ST. LOUIS COLLEGE OF PHARMACY
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Sheila Haar Siegel Designers
Adrienne Hooker Colleen Krutewicz Contributing Writers
Stacy Austerman Brad Brown Blaire Leible Garwitz Maureen Harmon Greg Katski Proofreader
Nancy Busch Class Notes
Kristine Bryant President, Alumni Association
Bill Reed ’67
Nancy Konieczny ’77 President
Vice President, Advancement
Brett T. Schott Director, Alumni Relations
Responding to the Ebb and Flow Andrew Crannage ’08 was going to be a dentist—until he starting working in his local pharmacy. Add the defining moments of his sixthyear rotation and residency year, and he now practices as an internal medicine clinical pharmacist and assistant professor at the College.
John A. Pieper, Pharm.D.
From world religions and cultural heritage to illness, identity, and inequality, STLCOP classes cover a wide range of social issues— all to help prepare students to positively impact patients and society.
Blaire Leible Garwitz
Chairman, Board of Trustees
Vice President, Marketing and Communications
Tackling Tough Topics
Clearing the Air on Asthma The College is squaring off against asthma on multiple fronts. Collectively, our professors illustrate here both the complexity of the disease, the unique role of pharmacists in treating it, and the interdisciplinary approach needed to diminish its toll.
Director, Institutional Giving
Jason Huff Script magazine is a joint effort of the College and the Alumni Association, published three times a year for alumni, students, and friends of the College. Questions or comments may be addressed to Sheila Haar Siegel at firstname.lastname@example.org.
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Full Immersion In the 21st century, academic research in pharmacy is more than drug discovery. It involves highly specialized research, development and application, and patient care. It is about taking what works and making the most of it.
ST. LOUIS COLLEGE OF PHARMACY College Receptionist
W W W . S T L C O P. E D U / S C R I P T
Feature: How to Expand Global Outreach
Student Profile: Miss Missouri USA Ellie Holtman
Alumni Profile: Greg Boyer ’76
Faculty at the College continue to be widely quoted across the country as experts in the practice of pharmacy. Here are some recent highlights: President John A. Pieper wrote an op-ed for the St. Louis Post-Dispatch about the new role Missouri pharmacists can take in medication therapy (MTS) services. Terry Seaton, professor of pharmacy practice, spoke with KMOX-AM in St. Louis about the new MTS rules as well. Amie Brooks ’99/’00, associate professor of pharmacy practice, spoke with a reporter from Everydayhealth.com about ways patients can better manage their diabetes medication. When a new study questioned the effectiveness of amoxicillin in respiratory infections, St. Louis’ KTVI (Channel 2) interviewed Ryan Moenster ’04, assistant professor of pharmacy practice, about the details and patients’ treatment options. Anastasia Roberts, assistant professor of pharmacy practice was quoted by AMN Healthcare in an article looking at ways pharmacists and nurses can help patients improve medication reconciliation. After a news report focused on the amount of vitamin D in some supplements, KMOV in St. Louis (Channel 4) talked to Terry Seaton, professor of pharmacy practice, about buying supplements from reputable sources and looking for supplements with well-established standards, such as those that bear the U.S. Pharmacopeial Convention (USP) label. When Nicole Gattas, assistant professor of pharmacy practice, came down with a cold she told John Pertzborn from KTVI (Channel 2) what she stocked in her medicine cabinet. When a skydiver was preparing to jump from outer space, Richard McCall, professor of physics, spoke with The Wall Street Journal and St. Louis’ KSDK-TV (Channel 5). He discussed the effects of the human body during the Red Bull Stratos jump.
Associate professors Abigail Yancey (left) and Alicia Forinash reviewed studies of herbal and pharmaceutical products to determine which options increase milk supply for breastfeeding mothers.
Was Mom Right: Does Fenugreek Help? For decades, breastfeeding mothers have tried to stimulate milk production by using herbal products and pharmaceutical options to feed their babies. Alicia Forinash ’00/’01, Pharm.D., BCPS, BCACP, associate professor of pharmacy practice; Abigail Yancey ’02/’03, Pharm.D., BCPS, associate professor of pharmacy practice; and Kylie Barnes ’10, assistant professor of pharmacy practice at the University of Charleston, reviewed studies and trials of the most popular treatments and found there was no data to show they worked. The review, co-authored with Thomas Myles, M.D., Saint Louis University, was published in the October 2012 issue of The Annals of Pharmacotherapy. The review focused on studies of herbal products, including fenugreek and milk thistle, along with pharmaceutical options oxytocin, metoclopramide, and domperidone. “Our goal was to educate pharmacists and physicians with the options that are out there to increase milk supply,” Yancey says. “There is a lack of literature out there in this area. There are random case reports and some small randomized control trials, but there is not a really good review of available medications.” The authors found that mothers should first pursue and exhaust all non-pharmacological options. That includes making sure the mother has enough rest, good fluid intake, and nutrition. “Relaxation is important so mothers don’t get uptight and stressed when trying to breastfeed because that has negative effects on milk production,” Forinash says, “If you’ve tried that without success, the evidence out there right now shows that taking prescription medication or herbal products is not very effective. Anecdotally, the next best step would be to try metoclopramide or fenugreek.” Yancey says in reviewing other studies, it was difficult to determine if either the medication or herbal product was increasing milk supply. “Increased milk could also
have been the result of mothers going to see a physician or a lactation specialist and learning non-pharmacological techniques,” she says. “Maybe it was the support that was increasing the milk supply, or maybe it was the pharmacological agent.” The idea for the review came about through personal and professional experience. “Both Dr. Forinash and I are working mothers,” Yancey says. “We wanted to learn what kind of support mothers get and what kinds of resources are available,” Yancey says. The pair regularly responds to patients’ request for information on increasing milk supply at their clinical site at St. Mary’s Health Center. Forinash is the ambulatory care clinical pharmacist at the OB-GYN Clinic while Yancey is a clinical pharmacy specialist in internal medicine. Barnes also worked at St. Mary’s as a PGY-2 ambulatory care pharmacy resident. “As I talked with more of my patients and friends, maintaining an adequate milk supply is something mothers struggle with on a daily basis,” Barnes says. “Breastfeeding is hard,” Forinash says. “And mothers need a lot of support. I think it could be a natural fit for pharmacists to help since we are so easily accessible.”
News Briefs Holstad Named Interim Dean of Pharmacy On Jan. 1, Sheldon G. Holstad, Pharm.D., professor of pharmacy practice, was appointed to the position of interim dean of pharmacy. Holstad succeeds Wendy Duncan, Ph.D., who will be leaving the College this spring. Holstad has been with the College since 1987. He earned both his Bachelor of Science in pharmacy and Doctor of Pharmacy degrees from the University of Iowa. He also completed a postgraduate psychopharmacology research fellowship at the University of Iowa prior to joining STLCOP. Holstad has served in teaching, clinical, research, and administrative roles within the College’s pharmacy practice division. He has taught in most of the College’s pharmacy practice courses, most recently focusing on literature evaluation and the application of biostatistics. “One of the things I’ve derived the most satisfaction from in the past few years is working with junior faculty,” Holstad says. “I think mentoring is an important part of faculty achievement and satisfaction in academics.” Since 1999, Holstad has been clinical pharmacist and faculty coordinator of DrugDigest.org, an ongoing collaboration between the College and Express Scripts. The site is designed for patients to learn about drug effects and interactions. His research experience includes collaborative projects in clinical psychopharmacology, molecular psychobiology, and pedagogical methods and implementation. Most recently, he has been involved in the early stages of research into health outcomes and pharmacoeconomics. “It’s very encouraging to see the advancement of research on campus. I’m looking forward to seeing what I can do to contribute to the advancement of that goal,” Holstad says.
President Named to National Pharmacy Board College President John A. Pieper, Pharm.D., FCCP, has been appointed to the Board of Pharmacy Specialties (BPS). His three-year term began on Jan. 1. In addition to the board, he was chosen to serve as a member of the BPS executive committee. “I am honored to join this prestigious board,” Pieper says. “I look forward to working with my new colleagues as we continue to advance the profession of pharmacy.” As a member of the board, Pieper will be among those responsible for overseeing the specialty certification process for pharmacists across the country.
BPS awards specialty certifications in six areas of pharmacy practice, including ambulatory care, nuclear pharmacy, nutrition support pharmacy, oncology, psychiatric pharmacy, and pharmacotherapy. Many pharmacists have chosen to pursue these advanced certifications to further their career and document their specialized experience. “Specialty certifications recognize the expertise and extra work pharmacists pursue to benefit their patients,” Pieper says. This year the board is set to consider two petitions to recognize Critical Care Pharmacy and Pediatric Pharmacy as certified specialties. The board’s origins date to 1973 when the American Pharmacists Association (APhA) established a task force on specialties in pharmacy. The BPS was officially organized as an independent agency of APhA in 1976.
College Honored for Community Engagement St. Louis College of Pharmacy was recently named to the 2013 President’s Higher Education Community Service Honor Roll by the Corporation for National and Community Service, which is the highest honor a college or university can receive for its commitment to volunteering, service-learning, and civic engagement. “The recognition acknowledges the hard work everyone at the College does to improve the health and well-being of those living in the St. Louis region,” said College President John A. Pieper, Pharm.D. “Through our community work with organizations, we’re demonstrating how pharmacists are medication experts and are an intergral part of the health care team.” The College was commended for the thousands of hours of community service performed during the past year by students, faculty, and staff through STLCOP C.A.R.E.S. (Community Awareness Reaching Everyone in St. Louis); the St. Louis Medication Disposal Initiative in partnership with the city of St. Louis and the DEA; and our collaboration with the Saint Louis Science Center for STLCOP students’ fourth-year introductory practice experiences. Of the more than 5,000 colleges and universities in the country, fewer than 700 received this recognition. Read more about the award at www.nationalservice.gov/honorroll. SCRIPT MAGAZINE
Asthma, a chronic disease affecting nearly 20 million Americans, is one of the most common and costly diseases in the U.S. While the statistics are staggering, understanding the causes and triggers of asthma and knowing the best medications for prevention and treatment can allow patients to lead healthy, active lives. Tricia Berry ’94/’95, Pharm.D., BCPS, director of experiential programs at St. Louis College of Pharmacy; Theresa Prosser, Pharm.D., BCPS, professor of pharmacy practice; and Suzanne Bollmeier ’99/’00, Pharm.D., BCPS, AE-C, associate professor of pharmacy practice, lend their expertise to give insight into the anatomy of this disease.
Asthma is characterized by inflammation of the air passages, resulting in
the temporary narrowing of the airways that transport air from the nose and mouth to the lungs. “A few things are happening in the lungs that make it difficult to breathe,” Berry explains. “The muscles are constricting, the lining of the airways gets inflamed and thickens, and mucus is accumulating.”
Research has shown that asthma has genetic links. If only one parent
has asthma, chances are one in three that each child will have asthma. If both parents have asthma, the probability increases to seven in 10. Environmental triggers, such as pet dander, molds, cigarette smoke, and perfume, can also cause asthma.
Asthma accounts for 25 percent—1.75 million—of all emergency
room visits in the U.S. each year, and African Americans are three times more likely to be hospitalized “Poverty is a common link to many of these disparities,” Prosser says. “Older housing has a higher incidence of indoor mold. Lower income people may also be more likely to have occupational exposures to dust and fumes and live in industrial urban areas with poorer air quality.”
Among children ages 5 to 17, asthma is the leading
cause of school absences from a chronic illness. It accounts for a loss of more than 14 million school days per year—about 8 days for each school-age child with asthma—and more hospitalizations than any other childhood illness. “Asthma may impact a child’s quality of life,” Bollmeier says. “If not well controlled, a child’s symptoms may require they sit out from desired activities such as gym class, recess, and organized after-school sports.”
Asthma medications may be either inhaled or taken in tablet form and are divided into two
types: quick-relief and long-term control. “The majority of asthma medicines are inhaled, both short and long-term,” Berry says. “When a patient uses an inhaled medicine, it goes directly to the lungs, which reduces the side effects that may come from a tablet.”
An asthma management plan—reviewed together by the patient and
pharmacist—can help the patient manage their asthma. This management plan has four parts: identifying and minimizing contact with asthma triggers; taking medication as prescribed; monitoring one’s condition and recognizing early signs that it may be worsening; and knowing what to do when asthma worsens.
Bollmeier also recommends repeat instruction on properly using
asthma treatment devices. “When pharmacists routinely review proper technique with patients, it improves regimen adherence,” she says.
Understanding environmental triggers and knowing ways
to prevent them is also key to controlling asthma. “Pharmacists can educate patients to avoid exercise during poor air quality days, to empty trash receptacles often to avoid the presence of cockroaches, and to use mattress encasings that limit dust mite exposure,” Bollmeier says. “Smoking cessation techniques and pharmacotherapies should also be discussed with asthma patients and their household contacts.”
The Asthma Friendly Pharmacy (AFP) program
was initially created as the pharmacy component of a multidisciplinary partnership, the Controlling Asthma in St. Louis Project, coordinated by the St. Louis Regional Asthma Consortium and funded by the Centers for Disease Control and Prevention. An AFP is certified by the College and instructs patients on how to use their asthma devices and medications effectively, stresses the importance of following an asthma management plan, and offers ways to minimize medication side effects. Currently, eight pharmacies in St. Louis are recognized as AFPs.
*Additional information taken from the Asthma and Allergy Foundation of America, www.aafa.org
BY STACY AUSTERMAN PHOTOGRAPHY BY JENNIFER SILVERBERG