § 314.520, which is for FDA approval with rethe FDA for attempting to address an evident problem but 2 strictions to assure safe use. In this case the distribution is feel that the current process is greatly flawed. restricted to certain facilities or physicians with special The FDA realizes that the iPLEDGE™ program requires training or experience. With iPLEDGE™, Accutane™ sponadditional cooperation from all involved in the isotretinoin sors agreed “to implement a program that requires registraprescribing and dispensing process and understands the tion in the iPLEDGE™ program of wholesalers, prescribimportance of minimizing the burden on patients. The FDA, ers, pharmacies and patients who agree to accept specific however, also recognizes that with this medication there is responsibilities designed to minimize pregnancy exposures a need for increased regulation to ensure patient awarein order to distribute, prescribe, dispense and use Accuness and proper use.1 iPLEDGE™ is a model in the phartane.”3 maceutical industry as a risk management program. It innoIn 2010, the iPLEDGE™ program took further steps to en- vatively involves healthcare from the beginning of prescribsure isotretinoin and similar acne products remained on the ing to the end of therapy, ensuring the patient is included in market when the iPLEDGE™ Risk Evaluation and Mitigaall steps. Overall, the main point is patient safety, even tion Strategies (REMS) initiative was accepted.4 Most ele- when there are some inconveniences present. The greatments for the iPLEDGE™ program were previously defined est issue is that there is currently no safer alternative availbefore the REMS approval; however, the REMS additional- able. The iPLEDGE™ program has allowed a viable medi-

Have an Idea?: This column is designed to address timely and practical issues of interest to pharmacists, pharmacy interns and pharmacy technicians with the goal being to encourage thought, reflection and exchange among practitioners. Suggestions regarding topics for consideration are welcome. Please send them to jfink@uky.edu.

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July 2014

The Kentucky Pharmacist online cal option for severe recalcitrant nodular acne to remain on the market, and without it, isotretinoin and similar medications may have been removed a long time ago. While isotretinoin continues to be the “wonder drug” of choice, the FDA must be diligent in keeping patients as safe as possi- 4. ble.

References 1.

U.S. Food and Drug Administration [Internet]. Accutane (isotretinoin) Questions and Answers. [updated 2009 Feb 22; cited 2013 Oct 21]. Available from: http://www.fda.gov/Drugs/ DrugSafety/ PostmarketDrugSafetyInformationforPatientsandProviders/ ucm094308.htm#register.

2.

21 C.F.R. §314.520 (2013).

3.

U.S. Food and Drug Administration [Internet]. Public Health Advisory: Strengthened Risk Management Program for Isotretinoin Public Health Advisory. [updated 2013 Aug 16; cited 2013 Oct 21]. Available from: http://www.fda.gov/Drugs/

DrugSafety/ PostmarketDrugSafetyInformationforPatientsandProviders/ DrugSafetyInformationforHeathcareProfessionals/ PublicHealthAdvisories/ucm164132.htm.

U.S. Food and Drug Administration [Internet]. Questions and Answers on the Federal Register Notice on Drugs and Biological Products Deemed to Have Risk Evaluation and Mitigation Strategies. [updated 2009 Jun 18; cited 2013 Oct 21].

Available from: http://www.fda.gov/RegulatoryInformation/ Legislation/FederalFoodDrugandCosmeticActFDCAct/ SignificantAmendmentstotheFDCAct/ FoodandDrugAdministrationAmendmentsActof2007/ ucm095439.htm.

5.

21 C.F.R. §208.24 (2013)

6.

Bonebrake R, Casey MJ, Huerter C, Ngo B, O’Brien R, Rendell M. Ethical Challenges of Pregnancy Prevention Programs. CUTIS [Internet]. 2008 Jun [cited 2013 Oct 21];81:494 -500. Available from: http://www.cutis.com/index.php? id=27148&cHash=071010&tx_ttnews[tt_news]=196898.

In Memoriam KPhA offers condolences for the families of Emil Baker, of Mt. Sterling and Kristian Lynn Linton, of Lexington.

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July 2014

Pharmacists Mutual

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Cardinal Health

July 2014

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THE KENTUCKY PHARMACIST

KPhA Board of Directors/Staff

July 2014

KPhA BOARD OF DIRECTORS

HOUSE OF DELEGATES

Duane Parsons, Richmond dandlparsons@roadrunner.com

Chair 502.553.0312

Ethan Klein, Louisville kleinethan@gmail.com

Speaker of the House

Bob Oakley, Louisville Boakley@BHSI.com

President

Chris Harlow, Louisville cpharlow@gmail.com

Vice Speaker of the House

Chris Clifton, Villa Hills chrisclifton@hotmail.com

President-Elect

KPERF ADVISORY COUNCIL

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Secretary

Kim Croley, Corbin kscroley@yahoo.com

Glenn Stark, Frankfort glennwstark@aol.com

Treasurer

KPhA/KPERF HEADQUARTERS

Raymond J. Bishop raybishop13@gmail.com

Past President Representative

Directors Matt Carrico, Louisville* matt@boonevilledrugs.com Tony Esterly, Louisville tonye50@hotmail.com

Robert McFalls, M.Div. Executive Director rmcfalls@kphanet.org

Matt Foltz, Villa Hills mfoltz@gomedcare.com

Scott Sisco, MA Director of Communications & Continuing Education ssisco@kphanet.org

Chris Killmeier, Louisville cdkillmeier@hotmail.com Mallory Megee, Nicholasville mallory.megee@uky.edu

University of Kentucky Student Representative

Jeff Mills, Louisville jeff.mills@nortonhealthcare.org

Angela Gibson Director of Membership & Administrative Services agibson@kphanet.org Leah Tolliver, PharmD Director of Pharmacy Emergency Preparedness ltolliver@kphanet.org

Chris Palutis, Lexington chris@candcrx.com Christian Polen cpolen7392@my.sullivan.edu

1228 US 127 South, Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.twitter.com/KPhAGrassroots www.youtube.com/KyPharmAssoc

Sullivan University Student Representative

Elizabeth Ramey Receptionist/Office Assistant eramey@kphanet.org

Richard Slone, Hindman richardkslone@msn.com Mary Thacker, Louisville mary.thacker@att.net Sam Willett, Mayfield duncancenter@bellsouth.net * At-Large Member to Executive Committee

KPhA sends email announcements weekly. If you arenâ&#x20AC;&#x2122;t receiving: eNews, Legislative Updates, Grassroots Alerts and other important announcements, send your email address to ssisco@kphanet.org to get on the list.

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50 Years Ago/Frequently Called and Contacted

July 2014

50 Years Ago at KPhA WHO KNOWS? THIS MAY BE THE RIGHT DIRECTION (From E. Murphy Josey’s Scoops ‘n’ Scraps report from APhA meeting) Speaking before the American Pharmaceutical Association’s annual meeting in the New York Hilton, Dr. Henry T. Clark, Jr., administrator, Division of Health Affairs, University of North Carolina, challenged the profession of pharmacy to develop more purely professional pharmacies to keep pace with the specialization of medicine.

Commenting on the increasingly important role of the pharmacist as drug consultant to the physician, Dr. Clark said, “serious consideration should be given to developing a new type of specialist in pharmacy practice, a man who would have a Master’s or Ph.D. degree, would under normal circumstances function as the head of the professional pharmacy and would be fully qualified and accepted as full consultant to the physician.

As a further stride in improving the quality of pharmacy services, Dr. Clark suggested that practitioners be re-examined at various stages in their careers to keep them professionally competent and up-to-date on the latest advances in their science.

- From The Kentucky Pharmacist, August 1964, Volume XXVII, Number 8.

Frequently Called and Contacted Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org

Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org info@kshp.org American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org

National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 info@ncpanet.org Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu Kentucky Regional Poison Center (800) 222-1222

KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA informed by sending this information to eramey@kphanet.org.

Deceased members for each year will be honored permanently at the KPhA office.

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July 2014

THE

Kentucky PHARMACIST 1228 US 127 South Frankfort, KY 40601

Mark your Calendar Or weâ&#x20AC;&#x2122;ll send Duane and Kim after you!

2014 Mid-Year Conference on Legislative Priorities November 14-15, 2014 Griffin Gate Marriott Resort Lexington, KY

Save the Date 137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

For more upcoming events, visit www.kphanet.org.

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