North Carolina Pharmacist Volume 102 Number 4

North Carolina Pharmacist Volume 102 Number 4 Fall 2021

Advancing Pharmacy. Improving Health.

The long-acting injectable authority went into effect October 1, 2021.

Look inside to see what NCAP is doing for you!

Official Journal of the North Carolina Association of Pharmacists ncpharmacists.org

Call for Articles North Carolina Pharmacist (NCP) is currently accepting articles for publication consideration.

We accept a diverse scope of articles, including but not limited to: original research, quality improvement, medication safety, case reports/case series, reviews, clinical pearls, unique business models, technology, and opinions.

NCP is a peer-reviewed publication intended to inform, educate, and motivate pharmacists, from students to seasoned practitioners, and pharmacy technicians in all areas of pharmacy.

Articles written by students, residents, and new practitioners are welcome. Mentors and preceptors – please consider advising your mentees and students to submit their appropriate written work to NCP for publication.

Don’t miss this opportunity to share your knowledge and experience with the North Carolina pharmacy community by publishing an article in NCP. Click on Guidelines for Authors for information on formatting and article types accepted for review.

For questions, please contact Tina Thornhill, PharmD, FASCP, BCGP, Editor, at tina.h.thornhill@ gmail.com.

North Carolina Pharmacist is the Official Journal of the North Carolina Association of Pharmacists Located at: 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649 www.ncpharmacists.org

Official Journal of the North Carolina Association of Pharmacists 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649

www.ncpharmacists.org

North Carolina Pharmacist Volume 102 Number 4

Fall 2021

EDITOR-IN-CHIEF Tina Thornhill

A Few Things Inside

LAYOUT/DESIGN Rhonda Horner-Davis

• From the Executive Director...................................................................................4

EDITORIAL BOARD MEMBERS Anna Armstrong Jamie Brown Lisa Dinkins Jean Douglas Brock Harris Amy Holmes John Kessler Angela Livingood Bill Taylor

BOARD OF DIRECTORS EXECUTIVE DIRECTOR Penny Shelton PRESIDENT Beth Mills PRESIDENT-ELECT Matthew Kelm PAST PRESIDENT Dave Phillips TREASURER Ryan Mills SECRETARY Paige Brown Kevin Rhash, Chair, SPF Tyler Vest, Chair, NPF Anna Armstrong, Chair, Community Angela Livingood, Chair, Health-System Janine Bailey, Chair, Chronic Care Irene Ulrich, Chair, Ambulatory Ouita Gatton, At-Large Vinay Patel, At-Large Riley Bowers, At-Large North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists.

An electronic version is published quarterly. The journal is provided to NCAP members through allocation of annual dues. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement. Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher.

• From the President.............................................................................................6 • Impact of a Pandemic..............................................................................................8 • Bowl of Hygeia Award Recipients.........................................................................17 • NCAP Election Results........................................................................................19 • Medication Administration Scope Advancement..................................................20 • Call for Posters.....................................................................................................22 • NCAP Advocacy Fund Contributers.....................................................................26 • New Drug Monograph..........................................................................................28 • Pharmacists Call to Action....................................................................................34

North Carolina Pharmacist is supported in part by: • Alliance for Patient Medication Safety (APMS)....................................5 • The Partnership for SAFEMEDICINES ................................................7 • NCAP Career Center ................................................................13 and 32 • Pharmacy Quality Commitment ...............................................18 and 27 • Edupharmtech ......................................................................................18 .

• EPIC Pharmacies Inc ...........................................................................18 • Athenex, Inc..........................................................................................24 • Pharmacy Technician Certification Board (PTCB) .............................36 • VUCA Health ...........................................................................38 and 40 • Pharmacists Mutual Companies ..........................................................39 • Your Community Health Plan ..............................................................42 CORRECTIONS AND ADVERTISING For rates and deadline information, please contact Rhonda Horner-Davis at rhonda@ncpharmacists.org

•From the Executive Director• Penny Shelton, PharmD, BCGP, FASCP

The Association’s Assiduity

Okay, if the title caught your eye, well then step one has been achieved. Please read on! My column this issue is about NCAP’s ‘careful and unremitting attention’ to all the ongoing work behind the scenes to enact the different provisions, granted to pharmacists, in the passage of H.196, and H.96/S.575.

These new laws expand scope for our profession, by allowing pharmacists to administer long-acting, and other injectable medications, pursuant to a prescription; and by allowing pharmacists to furnish certain medications, pursuant to statewide standing orders or protocols. The long-acting injectable authority went into effect October 1, 2021; and if all goes well, the other provisions will become effective, as early as, February 1, 2022. Soon, North Carolinians will be able to obtain nicotine replacement therapies, post-exposure prophylaxis for HIV, glucagon products, prenatal vitamins, oral and transdermal hormonal contraceptives, from their pharmacists, without a prescription.

NCAP has spent numerous hours and resources advocating for these new authorities; howev-

er, our work, for the profession, did not stop with the passage of these bills. Instead, our efforts have shifted to three very important roles: • • Conversing with stakeholders, NC Medicaid and other payers regarding payment for services related to these new authorities; • • Coordinating teams to help with the drafting of statewide standing orders; and • • Creating training content and resource toolkits to equip pharmacists with what they need to legally, safely and efficiently provide these services for patients.

Conversing: North Carolina Medicaid has listened and worked diligently to create a means for pharmacists to bill an administration fee, when they give a long-acting injectable. We have also talked with them about how the 2022 statewide standing orders will have protocols that require screening, assessment, expanded patient education beyond just the medication counseling points, and time involved in required documentation and communication. If they want pharmacists to help address public health needs in our state, like unintentional pregnancies, smoking, and HIV, then the state needs to pay pharmacists for the patient care, as well as for the product. To date, our discussions have been very positive; and we are having similar discussions Page 4

with other health plans.

Coordinating: We are blessed to have amazing members and pharmacy practitioners in our state. NCAP moved quickly to organize small teams of individuals to help us draft standing orders.

Why did we do this? In conversation with our Board of Pharmacy, we believed that our profession needed to be proactive; and that this was an opportunity to forge an even stronger relationship between NCAP and the Division of Public Health at NC DHHS. If we were to help on the frontend with the work that goes into issuing a standing order, let alone five different ones, we believed it would be more likely to reach stakeholder consensus in a timely manner. We knew that February 2022 would come around quickly, and this was our Association’s way to help Dr. Tilson and her staff. Currently, drafts have been written, reviewed by a Board of Pharmacy Committee, revised and submitted to NC DHHS, reviewed by their teams, and feedback provided to us on four of the five drafts. NCAP is currently working on incorporating DHHS feedback, and we are also awaiting input from the NC Medical Society. Next steps include recirculating the drafts to the Board of Pharmacy, DHHS, and including the NC Medical Board.

Creating: The long-acting inject-

able authority requires pharmacists, who want to administer these medications, to be a certified immunizing pharmacist, and to have completed long-acting injectable training. In October, and coinciding with the effective date for this new authority, NCAP made available an all-virtual, 24/7 training program. In addition, we created a long-acting injectable resource toolkit. In this issue of North Carolina Pharmacist, you will find a brief article on our LAI program. We have also been working on an educational training and resource toolkit for hormonal contraception, post-exposure prophylaxis for HIV, and tobacco cessation. These should be ready in January 2022. We also plan to develop a resource page on our website for the new glucagon and prenatal vitamin authorities.

Your assiduous Board of Directors and staff will be meeting on December 15th, and the agenda will include both the approval of revisions to our strategic plan, and an updated advocacy strategic plan. We will be posting these documents in the coming days for our members. Also, in the new year, members will begin to see more activity in our online communities, and our staff will be unveiling a new electronic news format. We’ve been working on changes that should provide even more timely delivery of news, announcements and alerts. As the year winds down, I hope this column provides you with a snapshot of some of the important work that the Association has been conducting.

On behalf of the NCAP Board of Directors and staff, we hope that you have a wonderful and joyous holiday season.

Pharmacy Proud, Penny

Page 5

•From the President• Dr. Beth Mills, PharmD, CPP, BCACP, CDE

Dear members,

It’s hard to believe 2021 is coming to an end and we will soon ring in 2022! This is the time of year we reflect on the successes and difficulties of the past year and set goals for the next.

It has been an honor to serve as President of NCAP this year and I am proud of all we have accomplished together. While this past year presented many challenges, not the least of which was COVID-19, NCAP has proven once again we are a strong, viable association.

NCAP has achieved many triumphs this year. Most notably, we had one of the most successful legislative sessions to date with the passage of three out of five bills. After a long fight, we were able to get a revised version of the PBM bill passed. NCAP will be meeting with the Commissioner of Insurance to work on the logistics of the bill to reign in PBM abuses and ensure pharmacists have a system in place for complaints and grievances. Two of the three successful bills, Medication Administration and Public Health, were combined into one bill. This bill expands immunizing pharmacists’ scope of practice

to include prescribing hormonal contraception, tobacco cessation, HIV post exposure prophylaxis, and administering long-acting injectable medications. Check our website for new and upcoming training programs to get you ready for these new authorizations.

The annual convention looked a little different this year. All academy conventions were combined into a virtual 3 day event with a variety of content for all practice areas. The convention was a huge success and we are looking forward to an even better conference in June, 2022 as we begin planning for an in-person event back at the Benton Convention Center in Winston Salem. Education is always a top focus for NCAP and this year was no different. We continued the Sunday CE series, held multiple

live webinars, held trainings and certifications, and created timely resources such as the Diabetes Prevention and Long-Acting Injectable Administration Toolkits.

It has been a busy year! This is just a brief look into all that was accomplished. Be on the lookout for the 2021 Annual Report which highlights all of our achievements for the year! Thank you to our Executive Director, Penny Shelton, the NCAP staff, Executive Committee and Board of Directors for their hard work and dedication. A huge thank you goes out to our NCAP membership and the many volunteers as well! Without you, we would not have been able to accomplish all that we did.

Have a wonderful and blessed Holiday Season!

Beth Mills

Please note the NCAP office will be closed December 23rd through December 31st.

If you need immediate assistance during this time, please contact Rhonda Horner-Davis at: rhonda@ncpharmacists.org We hope you have a safe and happy holiday!

NCAP Staff & Board Members Page 6

Page 7

Impact of a Pandemic on Resilience Levels within a Health-System Pharmacy By: Dr. Kristen Augustina Korankyi Dr. Shannon Nicole Kraus Dr. Docia Okai

via descriptive statistics.

Key Points: • COVID-19 increased responsibilities of healthcare workers and this study examines its psychological effect on pharmacy staff in a large academic medical center.

• There was a slight increase in feelings of depression experienced by the pharmacy team based on a 3.2 point average change on the Patient Health Questionnaire 9 (PHQ-9).

• Programs to promote resilience such as an online app/website with resilience training tips may help to prevent burnout in pharmacy team members with future studies examining their success.

Abstract Purpose: Determine the impact of a pandemic on levels of resilience, burnout, and overall well-being among staff members at a health-system pharmacy.

Methods: Participants were emailed a REDCap® IRB approved survey comprised of the validated General Well-Being Index (WBI),

Patient Health Questionnaire 9 (PHQ-9), COVID-19 related questions adapted from the Copenhagen Burnout Inventory and supplemental demographic questions.

During the three-week survey collection period, email reminders were sent weekly. Additional supplemental questions solicited current perspectives on resilience and ways to promote employee well-being. Results were analyzed Page 8

Results: 142 staff members responded (with 14 partial responses) resulting in a 90.1% completion rate and a 21.7% survey response rate. The median score for WBI was 2, which is similar to the median score in a national sample of US workers. A WBI score of ≥2 indicates greater risk of adverse outcomes including 2.9-fold higher risk of burnout and 1.8-fold higher risk of severe fatigue. There was no difference in the overall PHQ-9 score based on position within the pharmacy, however, technicians did experience a slightly significant change (~4.4-unit increase) compared to pharmacists (p<0.0401).

There were no statistically significant demographic differences reported on WBI. Conclusion: Reported burnout levels among a pharmacy department during a pandemic are similar to US workers surveyed prior to the

pandemic. There does not appear to be an influence of demographic variables related to PHQ-9 or WBI scores. Nonetheless, there is an opportunity to prioritize resilience training in order to cultivate well-being within the pharmacy department.

Keywords: professional burnout, resilience, health-system pharmacists, technicians, pandemic, COVID-19 Introduction Burnout is a continual stress reaction characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment.1 During the earlier months of 2019, the coronavirus (COVID-19) pandemic hit the world and ultimately shook the core of healthcare. As infection rates increased, mortality rates did as well.2 This perpetuated an increase in demand for healthcare workers with a parallel decrease in medical supplies and equipment. Shifts in demand translated into long working hours and strenuous working environments. Apart from the increased work burden, fear of contracting the virus and infecting loved ones were major contributors to stress. Previous literature evaluated the impact of the pandemic on emergency healthcare workers, by comparing individuals who worked in that department before the pandemic to those who were transferred there as a result of the pandemic.3 The Copenhagen Burnout Inventory was used and showed that all health care workers were experiencing moderate to severe burnout during the pandemic and nurses had higher burnout rates compared to physicians.3 A

majority of the survey participants agreed that ways to cope with burnout should include the use of technological media such as watching TV or videos on the internet, spending time with loved ones and acts of gratitude from peers or from the work department.3 Additionally, a multicenter cohort survey was conducted in 2018 to measure the levels of and risk factors of burnout among health-system pharmacists.4 The Maslach Burnout Inventory Human Services Survey (MBI-HSS) was used to measure the degree of burnout. The survey study examined three MBI-HSS subscales of emotional exhaustion, depersonalization and reduced personal accomplishment with each scored individually. The results of the study showed that the survey participants were at a moderate risk of burnout with the highest percent of burnout in administration and the intensive care unit.4

Hospitals within the system range in size from 50 to 900 beds. Patient acuity and specialty services at each hospital vary, but overall include oncology, emergency medicine, pediatrics, trauma, transplant, and general medicine. Participants were identified by an all pharmacy staff distribution list using Microsoft Outlook (Microsoft Corporation, Redmond, WA). During the 3-week survey collection period, email reminders were sent weekly.

Study variables and outcomes of interest

The primary outcome of this institutional review board approved study included results from the General Well-Being Index (WBI), a validated tool used to screen for dimensions of distress including fatigue, burnout, depression, anxiety/stress, mental/physical quality of life.5 Additionally, COVID-19 related questions were adapted Overall, current research on pharfrom the Copenhagen Burnout macist burnout especially in light Inventory and the Patient Health of a pandemic seems to be non-ex- Questionnaire (PHQ-9) to screen istent. Therefore, the goal of this for depression6,7. Secondary outquality improvement (QI) project is comes included demographics (age, ethnicity, gender, marital status), to determine the impact of a pandemic on levels of resilience, burn- work characteristics (work location, position [technician, resident, out, and overall well-being among pharmacists, pharmacy technicians, pharmacist, manager/ supervisor/ director, other], years of service), pharmacy residents, pharmacy and open-ended survey questions leaders and pharmacy staff memto elicit information on current bers at a health-system pharmacy. perspectives on resilience and ways Methods that a health-system pharmacy department could promote employee Study Population well-being. Results from the survey were used to determine the state The survey population included 591 of resilience among the pharmacy Wake Forest Baptist Health emdepartment before and during the ployees including residents, techni- COVID-19 pandemic and how to cians, pharmacists, administration, best build resilience among the and support staff at five hospitals pharmacy team. who were involved in inpatient and outpatient services (Figure 1).

Study design Page 9

Study data were collected and managed via anonymous survey collection using REDCap® (Research Electronic Data Capture) tools hosted at Wake Forest Baptist Health. REDCap® is a secure, web-based application designed to support data capture for research studies. Only the study staff had access to the REDCap® database and electronic survey created solely for use in the project.

The survey assessed current state of resilience, burnout and overall well-being among health-system pharmacy department employees

and the influence of key demographic characteristics (Appendix 1). All participants who met the inclusion criteria of being a Wake Forest Baptist Health pharmacy employee were sent an electronic survey with the validated WBI, PHQ-9 and supplemental demographic questions. The general WBI is a brief assessment designed to identify healthcare workers in severe distress and most likely in need of an individualized intervention. The WBI has been completed by > 35,000 individuals and evidence indicates that the tool also identifies healthcare workers whose degree of distress places them at Page 10

risk for serious adverse consequences (i.e. medical error, turnover, and/or suicidal ideation).5 The WBI also includes questions about satisfaction with work-life integration and meaning in work.

Scores on the WBI correlate with meaning in work, high/low quality of life, fatigue, burnout, and recent suicidal ideation.5 The PHQ-9, or Patient Health Questionnaire is a validated instrument that consists of 9 criteria upon which the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) depressive disorders are based.

It is adapted from the full PHQ.6 The Copenhagen Burnout Inven-

tory measures personal burnout, work-related burnout, and client-related burnout.7

(83.6%) and were between the ages of 25-34 years old (44.5%). Also, many respondents were married or in a domestic partnership (61.3%) Data analysis and white (84.7%). In terms of outcomes related to depression, about Descriptive statistics comprised 47% of participants had a PHQ-9 the bulk of the statistical analysis. score of 2 which indicates minimal The statistical analysis included depression. The average change in frequencies and percentages for PHQ-9 score comparing feelings analyzing the baseline characterisbefore and during the pandemic tics and change in PHQ-9 and WBI was 3.2 points, which represents a scores. ANOVA along with Wilslight increase in feelings of decoxon Rank Sums test and Kruspression during the COVID-19 kal-Wallis test were used in order to pandemic. There was no difference adjust for covariates with a p-value in the overall PHQ-9 score based of less than 0.05. on position in the pharmacy (technician, pharmacist, resident, or The WBI includes 9 questions, 7 supervisor/director; p= 0.1048), are in the form of “yes” and “no” however, technicians did experiquestions and the last 2 questions ence a slightly significant change are answered using a Likert scale. (an average 4.4 unit increase in One point is assigned for each yes PHQ-9 score) compared to pharto the 7 questions. For Likert type macists, with an average 2.6-unit questions, response of a 1 or 2 on increase (p< 0.0401). In terms of the 7-point scale is given 1 point.5 the WBI, the median score was For the PHQ-9, major depression 2 (56.1% of participants), which is diagnosed if 5 or more of the 9 correlates with national averages depressive symptom criteria have and represents an increased risk of been present at least “more than burnout and severe fatigue. There half of the days” in the past 2 weeks, were no statistically significant and 1 of the symptoms is depressed differences reported on the WBI mood or anhedonia.6,8 Other related to demographic variables depression is diagnosed if 2, 3,or (p= 0.6266).

4 depressive symptoms have been present at least “more than half the In addition to completing the days” in the past 2 weeks, and 1 of survey, participants were asked the symptoms is depressed mood to report what program format or anhedonia. The PHQ-9 is scored would be preferred in order to on a scale of 0 to 27 with ratings help promote resilience learning of minimal depression to severe for the pharmacy team (Figure 2). depression.6,8 A majority of participants (52%) stated an online app/website with Results resilience training tips of advice would be helpful. Other formats Overall, 142 staff members rewere ranked from highest to lowest sponded to the survey with 14 percentages in the following order: partial responses, resulting in a half-day group workshop with a 90.1% completion rate and a 21.7% blend of in person and online comsurvey response rate. A majority ponents (25%), individual coaching of the respondents were female sessions (16%), and 7% reported Page 11

“other.” Comments left in the “other” field included daily focused attention on well-being during team meetings/interactions with colleagues, half-day group workshop plus an app for maintenance and reinforcement of tips and advice, and flex scheduling for employees to manage childcare/schooling and other personal needs.

Discussion Healthcare professionals are relied upon daily to provide quality care for patients in a very fast paced environment. The demands placed upon healthcare workers can lead to feelings of burnout and emotional exhaustion, even without the impact of a global pandemic.

In the 2018 study looking at levels and risk factors for professional burnout among health-system pharmacists, 53.2% of participants reported a high degree of burnout on at least one subscale of the MBI-HSS (emotional exhaustion, depersonalization, and reduced personal accomplishment) and 8.5% of respondents had scores indicating burnout on all 3 subscales.4 However, this study did not look at ways resilience could be built into the pharmacy profession or assess the impact of a pandemic on levels of burnout. Therefore, our present study indicates that in terms of depression before and during the pandemic, there was a slight increase in scores (3.2 points) during the pandemic. Additionally, the WBI score was reported as the national median of 2, indicating an increased risk of burnout and severe fatigue. Many respondents, 42.2% (54 people) were not aware of the current resources the institution had to deal with feelings of burnout and out of those who were aware of the current resources, only

Figure 2. If a program was started to help promote resilience learning for our pharmacy team, which format woud be best?

Online app/website with resilience training tips and advice

7.03 15.63

52.34 25

Half-day group workshop (with a blend of in person and online components) Individual coaching sessions Other

Figure 2. Other indicates responses that were descriptive that were not choices provided in the survey.

These include: daily focused attention on well-being during team meetings/interactions with colleagues; half-day group workshop plus an app for maintenance and reinforcement of tips and advice; flex scheduling so employees can manage childcare/schooling and other personal needs.

28.1% actually used the resources.

This illustrates that the methods available to build resilience before the pandemic need to be refined.

Overall, the results of our study indicate that COVID-19 did not significantly affect the well-being of pharmacy staff within a larger healthcare system. However, the Our study identified methods median WBI score reflects an into deliver resilience training to creased risk of burnout and fatigue, pharmacists. Other studies have which demonstrates that there must examined methods of resilience be continued efforts to increase training for healthcare professionresilience among pharmacy staff als, with the predominant profesmembers. Our study also identified sions being nurses and physicians. a specific subset of pharmacy team These methods included continumembers who are at an increased ing education courses focused on risk of burnout and fatigue. Technimindfulness-based stress reduction, cians experienced a slightly signifyoga/breathing exercises, lifestyle icant change in PHQ-9 score (an advice (diet/exercise), and stress average 4.4 unit increase in PHQ-9 management delivered in a variety score) compared to pharmacists, of ways including a half-day group with an average 2.6-unit increase workshop (in person/online), small (p< 0.0401). Our study also identigroup learning, one-on-one coach- fied methods to increase resilience ing sessions, and the use of an onand include an online app/website line app.9, 10,11,12,13,14,15 In our study, with resilience training tips and many participants stated an online a hybrid online/in person group app/website with resilience training coaching session on resilience. tips of advice would be helpful.

These methods were similar to Page 12

those employed in previous studies for nurses and physicians, which demonstrated improvements in resilience. Therefore, future studies may examine the impact of these training strategies on levels of burnout among health-system pharmacy team members.

Strengths of this study includes the use of Copenhagen Burnout Inventory and the PHQ-9, which assessed the physiological and psychological well-being of the participants. Additionally, this was a multi-centered study in a health-system pharmacy which adds to the body of literature on healthcare professional burnout.

Limitations include a small sample size. Additionally, the time period in which the study was conducted may be a confounding variable seeing as it was at the end of the first wave of COVID-19. Future research on resilience in pharmacy staff members would possibly require a larger population of pharmacy team members in a variety of healthcare institutions, including smaller hospitals in addition to large academic medical centers.

Diversifying the study population would help to examine trends in healthcare environments that increase risk of burnout (such as having larger volumes of prescriptions for multiple complex patients or increased patient care activities) and different perspectives on ways to promote resilience.

Conclusion Results of this study demonstrated there was not a statistically significant difference in the well-being of the pharmacy staff at Wake Forest Baptist Health before and during the pandemic. However, the median WBI score reflects an increased

risk of burnout and severe fatigue.

Half of survey respondents stated that an app or website with training would help promote resilience in the workplace. While timing of the survey may have impacted the results, it is nonetheless imperative to have resources to promote employee well-being during events such as COVID-19.

Authors: Kristen Augustina Korankyi, PharmD (Corresponding Author), High Point University Fred Wilson School of Pharmacy, High Point, NC and Wake Forest Baptist Health, Winston-Salem, NC. Kristen.Korankyi@cuw. edu. Shannon Nicole Kraus, PharmD, MS, BCPS, Wake Forest Baptist Health, Winston-Salem, NC. Docia Okai, PharmD, Wingate University School of Pharmacy, Wingate, NC and Wake Forest Baptist Health, Winston-Salem, NC. Disclosures The authors of this manuscript have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter.

doi:10.2146/ajhp170818 5. Dyrbye LN, et al. “Ability of a 9-item Well-Being Index to Identify Distress and Stratify Quality of Life in US Workers.” J Occup Environ Med. 2016; 58(8):810-7.

Kroenke K, Spitzer R, Williams J. The PHQ9. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x 6. Talaee N, Varahram M, Jamaati H et al.

Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire. Journal of Public Health. 2020. doi:10.1007/s10389-020-01313-z 7. Patient Health Questionnaire (PHQ-9).

Med.stanford.edu. http://med.stanford.edu/ fastlab/research/imapp/msrs/_jcr_content/ main/accordion/accordion_content3/download_256324296/file.res/PHQ9%20id%20 date%2008.03.pd. Published 2020. Accessed September 7, 2020.

8. Goodman M, Schorling J. A Mindfulness Course Decreases Burnout and Improves Well-Being among Healthcare Providers.

The International Journal of Psychiatry in Medicine. 2012;43(2):119-128. doi:10.2190/ pm.43.2.b 9. Matheson C, Robertson H, Elliott A, Iversen L, Murchie P. Resilience of primary healthcare professionals working in challenging environ-

ments: a focus group study. British Journal of General Practice. 2016;66(648):e507-e515. doi:10.3399/bjgp16x685285 10. Cheshire A, Hughes J, Lewith G et al. GPs’ perceptions of resilience training: a qualitative study. British Journal of General Practice.

2017;67(663):e709-e715. doi:10.3399/bjgp17x692561 Maunder R, Lancee W, Mae R et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC Health Serv Res. 2010;10(1). doi:10.1186/1472-6963-10-72 11. West C, Dyrbye L, Rabatin J et al. Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism. JAMA Intern Med. 2014;174(4):527. doi:10.1001/jamainternmed.2013.14387 12. Bauer-Wu S, Fontaine D. Prioritizing Clinician Wellbeing: The University of Virginia’s Compassionate Care Initiative. Glob Adv Health Med. 2015;4(5):16-22. doi:10.7453/ gahmj.2015.042 13. Dyrbye L, Shanafelt T, Gill P, Satele D, West C. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians. JAMA Intern Med. 2019;179(10):1406. doi:10.1001/jamainternmed.2019.2425

NCAP Career Center Connecting Talent with Opportunity

References: 1. PhysicianBurnout.AHRQ.https://www.ahrq. gov/prevention/clinician/ahrq-works/burnout/ index.html. Accessed November 2, 2020.

2. Burrer, S., de Perio, M., Hughes, M., Kuhar, D., Luckhaupt, S., McDaniel, C., Porter, R., Silk, B., Stuckey, M. and Walters, M., 2020.

Characteristics Of Health Care Personnel With COVID-19 — United States, February 12–April 9, 2020. [online] CDC. 3. W.P.D. Chor, W.M. Ng, L. Cheng, et al., Burnout amongst emergency healthcare workers during the COVID-19 pandemic: A multi-center study, American Journal of Emergency Medicine, https://doi.org/10.1016/j. ajem.2020.10.040.

4. Durham M, Bush P, Ball A. Evidence of burnout in health-system pharmacists.

American Journal of Health-System Pharmacy. 2018;75(23_Supplement_4):S93-S100.

www.ncpharmacists.org North Carolina Association of Pharmacists Career Center is the perfect location for finding your next career opportunity.

This site brings industry leading employers together with local, qualified pharmacists. Here you can upload a resume, search the Resume Bank, post an opportunity, or search jobs!

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Appendix 1. Survey Questions

Well Being Index Questions

Response Options

During the past month have you felt burned out by your work?

Yes No

During the past month have you worried that your work is hardening you emotionally?

During the past month have you often been bothered by feeling down, depressed, or hopeless?

During the past month have you fallen asleep while sitting inactive in a public place?

Yes No Yes No Yes No

During the past month have you felt that all the things you had to do were piling up so high that Yes you could not overcome them?

No During the past month have you been bothered by emotional problems (such as feeling anxious, Yes depressed, or irritable)?

No During the past month has your physical health interfered with your ability to do your daily work at home and/or away from home?

Yes No

Please rate how much you agree with the following statement: The work I do is meaningful to me.

Very strongly disagree Strongly disagree Disagree Neutral Agree Strongly agree Very strongly agree

Please rate how much you agree with the following statement: My work schedule leaves me enough time for my personal/family life.

Very strongly disagree Strongly disagree Disagree Neutral Agree Strongly agree Very strongly agree

Questions adopted from the Copenhagen Burnout Inventory and Patient Health Questionnaire-9

Response Options

Since the start of the COVID-19 pandemic, how much do you worry about your family members and friends getting sick as a result of your exposure?

Not at all Mildly Moderately Highly, extremely

Since the start of the COVID-19 pandemic, how much do you worry about getting infected by COVID-19?

Almost never Once or a few times per month Once or twice a week Four or five times a week Almost every day

Since the start of the pandemic until now, how often have you had little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day

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Since the start of the pandemic until now, how often have you felt down depressed or hopeless?

Not at all Several days More than half the days Nearly every day

Since the start of the pandemic until now, how often have you had trouble falling or staying asleep or sleeping too much?

Not at all Several days More than half the days Nearly every day

Since the start of the pandemic until now, how often have you felt tired or had little energy?

Not at all Several days More than half the days Nearly every day

Since the start of the pandemic until now, how often have you had a poor appetite or overeating? Not at all Several days More than half the days Nearly every day Since the start of the pandemic until now, how often have you felt bad about yourself--or that you are a failure or have let yourself or your family down?

Not at all Several days More than half the days Nearly every day

Since the start of the pandemic until now, how often have you had trouble concentrating on things, such as reading the newspaper or watching television?

Not at all Several days More than half the days Nearly every day

Since the start of the pandemic until now, how often have you been moving or speaking so slow- Not at all ly that other people could have noticed or being so fidgety or restless that you have been moving Several days around a lot more than usual?

More than half the days Nearly every day Since the start of the pandemic until now, how often have you had thoughts that you were better Not at all off dead or of hurting yourself?

Several days More than half the days Nearly every day Before the pandemic, how often did you have little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day

Before the pandemic, how often did you feel down, depressed, or hopeless?

Not at all Several days More than half the days Nearly every day

Before the pandemic, how often did you had trouble falling or staying asleep or sleeping too much?

Not at all Several days More than half the days Nearly every day

Before the pandemic, how often did you felt tired or have little energy?

Not at all Several days More than half the days Nearly every day

Before the pandemic, how often did you had a poor appetite or overeat?

Not at all Several days More than half the days Nearly every day

Page 15

Before the pandemic, how often did you feel bad about yourself--or that you are a failure or have Not at all let yourself or your family down?

Several days More than half the days Nearly every day Before the pandemic, how often did you have trouble concentrating on things, such as reading the newspaper or watching television?

Not at all Several days More than half the days Nearly every day

Before the pandemic, how often did you move or speak so slowly that other people could have noticed or so fidgety or restless that you had been moving around a lot more than usual?

Not at all Several days More than half the days Nearly every day

Before the pandemic, how often did you have thoughts that you were better off dead or of hurting yourself?

Not at all Several days More than half the days Nearly every day

Additional Survey Questions

Response Options

If a program was started to help promote resilience learning for our pharmacy team, which format would be best?

Online app/website with resilience training tips and advice Half-day group workshop (with a blend of in person and online components Individual coaching sessions Other

Before COVID-19 were you aware of your employer’s resources to cope with burnout? If yes, did Yes and I used the resources you use the resources?

Yes but I did not use the resources Somewhat No Rate how much you agree to the following statement: Decrease in working hours and/or income Strongly agree is a great contributor to COVID-19 related burnout.

Agree Neutral Disagree Strongly disagree Since the start of COVID-19, did your hours…

Increase Decrease Stay the same

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2022 RESULTS Each year the North Carolina Association of Pharmacists holds an election to fill available seats on the various practice academy leadership teams and the executive board. Thank you so much for taking the time to vote. I am pleased to share the results of our most recent election. The following elected members will begin serving their terms on January 1, 2022.

Executive Board

Chronic Care Practice Academy

President-elect:

Chair-elect:

Ouita Gatton

At-large:

Health-Systems Practice Academy Chair-elect:

David Phillips

Jeffrey Reichard

At-large:

At-large:

Macary Weck Marciniak

Taylor McDaniel

Oksana Kamneva

Ambulatory Care Practice Academy

Community Care Practice Academy

ASHP Delegates

Chair-elect:

Chair-elect:

Andy Warren

At-large:

Gwen Seamon Mackie King

Katie Trotta

At-large:

Christine Heath Caroline Miller Jonathan Harward Tori Watkins Page 19

Angela Livingood Mary Parker

Congratulations to all on your new positions!

Medication Administration Scope Advancement New LAI Training & Resource Toolkit for North Carolina Pharmacists By: Cynthia Hicks, PharmD Candidate

Adherence is perhaps the quintessential factor tied to patient outcomes, medication management, and quality measures. Yet, adherence depends on human behavior; therefore, medication non-adherence remains a dangerous and costly healthcare issue. Long-acting injectable (LAI) medications are one option to improve adherence, and LAIs are especially important for behavioral health. However, according to plan administrators and pharmacists working for behavioral health local management entities, LAIs are woefully underutilized.

LAIs often go unprescribed, despite strong evidence of their ability to significantly improve patient functioning and quality of life. Why are LAIs underutilized? The primary reason is poor access to care. Other causes include providers not carrying inventory or having the staff to administer the injections; the driving distance to the provider’s office may be too great for the patient to return for their injections regularly. Furthermore, the shortage of behavioral health and primary care providers in our state compounds the problem. The underutilization of LAIs

worsened during the COVID-19 pandemic when healthcare providers shifted to telehealth for care, making it nearly impossible for patients to receive injections.

The accessibility and the incredible care that local community pharmacists provide were seen as a potential solution, but only if pharmacists were legally allowed to administer LAIs.

On October 1, 2021, a new law, SL 2021-3, allowed North Carolina pharmacists to administer LAIs. Section 2.9.(a) of G.S. 90-85.15B of the Pharmacy Practice Act will be amended to allow immunizing pharmacists to administer LAI medications to patients 18 years of age or older, pursuant to a prescription. The North Carolina Board of Pharmacy (NCBOP) has promulgated a temporary rule, 21 NCAC 46 .2514, to enact this new authority. Rather than provide a list of approved medications within this rule, LAIs were defined as “medications formulated to produce sustained release and gradual absorption of the active pharmaceutical ingredient over an extended period of time following subcutaneous or intramuscular injection.”

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This new law requires immunizing pharmacists to complete formal training on LAI administration and notify the NCBOP. The North Carolina Association of Pharmacists (NCAP) has developed an online, 24/7 accessible LAI training for pharmacists. The training is packaged to deliver content through smaller learning modules. Each module is 45 minutes or less in duration, allowing pharmacists to learn at their own pace and fit the training into their busy schedules.

The training is ACPE-approved for 5 hours of continuing education credit. In addition to the learning modules, registrants gain access to an LAI Toolkit. The toolkit includes documents that address the importance of using LAIs, copies of the LAI law and rules, stigma resources, clinical service implementation guidelines, sample advertisements to promote this new service, and mental health educational materials for patients. The toolkit also contains supplemental information to help pharmacists establish an LAI clinical service. The toolkit also includes a convenient medication resource guide with administration demonstration videos, individual product medical science liaison contact information, drug package inserts, contact info to request demo kits, assessment forms, and patient/ provider satisfaction surveys.

Are you interested in setting up an LAI service in your pharmacy or practice? Are you ready to help improve LAI utilization?

Have you completed your training? To get started, click here.

Author: Cynthia Hicks is a PharmD Candidate at East Tennessee State University.

North Carolina Association of Pharmacists

DID YOU KNOW THAT ON NOVEMBER 1ST, 2021 NC MEDICAID & MEDICAID MANAGED CARE PLANS REIMBURSE PHARMACISTS FOR LAI ADMINISTRATION?

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Page 21

NCAP Annual Meeting to Hold its 7th Annual Poster Session!

The NCAP 2022 Annual Convention will be June 9th and 10th at the Benton Convention Center in Winston-Salem, NC. We will host our 7th annual poster session during the Convention. Presenting a poster at this NCAP event is an excellent opportunity to share your research with pharmacy practitioners all around the state! Selected abstracts will be published in the North Carolina Pharmacist: The Official Journal of the North Carolina Association of Pharmacists. Submissions by practitioners, students, and residents are welcome!

Details of when and how the poster session will be presented will be advised to all authors of the posters chosen for presentation when they are notified their work has been selected.

Abstract Headings: Objective, methods, results, conclusions • Case Report or Series: Description of a unique patient case or series. May include novel indication, dose or administration of a medication. Abstract Headings: Introduction, case(s), discussion • Word Count: 300 words (excluding author names and title) Abstracts describing ongoing research will be considered with partially completed data. Descriptions of planned research without any data will not be accepted. Abstracts will be evaluated based on readability and organization, relevance, and potential impact to pharmacy practice.

Please submit your name, your credentials, and your abstract as a Word document to Mindy Parman mgparman@gmail.com. Deadline: April 8, 2022.

Status of submissions will be communicated to authors

by April 29, 2022.

Categories: • Original Research: Clinical or educational research appealing to an audience of pharmacy professionals in North Carolina. May include health services, pharmacotherapy, medication safety, or patient outcomes.

Abstract Headings: Objective, methods, results, conclusions • Quality Improvement Evaluations: Assessments of quality improvement measures such as medication use evaluations or process improvements. May include ideas and practices new to system, or practice setting.

Abstracts will be printed as submitted in the North Carolina Pharmacist: The Official Journal of the North Carolina Association of Pharmacists. Edits to abstracts cannot be made after submission.

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NOTE: Poster presenters MUST register for the Convention for the day of presentations. There will be no discounted registration, honorarium or speaker fee.

Time to Nominate!

Example of a structured abstract: Category: Original Research

Title: Evaluation of Compliance with National Guidelines for Insulin Initiation Authors: Kira Harris, PharmD, BCPS, CDE1,2, Jacqueline Olin, MS, PharmD, BCPS, CPP, CDE, FASHP, FCCP2 Institution: Crown Point Family Physicians, Charlotte NC; Wingate University School of Pharmacy, Wingate NC Objective: The primary purpose of this study was to determine compliance with the American Diabetes Association recommendation to initiate insulin in patients with an A1c≥10% at an outpatient family medicine clinic in 2014. Secondary objectives were to determine if initiation of insulin within 3 weeks of an A1c ≥ 10% increased the rate or decreased the time to achieve an A1c<7%, and to determine if pharmacist involvement increased the rate of reaching an A1c<7%.

Methods: The medical records of 121 patients with type 2 diabetes mellitus (T2DM) and an A1c≥10% from January 1, 2014 to December 31, 2014 were reviewed.

Patients already receiving insulin or those without a follow-up A1c were excluded. Data collected included patient demographics, duration of diabetes, baseline and follow-up diabetes medications, baseline and follow-up A1c values, as well as pharmacy referrals.

Results: Fifty-five patients with a mean age of 55 years, a mean duration of diabetes of 6.4 years, and a mean baseline A1c of 11.7% were included. Most patients were receiving no therapy (29%), monotherapy (27%) or dual therapy (29%) at baseline. Insulin was initiated in 5 patients (9.1%, p<0.05) within 3 weeks of the qualifying A1c. Another 5 patients (p<0.05) received insulin at some point during the study. An A1c<7% was achieved in 35.6% of patients not receiving insulin, 20% of patients receiving immediate insulin, and no patients who received insulin after 3 weeks. The mean time to A1c<7% was 6 months for patients not on insulin and 3 months for those receiving immediate insulin. Thirty-three percent of patients who met with a pharmacist reached an A1c<7% compared to 30% of patients who did not.

Conclusion: Adherence with insulin initiation guidelines and rate of achieving A1c<7% in patients with A1c≥10% is low and increasing pharmacy involvement may increase the rate of reaching goal A1c.

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AWARDS

2022 It’s that time again. Time to nominate someone you know for one of the many awesome awards we present during our annual convention. Each and every one of you knows someone who has been knocking it out of the park. When it comes to doing their job, no one does it better. They inspire, encourage and go above and beyond expectations. This year our award recipients will be recognized during the NCAP 2022 Convention, June 9 and 10 at the Benton Convention Center in Winston-Salem, NC. Click here to find the perfect award to nominate that pharmacy hero you have in mind. Submit your nominations by April 4, 2022. Any questions? Contact Angie at angie@ncpharmacists.org.

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New Drug Monograph By: Madeline McMillan, PharmD Candidate 2022

Generic Name: atogepant Brand Name: QuliptaTM Classification: Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist FDA Approval: September 28, 2021 Indication1: Approved for the prevention of episodic migraine in adults.

Contraindications: None.

Pharmacology : Atogepant is a calcitonin gene-related peptide (CGRP) receptor antagonist.

CGRP helps modulate pain transmission in the brainstem. During an acute migraine attack, CGRP levels are usually increased.

1,2

Pharmacokinetics1,2 Absorption Atogepant is orally absorbed and reaches peak plasma concentrations

within 1-2 hours. The absorption of atogepant is not significantly affected by food; therefore, it may be administered without regard to meals.

Distribution Atogepant is approximately 95% protein bound. The volume of distribution after oral administration was approximately 292 L. Metabolism Atogepant is primarily metabolized

by CYP3A4.

Elimination Atogepant was excreted as 42% unchanged drug in the feces and 5% unchanged drug in the urine. The approximately elimination half-life of atogepant is 11 hours.

Drug Interactions1 CYP3A4 inhibitors Concentrations of atogepant may be increased by CYP3A4 inhibitors. If atogepant must be administered in combination with a strong Page 28

CYP3A4 inhibitor, the daily dose should be reduced to 10 mg daily.

For coadministration of atogepant with moderate or weak CYP3A4 inhibitors, dose reduction may not be necessary.

CYP3A4 inducers Concentrations of atogepant may be reduced by CYP3A4 inducers. If administration of atogepant along with a strong CYP3A4 inhibitor is necessary, the recommended dose of atogepant is either 30 mg or 60 mg daily.

OATP inhibitors Concentrations of atogepant may be increased by OATP inhibitors.

The recommended dose of atogepant is 10 mg or 30 mg daily when being used in combination with an OATP inhibitor.

Clinical Efficacy3,4 Goadsby and colleagues conducted a phase 2b/3 trial to assess the safety, tolerability, and efficacy of atogepant for the prevention of episodic migraines. Participants

from 78 different practice sites were included in this randomized, double-blind, placebo-controlled, parallel-group trial. Participants were eligible if they were between the ages of 18 and 75 years old, had a history of migraine with or without aura diagnosed for at least a year prior, and onset before age 50. Participants also needed to average 4 to 14 monthly migraine days in the 3 months before the trial. Participants were excluded if they had more than 15 headache days per monthly, inadequate response to at least 3 other migraine prevention medications, used opioids or barbiturates more than 2 days per month, triptans or ergots more 10 days per month, or other analgesics more than 15 days per month. Patients with significant renal or hepatic dysfunction were also excluded from the trial. All participants were required to use an approved form of contraception, and female patients of childbearing potential were required to have a negative urine pregnancy test prior to starting treatment.

There were 825 patients were randomly assigned 2:1:2:2:1:1 to receive placebo, atogepant 10 mg daily, atogepant 30 mg daily, atogepant 60 mg daily, atogepant 30 mg twice daily, or atogepant 60 mg twice daily. Baseline characteristics were similar between study groups, including monthly migraine days at baseline. The treatment was administered over 12 weeks, during which patients attended 8 clinic visits and used an electronic diary to log information about headache frequency, duration, symptoms, characteristics, and any acute medication use.

The primary efficacy endpoint was

the change from baseline in mean monthly migraine days across the 12-week treatment period. Secondary outcomes included change from baseline in mean monthly headache days, proportion of patients who saw at least a 50% reduction in monthly migraine days, and change from baseline in acute medication use days per month. After 12 weeks of treatment, patients treated with atogepant had significant fewer monthly migraine days.

The average number of monthly migraine days were reduced by 2.9 days in the placebo group, 4.0 days in the atogepant 10 mg daily group, 3.8 days in the 30 mg daily group, 3.6 days in the 60 mg daily group, 4.2 in the 30 mg twice daily group, and 4.1 days in the 60 mg twice daily group (p < 0.05). Patients who were in the atogepant 30 mg twice daily and atogepant 60 mg twice daily groups also saw significant reduction in the number of days requiring acute medication use compared to the placebo group (-1.4 days and -1.2 days, respectively; p < 0.05). The 30 mg twice daily and the 60 mg twice daily groups also saw significantly more patients have at least a 50% reduction in average monthly migraine days compared to placebo (58% and 62% of patients, respectively; p < 0.05).

The most common adverse effects observed in this trial were nausea, upper respiratory tract infections, nasopharyngitis, constipation, and fatigue. This study concluded that atogepant was safe and effective for the prevention of episodic migraines.

Ailani and colleagues conducted further research into the efficacy of atogepant for the prevention of migraines in a phase-3, double-blind, randomized, controlled trial bePage 29

tween December 2018 and June 2020. There were 910 participants randomized 1:1:1:1 to receive either daily atogepant (10 mg, 30 mg, or 60 mg) or placebo for 12 weeks.

Patients were eligible for the trial if they were between 18 and 80 years of age with 4 to 14 migraine days per month in the 3 months prior to the trial. Patients also needed to have at least a 1-year history of migraine with or without aura, diagnosis consistent with the International Classification of Headache Disorders 3rd edition (ICHD-3), and diagnosis prior to age 50.

Patients were excluded if they had a diagnosis of chronic migraine, cluster headaches, painful cranial neuropathy, or at least 15 migraine days per month in the 3 months prior to the trial. Patients were also excluded if they did not respond to more than 4 oral medications for the treatment of migraines.

Any patients who used opioids or barbiturates more than 2 days per month, triptans or ergots more than 10 days per month, or other analgesic agents (acetaminophen, NSAIDs, aspirin) more than 15 days per month were excluded.

Participants were required to use a medically approved and effective method of contraception and any female participants who were pregnant, lactating, or planning to become pregnant were excluded.

All participants in the trial were instructed to take 3 tablets, either 3 placebo tablets or 2 placebo tablets and their assigned dose of atogepant, at the same time each day for 12 weeks. Patients were allowed to take acute migraine treatments such as triptans, ergot derivatives, opioids, analgesics, NSAIDs, and antiemetic agents. Patients were

not allowed to use any other preventative migraine treatments 30 days before the trial or during the trial. Patients used electronic diaries to record headache duration, headache clinical features, non-headache symptoms, and acute treatments used. Other health outcome measures used in this trial include the Activity Impairment in Migraine Diary (AIM-D) and the Migraine-Specific Quality of Life Questionnaire (MSQ). Patients had follow-up visits every 4 weeks for efficacy and adverse effect monitoring.

The primary efficacy endpoint was the change from baseline number of migraine days per month over the 12 weeks of treatment. Secondary efficacy endpoints were the change from baseline in the mean number of headache days per month, change from baseline in the number of days using medication to treat migraine attacks, a reduction of at least 50% from baseline in average monthly migraine days, change from baseline in MSQ score, and change from baseline in the AIM-D score. Baseline characteristics, including baseline average number of migraine days per month, were similar between the study groups.

After 12 weeks, patients taking atogepant had significantly fewer migraine and headache days per month, as well as significantly fewer days that required acute medication use. The number of monthly migraine days was reduced by 2.5±0.2 in the placebo group, 3.7±0.2 in the 10 mg group, 3.9±0.2 in the 30 mg group, and 4.2±0.2 in the 60 mg group (p < 0.001). Similarly, the average number of days that required acute medication use was

reduced by 2.4 days in the placebo group, 3.7 days in the 10 mg group, 3.7 days in the 30 mg group, and 3.9 days in the 60 mg group (p < 0.001). There were also significantly more patients who achieved at least 50% fewer monthly migraine days, with 62 (29.0%) patients in the placebo group, 119 (55.6%) in the 10 mg group, 131 (58.7%) in the 30 mg group, and 135 (60.8%) in the 60 mg group (p < 0.001).

The most common adverse effects in the study groups were constipation, nausea, fatigue, somnolence, upper respiratory tract infections, and nasopharyngitis. Overall, atogepant was well tolerated and effective at reducing the average number of migraine days per month in patients with episodic migraines.

Adverse Effects1,2: The most common adverse effects of atogepant observed in clinical trials were nausea (7%), constipation (6%), and fatigue (5%), and decreased body weight (4%).

Dosing1: Adult patients may take 10 mg, 30 mg, or 60 mg daily. Do not exceed 60 mg daily. Patients with significant renal impairment (CrCl < 30 mL/min) or on dialysis should receive 10 mg daily. Use is not recommended for patients with severe hepatic impairment (ChildPugh Class C). Atogepant is available in a 10 mg, 30 mg, and 60 mg oral tablet.

Pregnancy and Lactation1: The safety of atogepant in pregnant women has not been assessed in human patients. Animal studies showed that oral administration of atogepant throughout gestation led to lower fetal body weight and decreased skeletal ossification at higher doses (125 and 750 mg/kg).

Page 30

At the no-effect dose (15 mg/kg/ day) for adverse effects on fetal development, plasma exposure (AUC) was about 4 times the AUC reached in humans at the maximum recommended human dose of 60 mg/day.

There are no data regarding the presence of atogepant in human milk or the effects it may have on an infant. Animal studies showed that following oral administration of atogepant, the levels of atogepant in milk was about twice that of the maternal plasma concentration.

Storage1: Store between 20°C and 25°C (68°F and 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F).

Cost1,2: Cost information is not yet available.

Summary/Use in Clinical Practice1-6 The American Academy of Neurology (AAN) currently recommends antiepileptic agents (topiramate, divalproex), beta blockers (metoprolol, propranolol), and some antidepressants (venlafaxine, amitriptyline) for the prevention of episodic migraines. The 2012 AAN guidelines have not yet been updated to include recommendations regarding the use of CGRP receptor antagonists. CGRP receptor antagonists have recently emerged as a new option for treatment of migraines, with some agents indicated for prevention and others indicated for acute treatment. Other CGRP receptor antagonists available include galcanezumab (Emgality®), erenumab (Aimovig®), fremanezumab (Ajovy®), eptinezumab (Vyepti®), rimegepant (Nurtec®), and ubrogepant (Ubrelvy®). Galca-

nezumab, erenumab, fremanezumab, and eptinezumab are monoclonal antibodies that are indicated for migraine prophylaxis. They are administered via monthly subcutaneous injection (galcanezumab, erenumab, fremanezumab) or intravenous infusion (eptinezumab).

Fremanezumab and eptinezumab also have the option to be administered every 3 months. Rimegepant and ubrogepant are small molecule CGRP antagonists that are administered orally, much like atogepant.

Rimegepant is indicated for both the prevention and acute treatment of migraines, while ubrogepant is indicated for the acute treatment of migraines. Atogepant is the latest addition to the CGRP receptor antagonist class, and is safe and effective for the prevention of episodic migraines in adults. Future studies are planned to investigate the effectiveness of atogepant for the treatment of chronic migraines and migraines refractory to other treatments.

At this time, there is insufficient evidence to support the use of atogepant in pregnant or lactating patients. Animal studies indicate that atogepant may cause fetal harm.

Atogepant has not been studied for safety or effectiveness in pediatric patients. Atogepant appears to be safe in patients with renal dysfunction, but may require dose adjust in those with severe renal dysfunction (CrCl < 30 mL/min) or on hemodialysis. Use of atogepant is not appropriate in patients with severe hepatic dysfunction (Child-Pugh Class C).

inform their health care providers if they are taking other medications or supplements including ketoconazole, cyclosporine, clarithromycin, rifampin, carbamazepine, phenytoin, St. John’s wort, or efavirenz. The most common adverse effects associated with atogepant are nausea, constipation, fatigue, and decreased body weight.

Author: Madeline McMillan is a PharmD Candidate in the Class of 2022 at Campbell University College of Pharmacy and Health Sciences. m_mcmillan0227@email. campbell.edu References: 1. Atogepant (QuliptaTM). Package insert. Abb-

Vie Inc.; 2021.

2. Lexi-Drugs. Lexicomp [database online].

Hudson, OH: Lexicomp, Inc. http://online.lexi. com. Updated 2021. Accessed October 14, 2021.

3. PJ, Dodick DW, Ailani J, et al. Safety, tolerability, and efficacy of orally administered atogepant for the prevention of episodic migraine in adults: a double-blind, randomised phase 2b/3 trial [published correction appears in Lancet Neurol. 2020 Nov;19(11):e10]. Lancet Neurol. 2020;19(9):727-737. doi:10.1016/S14744422(20)30234-9.

4. Ailani J, Lipton RB, Goadsby PJ, et al. Atogepant for the Preventive Treatment of Migraine. N Engl J Med. 2021;385(8):695-706. doi:10.1056/ NEJMoa2035908.

5. Silberstein SD, Holland S, Freitag F, et al.

Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society [published correction appears in Neurology. 2013 Feb 26;80(9):871]. Neurology. 2012;78(17):13371345. doi:10.1212/WNL.0b013e3182535d20.

6. Ashina M, Buse DC, Ashina H, et al.

Migraine: integrated approaches to clinical management and emerging treatments. Lancet.

2021;397(10283):1505-1518. doi:10.1016/S01406736(20)32342-4.

NCAP supports various practice academies, forums, networks, committees, task forces, and special project teams. Click here to fill out a form for committees and/or projects you would be interested in serving on. Indicating more than one area of interest helps us better ensure that we can place most, if not, all volunteers.

Patients should be counselled to take atogepant at approximately the same time every day, without regard to food. Patients should also Page 31

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FELLOW PRACTITIONER RECOGNITION PROGRAM In an effort to promote, sustain, and foster the advancement of pharmacy practice across North Carolina, NCAP is providing a Fellow Practitioner Recognition Program for Pharmacist and Pharmacy Technician members across all practice settings.

Check out the Professional Development section of our website for more information and to learn how to apply!

Awarding NCAP Fellow status (FNCAP) is one means by which NCAP fosters and rewards demonstrated excellence in the practice of pharmacy.

Now accepting applications!

Priority deadline: March 18, 2022

Page 33

Pharmacists Call to Action as Opioid Crisis Worsens in North Carolina By: Tyler Distasio PharmD Candidate

In the United States, drug overdose deaths have soared during the pandemic, with more than 100,000 overdose-related deaths. The National Center for Health Statistics has connected 93% of those deaths to opioid use.

Depicted in the graph below, data from the North Carolina Injury and Violence Prevention Branch shows in October 2021, overdose ED visits rose 1.1% compared to October 2020. 2020 also set a record with over a 23% increase in overdose ED visits, the largest increase reported since 2017.

In examining overdose ED visits by county, those that rank highest ending October 2021 concentrate in areas with known barriers to overdose prevention services for those with opioid use disorder. There is also a growing need for innovative approaches to increase treatment capacity by providing lifesaving medications such as buprenorphine in these areas. Collaboration between pharmacists and prescribers Page 34

versed in the treatment of opioid use disorder and knowledgeable regarding the barriers in acquiring buprenorphine can be instrumental in improving patient access.

Pharmacists can play a crucial role in working with prescribers to sustain patient recovery by providing education, monitoring for relapse or withdrawal, and adherence to therapy. Utilizing existing partnerships with providers and a team approach to communicating with wholesalers on buprenorphine needs can also prevent gaps in treatment so often associated with wholesaler acquisition of buprenorphine.

Since 2016, NCAP has been instrumental in providing training for pharmacists in Opioid Stewardship. One training that speaks explicitly to the pharmacist’s role in treating opioid use disorder is our 16- hour ACPE accredited virtual training entitled “Pharmacists Caring for Patients with Opioid Use Disorder.” This certificate level training addresses the treatment, recovery, and prevention of substance use disorders, conceptualizing addiction as a chronic brain disease affected by genetic, behavioral, cultural and socioeconomic factors. In addition, it leaves pharmacists with the tools necessary in developing service models consistent with treating patients in their practice setting.

To learn more and register for this program click here.

Coming 2022, don’t miss out on your chance to add to your opioid repertoire by joining us for the all-new program entitled “B.U.P.E. (Buprenorphine Understanding in the Pharmacy Environment). “ This 1-hour LIVE event provides an interactive virtual opportunity for pharmacists to understand the “Why,” “Who,” and “How To” of buprenorphine dispensing with training on effective communication modeling with wholesalers, prescribers, and patients. NCAP will offer this LIVE training six times between February and August of 2022 to accommodate the busiest schedules so no one misses out.

STAY TUNED TO NCAP FOR MORE INFORMATION IN THE NEW YEAR!

Tyler Distasio PharmD Candidate Class of 2022 Campbell University College of Pharmacy & Health Sciences

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Sheila Thornton Warfield Sheila.Warfield@redsailtechnologies.com

The New Integra X Files™ – Game-Changing Insights for LTC

Exploring and solving for the X factor that will help to reshape the future of long-term care pharmacy.

(Anacortes, WA – December 8, 2021) Integra®, RedSail Technologies® leading long-term care and institutional brand, is thrilled to launch its new Integra X Files – a knowledge series. Designed and formatted to recognize the unique needs of long-term care and bring voice to solutions, the Integra X Files will inform, educate, and inspire.

Integra will partner with industry experts, thought leaders, and subject matter experts to bring quality and relevant content to readers and listeners that’s grounded in four key content pillars: Growth, Pharmacy Operations, Policy, and Technology.

The Integra X Files will use two key platforms to share information – a bi-weekly blog that will be co-written by long-time industry consultant Paul Baldwin, founder of Baldwin Health Policy Group, LLC. And a monthly podcast to be hosted by Frances Nahas, Chief Strategy Officer for RedSail Technologies, and Jim McDonald, Vice President of Sales for Integra. Podcast guru Todd Eury, founder of the Pharmacy Podcast Network, will partner with Integra to amplify its message to listeners.

“As long-term care continues to evolve, it’s important that we step up as a company to help lead the way by providing insights and actionable takeaways that readers and listeners can use to create better pharmacies for their staff, their patients, and the facilities they support,” says Bob Bates, Executive Vice President for RedSail Technologies and General Manager of Integra.

Bates continued, “We are focused on looking forward to understand and respond to market trends, regulations, and address the needs of the post-COVID world. The Integra X Files will give us a platform to share our insights with customers.”

Todd Eury adds that, “If anyone will commit resources to the needs of long-term care, it’s Integra. I’ve partnered with them over the last 15 years, and their reputation is grounded in excellence and providing value to customers.”

The Integra X Files makes its debut today, Wednesday, December 8, 2021, with special guest, Chad Worz, Pharm.D., BCGP, and CEO of the American Society of Consultant Pharmacists.

To learn more about the Integra X Files and to subscribe, visit integraxfiles.com.

About RedSail Technologies RedSail Technologies, LLC, features brands – PioneerRx®, Integra®, PowerLine®, QS/1®, and PUBLIQ® Software – that offer cutting-edge and comprehensive healthcare and governmental software solutions. With the largest independent pharmacy network in the country and the most installed pharmacy management system, RedSail Technologies® is making patient care a competitive and profitable advantage once again. Its passion and advocacy for the independent, institutional pharmacy software markets spans over 40 years, and it has excelled in governmental software for 50 plus years.

About Integra Integra designs software tailored exclusively to help pharmacists offer world-class care that improves patient outcomes and lifestyles. Integra offers PrimeCare®, the state-of-the-art pharmacy management system for long-term care pharmacy operations, DocuTrack®, WebConnect®, DeliveryTrack®, Logix®, and Mevesi®. Integra is the premiere partner in the long-term care, institutional, and closed-door pharmacy marketplace. For additional information about Integra and the products and services it provides, visit integragroup.com or call 866.257.4279.

About Pharmacy Podcast Network The Pharmacy Podcast Network (PPN) has over 100,000+ listeners and subscribers and is the most popular and downloaded podcast about the pharmacy industry. With 30+ different podcast programs and over 40 different co-hosts helping to develop audio content about different subjects in pharmacy, the PPN delivers a unique publication to all healthcare professionals with a specific focus on pharmacy.

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Free For NCAP Members Have you ever: Wanted to offer more to your patients at risk for diabetes?

Thought about providing diabetes prevention education in your pharmacy or community?

Wondered if there were easy-to-use materials for teaching a diabetes prevention class to your patients?

Well, NCAP has a diabetes prevention toolkit to help you!

Developed through a collaboration between the North Carolina Association of Pharmacists (NCAP) and Campbell University pharmacy students, this Diabetes Prevention Toolkit is designed to assist NC pharmacists in “Joining the Charge” on diabetes prevention. Learn how you can support the CDC’s National Diabetes Prevention Program or incorporate NCAP’s own diabetes prevention initiative, “A Healthier You”, into your own practice.

Did you know the average pharmacy prints 35 miles of paper each year?

By using MedsOnCue you can do your part to #savetheearth. VUCA Health has been engaging with boards of pharmacy across the country and your pharmacy management system vendor to allow patients to select a new digital form of medication information, including videos. Contact us today to learn more on how you can enhance your patient engagement and minimize your printing burden.

Click Here For More Information Not a member? Join NCAP today by logging in to our website at ncpharmacists.org and click the “Join Now” button on our homepage to access this toolkit and other great continuing education or professional development opportunities.

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VUCA Health has created the largest library of medication education videos that can integrate into websites, mobile apps, smart speakers, and pharmacy management systems.

We work directly with health systems, pharmacies, and developers to equip them with a new way to deliver patient education and improve outcomes.

In all 50 states, pharmacies can now offer a paperless alternative to the traditional leaflets given with every prescription.

VaccineSheets.com - Vaccine Info Statements all in one place.

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It’s not to late to join!

NCAP and the New Practitioner Forum Present Leadership and Financial Buzz!

The NCAP New Practitioner Forum (NPF) is hosting Leadership Buzz with a new addition; we’re adding Financial Buzz! Financial Buzz addresses the unique financial needs of individuals in the early years of their career. Sessions will be facilitated by leaders across the state and members of the NPF Leadership Team.

Residents, fellows and recent graduates (2015-2021) are invited to join the group for personal and leadership development through reading and discussing diverse books and/or attending the virtual presentation of the Early Career Financial Series. It is requested that Leadership Buzz participants commit to at least 4 out of the 5 book sessions. If you have questions or would like to join the group, please, contact Tyler Vest, NPF Chair, at Tyler.Vest@duke.edu Tyler.Vest@duke.edu.. For more details and to register, click here here..

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