The Kentucky Pharmacist (January/February 2019)

Vol. 14 No. 1 January/February 2019

THE KENTUCKY

PHARMACIST Official Journal of the Kentucky Pharmacists Association

INSIDE:  

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Pharmacist Day at the Capitol—February 28 Register Today: Kentucky Opioid Summit—March 30 New & Improved Online CPE Submission

TABLE OF CONTENTS FEATURES KPhA Welcomes New Staff Members |8| Register Today—Kentucky Opioid Summit |27| Kentucky’s Longest-Working Pharmacist |30| Financial Forum |31| Rx and the Law |34|

Mission Statement: The mission of KPhA is to advocate for and advance the profession through an engaged membership.

On the Cover 

Pictured Left t to Right: KPhA President Chris Palutis, KPhA Past President J Leon Claywell, U.S. Congressman Brett Guthrie, Allison Robie, KPhA Executive Director Mark Glasper. Claywell and Robie are constituents of Congressman Guthrie.

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Kentucky State Capitol Building

Editorial Office: ©Copyright 2019 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.

Publisher: Mark Glasper Managing Editor: Sarah Franklin Editorial, advertising and executive offices at 96 C Michael Davenport Blvd., Frankfort, KY 40601.

Phone: 502.227.2303 Fax: 502.227.2258.

Email: info@kphanet.org.

Website: www.kphanet.org.

IN EVERY ISSUE President’s Perspective |3| My KPhA Rx |6| Advocacy Matters |9| Continuing Pharmacy Education |12| Continuing Pharmacy Education Quiz—Jan |17| Answer Sheet—Jan |18| Continuing Pharmacy Education Quiz—Feb |25| Answer Sheet—Feb |26| New KPhA Members | 29| Pharmacy Policy Issues | 32| Pharmacy Law Brief | 33|

ADVERTISERS EPIC |4 & 29| APSC|5| PTCB |19| Pharmacists Mutual |36| Cardinal |37|

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PRESIDENT’S PERSPECTIVE Another very enjoyable holiday season has just come to a conclusion. Now, when I step outside and feel the crisp air and see the bright blue sky, I can’t help but think of the LEGISLATIVE SESSION that is about to begin. Every year at this time, the strategy we have been formulating for the past 6 months or so will be put to the test. As you all know, as pharmacists, we have to stand up and fight for ourselves as do all other professions. I am very proud to say that KPhA has your back.

Another goal we have is our continued progress to Provider Status. I believe, as pharmacists, we have become one of the most trusted professions due to our accessibility along with our compassion, empathy and unwavering desire to make the lives of Chris Palutis the patients we serve better.

President, KPhA “As you all know, as pharmacists, we have But with that said, we also to stand up and fight for ourselves as do provide valuable services to our patients for which we all other professions. I am very proud to are not reimbursed. That would be fine, except that these same services are reimbursed to other providers. say that KPhA has your back.”

In my opinion, we should not look to take over the services other providers have long been providing and want Everyone involved in Government Affairs for the associto continue to provide. Just like we, as pharmacists, ation has worked very hard to identify our legislative would not want any other provider to take over being priorities. With the full backing of the House of Delethe “drug experts”. But there are certainly opportunities gates, we are ready to once again go to battle on your for us to enhance our offerings in our ever changing behalf in Frankfort. We have an extremely aggressive healthcare landscape. agenda, but I believe that we need to be aggressive, or we will not be taken seriously. As you may already “With that said, I urge all of you to know, we are up against very stout competition, namely the PBMs (Pharmacy Benefit Managers), but also other become engaged when called upon by our organizations that want to dip into our profession in orKPhA.” der to better their own.

One of our goals this session is to ensure we are provided a “level playing field” when it comes to services we can provide and reimbursement from PBMs. We are not asking for any special treatment or advantages. We simply want a fair chance to be in the game. This is not an easy task and involves many facets of what we do as pharmacists every day. It includes things as basic as reimbursement rates, the patient’s right to choose (the ability to dispense specialty drugs locally vs. a patient being forced to mail order), and continues all the way up to unfair solicitation by PBM owned mail order pharmacies. To me, it is hard to imagine that a PBM is allowed to capture data when a local pharmacy fills a prescription and then funnel that info to their affiliated mail order pharmacy in an effort to try and redirect the patient to use their services. But, yes, this actually happens every day. These are just a few examples of legislation we are pushing for this session.

As you may know, it is hard work to champion the passage of new legislation. It is equally as hard to rally against legislation that is championed by our adversaries that will negatively impact our profession. With that said, I urge all of you to become engaged when called upon by our KPhA. We do not ask for your involvement from a grassroots perspective unless we know it is needed and will have a very dramatic impact. If we stick together and all fight for the common good of our profession, we can overcome any obstacle. Thank you for your support and I hope to see you all in Frankfort or hear about the letters or phone calls made to your respective legislators.

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MY KPhA Rx SAVE THE DATE: Pharmacists Day at the Capitol: February 28, 2019

By Mark Glasper KPhA Executive Director/CEO I am pleased to report KPhA has arranged once again to have Pharmacists Day at the Capitol February 28, 2019, 8:30 a.m.-2 p.m., in Frankfort. It’s been a while since pharmacists have had a day to call their own in Kentucky and that’s why we’re so proud to provide this opportunity for pharmacists in all practice settings to unite and advocate on behalf of the profession.

KPhA Past President Leon Claywell meets with Sen. Jimmy Higdon about issues affecting pharmacy.

Picture this: pharmacists, pharmacy students and pharmacy technicians from across the Commonwealth, and all in white coats, descending on the Capitol to meet with their legislators about the issues that matter most to pharmacy. Legislators

take note of such a show of force. They cannot ignore their constituents’ concerns when they are brought to the hallowed halls of the Capitol.

We’re making plans now for an effective day of advocacy, including briefings on pharmacy issues and meetings with legislators. I urge you to save the date and plan to meet with your colleagues for Pharmacists Day at the Capitol. You won’t forget it and, I promise you, neither will your legislators!

The Issues KPhA President Chris Palutis has already set the stage in his President’s Column on p. 3 for the issues to be discussed with legislators during Pharmacists Day at the Capitol. These issues were approved unanimously by the House of Delegates in November and will provide direction to our efforts.

However, as session begins in January and moves through February, the issues affecting pharmacy will become clearer and we may need to redirect our efforts based on what we are seeing and hearing.

Our lobbyist, Shannon Stiglitz, serves as our eyes and ears at the Capitol and she does a wonderful job of learning what’s happening behind the scenes for us. I think it’s safe to say that bills introduced during session go through a metamorphosis before they are either passed or wither and die on the vine.

It’s staying in tune with these bills as they are discussed in committee (and out of committee) that Shannon does so well.

Along the way, we will monitor implementation progress of SB 5 sponsored by Sen. Max Wise and passed in the 2018 session. It is to provide greater transparency and Medicaid oversight of PBMs along with more appropriate dispensing fees for Kentucky pharmacists. We will continue to keep

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you apprised of any developments as this legislation of all, we need your voice! is a barometer for dealing with PBM issues not only in Kentucky but nationally as well.

The Agenda We are assembling an effective program that will inspire and prepare you to meet with your legislators during Pharmacists Day at the Capitol. We want to make the process as easy as possible for you to learn about the issues affecting pharmacy and then to take that knowledge with you as you sit down with your elected officials. We will even match you up with your legislators and schedule your appointments.

Pharmacists Day at the Capitol Agenda 8:30-9 AM

Registration

9-10 AM

Welcome

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Recognize Pharmacy Legislators

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Recognize Recipients of Friends of Pharmacy Awards

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Message from Leadership

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Review Current Legislation Talking Points

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Instructions

KPhA Board of Directors Member Richard Slone pictured with his legislator, Rep. John Blanton.

10 AM-1 PM Legislator Appointments 12-1 PM

Lunch Available

1:30 PM Group Photo in Capitol Rotunda (White Coats REQUIRED) 2 PM Session

Gallery Passes Distributed to Attend

The Show of Force I encourage you now to set this day aside and make plans to attend Pharmacists Day at the Capitol.

Let’s show our elected officials in Frankfort just how strong the pharmacy profession is in Kentucky and how much we care about the laws affecting us.

We need you, we need your white coat and, most

KPhA leadership meet with newly elected pharmacy members of the Kentucky House of Representatives, seated (l-r) Rep. Robert Goforth, Rep. Steve Sheldon, Rep. Adam Bowling and Rep. Derek Lewis; standing (l-r) Past President Leon Claywell, Board Member and Government Affairs Committee Chair Richard Slone, President Chris Palutis, Chair Chris Harlow, Board Member Matt Carrico and President-Elect Don Kupper. Unable to attend was Rep. Danny Bentley.

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KPhA Welcomes New Staff Members Please join us in welcoming new members of our KPhA team! The positions are funded from grants provided by the Kentucky Department of Public Health.Jessica Johnson, PharmD, will develop educational programs for prescribers across the state in targeted counties in high risk areas of opioid abuse on preventive measures and best practices. She will travel the state to engage these prescribers in their offices and at evening continuing education sessions.Michele Pinkston, PharmD, BCGP, will move into the role formerly held byJody Jaggers, PharmD, and her efforts will focus on emergency preparedness and volunteer engagement. Additionally, she will help with Naloxone education events when we use the mobile pharmacy Surge Unit #1. In his new role, Jody will focus on Naloxone education and distribution, as well as coordinating the distribution of grant funded naloxone to pharmacies and health departments across the state.

Jessica Johnson, PharmD, KPhA Director of Pharmacy Education Jessica is a second-career pharmacist who practiced in health system ambulatory care following her PharmD graduation from Sullivan University in 2015. She also holds a bachelors degree in chemistry from the University of Louisville. She enjoys yoga, reading, and spending time in the parks near her home. She lives in Louisville with her children, Isaac and Sam. Jessica@kphanet.org

Michele Pinkston, PharmD, BCGP, KPhA Director of Emergency Preparedness Michele Pinkston is a graduate of the University of Kentucky College of Pharmacy.

She is an experienced community hospital pharmacist, having previously served as a pharmacy director and inpatient pharmacy manager. She currently resides in Versailles with her husband, Paul, and daughter, Claire.

Michele@kphanet.org

Jody Jaggers, PharmD, will continue working at KPhA in the role of Director of Pharmacy Public Health Programs.jjaggers@kphanet.org. He previously served as KPhA Director of Emergency Preparedness for the past two years.

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Advocacy Matters Ways you can support KPhA’s Advocacy efforts today! 

Participate in grassroots advocacy efforts

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Get to know your legislators—they should know your name

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Donate to the Political Advocacy Council and the Government Affairs Fund

Donate online to the KPhA Government Affairs Fund Funds contributed to KPhA Government Affairs are applied directly to our lobbying efforts in terms of staffing and contracted lobbying services. Company donations are acceptable for Government Affairs contributions, unlike contributions to Political Advocacy Funds, like KPPAC. Go to www.kphanet.org. |9| www.KPHANET.org

Announcements & Reminders KPhA Board of Directors—Nominate Today!

The Organizational Affairs Committee is accepting nominations for PresidentElect, Treasurer, and three Board of Director positions for the Kentucky Pharmacists Association. You are invited and encouraged to become involved in YOUR profession by applying for a leadership position with KPhA or nominating a colleague that KPhA should consider for volunteer service.

Please submit your nominations by completing the online nomination form no later than February 28, 2019. Please include your CV, photo of nominee and a statement on why you want to run for the office or why you are nominating this individual.

Visit the KPhA website to nominate today!

2019 Annual Award Nominations We invite you to nominate your colleagues for the distinguished annual awards presented at the 141st KPhA Annual Meeting & Convention which will be held June 21 23, 2019 at Griffin Gate Marriott Resort & Spa in Lexington. 

Bowl of Hygeia Award

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Distinguished Service Award

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Meritorious Service Award

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Pharmacist of the Year Award

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Professional Promotion Award

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Distinguished Young Pharmacist of the Year Award

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Excellence in Innovation Award Sponsored by Upsher-Smith Laboratories

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Technician of the Year Award

To learn more about the criteria for the awards and to submit nominations visit the KPhA website.

Submit nominations online by February 28, 2019.

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Support KPERF with AmazonSmile!

Did you know that Amazon donates 0.5% of the price of your eligible AmazonSmile purchases to the Kentucky Pharmacy Education and Research Foundation Inc.? This contribution supports our educational initiatives.

All you need to do is: Step One: Go to Smile.Amazon.com (https://smile.amazon.com/ch/31-1012133) Step Two: Choose the Kentucky Pharmacy Education and Research Foundation Inc. as your charity.

Step Three: Whenever you are shopping, start at Smile.Amazon.com Take advantage of this easy way to do your holiday shopping and help the KPERF!

The Campaign for Kentucky’s Pharmacy Future

141st KPhA Annual Meeting and Convention June 20-23, 2019 | Lexington Griffin Gate Marriott Resort & Spa

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January CPE Article Pharmacological Management of Dementia By: Abigail Krabacher PharmD, Rachel Engel PharmD Candidate The authors declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity # 0143-0000-19-001-H01-P /T 1.0 Contact Hours (0.10 CEU) Expires 1/29/22

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy

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

Define the diagnosis of dementia using DSM-5

2.

Select an appropriate treatment plan for dementia based on patient presentation

3.

Recognize behavioral and psychological symptoms and their impact on dementia patients

4.

Summarize current literature on emerging treatment option for behavioral and psychological symptoms

Dementia is defined as the loss of cognitive functioning, including thinking, reasoning, and remembering, that interferes with a patient’s daily life. Dementia is most commonly found in elderly patients, however, according to the National Institute on Aging, it is not considered an aspect of the normal aging process and can be contributed to multiple causes (1). Alzheimer’s disease is estimated to account for 60-80% of dementia cases. An estimated 5.5. million Americans are living with Alzheimer’s disease, 60% of these patients live in the community, of which 25% of patients living in the community provide care for themselves while living alone.

Nursing home patients, 42%, are known to have a diagnosis of dementia, and about 61% of nursing home residents have moderate to severe cognitive impairment (2). Other causes of dementia include vascular dementias, Lewy Body dementia, Fronto Temporal dementias and dementia associated with Parkinson’s disease, Huntington’s disease, head trauma, alcohol, etc (3).

tivities. Symptoms must not occur exclusively in the context of a delirium, nor are they better explained by another mental disorder (4).

As part of the DSM-5 criteria for the diagnosis of dementia, we must delineate dementia from delirium. In contrast to delirium’s acute onset, dementia presents with a chronically progressing onset. Dementia presentation is markedly different from delirium as well. Dementia presents with forgetfulness and impaired memory, whereas patients presenting with delirium are usually confused, disturbed, showing a bizarre mental status, and experience hallucinations (5).

Cognitive assessment exams are utilized to detect,p evaluate and classify the degree of dementia in patients. The Mini-Cog and Addenbrooke’s Cognitive Examination-Revised (ACE-R) are utilized, however the most commonly used cognitive assessment exam is the Mini-Mental State Exam (MMSE).

This test allows up to 30 points, and classifies deThe American Psychiatric Association DSM-5 di- mentia as mild, moderate and severe with scores of 19 to 26, 10 to18, and less than 10 respectively, altagnoses dementia as a significant decline from a previous level of performance in one or more of the hough scales may vary among institutions (6). following cognitive domains: learning and The pathophysiology of dementia includes dememory, language, executive function, complex creased amounts of acetylcholine in the brain and attention, perceptual-motor and social cognition. In excessive extra-synaptic activity at the N-methyl-Daddition, these cognitive deficits must interfere aspartate (NMDA) glutamate receptors in the with an individual’s independence in everyday ac- brain. There are two classes of pharmacologic ther|12| Kentucky Pharmacists Association | January/February 2019

apies approved for use in patients with dementia dependent on the severity and progression of the disease. These two classes are cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists. Our treatment options are limited in that they do not stop or reverse the progression of the disease, but rather target and improve the symptoms of dementia (7).

Cholinesterase inhibitors include donepezil, rivastigmine, and galantamine. These medications work by inhibiting the breakdown of the neurotransmitter acetylcholine in the brain therefore increasing the available level. This pharmacologic class is the recommended therapy for Alzheimer’s and Lewy body dementia. The lack of clinical data showing reduction of symptoms while utilized in Parkinson’s or vascular dementia prevents an approved indication. The only FDA labeled indication for all three medications in this class is for mild to moderate Alzheimer’s dementia however, donepezil alone is FDA approved for severe dementia. Rivastigmine carries an additional FDA approval for Parkinson’s dementia. In clinical trials, cholinesterase inhibitors have shown an average of 30-40% improvement in cognition, neuropsychiatric symptoms and activities of daily living (7).

common side effects associated are dizziness and hallucinations. Memantine does require considerations to dosing, including increased caution in use if a patient’s renal function is impaired (CrCl <30) or in severe hepatic impairment (7). In patients who are found to have severe Alzheimer’s disease, there is a combination product of donepezil and memantine available. This product can be beneficial when it comes to compliance which is often a barrier to patients with this disease. (8).

Alternative treatment options such as vitamin E and selegiline have been studied as off label indications. Both appear to act in a similar manner as an antioxidant in the body with hope of showing improvement in cognitive function for patients with Alzheimer’s disease. The TEAM-AD trial is a notable trial conducted in the Veterans Administration health system that compared vitamin E alone to memantine alone, memantine plus vitamin E and placebo. The study enrolled 614 patient for 4 years and showed a 3.14 point reduction on the Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) in the vitamin E group compared to placebo. It should be noted that vitamin E was dosed at 2000 IU in this study despite doses of vitamin E above 400 IU having been associated with a 1.04 relative risk of all-cause morThose who are using cholinesterase inhibitors as tality(9,10). Further studies evaluating the safety therapy for dementia should continue therapy inand efficacy of vitamin E are warranted. The majordefinitely as long as the patient is tolerating the ity of studies looking at selegiline use in Alzheimedication. Common adverse effects seen with mer’s disease have been low-quality with significholinesterase inhibitors are nausea, anorexia, diar- cance only found in meta-analysis. While these rhea/constipation, bradycardia, hypotension and studies showed a benefit in cognitive function and sleep disturbances. Rare adverse events with cholin- mood, more evidence from randomized-controlled esterase inhibitors are neuroleptic malignant syntrials are needed (11). drome and rhabdomyolysis. These three medications should be used with caution in patients talking Arguably one of the most impactful aspects of decholinergic medications as well as those with brady- mentia disease are the behavioral and psychological cardia or heart block. Of note, galantamine should symptoms (BPSD). The BPSD include a wide range be avoided in end stage renal disease or severe he- of behaviors including but not limited to: delusions, patic impairment (7). depression, aggression, wandering, sleep disturbances, and sexualized behaviors. 90% of all patients The second pharmacologic class for dementia is the with dementia will experience at least one BPSD NMDA receptor antagonist, memantine, which and the behaviors often fluctuate as the disease prodemonstrates a neuroprotective effect by protecting gresses4. The impact of these behaviors is immense. against excessive glutamate stimulation of the Not only does it decrease the patient’s quality of life NMDA receptor. Memantine is indicated for mod- and increase mortality, but it increases the burden erate to severe Alzheimer’s disease, with limited on the caregiver and leads to increased initialization evidence supporting benefit and no labeled indica- (12). tion for mild Alzheimer’s and vascular dementia.

While overall memantine is well tolerated the most |13| www.KPHANET.org

Before treatment is initiated for BPSD there are several modifiable risk factors that should be considered. Infections, dehydration, pain, constipation, and hypoxia are just some clinical factors that can present as symptoms similar to BPSD in patients with dementia. As professionals in the pharmacy practice we must always evaluate to see if behaviors may be drug induced. Anticholinergic agents and benzodiazepines are common culprits, and any recent medication change should be evaluated. There are also many environmental factors that may contribute to symptoms that present like BPSD. Loneliness, frustration, new surroundings, discomfort from positioning, sensory disturbances such as bright light or loud noises all combined with a decreasing ability to effectively communicate are all modifiable risk factors for BPSD (13).

compared sertraline or mirtazapine to placebo in 218 patients. There were no improvements in the CSDD scale after 13 weeks in either treatment group compared to placebo (18). This trial demonstrated the importance of non-pharmacological therapy in demented patients experiencing depression.

A commonly seen class of medication that are initiated off label for BPSD are atypical antipsychotics.

However, these agents should only be utilized in severe agitation or psychosis that is putting the patient at risk. The limitation for use is due to the boxed warning that all antipsychotics carry for increased risk of mortality in patients with dementiarelated psychosis. It is vital to consider the risks and benefits with these agents as well as initiate with a lower dose, typically one-third to one-half the norFirst-line treatment of BPSD should be nonmal starting dose. Once an adequate dose has been pharmacological treatment. These treatments inreached the agent should be continued for four clude but are not limited to reminiscence therapy, weeks, after which if there is no improvement the light therapy, music therapy, and validation thera- dose should be tapered off. If the patient improved py. Non-pharmacological treatment should be con- an attempt should be attempted to taper off every tinued even if pharmacological treatment is added four months (19) (14). Pharmacological treatment should only be initiated if the patient is at risk of harming themselves An important drug in the class of atypical antipsychotics to mention is pimavanserin, which in 2016 or others. was FDA approved to treat Parkinson disease psyThe most common BPSD seen is depression. After chosis. Pimavanserin has no action on dopamine a patient with dementia has been diagnosed with receptors therefore it should not worsen other Pardepression, often by using the Cornell Scale for De- kinson disease symptoms however, it does have the pression in Dementia (CSDD), nonboxed warning for increased mortality in elderly pharmacological treatment is recommended for 8- patients with dementia-related psychosis (20).

12 weeks (15). Pharmacological treatment is added on if the initial presentation is severe or the patient Carbamazepine, while not an antipsychotic, has shown benefit in decreasing agitation and aggresfails non-pharmacological treatment (16) sion when used off label. A smaller study of 51 paPharmacological treatment options that can be uti- tients showed an improvement in symptoms in 77% lized include sertraline, citalopram, mirtazapine, of the treatment group compared to only 21% of venlafaxine, and bupropion SR. Citalopram was the placebo group. The average carbamazepine shown to be non-inferior in studies to risperidone in dose in this study was 300 mg. While this study is controlling agitation, so it may be more beneficial if promising, more data is necessary to fully evaluate agitation is also present. It is important to note that the efficacy and the many interactions and side efdoses of citalopram for adults greater than 60 years fects of carbamazepine must be considered (21). should be limited to 20 mg per day to risk of QTc Similar to carbamazepine, valproic acid has been prolongation. Trazodone can be considered as a second-line option, but caution should be taken due studied off-label for its efficacy in reducing agitation and aggression in dementia patients. Studies to the increased risk for sedation, falls, and QTc suggest that there may be some benefit when prolongation (17). valproic acid is used as adjunct therapy. Results While antidepressants are our first-line option for were seen with lower doses (7-12 mg/kg per day) patients, there have been studies that have failed to and the goal serum level was lower at 40-60 demonstrate their benefit. The HTA-SADD study mcg/mL. The many drug interactions as well as |14| Kentucky Pharmacists Association | January/February 2019

the burden of having to check drug serum levels are burdens to valproic acid’s utility (22).

4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.

Disturbances in sleep is a common BPSD that while often a burden for the caregiver, there has been no proven correlation between improved sleep and cognitive function or daytime awakening (23).

Some pharmacological agents utilized include trazodone, melatonin, and ramelteon. Meta-anaylsis of melatonin showed an increased sleep time of 25 minutes, trazodone an average of 46 minutes, and there was no benefit showed in ramelteon (25). Due to the lack of data supporting pharmacological treatment or the negative effects of lack of sleep in these patients, treatment should only be considered if there is significant caregiver burden and nonpharmacological options should be first line (26).

5. Lippman S, Perugula ML. Delirium or Dementia. Innov Clin Neurosci. 2016; 13 (9-10): 56-57.

Sexual behavior seen as part of BPSD often are a burden for patient’s caregivers. There are many medications that can be utilized off-label due to their adverse effects of decreased libido. Atypical antipsychotics are common but synthetic progestin, finasteride, and estrogen have also shown promising results. There have been some case reports of treatment-resistant sexual behavior responding to gabapentin therapy (26).

In conclusion when addressing treatment of a behavior or psychological symptom of dementia nonpharmacological treatment should be first-line and continued if medication therapy initiated. Due to the fluctuation of the dementia disease medication use should be routinely re-evaluated. While antipsychotics may demonstrate effective results, their use should be limited due to risk of mortality. There are many promising small studies and case reports of other agents that should be further investigated to determine alternative agents.

References: 1. National Institute on Aging. Basics of Alzheimer’s Disease and Dementia: What is dementia? U.S. Department of Health and Human Services. Bethesda, MD 2017. https://www.nia.nih.gov/health/what-dementia 2. Fazio S, Pace D, Maslow K, et al; Alzheimer’s Association Dementia Care Practice Recommendations, The Gerontologist, 2018; 58(1): S1-S9. doi:10.1093/geront/gnx182

6.Tsio KKF, Chan JYC, Hirai HW, et al. Cognitive tests to determine dementia. JAMA Intern Med. 2015;175(9):1450-1458.

7.Rabins PV, Blacker D, Rovner BW. et al. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Second edition. Am J Psychiatry. 2015; 164(12):5-56.

8. Namzeric [package insert]. Cincinnati, OH Abbreviation: Forest Laboratories Inc; 2014.

9. Dysken MW, Sano M, Asthana S. Effect of vitamin E and memantine on functional decline in Alzheimer disease. JAMA. 2014; 311(1):33-44. Doi:10.1001/jama.2013.28283.

10. Lock M. Vitamin E might increase risk of death. Can Fam Physician. 2005; 51(6):829-831.

11. Birks J, Flicker L. Selegiline for Alzheimer’s disease. Cochrane Database Syst Rev. 2003;(1):CD000442.

12. Macfarlane S, O’Connor D. Managing behavioral and psychological symptoms in dementia. Aust Prescr. 2016; 39(4):123-125. doi: 10.18773/austprescr.2016.052.

13.Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol. 2012; 3(73). doi:10.3389/fneur.2012.00073.

14. Hill, V. Behavioral and Psychological Symptoms of Dementia (BPSD). Presented at: London Dementia GP Leads Network Meeting. October, 18 2017. Presentation available at: http://www.londonscn.nhs.uk/wp-content/uploads/2017/10/demhill-181017.pdf.

15. Alexapoulos GS, Abrams RC, Young RC, et al. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1988; 23(3):271-84. doi:10.1016/0006-3223(88)90038-8.

16. Leong C. Antidepressants for depression in patients with dementia: a review of literature. Consult Pharm. 2014;29(4):254-63. doi:10.4140/TCT.n.2014/254.

17. Wang F, Feng TY, Yan S, et al. Drug therapy for behavioral and psychological symptoms of dementia. Curr Neurophramacol. 2016; 14(4). doi: 10.2174/1570159X14666151208114232.

18. Banergee S, Hellier J, Dewey M, et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomized, multicenter, double-blind, placebo-controlled trial. Lancet.

2011;378(9789):403-11. doi:10.1016/S0140-6736(11)60830-1.

19. Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2106; 173(5):543-6. doi:10.1176/appi.ajp.2015.173501.

20. Traynor K. Pimavanserin approved for Parkinson’s-related hallucinations, delusions. Am J Health Syst Pharm. 2016; 73(12):853.

3. Swaffer K, Low LF. (2016). “Diagnosed with Alzheimer’s or andoi:10.2146/news160037. other dementia: A practical guide for what’s next for people with dementia, their families and care partners”, New Holland Publishers: 21. Tariot PN, Erb R, Podgorski CA, et al. Efficacy and tolerability Sydney, p 17. of carbamazepine for agitation and aggression in dementia. Am J Psychiatry. 1998;155(1):54-61.

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22. Dolder CR, Nealy KL, McKinsey J. Valproic Acid in dementia: Does an optimal dose exist? J Pharm Pract. 2012; 25(2):142-50. doi: 10.1177/0897190011424802. Epub 2011 Nov 17.

23. Xu J, Wang LL, Dammer EB, et al. Melatonin for sleep disorders and cognition in dementia: a meta-analysis of randomized controlled trials. Am J Alzheimers Dis Other Demen. 2015; 30(5):43947.doi:10.11777/1533317514568005.

24. McCleery J, Cohnen DA, Sharpley AL. Pharmacotherapies for sleep disturbances in Alzheimerâ&#x20AC;&#x2122;s disease. Cochrane Database Syst Rev. 2014;(3):CD009178.doi: 10.1002/14651858.

25. Joller P, Gupta N, Seitz DP. Approach to inappropriate sexual behavior in people with dementia. Can Fam Physician.2013;59(3):255-60

KPERF Launches New Continuing Education Platform In the coming weeks we will be transitioning to a new Continuing Education platform. In the past year we have integrated online CPE, but it was not a comprehensive online solution. Now, when you complete your CPE article activities online the credits will be automatically sent to CPE Monitor. You can also begin an activity, pause, and come back to complete the credits. You will also receive an email once your activity is complete, so that you can keep track of the activities you complete. We will continue to allow for mailed quiz submissions, but highly recommend that you try out the new platform!

Please contact Sarah Franklin (sarah@kphanet.org or 502.227.2303) with any questions. We are happy to assist you in obtaining your FREE CPE credits through The Kentucky Pharmacist!

Check out the 2019 articles at the link below and we will provide updates once previously released articles are available online: www.kphanet.org/the-kentucky-pharmacist-cpe-articles-2019

|16| Kentucky Pharmacists Association | January/February 2019

January 2019 — Pharmacological Management of Dementia

1. A patient who experiences acute onset of confusion accompanied by psychosis is most likely experiencing which of the following?

6. Which dose of vitamin E was shown to have an increase of mortality?

A. Alzheimer’s dementia

B. 200 IU Daily

B. Lewy Body dementia

C. 300 IU Daily

C. Delirium

D. 500 IU Daily

D. Vascular dementia

7. True or False: Benzodiazepine therapy in dementia patients can cause a presentation similar to behavioral and psychological symptoms?

2. What medication when given with donepezil would be most likely to increase the risk of adverse effects?

A. Aspirin B. Neostigmine C. Hydrochlorothiazide D. Lithium 3. Patient presents with new diagnosis of mild Alzheimer’s dementia. Past medical history is significant for COPD, atrial fibrillation, and cirrhosis. Which is the best option for initial therapy in this patient?

A. Donepezil B. Rivastigmine C. Memantine D. Selegiline 4. Which of the following patients meet FDA approved indication for memantine?

A. Patient newly diagnosed with Parkinson’s dementia B. Patient with a history of frontrotemperal dementia C. Severe dementia in a patient with Alzheimer’s disease D. Patient with mild dementia secondary to an undetermined disease 5. Which of the following best describes memantine’s mechanism of action?

A. 100 IU Daily

A. True B. False 8. A dementia patient presents with new onset moderate depression. Which of the following is best for initial treatment?

A. Sertraline B. Non-Pharmacological therapy C. Olanzapine D. Bupropion 9. Which of the following regarding antipsychotic use in dementia patients is incorrect?

A. If effective the patient should continue antipsychotics longterm B. Use can increase risk of mortality C. Doses should be initiated at ½ to 1/3 of normal starting dose D. Pimavanserin has an FDA indication specifically for Parkinson disease psychosis 10. True or False: A full night of sleep (approximately 6-8 hours) is vital for cognitive improvement in patients with a diagnosis of dementia.

A. True B. False

A. Cholinesterase inhibitor B. Blocks glutamate stimulation of NMDA receptor C. Acts as a metabolic precursor to dopamine D. Partial agonist action on 5-HT receptors

Submit Quiz Online

|17| www.KPHANET.org

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, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

Expiration Date: 1/29/2022 Successful Completion: Score of 80% will result in 1.0 contact hour or .10 CEUs. TECHNICIANS ANSWER SHEET January 2019 â&#x20AC;&#x201D; Pharmacological Management of Dementia (1.0 contact hour) Universal Activity # 0143-0000-19-001-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. 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 Achieved 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 If yes, please explain on a separate sheet.

Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #__________________________ Birthdate _______ (MM)_______(DD)

PHARMACISTS ANSWER SHEET January 2019 â&#x20AC;&#x201D; Pharmacological Management of Dementia (1.0 contact hour) Universal Activity # 0143-0000-19-001-H01-P Name _______________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 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 Achieved 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 If yes, please explain on a separate sheet.

Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy

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

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.  



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



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 at the beginning of the article.



Article should begin with the goal or goals of the overall program – usually a few sentences.



Include 3 to 5 objectives using SMART and measurable verbs.



Feel free to include graphs or charts, but please submit them separately, not embedded in the text of the article.



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.

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 should address topics designed to narrow gaps between actual practice and ideal practice in pharmacy. Please see the KPhA website (www.kphanet.org) under the Education link to see previously published articles.

Articles must be submitted electronically to the KPhA director of communications and continuing education (info@kphanet.org) by the first of the month preceding publication.

|19| www.KPHANET.org

February CPE Article The Layered Learning Practice Model: A Contemporary Approach to Precepting By: Brittany Lenihan, PharmD Candidate, University of Kentucky College of Pharmacy; Christopher Miller, PharmD, MS, MBA, BCNSP, Clinical Assistant Professor, Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy The author declares that there are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity #0143-0000-19-002-H04-P /T 1.0 Contact Hour (0.10 CEU) Expires 1/29/2022

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy

Goal: To raise the level of pharmacist awareness of the layered learning practice model used in experiential learning including benefits, challenges, and key attributes required for implementation.

Learning Objectives: At the conclusion of this knowledge-based article, the reader should be able to: 1.Define the layered learning practice model (LLPM) 2. Identify key attributes to successful implementation of the LLPM 3. Describe the role of each participant in the LLPM 4. Recognize the challenges and benefits associated with the LLPM

The increasing enrollment in doctor of pharmacy degree programs has created a proportional increase in the demand for experiential education placements.1-3 Accommodating additional students can be challenging for pharmacists who are already balancing precepting students with an everexpanding workload.4

The model requires a minimum of three layers; it typically consists of a pharmacy attending as the senior preceptor, a postgraduate resident, and a pharmacy student (Figure 1). This model was designed to refine the traditional precepting model to establish a service-based pharmacy team. In this model, the attending pharmacist becomes the head of a pharmacy clinical team rather than being the To address this problem, the University of North direct provider of pharmacist care services.11 The Carolina Medical Center (UNCMC) and the attending pharmacist leads the rotation experience Eshelman School of Pharmacy developed the Lay- and is ultimately responsible for evaluations, grade ered Learning Practice Model (LLPM), for which assignments, and patient-centered care. The postthey were awarded the 2011 ASHP Best Practices graduate resident, under the supervision of the senAward. The LLPM provides a framework for inte- ior preceptor, serves as mentor and primary precepgrating a greater number of learners into a given tor for the pharmacy student (s). Pharmacy stupractice site. Mirroring the medical team model, dents are the third layer of the model and complete the LLPM is a teaching strategy that utilizes a hier- direct patient care activities under the direction of archical team structure in which each team memthe pharmacy resident. These activities may inber is responsible for precepting the learner in the clude acquiring medication histories, reconciling level below them.3,7-8 The LLPM improves precep- medications during transitions, providing patient tor efficiency and extends clinical pharmacy sermedication education, assisting with medication vices while providing quality precepting experience access, and documenting patient care encounters in for residents and enhanced learning opportunities the medical record. The LLPM can be adapted for student pharmacists.8-10 based on the needs of each institution and the num|20| Kentucky Pharmacists Association | January/February 2019

Figure 2—Responsibilities and Expectations of Key LLPM Practitioners and Learners

ber of learners.3,7-8 For example, rotations may have PGY2 residents precept PGY1 residents, PGY1 residents precept pharmacy students, APPE students teach IPPE students, technicians teach APPE/IPPE students, etc.

The investigators identified seven key attributes for effective application of the LLPM5:

Implementation

2. Systematic approach—A systematic approach can prioritize the needs of the organization and improve patient care

Pinelli, in an interview with AJHP, describes the comprehensive implementation of the LLPM through a collaboration agreement between UNCMC and Eshelman School of Pharmacy.5,6 The goals of this partnership were defined as: 1) expansion of clinical pharmacist care services, where there were no previous services offered, 2) accommodation of an increased number of student and resident learners, 3) engagement of students and residents to support new clinical services within the Healthcare System, and 4) accountability and responsibility for National Patient Safety Goals related to medication utilization.

1. Shared leadership—Shared leadership between the practice site and college of pharmacy allows for optimal collaboration and cohesiveness

3. Good communication—Good communication regarding the LLPM is necessary throughout entire organization in order to foster a shared understanding of the LLPM process and purpose 4. Flexibility for attending pharmacists—Flexibility for attending pharmacists allows rotations to be catered to the specific needs of the practice site and participants 5. Adequate Resources—Adequate resources such as physical space for learners should be ascertained and planning of the LLPM should be within the context of available resources

After the successful implementation of the LLPM on twenty-five inpatient and ambulatory care services at the UNCMC, Pinelli and colleagues designed a study to identify successful attributes of the 6. Commitment—Commitment from all parties model.5 Comprehensive interviews were conducted (students, residents, attending pharmacists, practice with 24 out of 25 eligible attending pharmacists. |21| www.KPHANET.org

Figure 2 â&#x20AC;&#x201C; Benefits and Challenges with the LLPM

sites, and colleges of pharmacy) is essential for the development and sustainability of the LLPM

There have been several challenges associated with the LLPM (Figure 2) as identified by institutions that use this educational strategy. Those most often 7. Evaluationâ&#x20AC;&#x201D;Evaluation of LLPM participants reported include scheduling conflicts, varying levels and practice sites provides an opportunity for feed- of interest and competency at each layer, and less back and can identify areas for improvement direct preceptor oversight.5 Many of these problems Furthermore, for preceptors or facilities looking to can be mitigated during the orientation and preexperience planning steps. Thorough presuccessfully implement the LLPM, Loy and colleagues recommend the utilization of four key steps experience planning and orientation delineates the 3: expected roles of each participant and allows for early identification of any potential conflicts. To a) Orientation to the LLPM minimize scheduling issues, efforts should be made to schedule residents on the same months as stub) Preexperience planning dents and a centralized calendar should be used for c) Implementation all learner rotations at a site. If a resident lacks confidence in their clinical or teaching abilities, the d) Postexperience evaluation senior preceptor may recommend background reading and offer greater supervision until the resident demonstrates competency. Decreased individOrientation introduces participants to the LLPM ualized attention can be alleviated with scheduled and outlines the expectations for each layer of the opportunities for feedback. model. Preexperience planning allows the resident to work alongside the attending pharmacist in cre- Promising Results ating rotation calendars, assignments, and rubrics.

Despite its challenges, use of the LLPM can result During the implementation phase, the pharmacy in the growth of clinical patient care services as student performs clinical activities under the superwell as measurable improvement in patient and vision of the resident. Postexperience evaluation economic outcomes. The increased number of allows for feedback to all layers of the model and learners provided by the LLPM can be utilized to identifies areas for improvement of the LLPM. expand pharmacy services with activities such as medication therapy management and discharge Barriers |22| Kentucky Pharmacists Association | January/February 2019

counseling. Studies have demonstrated that these residents who can offer professional development services can result in improved patient care, greater advice. Residents serving as part of a LLPM will patient satisfaction, and cost savings (Table 1). 5,8-9 see an advancement in teaching abilities, leadership skills, and clinical knowledge. For senior precepThis was seen in a study by Soric and colleagues, tors, advantages include higher efficiency and the which aimed to evaluate the economic and patient quality assurance provided by the multiple layers of satisfaction outcomes of using a LLPM in a small critical review. Although the LLPM has some discommunity hospital. The authors found that imple- advantages, it has the ability to improve patient mentation of the LLPM resulted in a significant re- care, reduce costs and better prepare the future genduction in medication costs per discharge and imeration of pharmacists for clinical practice. proved the medication education process for inpatients.12 References Similar results were seen in studies conducted at Cleveland Clinic Florida (CCF) and UNCMC. Bates and colleagues used the LLPM model at UNCMC to provide medication reconciliation and counseling to patients upon discharge, a service that was not previously offered by the pharmacy. The team was able to carry out these activities in 51% of patients in malignant hematology and medical oncology wards and identified an average of 1.7 medication-related problems per encounter.8 Delgado and colleagues conducted a study at CCF in which pharmacy students within a LLPM performed medication histories, patient education, discharge counseling, and medication regimen review.

The primary outcome examined was change in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. HCAHPS (pronounced H-Caps) is a standardized survey endorsed by the Centers for Medicare and Medicaid Services that measures patients’ perspective on hospital patient care. Two of the survey’s twenty-seven questions are specific to medication education.13 Delgado’s research team found that use of the LLPM resulted in an increase in HCAHPS scores (58% versus 70%), as well as an increase in pharmacy interventions per patient per day (0.9 versus 1.4) and bedside medication delivery capture rate (48% versus 65%).9 Conclusion Accommodating the growing number of pharmacy students requires an update to the traditional model of precepting in which a clinical pharmacist works with only one learner at a time. Adoption of the LLPM facilitates the simultaneous instruction of multiple learners and provides many benefits to participants. Students are afforded the opportunity to experience direct patient care and work alongside

1. American Journal of Health-System Pharmacy et al. Capacity of hospitals to partner with academia to meet experiential education requirements for pharmacy students. Am J Pharm Educ.

2008;72(5):Article 117.

2. Brackett PD, Byrd DC, Duke LJ, et al. Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium. Am J Pharm Educ. 2009;73(5) Article 82 3. Loy BM, Yang S, Moss JM, et al. Application of the layered learning practice model in an academic medical center. Hosp Pharm. 2017;52(4):266–272.

4. Hartzler ML, Ballentine JE, Kauflin MJ. Results of a survey to assess residency preceptor development methods and precepting challenges. Am J Health Syst Pharm. 2015; 72: 1305–1314.

5. Pinelli NR, Eckel SF, Vu MB, et al. The layered learning practice model: lessons learned from implementation. Am J Health Syst Pharm. 2016;73(24):2077–2082.

6. Zellner, W. and Pinelli, N. (2016). Layered Learning Practice Model. [audio podcast] AJHP Voices. Available at: http://ajhpvoices.org/ [Accessed 6 Dec. 2018].

7. Buie L. The layered learning practice model and the pharmacy practice model initiative. http://connect.ashp.org/blogsmain/blogviewer/?BlogKey=1ff0fea1dd0b-46c3-81f6-b5c5ec1e0e95. Accessed December 4, 2018 8. Bates JS, Buie LW, Amerine LB, et al. Expanding care through a layered learning practice model. Am J Health Syst Pharm. 2016; 73: 1869– 1875.

9. Delgado O, Kernan WP, Knoer SJ. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health Syst Pharm. 2014; 71: 1871–1876.

10. Cobaugh DJ. Layered learning: The confluence of pharmacy education and practice. Am J Health Syst Pharm. 2016; 73(24):2035.

11. Bates JS, Buie LW, Lyons K, et al. A study of layered learning in oncology. Am J Pharm Educ. 2016; 80: 68 12. Soric MM, Glowczewski JE, Lerman RM. Economic and patient satisfaction outcomes of a layered learning model in a small community hospital. Am J Health Syst Pharm. 2016;73(7):456–462.

13. Centers for Medicare and Medicaid Services. HCAHPS: patients’ perspectives of care survey. www.cms.gov/medicare/qualityinitiatives-patient-assessment-instruments/ hospitalqualityinits/hospitalhcahps.html (accessed 2018 Dec 6).

|23| www.KPHANET.org

|24| Kentucky Pharmacists Association | January/February 2019

February 2019 â&#x20AC;&#x201D; The Layered Learning Practice Model: A Contemporary Approach to Precepting 1. The most typical three-layered learning model would consist of the following: A. Clinical Pharmacist, APPE student, IPPE student B. APPE student, pharmacy technician, IPPE student C. Physician, nurse, pharmacist D. Attending pharmacist, pharmacy resident, APPE student 2. Which of the following does NOT represent a key attribute defined in the literature for successful implementation of the LLPM? A. Attending pharmacist maintaining a defined structured approach B. Shared leadership between the institution and College of Pharmacy C. Maintaining a systematic approach that prioritizes needs and optimizes patient care D. Commitment for success from all parties involved in the layered learning process 3. Evaluation A. Is a key attribute for successful implementation of the LLPM B. Provides an opportunity for feedback for all LLPM participants C. Can identify areas for improvement D. All of the above 4. Which of the following represents a recognized barrier or challenge in implementing a layered learning practice model?

A. Providing optimal patient care B. Scheduling complexities of the model C. Quality of learning experience for experiential learners D. Resident teaching opportunities 5. Which of the following is NOT an advantage of the LLPM? A. Ability to expand pharmacy services B. Health system cost savings C. Opportunity for students to provide direct patient care D. Opportunity for APPE student to spend more time with the preceptor attending pharmacist 6. Challenges associated with the LLPM can be alleviated by: A. Minimizing overlap between pharmacy residents and students B. Thorough preexperience planning and orientation C. Limiting opportunities for feedback D. Expansion of pharmacy services 7. The team leader with overall responsibility in a pharmacy -based layered learning model would be A. General pharmacy practitioner B. Attending pharmacist C. The PGY2 resident D. The PGY1 resident

8. Which of the following is the most appropriate responsibility for an APPE student pharmacist functioning as part of the LLPM? A. Assume ultimate responsibility for patient outcomes B. Serve as mentor and primary preceptor for pharmacy residents C. Create rotation calendar, assignments, and rubrics D. Complete direct patient care activities 9. A key finding of the 2016 AJHP Bates et al. LLPM study was?

A. Increased patient satisfaction based on HCAHPS scores B. Increased bedside discharge prescription capture D. Increased identification of medication related problems C. Reduction in total medication discharge cost 10. Based on the literature and reported studies, which of the following can be used to help justify benefits of the pharmacy LLPM? A. Improvement in patient satisfaction scores in the medication education domain (HCAHPS) B. Increased revenue capture via expansion of services C. Expansion of experiential student capacity for the College of Pharmacy D. All the above can help justify implementation of LLPM

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, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

Expiration Date: 1/29/2022 Successful Completion: Score of 80% will result in 1.0 contact hour or .10 CEUs. TECHNICIANS ANSWER SHEET February 2019 — The Layered Learning Practice Model: A Contemporary Approach to Precepting (1.0 contact hour) Universal Activity # 0143-0000-19-002-H04-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D 10. A B C D Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieved 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 If yes, please explain on a separate sheet.

Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #__________________________ Birthdate _______ (MM)_______(DD)

PHARMACISTS ANSWER SHEET February 2019 — The Layered Learning Practice Model: A Contemporary Approach to Precepting (1.0 contact hour) Universal Activity # 0143-0000-19-002-H04-P Name _______________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D 10. A B C D

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieved 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 If yes, please explain on a separate sheet.

Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy

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

|27| www.KPHANET.org

6. See It All KPhA is the only statewide pharmacy organization that represents all pharmacists in all practice settings—you can learn about all the opportunities available within pharmacy and gain insights from pharmacists representing a variety of practice settings.

7. Develop Your Leadership Skills Participate as an active leader in a variety of committees and volunteer leadership positions that will develop your skills as you give back to your profession.

1. Strengthen Your Career KPhA members enjoy educational opportunities designed to increase knowledge and keep up with the latest information.

2. Advance Patient Care

8. Make a Positive Impact By joining KPhA, you are taking a step to ensure the future of the profession in Kentucky. We can’t do this important work without YOU.

The more you learn about drug and treatment updates through our publication, The Kentucky Pharmacist, as well as through attending OUR KPhA meetings, the better equipped you are to help your patients.

9. Make the Connection

3. Network with Others in Your Field

KPhA partners with many industry partners that offer discounts or important expertise that can positively impact your pharmacy.

KPhA members are invited to join their colleagues at the KPhA Annual Meeting & Convention and the Legislative Conference.

4. Advocate for Your Profession By joining KPhA, you are supporting the only organization representing the unified voice of all pharmacists.

During the past year, KPhA’s work on health care legislation and regulation increased policy makers’ awareness of the pharmacist’s role in health care. KPhA continues to

10. Gain the Competitive Edge KPhA gives you exclusive access to unique experiences, career information, and resources designed to meet your needs and provide support as you advance in your career.

5. Proclaim Your Professionalism Adding your name to the ranks of your colleagues who are members declares your pride in the profession. Support KPhA’s advocacy efforts as we work with policy makers to implement health care reform legislation and as we continue to advocate for regulations that positively impact the profession. |28| Kentucky Pharmacists Association | January/February 2019

JOIN TODAY WWW.KPHANET.ORG

Welcome to KPhA! Weâ&#x20AC;&#x2122;re so happy to have you!

The list reflects new memberships received from November 1, 2018â&#x20AC;&#x201D; December 31, 2018 Jacob Addison Technician

Lynn Lamkin Pharmacist

Eric Keith Pearson Pharmacist

Lisa Babb Pharmacist

Tim Lawson Pharmacist

Michele Pinkston Pharmacist

Luke Brewer Technician

Jenna Mays Technician

Alex Schickli Pharmacist

Tina Collins Associate Member

Ashley McCay Pharmacist

John Serafini Pharmacist

Mallory Durham Pharmacist

Joseph Morgan Pharmacist

Rebecca Thornbury Associate Member

James Jasis Pharmacist Member

Lance Murphy Pharmacist

Trina Curry Warford Pharmacist

Dhaval Kotak Pharmacist

Shelley Nall Pharmacist

Darshale White Pharmacist

|29| www.KPHANET.org

Feature Article Kentucky’s Longest-Working Pharmacist Author: Luke Schmid, PharmD Candidate I Class of 2020, Sullivan University College of Pharmacy & Health Sciences If you look up the lowest active license number for pharmacists in Kentucky, you might stumble across the name, William Danhauer Jr. A lower license number, as it is known, indicates when the license was obtained. William Danhauer Jr., 91 years old, of Owensboro, Kentucky, is currently the state’s oldest practicing registered pharmacist (License Number 4973). He remains faithful to his store, Danhauer Drugs, in Owensboro, and plays an active role in his community.

better themselves for the field, Mr. Danhauer suggested that involvement in pharmacy organizations is critical. “It’s a way to give back,” Mr. Danhauer stated. Mr. Danhauer was personally involved on the Kentucky Board of Health during the 1960s and feels strongly that giving back is one of the most important aspects of the job. His son, Jeffrey Danhauer, has been involved in several organizations, as well, including the Kentucky State Board of Pharmacy and the Kentucky Pharmacists Association. Mr. Danhauer stressed that students not Mr. Danhauer took the state pharmacy board exam in July of focus too much on money or the future, but on what you can 1950. “It was a Wednesday,” he recalled, and has remained at do now for the community with the opportunities available.

Danhauer Drugs ever since. His father started the store in November of 1904. This was just three years after Walgreens “It has been a good life,” Mr. Danhauer remarked. He continwas started, and much earlier than CVS or many of the other ues to work at Danhauer Drugs in Owensboro to this day. retail pharmacies known today. His independent pharmacy Mr. Danhauer’s faith and family have motivated his work has lasted through the years, and he attributes it to taking care throughout his life, still attending service at St. Stephen Cathof his customers. His father’s philosophy was: “If you take olic Church when he can. He has seven children and 29 great care of your customers, they take care of you.” Mr. Danhau- grandchildren. Interestingly, but not surprisingly, all seven er’s father was a very hardworking man. “If he did a good children chose to enter the medical field. His son, Jeffrey deed, he never reported it,” said Mr. Danhauer. His father Danhauer, currently runs Danhauer Drugs, and plays an acwas the first pharmacist from Owensboro to attend college, tive role in the community as well. His pharmacy serves sevand he inspired Mr. Danhauer to follow in his footsteps. eral nursing homes, group homes, and healthcare facilities throughout Daviess County and the surrounding areas. They Before age 18, Mr. Danhauer had offer custom packaging to help individual patients stay comjoined the Navy, and upon leaving pliant, along with free delivery. In addition to this, patients at 19, he had selected to attend the benefit from their diabetes management, wound care, and Louisville College of Pharmacy. complete department of respiratory services. Mr. Danhauer While attending the Louisville Colhas helped a multitude of patients in his 68 years as a pharmalege of Pharmacy, he lived with othcist, and his pharmacy continues this legacy of service. True er pharmacy and medical students at to this day, still rings Danhauer Drugs’ motto: “Faithful to the YMCA on 3rd and Broadway. your trust since 1904.”

Looking back at his first year of schooling, Mr. Danhauer recalled it was only $1000 in total for room and board. The GI Bill covered other William Danhauer Jr. expenses and provided him with a $75 stipend each month. His class was composed of 90 to 95 students, 6 of whom were women. He went on to graduate in June of 1950. His father had worked very hard throughout the second world war, and suffered a heart attack around this time. Mr. Danhauer returned to the store to help, and has played a key role ever since.

jobs.kphanet.org

As the longest-standing registered pharmacist in Kentucky, Mr. Danhauer has a lot of wisdom to offer his fellow employees and future students. When asked how future students can

THE location for pharmacy job seekers + employers for

|30| Kentucky Pharmacists Association | January/February 2019

targeted positions

Financial Forum Comprehensive Financial Planning: What It Is, Why It Matters?

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

Just what is comprehensive financial planning? As you invest and save for retirement, you may hear or read about it – but what does that phrase really mean? Just what does comprehensive financial planning entail, and why do knowledgeable investors request this kind of approach? While the phrase may seem ambiguous to some, it can be simply defined.

Basing decisions on a plan prevents destructive behaviors when markets turn unstable. Quick decision-making may lead investors to buy high and sell low – and overall, investors lose ground by buying and selling too actively. Openfolio, a website which lets tens of thousands of investors compare the performance of their portfolios against portfolios of other investors, found that its average investor earned 5% in 2016. In Comprehensive financial planning is about building wealth contrast, the total return of the S&P 500 was nearly 12%. through a process, not a product. Financial products are eveWhy the difference? As CNBC noted, most of it could be rywhere, and simply putting money into an investment is not chalked up to poor market timing and faulty stock picking. A a gateway to getting rich, nor a solution to your financial iscomprehensive financial plan – and its long-range vision – sues. helps to discourage this sort of behavior. At the same time, Comprehensive financial planning is holistic. It is about the plan – and the financial professional(s) who helped create more than “money.” A comprehensive financial plan is not it – can encourage the investor to stay the course.1 only built around your goals, but also around your core valA comprehensive financial plan is a collaboration & results ues. What matters most to you in life? How does your wealth in an ongoing relationship. Since the plan is goal-based and relate to that? What should your wealth help you accomplish? values-rooted, both the investor and the financial professional What could it accomplish for others? involved have spent considerable time on its articulation.

Comprehensive financial planning considers the entirety of There are shared responsibilities between them. Trust your financial life. Your assets, your liabilities, your taxes, strengthens as they live up to and follow through on those your income, your business – these aspects of your financial responsibilities. That continuing engagement promotes comlife are never isolated from each other. Occasionally or fremitment and a view of success. quently, they interrelate. Comprehensive financial planning Think of a comprehensive financial plan as your compass. recognizes this interrelation and takes a systematic, integrated Accordingly, the financial professional who works with you approach toward improving your financial situation. to craft and refine the plan can serve as your navigator on the Comprehensive financial planning is long range. It presents journey toward your goals. a strategy for the accumulation, maintenance, and eventual The plan provides not only direction, but also an integrated distribution of your wealth, in a written plan to be implementstrategy to try and better your overall financial life over time. ed and fine-tuned over time.

As the years go by, this approach may do more than “make What makes this kind of planning so necessary? If you aim money” for you – it may help you to build and retain lifelong to build and preserve wealth, you must play “defense” as well wealth. as “offense.” Too many people see building wealth only in References terms of investing – you invest, you “make money,” and that 1 - cnbc.com/2017/01/04/most-investors-didnt-come-closeis how you become rich. That is only a small part of the stoto-beating-the-sp-500.html [1/4/17] ry. The rich carefully plan to minimize their taxes and debts as well as adjust their wealth accumulation and wealth preservation tactics in accordance with their personal risk tolerance and changing market climates.

Cont. on pg. 33 |31| www.KPHANET.org

Pharmacy Policy Issues Pharmacist Attitudes toward Syringe Exchange Submit Questions: jfink@uky.edu Programs Author: Leah W. Ginter, Pharm.D., is a 2018 graduate of the PharmD program at the University of Kentucky College of Pharmacy. A native of Louisville, Kentucky, she completed her pre-professional degree work while earning a degree in health communication at the University of Kentucky.

Syringe exchange programs (SEPs), also known as needle exchange programs, have been studied and implemented in the United States since 1988.2 Each syringe exchange program is different; the program will decide how to best implement their individual program to meet their community’s needs. In these programs, the syringes may be free, available at a low-cost, or old syringes may be required for the dispensing of new syringes.

Programs may offer free disposal of used needles and other paraphernalia, education about clean injection Discussion: According to the Centers for Disease Conpractice, free addiction counseling, and some free trol and Prevention (CDC), “about one quarter of HIVhealthcare (such as sexually transmitted disease screeninfected persons in the United States are also infected ing). There are currently 47 SEPs in Kentucky across with Hepatitis C virus.”1 Both HIV and HCV are transvarious counties with some programs serving multiple mittable through the blood, causing HCV to be a “50areas, such as the Ashland SEP which also serves Boyd 90% co-infection in HIV-infected drug-users.”1 KenCounty. Of Kentucky’s 120 counties, 45 currently are tucky and surrounding states have some of the highest serviced by these programs (some counties share and toll for overdose deaths, with many of these overdoses others have multiple within the same county). In 2016, from heroin, opioids, and other substances that are bethe CDC identified 220 counties that were at risk for ing injected using needles that have been used by HIV outbreak, and nearly one-quarter of these counties friends or even perfect strangers. Kentucky and the surwere in Kentucky.2,3 Figure 1 shows current and rounding states also have some of the highest rates for planned SEPs in comparison to the 54 counties at risk blood borne diseases such as HIV and HCV. of outbreak.

Issue: With diseases such as Human Immunodeficiency Virus (HIV) and Hepatitis C virus (HCV) on the rise throughout the state of Kentucky, many Health Departments have been urged by public health officials and healthcare providers alike to create syringe exchange programs to decrease the transmission rate of these viruses due to the sharing of needles between drug users. Are pharmacists frequently involved in these programs?

What are pharmacist attitudes regarding syringe exchange programs?

Figure 1 Available at chfs.ky.gov/dph/epi/HIVAIDS/prevention.htm

Traditionally, pharmacists do not participate in syringe exchange programs. However, we are directly involved the counseling about HIV and HCV medications as well as with the dispensing of syringes, whether they be prescription or over-the-counter. There are two different schools of thought regarding SEPs within the state, one that believes them to be helpful and the other believes them to be hurtful. Those that believe SEPs are positive see these programs as way to prevent outbreaks in our area with harm reduction being at the center of their argument. These programs do not initiate or encourage IV drug use but rather connect current users to education for safer use and addiction treatment. The SEPs Cont. on pg. 35

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Pharmacy Law Brief Legislation versus Regulation Author: Joseph L. Fink III, BSPharm, JD, DSc (Hon), FAPhA, 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 recently was looking for a specific provision in Kentucky pharmacy law and my search took me through the provisions relevant to pharmacy practice appearing in both the Kentucky Revised Statutes and the Kentucky Administrative Regulations. I recall a discussion about the distinction between the two during our legal education while in pharmacy school but a refresher would be helpful.

Response: We often speak about “pharmacy law” without drawing a distinction between whether what we’re referring to is a statute or a regulation. The distinction can be quite important as the law comes alive to affect practice of pharmacy and other professions. Hence, it is appropriate to revisit concepts discussed in high school civics class or a collegiate political science class.

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.

discretion vested in the legislature, mounting a challenge to a statute can be an uphill struggle.

Statutes can be found relatively easily these days by doing an Internet search. Federal statutes are compiled in the United States Code (U.S.C.) with the format being a A statute originates with the legislature, be it Congress number indicating the title (subdivision) within the at the federal level or the General Assembly at the state Code, followed by “U.S.C.” and then the specific seclevel. After successfully passing both houses of the legis- tion number. For example, the Federal Food Drug and Cosmetic Act is found at 21 U.S.C. §201. At the state lature with identical provisions the bill is sent to the level statutes are compiled in K.R.S. – Kentucky Rehead of the executive branch of government for his or vised Statutes. One prominent example is the Kentucky her concurrence. This is an example of the important undergirding principle established by the Founding Fa- Pharmacy Practice Act found at K.R.S. 315.002. Notice thers known variously as checks and balances, counter- the different format used for the citation to the Kentucky statute as well as the lack of the section mark (§). vailing powers, or balance of powers whereby each of the three branches of government has some authority to Regulations originate with a different branch of governcounterbalance activities of another division. This was ment, the executive branch, through activities of adminput in place because the Founders of our country had istrative agencies such as the U.S. Food and Drug Adobserved the undesirability of centralizing power in one ministration or the Kentucky Board of Pharmacy. Regbranch as had been seen with King George III of Eng- ulations thus adopted can serve to fill in the details reland. lated to policies and procedures to make the statute The legislature has relatively broad discretion with regard to what the legislation addresses and what it requires. As will be seen below, that authority is much more broad than that of an administrative agency adopting a regulation. However, there are limits. The statute being adopted must be consistent with the “higher” forms of law, the constitution (both federal and state) and any relevant treaties the country has entered into with other nations. Due to this relative broad

come alive. Such administrative or regulatory agencies typically have much greater subject matter expertise than the legislature and hence are in a better position to address detailed requirements. But this does not mean that these agencies can adopt whatever they wish. All acts by the administrative agency must be linked back to some authority conferred by the legislature through statute. If an agency were to try to adopt something that exceeded its authority such activity would be labeled Cont. on pg. 35 |33| www.KPHANET.org

Rx and the Law Documentation in the Modern World Author: Don. R. McGuire Jr., R.Ph., J.D. This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

The world continues to change and the way that we communicate with each other continues to evolve. This includes communication between you and your patients, and you and the prescribers. Pharmacists need to be able to sufficiently document their communications to support the actions taken in the care of their patients.

phone calls. The typical entry for a phone call includes date, time, person talked to, the question at hand, and the resolution. Documentation created out of a pattern of consistent behavior is every bit as admissible as a document itself. Documentation of texts should include date, time, the number texted, the question, and the resolution.

Early in my career, prescriptions were written on paper or called into the pharmacy. If clarification was needed after hours, it meant a call to the prescriber’s answering service.

The response time was seldom fast. The next great improvement in communication was the introduction of pagers. The prescriber got a message to call the pharmacy directly, but didn’t know who the patient was or what the issue was.

About this same time, faxing of prescriptions began to become more common. This included faxing refill requests to the prescriber’s office and the return fax of the authorization.

This format created its own documentation. The next step forward was electronic transmission of prescriptions from the prescriber to the pharmacy. No paper copy is generated with this method, but significant electronic documentation is available.

Pharmacists should also take HIPAA into consideration when using texts to communicate about prescriptions. What protected health information (PHI), if any, is being transmitted? If PHI is being transmitted, is the PHI protected from disclosure? The pharmacist should be careful that correct phone number is used for this type of communication. If the pharmacist is using their personal phone for such communications, is the information protected so that family members don’t accidentally have access to the PHI? This is another good reason to not let your children play with your phone.

In today’s world, the speed of communication in the 1980s seems like the Stone Age. And as the speed of communication has increased, keeping a record or documenting these communications is not at the forefront of most people’s minds. Communications happen in the now. Keeping them for the future doesn’t seem important. But it is important in professional communications. Texting patients and prescribers has become more prevalent as a fast and efficient means of communication. While nothing is ever truly deleted from cyberspace, trying to recover texts from two years ago should not be your documentation plan. Approach the documentation of texting as you would a phone call.

Documentation should be readily retrievable. In the past, documentation on the prescription itself was the favored location. That is still a good place for it, but we do not always have a paper prescription today. Computer systems have expanded documentation functionality today. You can also use a log book (paper or electronic) to document all communications. Documentation for texts is analogous to that for

In the fast pace of today’s world, documenting texts can be forgotten, but it is as important as documenting phone calls.

Most pharmacists have developed a habit for documenting phone calls. This habit needs to be expanded to include the information that is being communicated by text. While those with Luddite tendencies might say that it would be better to eliminate the use of texting in this situation, I doubt that we will be able to stem the tide. Texting is becoming the preferred method of communication with many people. Proper documentation of those transactions is essential to complete your patient care records. © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

|34| Kentucky Pharmacists Association | January/February 2019

Financial Forum Cont. From Pg. 31 Pat Reding and Bo Schnurr may be reached at 800-2886669 or pbh@berthelrep.com. Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc. This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy.

Please note - investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty.

This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment.

Outbreaks. June 3, 2016. Available at https://www.wsj.com/ articles/cdc-identifies-counties-at-risk-of-hiv-outbreaks-1464912264.

Pharmacy Law Brief Cont. From Pg. 33 “ultra vires” as falling outside the authority of the agency and would be overturned if challenged in court.

Regulatory agencies do not have the broad discretion of the legislature so mounting a challenge to something done by an agency is not quite the uphill struggle one faces when challenging a statute, although that is not an activity to be undertaken blithely.

Regulations can also be easily located through an Internet search these days. Regulations from federal agencies are first proposed and published in the Federal Register, a daily publication available online (www.federalregister.gov). When proposals are published they are accompanied by a solicitation of comments. When the regulation is finalized after the submitted comments have been reviewed ,it again is published in that same outlet. Eventually the federal regulation will be compiled in the Code of Federal Regulations (C.F.R.). Citations to C.F.R. materials follow a format similar to that used for federal statutes – 21 C.F.R. §510.

In the Kentucky system regulations are cited as they apPharmacy Policy Issues Cont. From Pg. 32 pear in Kentucky Administrative Regulations – 201 will also remove used syringes from the streets, therefore K.A.R. 2:050. Note that as with statutes in Kentucky, increasing community safety. In opposition, some pharno section mark is used. macists see SEPs as vessels to enable and encourage drug use. Residents feel unsafe due to high volume of addicts in areas in which the programs are housed.

Should we begin syringe exchange programs in our own pharmacies as they do in other counties? Should we begin HIV and HCV prevention programs? SEPs are  rapidly growing throughout the country, especially in our state. As the opioid crisis in the United States continues to rise and, incidentally, so do the HIV and HCV  rates, as healthcare professionals we have a duty to help our patients and our communities.

Calendar of Events



References: 1. Centers for Disease Control and Prevention. HIV/AIDS and Viral Hepatitis. March 7, 2018. Available at https://www.cdc.gov/ hepatitis/populations/hiv.htm.

Kentucky Pharmacists Day at the Capitol Thursday, February 28, 2019, Frankfort Kentucky Opioid Summit Saturday, March 30, 2019, Lexington Kentucky Pharmacists Association Annual Convention & Meeting June 20—24, 2019, Lexington

Register and more details at kphanet.org!

2. Kentucky Cabinet for Health and Family Services. HIV Prevention Program. Available at http://chfs.ky.gov/dph/epi/HIVAIDS/ prevention.htm.

3. The Wall Street Journal. CDC Identifies Counties at Risk of HIV

|35| www.KPHANET.org

|36| Kentucky Pharmacists Association | January/February 2019

|37| www.KPHANET.org

2018—2019 KPhA BOARD OF DIRECTORS

HOUSE OF DELEGATES Tyler Stephens, Lexington Speaker of the House stevens.tyler@uky.edu

Chris Harlow, Louisville cpharlow@gmail.com

Chair

Chris Palutis, Lexington chris@candcrx.com

President

Don Kupper, Louisville donku.ulh@gmail.com

President-Elect

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Secretary

Bob Oakley, Louisville rsoakley21@gmail.com

Chair

Duane Parsons, Richmond dandlparsons@roadrunner.com

Treasurer

Clark Kebodeaux, Lexington clark.kebodeaux@uky.edu

Secretary

Joel Thornbury, Pikeville jthorn6@gmail.com

Past President Representative

Duane Parsons, Richmond dandlparsons@roadrunner.com

Treasurer

Chris Palutis, Lexington chris@candcrx.com

President, KPhA

Directors Angela Brunemann, Union Angbrunie@gmail.com

KPERF BOARD OF DIRECTORS

Kimberly Croley, Corbin kscroley@yahoo.com

Matt Carrico, Louisville* matt@boonevilledrugs.com

Kevin Lamping, Lexington klamping@riteaid.com

Jessika Chilton—Chinn, Beaver Dam jessikachilton@ymail.com Dharti Patel, Lexington dharti.patel2@uky.edu

Ben Mudd, Lebanon Vice Speaker of the House bpmu222@gmail.com

University of Kentucky Student Representative

Paul Easley, Louisville rpeasley@bellsouth.net Sarah Lawrence, Louisville slawrence@sullivan.edu

Chad Corum, Manchester pharmdky21@gmail.com

KPERF ADVISORY COUNCIL

Cassy Hobbs, Louisville cbeyerle01@gmail.com Stephen Drog, Louisville sdrog5833@my.sullivan.edu

Sullivan University Student Representative

Chris Killmeier, Louisville cdkillmeier@hotmail.com Jeff Mills, Louisville jeff.mills@nortonhealthcare.org Richard Slone, Hindman richardkslone@msn.com James "Blake" Wiseman, Benton blake.wiseman@gmail.com *At-Large Member to Executive Committee

Matt Carrico, Louisville matt@boonevilledrugs.com Kim Croley, Corbin kscroley@yahoo.com Kimberly Daugherty, Louisville kdaugherty@sullivan.edu Mary Thacker, Louisville mary.thacker@att.net

KPhA/KPERF HEADQUARTERS 96 C Michael Davenport Blvd., Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) info@kphanet.org www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.twitter.com/KPhAGrassroots www.youtube.com/KyPharmAssoc

|38| Kentucky Pharmacists Association | January/February 2019

“The Governor’s Seminars on Drug Abuse, conducted in Frankfort on January 27th, 28th and 29th were a huge success. This was the first such attempt to start a state-wide program for educating the masses on the staggering problems of drug abuse.”

- From The Kentucky Pharmacist, February 1969, Volume XXXII, Number 2

Frequently Called and Contacted Kentucky Pharmacists Association 96 C Michael Davenport Blvd.

Frankfort, KY 40601 (502) 227-2303 info@kphanet.org 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 (PTCB) 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 Kentucky Regional Poison Center (800) 222-1222 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 SUCOPHS 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu

KPhA Staff Mark Glasper Executive Director mglasper@kphanet.org Sarah Franklin Director of Communications & Continuing Education sarah@kphanet.org

Michele Pinkston, PharmD, BCGP Director of Emergency Preparedness Michele@kphanet.org Sydney Hull Office Assistant/Member Services Coordinator shull@kphanet.org

Angela Gibson Director of Finance & Administrative Services agibson@kphanet.org Jody Jaggers, PharmD Director of Public Health jjaggers@kphanet.org Jessica Johnson, PharmD Director of Pharmacy Education Jessica@kphanet.org |39| www.KPHANET.org

THE

Kentucky PHARMACIST 96 C Michael Davenport Blvd.

Frankfort, KY 40601