december 2012 gpha journal

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December 2012 Regarding License Renewals P. 3 from the Team at the Georgia Pharmacy Association

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Electronic version of GPhA Journal for December 2012.

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Page 1: December 2012 GPhA Journal

December 2012

Regarding License Renewals

P. 3

from the Team at the

Georgia Pharmacy Association

Page 2: December 2012 GPhA Journal

Editor: Jim [email protected]

Th e Georgia Pharmacy Journal® (GPJ) is the offi cial publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2012, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, offi cers or members of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose interested in writing for this publication are encouraged to request the offi cial “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email [email protected].

SUBSCRIPTIONS AND CHANGE OF ADDRESSTh e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

Th e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offi ces.

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

ADVERTISINGAdvertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at [email protected].

GPhA HEADQUARTERS50 Lenox Pointe, NEAtlanta, Georgia 30324t 404-231-5074 f 404-237-8435

gpha.org

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

For more information, contact your local representative:

www.phmic.com*

Guarantee a better

Quality of Life for your family.Life Insurance can provide for your loved ones by:

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

PO Box 370 • Algona Iowa 50511

Life insurance solutions from The Pharmacists Life Insurance Company.

Endorsed by:**

Hutton Madden800.247.5930 ext. 7149

678.714.9198

Message From Robert Hatton.........................................................2

1 Th e Georgia Pharmacy Journal 1

December 2012

Th e Georgia Pharmacy Journal

CONTENTSMessage From Jim Bracewell..........................................................4Welcome New GPhA Members......................................................5Assessing Impact and Patient Satisfaction of Immunization Services................................................................6

PharmPAC Supporters...............................................................18Continuing Education for Pharmacists..................................21

Pharmacists and TechniciansEncouraged to Register Now for CPE Monitor......................11Georgia State Board of Pharmacy Compounding Pharmacies and Pharmacists Advisory........................................................................................12Call for GPhA Award Entrees..................................................16

Page 3: December 2012 GPhA Journal

Editor: Jim [email protected]

Th e Georgia Pharmacy Journal® (GPJ) is the offi cial publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2012, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, offi cers or members of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose interested in writing for this publication are encouraged to request the offi cial “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email [email protected].

SUBSCRIPTIONS AND CHANGE OF ADDRESSTh e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

Th e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offi ces.

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

ADVERTISINGAdvertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at [email protected].

GPhA HEADQUARTERS50 Lenox Pointe, NEAtlanta, Georgia 30324t 404-231-5074 f 404-237-8435

gpha.org

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

For more information, contact your local representative:

www.phmic.com*

Guarantee a better

Quality of Life for your family.Life Insurance can provide for your loved ones by:

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

PO Box 370 • Algona Iowa 50511

Life insurance solutions from The Pharmacists Life Insurance Company.

Endorsed by:**

Hutton Madden800.247.5930 ext. 7149

678.714.9198

Message From Robert Hatton.........................................................2

1 Th e Georgia Pharmacy Journal 1

December 2012

Th e Georgia Pharmacy Journal

CONTENTSMessage From Jim Bracewell..........................................................4Welcome New GPhA Members......................................................5Assessing Impact and Patient Satisfaction of Immunization Services................................................................6

PharmPAC Supporters...............................................................18Continuing Education for Pharmacists..................................21

Pharmacists and TechniciansEncouraged to Register Now for CPE Monitor......................11Georgia State Board of Pharmacy Compounding Pharmacies and Pharmacists Advisory........................................................................................12Call for GPhA Award Entrees..................................................16

Page 4: December 2012 GPhA Journal

2 Th e Georgia Pharmacy Journal

Wow! It is hard to believe that the holidays are here! It feels like we just fi nished the convention in Hilton Head when in reality we are well into the year here at GPhA. De-cember is usually a relatively quiet month for the Executive Committee. We have the normal EC meeting and a Christmas dinner, but important issues, such as legislative agendas are usually fairly well defi ned by now.

Given that we have a chance to refl ect before heading into busy January, I would like to remind us of a few things for which we can be thankful. We are in a profession that allows us to help people while being able to support our loved ones. We do have some challenges ahead, but I know of no other group of professionals better poised to

make the impact needed to be successful in a changing environment. I will remind you that the current economic climate has compromised many occupations and we have not been singled out. Th e ever increasing demand combined with a limited amount of resources, has caused in-creased market pressures in almost every area. I, for one, believe that the changes will cause us to discover and develop new niches for our profes-sion and force us to do some things that we have been talking about for years. Increasing our participating immunizing pharmacies, expanding our role in MTM and advancing our specialty in compounding are just a few ways we can look to the future.

I would be remiss if I didn’t, once again, remind you of VIP day, Febru-ary 14th. A chance to infl uence your legislators and dialogue with your

colleagues. Please mark your calendars and plan to be there.Any December article would be wanting without a wish-list for Santa... so here goes. 1. PBM legislation that truly helps our profession control its destiny.2. New members eager to advance the role of their profession at the local, state and

national level.3. Wisdom for GPhA leadership to deal with the changing environment in an eff ec-

tive manner.4. A new truck for Robert ‘cause he has worn his out driving to Atlanta. Th ere!

Robert Hatton GPh President

MESSAGEfrom Robert Hatton

“Here’s wishing you a safe and happy

holiday season. Merry

Christmas and Happy New Year!”

Amendments to O.C.G.A. § 50-36-1 became effective January 1, 2012. Georgia law now requires all applicants for licensure, and all those

applying for renewal of an existing license to submit secure and verifi able documentation with their application that will be reviewed by the Board. Examples of secure

and verifi able documents are driver’s license, U.S. passport, or green card; however, a complete list of the approved Secure and Verifi able Documents may be found

on the Professional Licensing Board’s webpage.

All Georgia Pharmacists must now present verifiable documentation.

Pharmacists may submit their renewal online in minutes - just follow these quick and easy steps:

If pharmacists choose not to renew online and would like to request a renewal form that will be mailed to your address on fi le with board, please call (404)463-1100.

Please note that renewing by mail may take up to 4 weeks to process after the completed renewal form is received. A licensee cannot practice after their license expiration date.

AVOID ADDITIONAL DELAY & LATE FEES BY RENEWING NOW!

All Pharmacists are encouraged to submit their renewal applications early to avoid delays!

• Visit the Georgia Online Licensing site at www.sos.ga.gov/plb (Free internet access is available at every Georgia Public Library)• Click on the License Renewal link to begin the renewal process.• Step-by-Step instructions can be found here: www.sos.ga.gov/plb/renewal_process.htm• Update address, phone number, e-mail address and answer the renewal questions.• Pay renewal fee(s) using a American Express, Mastercard, or Visa on our secure server.• Upload your secure and verifi able document.• Print the receipt of payment.• Verify the renewal online by the end of the next business day. • Receive the renewed license in the mail.

A

Page 5: December 2012 GPhA Journal

2 Th e Georgia Pharmacy Journal

Wow! It is hard to believe that the holidays are here! It feels like we just fi nished the convention in Hilton Head when in reality we are well into the year here at GPhA. De-cember is usually a relatively quiet month for the Executive Committee. We have the normal EC meeting and a Christmas dinner, but important issues, such as legislative agendas are usually fairly well defi ned by now.

Given that we have a chance to refl ect before heading into busy January, I would like to remind us of a few things for which we can be thankful. We are in a profession that allows us to help people while being able to support our loved ones. We do have some challenges ahead, but I know of no other group of professionals better poised to

make the impact needed to be successful in a changing environment. I will remind you that the current economic climate has compromised many occupations and we have not been singled out. Th e ever increasing demand combined with a limited amount of resources, has caused in-creased market pressures in almost every area. I, for one, believe that the changes will cause us to discover and develop new niches for our profes-sion and force us to do some things that we have been talking about for years. Increasing our participating immunizing pharmacies, expanding our role in MTM and advancing our specialty in compounding are just a few ways we can look to the future.

I would be remiss if I didn’t, once again, remind you of VIP day, Febru-ary 14th. A chance to infl uence your legislators and dialogue with your

colleagues. Please mark your calendars and plan to be there.Any December article would be wanting without a wish-list for Santa... so here goes. 1. PBM legislation that truly helps our profession control its destiny.2. New members eager to advance the role of their profession at the local, state and

national level.3. Wisdom for GPhA leadership to deal with the changing environment in an eff ec-

tive manner.4. A new truck for Robert ‘cause he has worn his out driving to Atlanta. Th ere!

Robert Hatton GPh President

MESSAGEfrom Robert Hatton

“Here’s wishing you a safe and happy

holiday season. Merry

Christmas and Happy New Year!”

Amendments to O.C.G.A. § 50-36-1 became effective January 1, 2012. Georgia law now requires all applicants for licensure, and all those

applying for renewal of an existing license to submit secure and verifi able documentation with their application that will be reviewed by the Board. Examples of secure

and verifi able documents are driver’s license, U.S. passport, or green card; however, a complete list of the approved Secure and Verifi able Documents may be found

on the Professional Licensing Board’s webpage.

All Georgia Pharmacists must now present verifiable documentation.

Pharmacists may submit their renewal online in minutes - just follow these quick and easy steps:

If pharmacists choose not to renew online and would like to request a renewal form that will be mailed to your address on fi le with board, please call (404)463-1100.

Please note that renewing by mail may take up to 4 weeks to process after the completed renewal form is received. A licensee cannot practice after their license expiration date.

AVOID ADDITIONAL DELAY & LATE FEES BY RENEWING NOW!

All Pharmacists are encouraged to submit their renewal applications early to avoid delays!

• Visit the Georgia Online Licensing site at www.sos.ga.gov/plb (Free internet access is available at every Georgia Public Library)• Click on the License Renewal link to begin the renewal process.• Step-by-Step instructions can be found here: www.sos.ga.gov/plb/renewal_process.htm• Update address, phone number, e-mail address and answer the renewal questions.• Pay renewal fee(s) using a American Express, Mastercard, or Visa on our secure server.• Upload your secure and verifi able document.• Print the receipt of payment.• Verify the renewal online by the end of the next business day. • Receive the renewed license in the mail.

A

Page 6: December 2012 GPhA Journal

5Th e Georgia Pharmacy Journal

Jim Bracewell Executive Vice President

MESSAGEfrom Jim Bracewell

WELCOMENew GPhA Members

About GPhA Th e Georgia Pharmacy Association is the collective voice of the pharmacy profession, aggressively advocating for the profession in the shaping of public policy, encouraging ethical health care practices, advancing educational lead-ership while ensuring the profession’s future is economically prosperous.

Th e members of GPhA would like to welcome all our new members and encourage them to take advantage of all the benefi ts membership off ers.

Georgia Pharmacy Association

THANK YOU FOR YOUR MEMBERSHIP!

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

gpha.org

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

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

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

Team Up. Pressure Down.Coaching Patients to Take Control.

A Free One Hour (0.1 CEU)On Demand CPE Activity

Available At:

www.GoToCEI.org

Pharmacy School Students

Stephen LeePCOM

Alpharetta, GA

James GayMercer University

Richmond Hills, GA

Scott WelbornUGA

Duluth, GA

New Graduate Amy Knaperek, Pharm.D.

(1st year)Mills River, NC

Active Pharmacist Elsie Hester, R. Ph.

Marietta, GA

One of the things I am most thankful for this holiday season is the great team we have at GPhA. As we all sit around and enjoy the many bowl games, we recognize that all teams have players who want to play and win but at the end of the season only a few have winning seasons. Th ose that have winning seasons are the teams that have re-cruited the best and most talented team members. Th e GPhA Team is a winning team and they are getting better each month.

December, we will have a new member join our team, Kim McNeely who comes to us from an international association with great experience in membership development.

Th e November issue of James Magazine published by Internet News Agency and one of the most widely read magazines that focuses on the politics of Georgia government named Andy Freeman, GPhA Director of Government Aff airs, one of the top fi ft een lobbyists for associations in Georgia. Andy, we congratulate you and I am proud to have you on our GPhA .

One of the easiest winning teams that you can be part of is the Million Hearts Team. See the information below and become a member of the eff ort to teach patients to take control of their blood pressure. You are already a member of the GPhA nation. You can also be a member of a great winning national team.

Please plan to welcome her to GPhA.

eamT

Page 7: December 2012 GPhA Journal

5Th e Georgia Pharmacy Journal

Jim Bracewell Executive Vice President

MESSAGEfrom Jim Bracewell

WELCOMENew GPhA Members

About GPhA Th e Georgia Pharmacy Association is the collective voice of the pharmacy profession, aggressively advocating for the profession in the shaping of public policy, encouraging ethical health care practices, advancing educational lead-ership while ensuring the profession’s future is economically prosperous.

Th e members of GPhA would like to welcome all our new members and encourage them to take advantage of all the benefi ts membership off ers.

Georgia Pharmacy Association

THANK YOU FOR YOUR MEMBERSHIP!

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

gpha.org

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

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

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

Team Up. Pressure Down.Coaching Patients to Take Control.

A Free One Hour (0.1 CEU)On Demand CPE Activity

Available At:

www.GoToCEI.org

Pharmacy School Students

Stephen LeePCOM

Alpharetta, GA

James GayMercer University

Richmond Hills, GA

Scott WelbornUGA

Duluth, GA

New Graduate Amy Knaperek, Pharm.D.

(1st year)Mills River, NC

Active Pharmacist Elsie Hester, R. Ph.

Marietta, GA

One of the things I am most thankful for this holiday season is the great team we have at GPhA. As we all sit around and enjoy the many bowl games, we recognize that all teams have players who want to play and win but at the end of the season only a few have winning seasons. Th ose that have winning seasons are the teams that have re-cruited the best and most talented team members. Th e GPhA Team is a winning team and they are getting better each month.

December, we will have a new member join our team, Kim McNeely who comes to us from an international association with great experience in membership development.

Th e November issue of James Magazine published by Internet News Agency and one of the most widely read magazines that focuses on the politics of Georgia government named Andy Freeman, GPhA Director of Government Aff airs, one of the top fi ft een lobbyists for associations in Georgia. Andy, we congratulate you and I am proud to have you on our GPhA .

One of the easiest winning teams that you can be part of is the Million Hearts Team. See the information below and become a member of the eff ort to teach patients to take control of their blood pressure. You are already a member of the GPhA nation. You can also be a member of a great winning national team.

Please plan to welcome her to GPhA.

eamT

Page 8: December 2012 GPhA Journal

6 The Georgia Pharmacy Journal 7The Georgia Pharmacy Journal

Introduction

Immunizations save over 30,000 lives annually and prevent 14 million cases of disease each year.1 In 2007, 1.2 million people in the United States were hospi-talized with pneumonia, and more than 52,000 peopled died from the disease.1 In the Healthy People 2020 campaign, the Department of Health and Human Services has set a goal of reducing or eliminating the cases of vaccine-pre-ventable diseases, including tetanus, diphtheria, pertussis, and pneumonia.1 Part of this goal includes vaccinating 90% of noninstitutionalized adults age 64 years and older and 60% of noninsti-tutionalized adults aged 18 to 64 years against pneumococcal disease. 1 Ac-cording to the National Immunization Survey (NIS), current vaccination rates from 2007 are well below these goals.2 Rates of pneumococcal immunizations among African Americans and Hispanic patients over the age of 65 years are ap-proximately 10% lower than the national average.2 Due to these alarming rates as well as the threat of other emerging dis-eases, health care professionals, includ-ing pharmacists, will need to be capable of providing preventative health care to a growing and diverse population and re-sponding to new, emerging threats.

Immunization programs organized, developed, and implemented by phar-macists and student pharmacists have increased the percentage of immunized patients in the community.3-6 Com-munity pharmacies have a number of as-pects that facilitate delivery of immuni-zations. Convenient locations and long hours of operation make it attractive for patients, parents, and caregivers to have immunizations administered by local community pharmacies.7 Patients have also reported overall satisfaction with pharmacist-based immunization clin-ics, when considering professionalism, access to vaccinations, and communica-tion by the pharmacist.8

Vaccine administration in hard-to-reach populations has not received at-tention in the published literature.9 Hard-to-reach populations, while not

uniformly defined, have include undoc-umented immigrants, substance users, homeless patients, and homebound el-derly.9 Activities that have been pro-posed to increase immunization rates in these populations include commu-nity-based educational campaigns, ed-ucation of providers, broadening the provider base to include nurses and pharmacists to give vaccinations, and promoting a wider availability and ac-cess to the vaccines.9 No previous re-search has examined programs that provide immunizations to underserved populations in order to increase their immunization rate.

ObjectivesThe objectives of this study were to as-

sess whether participants gained knowl-edge about the immunization abilities of pharmacists through a community health fair, whether participants who received an immunization were satisfied with the services they received, wheth-er the healthfair provided a service that would have not otherwise been sought by participants, and the likeliness of par-ticipants to receive vaccination services from a pharmacy/pharmacist in the fu-ture.

MethodsParticipants who entered the health

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

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

PatientsParticipants were eligible to receive a

tetanus/diphtheria/pertussis or pneu-mococcal vaccination if they signed and completed the immunization ad-ministration questionnaire and consent form and did not meet any of the exclu-sion criteria. Participants were exclud-ed from receiving a tetanus/diphtheria/pertussis vaccine if they reported any of the following: age less than 18 years, en-cephalopathy not attributed to another identifiable cause within 7 days follow-ing previous dose of diphtheria, teta-nus, with pertussis (DTwP); diphtheria, tetanus, and pertussis (DTaP); or teta-nus, diphtheria, and acellular pertussis (Tdap), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylax-is) to a previous vaccine dose or com-ponent, immunosuppression including drug-induced immunosuppression, re-cent or current chemotherapy, progres-sive or unstable neurological disorder, Guillain-Barre syndrome within 6 weeks following previous dose of tetanus-con-taining vaccine, history of arthus-type hypersensitivity reaction following pre-vious dose of tetanus-containing vac-cine, or receipt of vaccination or booster in the last 5 years.10,11

Participants were excluded from re-ceiving a pneumococcal vaccine if they reported any of the following: age less than 18 years, age of 18-64 years of age without chronic disease state (diabetes, heart disease, COPD, liver disease, alco-holism, or kidney disease including di-alysis), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylax-is) to a previous vaccine dose or com-ponent, immunosuppression including drug-induced immunosuppression, re-cent or current chemotherapy, receipt of vaccination or booster in the last 5 years, or receipt of two doses of vaccine in life-time.12,13 Participants were eligible for inclusion in the survey study if they re-ceived a vaccination.

OutcomesThe outcomes of this study were the

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

StatisticsSurvey results are represented in fre-

quencies and percent response for each question is also reported.

ResultsThirty participants expressed interest

in receiving a vaccination, answered the immunization administration question-naire, and were screened and consented. Three participants were excluded (one current pregnancy, one with receipt of vaccination within five years, and one receiving chemotherapy). Twenty-seven participants received 29 total vaccina-tions, where two participants received pneumococcal and 27 participants re-ceived a tetanus/diphtheria/pertussis vaccination. Of the 27 participants who received at least one vaccination, 24 completed the immunization survey. Vaccination services were provided in Spanish and English only.

Most patients agreed or strongly agreed with the survey statements. All participants at least agreed that the health fair taught them that pharmacists can provide immunization vaccination services (66.7% strongly agreed, 33.3% agreed). Further, all patients were satis-fied with the services they received at the health fair regarding the vaccinations/immunizations (75% strongly agreed, 25% agreed). The survey results showed that because of the health fair, partici-pants were more likely to seek immuni-zation/vaccination services from a phar-macist or pharmacy in the future (45.8% strongly agreed and 54.2% agreed). Also, participants noted that in the fu-ture, they were likely to seek a pharma-cist or pharmacy to provide immuniza-tion / vaccination services and to seek education regarding vaccine-preventable diseases from a pharmacist or pharma-cy (54.2% strongly agreed, 45.8% agreed on both survey statements). On average, however, participants reported that prior

Assessing Impact and Patient Satisfaction of Immunization Services Provided by a Student Facilitated Community Health Fair

Authors and Affiliations: Meagan S. Barbee, PharmD1 Jill Augustine, PharmD2

Christina Gonzalez, PharmD Candidate3

J. Grady Strom, Jr., PhD, RPh3

1Emory Healthcare2University of Arizona College of Pharmacy3Mercer University College of Pharmacy and Health SciencesCorresponding Author:Meagan Barbee4333 Dunwoody Park #2214 Dunwoody, GA [email protected]

Conflict of Interest:Authors do not have any conflicts of interest or financial interest in any product or service discussed in the manuscript, including grants, em-ployment, gifts, stock holdings, or options, honoraria, consultancies, expert testimony, patients, and roy-alties.

Funding:This study was funded by a Student Incentive Grant for Innovation in Immunization Practices from the American Pharmacists Association Foundation Knowlton Center for Pharmacist-Based Health Solutions.

Abstract (200-250 words):

Objective(s): The objective of the survey was to assess whether participants gained knowledge about abilities of pharma-cists to provide vaccination services and the likeliness of participants to receive vaccination services from a pharmacy/pharmacist in the future.

Design: The study was a nonrandomized, cross-sectional survey of patients. Setting: Immunization services were provid-

ed at a community-based health fair targeted at underserved populations.

Patients: Immunization services were available to eligible patients who attended the health fair, and the survey was open to patients who received an immuni-zation.

Main outcome measure(s): Patients’ agreement with survey state-ments based on a four-point Likert scale.

Results: Twenty-nine vaccinations were pro-vided to 27 patients. Twenty-four pa-tients completed the survey (88.9%). All patients agreed or strongly agreed that the service taught them that pharmacists could provide immu-nization services. Participants were also more likely to seek immunization services from a pharmacy/pharmacist in the future (100% strongly agreed or agreed). Patients reported that they were more likely to seek education regarding vaccine-preventable diseas-es from a pharmacy/pharmacists in the future (100% strongly agreed or agreed). Most participants reported that prior to the health fair, they were planning on receiving a pneumococ-cal vaccination (87.5% strongly agree or agreed) or a tetanus/diphtheria/pertussis vaccination (70.2% strongly agreed or agreed).

Conclusions: Student pharmacists were able to pro-vide underserved patients immuniza-tions in a community health fair. Ed-ucating patients that pharmacists and student pharmacists can provide im-munization services may lead patients to seek pharmacists for such services in the future.

Keywords: immunization, pharmacist, patient satisfaction, student pharmacist

Page 9: December 2012 GPhA Journal

6 The Georgia Pharmacy Journal 7The Georgia Pharmacy Journal

Introduction

Immunizations save over 30,000 lives annually and prevent 14 million cases of disease each year.1 In 2007, 1.2 million people in the United States were hospi-talized with pneumonia, and more than 52,000 peopled died from the disease.1 In the Healthy People 2020 campaign, the Department of Health and Human Services has set a goal of reducing or eliminating the cases of vaccine-pre-ventable diseases, including tetanus, diphtheria, pertussis, and pneumonia.1 Part of this goal includes vaccinating 90% of noninstitutionalized adults age 64 years and older and 60% of noninsti-tutionalized adults aged 18 to 64 years against pneumococcal disease. 1 Ac-cording to the National Immunization Survey (NIS), current vaccination rates from 2007 are well below these goals.2 Rates of pneumococcal immunizations among African Americans and Hispanic patients over the age of 65 years are ap-proximately 10% lower than the national average.2 Due to these alarming rates as well as the threat of other emerging dis-eases, health care professionals, includ-ing pharmacists, will need to be capable of providing preventative health care to a growing and diverse population and re-sponding to new, emerging threats.

Immunization programs organized, developed, and implemented by phar-macists and student pharmacists have increased the percentage of immunized patients in the community.3-6 Com-munity pharmacies have a number of as-pects that facilitate delivery of immuni-zations. Convenient locations and long hours of operation make it attractive for patients, parents, and caregivers to have immunizations administered by local community pharmacies.7 Patients have also reported overall satisfaction with pharmacist-based immunization clin-ics, when considering professionalism, access to vaccinations, and communica-tion by the pharmacist.8

Vaccine administration in hard-to-reach populations has not received at-tention in the published literature.9 Hard-to-reach populations, while not

uniformly defined, have include undoc-umented immigrants, substance users, homeless patients, and homebound el-derly.9 Activities that have been pro-posed to increase immunization rates in these populations include commu-nity-based educational campaigns, ed-ucation of providers, broadening the provider base to include nurses and pharmacists to give vaccinations, and promoting a wider availability and ac-cess to the vaccines.9 No previous re-search has examined programs that provide immunizations to underserved populations in order to increase their immunization rate.

ObjectivesThe objectives of this study were to as-

sess whether participants gained knowl-edge about the immunization abilities of pharmacists through a community health fair, whether participants who received an immunization were satisfied with the services they received, wheth-er the healthfair provided a service that would have not otherwise been sought by participants, and the likeliness of par-ticipants to receive vaccination services from a pharmacy/pharmacist in the fu-ture.

MethodsParticipants who entered the health

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

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

PatientsParticipants were eligible to receive a

tetanus/diphtheria/pertussis or pneu-mococcal vaccination if they signed and completed the immunization ad-ministration questionnaire and consent form and did not meet any of the exclu-sion criteria. Participants were exclud-ed from receiving a tetanus/diphtheria/pertussis vaccine if they reported any of the following: age less than 18 years, en-cephalopathy not attributed to another identifiable cause within 7 days follow-ing previous dose of diphtheria, teta-nus, with pertussis (DTwP); diphtheria, tetanus, and pertussis (DTaP); or teta-nus, diphtheria, and acellular pertussis (Tdap), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylax-is) to a previous vaccine dose or com-ponent, immunosuppression including drug-induced immunosuppression, re-cent or current chemotherapy, progres-sive or unstable neurological disorder, Guillain-Barre syndrome within 6 weeks following previous dose of tetanus-con-taining vaccine, history of arthus-type hypersensitivity reaction following pre-vious dose of tetanus-containing vac-cine, or receipt of vaccination or booster in the last 5 years.10,11

Participants were excluded from re-ceiving a pneumococcal vaccine if they reported any of the following: age less than 18 years, age of 18-64 years of age without chronic disease state (diabetes, heart disease, COPD, liver disease, alco-holism, or kidney disease including di-alysis), current pregnancy, moderate or severe acute illness with or without fever, severe allergic reaction (e.g. anaphylax-is) to a previous vaccine dose or com-ponent, immunosuppression including drug-induced immunosuppression, re-cent or current chemotherapy, receipt of vaccination or booster in the last 5 years, or receipt of two doses of vaccine in life-time.12,13 Participants were eligible for inclusion in the survey study if they re-ceived a vaccination.

OutcomesThe outcomes of this study were the

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

StatisticsSurvey results are represented in fre-

quencies and percent response for each question is also reported.

ResultsThirty participants expressed interest

in receiving a vaccination, answered the immunization administration question-naire, and were screened and consented. Three participants were excluded (one current pregnancy, one with receipt of vaccination within five years, and one receiving chemotherapy). Twenty-seven participants received 29 total vaccina-tions, where two participants received pneumococcal and 27 participants re-ceived a tetanus/diphtheria/pertussis vaccination. Of the 27 participants who received at least one vaccination, 24 completed the immunization survey. Vaccination services were provided in Spanish and English only.

Most patients agreed or strongly agreed with the survey statements. All participants at least agreed that the health fair taught them that pharmacists can provide immunization vaccination services (66.7% strongly agreed, 33.3% agreed). Further, all patients were satis-fied with the services they received at the health fair regarding the vaccinations/immunizations (75% strongly agreed, 25% agreed). The survey results showed that because of the health fair, partici-pants were more likely to seek immuni-zation/vaccination services from a phar-macist or pharmacy in the future (45.8% strongly agreed and 54.2% agreed). Also, participants noted that in the fu-ture, they were likely to seek a pharma-cist or pharmacy to provide immuniza-tion / vaccination services and to seek education regarding vaccine-preventable diseases from a pharmacist or pharma-cy (54.2% strongly agreed, 45.8% agreed on both survey statements). On average, however, participants reported that prior

Assessing Impact and Patient Satisfaction of Immunization Services Provided by a Student Facilitated Community Health Fair

Authors and Affiliations: Meagan S. Barbee, PharmD1 Jill Augustine, PharmD2

Christina Gonzalez, PharmD Candidate3

J. Grady Strom, Jr., PhD, RPh3

1Emory Healthcare2University of Arizona College of Pharmacy3Mercer University College of Pharmacy and Health SciencesCorresponding Author:Meagan Barbee4333 Dunwoody Park #2214 Dunwoody, GA [email protected]

Conflict of Interest:Authors do not have any conflicts of interest or financial interest in any product or service discussed in the manuscript, including grants, em-ployment, gifts, stock holdings, or options, honoraria, consultancies, expert testimony, patients, and roy-alties.

Funding:This study was funded by a Student Incentive Grant for Innovation in Immunization Practices from the American Pharmacists Association Foundation Knowlton Center for Pharmacist-Based Health Solutions.

Abstract (200-250 words):

Objective(s): The objective of the survey was to assess whether participants gained knowledge about abilities of pharma-cists to provide vaccination services and the likeliness of participants to receive vaccination services from a pharmacy/pharmacist in the future.

Design: The study was a nonrandomized, cross-sectional survey of patients. Setting: Immunization services were provid-

ed at a community-based health fair targeted at underserved populations.

Patients: Immunization services were available to eligible patients who attended the health fair, and the survey was open to patients who received an immuni-zation.

Main outcome measure(s): Patients’ agreement with survey state-ments based on a four-point Likert scale.

Results: Twenty-nine vaccinations were pro-vided to 27 patients. Twenty-four pa-tients completed the survey (88.9%). All patients agreed or strongly agreed that the service taught them that pharmacists could provide immu-nization services. Participants were also more likely to seek immunization services from a pharmacy/pharmacist in the future (100% strongly agreed or agreed). Patients reported that they were more likely to seek education regarding vaccine-preventable diseas-es from a pharmacy/pharmacists in the future (100% strongly agreed or agreed). Most participants reported that prior to the health fair, they were planning on receiving a pneumococ-cal vaccination (87.5% strongly agree or agreed) or a tetanus/diphtheria/pertussis vaccination (70.2% strongly agreed or agreed).

Conclusions: Student pharmacists were able to pro-vide underserved patients immuniza-tions in a community health fair. Ed-ucating patients that pharmacists and student pharmacists can provide im-munization services may lead patients to seek pharmacists for such services in the future.

Keywords: immunization, pharmacist, patient satisfaction, student pharmacist

Page 10: December 2012 GPhA Journal

Strongly Agree Agree Disagree Strongly

Disagree N/A Total

8 Th e Georgia Pharmacy Journal

Immunization Services Immunization Services

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

DiscussionStudent pharmacists immunized 27

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

ing Caucasian and African American. Th rough health fairs which target pro-viding immunization services, immuni-zation rates of the underserved have the potential to improve.

Additionally, all of the participants stated that they were favorable to seek-ing a pharmacist or pharmacy in the future for immunizations or vaccina-tions. With the education of patients about the abilities of pharmacists, pa-tients and their families may seek phar-macies to provide vaccination services, including travel, childhood, and annual immunizations as well as other services. Th rough this education, pharmacies also have the ability to develop clinics and programs that are targeted at providing vaccinations.

Over the past several years, pharma-cists have been encouraged to increase

the number and types of services that they can off er to patients. Th is study has shown that pharmacists and student pharmacists can provide satisfactory vaccinations and immunization services to patients who might not have other-wise received these services. Pharma-cists have the ability to educate patients about vaccinations that cover a wide va-riety of diseases and increase access to such services. With an increased num-ber of patients seeking immunization services, pharmacists and pharmacies can increase the number of immuniza-tions off ered and provide access to im-munization services to populations that have low overall immunization rates.

LimitationsWith a small sample size and targeted

population, the conclusions of this study

are not universal. As a baseline survey was not gathered, the true eff ect of the health fair and services rendered on pa-tient perspectives of pharmacist- and student pharmacist-provided vaccina-tion services was not able to be assessed. Th e survey did not assess the likelihood of patients to approach a pharmacy or pharmacist for immunization services or related education prior to receiving their vaccination at the health fair. As with all survey studies, an inherent lim-itation of the current study was the reli-ance on a self-report method of data col-lection. Although eff orts were made to

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

ConclusionTh e results of this study support the

fi ndings of other studies favoring phar-macist-facilitated immunization ser-vices. With student pharmacists able to perform activities under the supervision of a pharmacist, this could increase the abilities of pharmacies to facilitate im-munization services, especially to un-derserved populations. In the current study, student pharmacists provided

References:1. Healthy People 2020. United States Department of Health and Human Services. http://www.healthypeople.gov/2020/default.aspx. Accessed November 10, 2011. 2. National Immunization Survey-Adult, 2007. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/stats-surv/nis/downloads/nis-adult-summer-2007.pdf. Accessed November 10, 2011. 3. Taitel M, Cohen E, Duncan I, Pegus C. Pharmacists as providers: targeting pneumococcal vaccination to high risk populations. Vaccine. 2011;29(45):8073-6. 4. Loughlin SM, Mortazavi A, Garey KW, Rick GK, Birtcher KK. Pharmacist-managed vaccination program increased infl uenza vaccination rate in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27(5):729-33. 5. Ragucci KR, Pearson WS, Mainous AG. Th e role of pharmacists in the delivery of infl uenza vaccinations. Vaccine. 2004;22(8):1001-6. 6. Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved infl uenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy. 2001;21(9):1115-22. 7. Ndiaye SM, Madhavan S, Washington ML, et al. Th e use of pharmacy immunization services in rural communities. Public Health. 2003;117(2):88-97.8. Bounthavong M, Christopher ML, Mendes MA, et al. Measuring patient satisfaction in the pharmacy specialty immunization clinic: a pharmacist-run immunization clinic at the Veterns Aff airs San Diego Healthcare System. Int J Pharm Pract. 2010;18(2):100-7. 9. Valhov D, Coady MD, Ompad DC, Galea S. Strategies for improving infl uenza immunization rates among hard-to-reach populations. J Urban Health. 2007;84(4):615-31. 10. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60 (No. 1): 13-15. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm11. Boostrix® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011.12. Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-8): 1-25. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr4608.pdf13. Pneumovax® 23 [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2011.14. Pneumonia. Centers for Disease Control and Prevention. http://www.cdc.gov/Features/Pneumonia/. Accessed December 15, 2011.

satisfactory immunization services to an underserved population in a community setting. Educating patients that phar-macists and student pharmacists can provide immunization services may lead patients to seek pharmacists for such ser-vices in the future.

We would like to acknowledge that the study was supported by the Student Incentive Grants for Innovation in Im-munization Practices from the American Pharmacists Association Foundation (APhA Foundation) Knowlton Center for Pharmacist-Based Health Solutions.

Table 1 n (%)

Survey Statement

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

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

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

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

Because of this health fair, I am MORE LIKELY to seek immunization / vaccination services from a phar-macist or pharmacy in the future.

In the future, I AM LIKELY to seek a pharmacist or pharmacy to provide my immunization / vaccination services.

In the future, I AM LIKELY to seek education regarding vaccine-preventable diseases from a pharmacist or pharmacy.

16 (66.7%)

18 (75%)

7 (29.2%)

10 (41.7%)

11 (45.8%)

13 (54.2%)

13 (54.2%)

8 (33.3%)

6 (25%)

14 (58.3%)

9 (37.5%)

13 (54.2%)

11 (45.8%)

11 (45.8%)

0 (0%)

0 (0%)

2 (8.33%)

5 (20.8%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1 (4.17%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

Compounding Labs

Pharmacy Planning & Design

Patient Consultation

Areas

Stocking Lozier Distributor

Full of line Pharmacy Fixtures

Custom Wood Work

Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

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

Rx Planning st

Speciali

Roland Thomas

experience in over 2,000

.pharmacies

Division of Display Options, Inc.

www.displayoptions.com

Page 11: December 2012 GPhA Journal

Strongly Agree Agree Disagree Strongly

Disagree N/A Total

8 Th e Georgia Pharmacy Journal

Immunization Services Immunization Services

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

DiscussionStudent pharmacists immunized 27

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

ing Caucasian and African American. Th rough health fairs which target pro-viding immunization services, immuni-zation rates of the underserved have the potential to improve.

Additionally, all of the participants stated that they were favorable to seek-ing a pharmacist or pharmacy in the future for immunizations or vaccina-tions. With the education of patients about the abilities of pharmacists, pa-tients and their families may seek phar-macies to provide vaccination services, including travel, childhood, and annual immunizations as well as other services. Th rough this education, pharmacies also have the ability to develop clinics and programs that are targeted at providing vaccinations.

Over the past several years, pharma-cists have been encouraged to increase

the number and types of services that they can off er to patients. Th is study has shown that pharmacists and student pharmacists can provide satisfactory vaccinations and immunization services to patients who might not have other-wise received these services. Pharma-cists have the ability to educate patients about vaccinations that cover a wide va-riety of diseases and increase access to such services. With an increased num-ber of patients seeking immunization services, pharmacists and pharmacies can increase the number of immuniza-tions off ered and provide access to im-munization services to populations that have low overall immunization rates.

LimitationsWith a small sample size and targeted

population, the conclusions of this study

are not universal. As a baseline survey was not gathered, the true eff ect of the health fair and services rendered on pa-tient perspectives of pharmacist- and student pharmacist-provided vaccina-tion services was not able to be assessed. Th e survey did not assess the likelihood of patients to approach a pharmacy or pharmacist for immunization services or related education prior to receiving their vaccination at the health fair. As with all survey studies, an inherent lim-itation of the current study was the reli-ance on a self-report method of data col-lection. Although eff orts were made to

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

ConclusionTh e results of this study support the

fi ndings of other studies favoring phar-macist-facilitated immunization ser-vices. With student pharmacists able to perform activities under the supervision of a pharmacist, this could increase the abilities of pharmacies to facilitate im-munization services, especially to un-derserved populations. In the current study, student pharmacists provided

References:1. Healthy People 2020. United States Department of Health and Human Services. http://www.healthypeople.gov/2020/default.aspx. Accessed November 10, 2011. 2. National Immunization Survey-Adult, 2007. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/stats-surv/nis/downloads/nis-adult-summer-2007.pdf. Accessed November 10, 2011. 3. Taitel M, Cohen E, Duncan I, Pegus C. Pharmacists as providers: targeting pneumococcal vaccination to high risk populations. Vaccine. 2011;29(45):8073-6. 4. Loughlin SM, Mortazavi A, Garey KW, Rick GK, Birtcher KK. Pharmacist-managed vaccination program increased infl uenza vaccination rate in cardiovascular patients enrolled in a secondary prevention lipid clinic. Pharmacotherapy. 2007;27(5):729-33. 5. Ragucci KR, Pearson WS, Mainous AG. Th e role of pharmacists in the delivery of infl uenza vaccinations. Vaccine. 2004;22(8):1001-6. 6. Van Amburgh JA, Waite NM, Hobson EH, Migden H. Improved infl uenza vaccination rates in a rural population as a result of a pharmacist-managed immunization campaign. Pharmacotherapy. 2001;21(9):1115-22. 7. Ndiaye SM, Madhavan S, Washington ML, et al. Th e use of pharmacy immunization services in rural communities. Public Health. 2003;117(2):88-97.8. Bounthavong M, Christopher ML, Mendes MA, et al. Measuring patient satisfaction in the pharmacy specialty immunization clinic: a pharmacist-run immunization clinic at the Veterns Aff airs San Diego Healthcare System. Int J Pharm Pract. 2010;18(2):100-7. 9. Valhov D, Coady MD, Ompad DC, Galea S. Strategies for improving infl uenza immunization rates among hard-to-reach populations. J Urban Health. 2007;84(4):615-31. 10. Centers for Disease Control and Prevention. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60 (No. 1): 13-15. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm11. Boostrix® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011.12. Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-8): 1-25. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr4608.pdf13. Pneumovax® 23 [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2011.14. Pneumonia. Centers for Disease Control and Prevention. http://www.cdc.gov/Features/Pneumonia/. Accessed December 15, 2011.

satisfactory immunization services to an underserved population in a community setting. Educating patients that phar-macists and student pharmacists can provide immunization services may lead patients to seek pharmacists for such ser-vices in the future.

We would like to acknowledge that the study was supported by the Student Incentive Grants for Innovation in Im-munization Practices from the American Pharmacists Association Foundation (APhA Foundation) Knowlton Center for Pharmacist-Based Health Solutions.

Table 1 n (%)

Survey Statement

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

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

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

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

Because of this health fair, I am MORE LIKELY to seek immunization / vaccination services from a phar-macist or pharmacy in the future.

In the future, I AM LIKELY to seek a pharmacist or pharmacy to provide my immunization / vaccination services.

In the future, I AM LIKELY to seek education regarding vaccine-preventable diseases from a pharmacist or pharmacy.

16 (66.7%)

18 (75%)

7 (29.2%)

10 (41.7%)

11 (45.8%)

13 (54.2%)

13 (54.2%)

8 (33.3%)

6 (25%)

14 (58.3%)

9 (37.5%)

13 (54.2%)

11 (45.8%)

11 (45.8%)

0 (0%)

0 (0%)

2 (8.33%)

5 (20.8%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1 (4.17%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

24 (100%)

Compounding Labs

Pharmacy Planning & Design

Patient Consultation

Areas

Stocking Lozier Distributor

Full of line Pharmacy Fixtures

Custom Wood Work

Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

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

Rx Planning st

Speciali

Roland Thomas

experience in over 2,000

.pharmacies

Division of Display Options, Inc.

www.displayoptions.com

Page 12: December 2012 GPhA Journal

10 The Georgia Pharmacy Journal The Georgia Pharmacy Journal

Melvin M. Goldstein, P.C.AT T O R N E Y AT L AW___

248 Roswell StreetMarietta, Georgia 30060

Telephone 770/427-7004Fax 770/426-9584

www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters

n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency

n Former Administrative Law Judge for the Office of State Administrative Hearings

CPE Monitor™ integration is well underway and soon all Accredita-tion Council for Pharmacy Edu-cation (ACPE)-accredited provid-ers will require pharmacists and pharmacy technicians to submit their NABP e-Profile ID and date of birth (MMDD) in order to obtain ACPE-accredited continuing phar-macy education (CPE) credit. In fact, many providers have already integrat-ed their systems and are requiring this information.As of press time, more than:• 950,000 CPE activity records are now stored in the CPE Monitor system• 120 ACPE-accredited providers are actively transmitting CPE data electronically• 188,000 pharmacists have created e-Profiles • 103,500 pharmacy technicians have created e-Profiles

CPE Monitor is a national collabo-rative service from NABP, ACPE, and ACPE providers that will allow licens-ees to track their completed CPE credits electronically. It is anticipated that in 2013 the boards of pharmacy will be able to request reports on their

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor

NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE

April 26-28, 2013 Legacy Lodge & Conference Center

Lake Lanier Islands Resort Lake Lanier Islands, GA

The 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference.

Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria:

(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations;(3) Community activities; (4) Clarity and vision in response to application questions.

I would like to nominate the following individual to attend the 2013 New Practitioner Leadership Conference: (Please Print)

Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For: ______________________________________________________________________________________Preferred Mailing Address: ______________________________________________________________________________

_______________________________________________________________________________ _______________________________________________ State: ______ ZIP: _____________ Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________ E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________

Address: [ ] Home or [ ] Work?________________________________________________________________________________ _________________________________________________________ State: _______ Zip: ___________________

Tel. (____) __________________ E-mail: ___________________________________________________________

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

Or, you may FAX this Nomination Form to: 404.237.8435Or, submit online at WWW.GPHA.ORG

If you have questions, please contact Regena Banks at GPhF: 404.231.5074 Email: [email protected]

20th Year Please return by January 18, 2013

This address is [ ] Home [ ] Work

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

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

- CORRECTION -In the November edition of the

Georgia Pharmacy Journal, Bent Gay’s name was spelled

incorrectly. We sincerely apologize and again would

like to congratulate Mr. Gay on being named the Next

Generation Long-term Care Pharmacist of the Year.

Page 13: December 2012 GPhA Journal

10 The Georgia Pharmacy Journal The Georgia Pharmacy Journal

Melvin M. Goldstein, P.C.AT T O R N E Y AT L AW___

248 Roswell StreetMarietta, Georgia 30060

Telephone 770/427-7004Fax 770/426-9584

www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters

n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency

n Former Administrative Law Judge for the Office of State Administrative Hearings

CPE Monitor™ integration is well underway and soon all Accredita-tion Council for Pharmacy Edu-cation (ACPE)-accredited provid-ers will require pharmacists and pharmacy technicians to submit their NABP e-Profile ID and date of birth (MMDD) in order to obtain ACPE-accredited continuing phar-macy education (CPE) credit. In fact, many providers have already integrat-ed their systems and are requiring this information.As of press time, more than:• 950,000 CPE activity records are now stored in the CPE Monitor system• 120 ACPE-accredited providers are actively transmitting CPE data electronically• 188,000 pharmacists have created e-Profiles • 103,500 pharmacy technicians have created e-Profiles

CPE Monitor is a national collabo-rative service from NABP, ACPE, and ACPE providers that will allow licens-ees to track their completed CPE credits electronically. It is anticipated that in 2013 the boards of pharmacy will be able to request reports on their

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor

NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE

April 26-28, 2013 Legacy Lodge & Conference Center

Lake Lanier Islands Resort Lake Lanier Islands, GA

The 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference.

Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria:

(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations;(3) Community activities; (4) Clarity and vision in response to application questions.

I would like to nominate the following individual to attend the 2013 New Practitioner Leadership Conference: (Please Print)

Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For: ______________________________________________________________________________________Preferred Mailing Address: ______________________________________________________________________________

_______________________________________________________________________________ _______________________________________________ State: ______ ZIP: _____________ Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________ E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________

Address: [ ] Home or [ ] Work?________________________________________________________________________________ _________________________________________________________ State: _______ Zip: ___________________

Tel. (____) __________________ E-mail: ___________________________________________________________

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

Or, you may FAX this Nomination Form to: 404.237.8435Or, submit online at WWW.GPHA.ORG

If you have questions, please contact Regena Banks at GPhF: 404.231.5074 Email: [email protected]

20th Year Please return by January 18, 2013

This address is [ ] Home [ ] Work

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

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

- CORRECTION -In the November edition of the

Georgia Pharmacy Journal, Bent Gay’s name was spelled

incorrectly. We sincerely apologize and again would

like to congratulate Mr. Gay on being named the Next

Generation Long-term Care Pharmacist of the Year.

Page 14: December 2012 GPhA Journal

October 30, 2012

The Georgia State Board of Pharmacy reminds pharmacies, pharmacists and medical practitioners who engage in compounding in this state that Board Rule 480-11 requires that all actions be performed in accordance with United States Pharmacopeia (USP) Stan-dards. USP<795> addresses the practice for Non-Sterile Compounding and USP Standard <797> addresses the practice for Sterile Compounding Preparations.

Georgia Pharmacies, Pharmacists and Practitioners are also reminded that Georgia law (O.C.G.A. Title 26, Chapter 4, Section 80) and Georgia State Board of Pharmacy Rules and Regulations (Chapter 480) require that medications can only be dispensed pursuant to the

receipt of a valid prescription from an authorized practitioner for a spe-cifi c patient. Th is prescription must be valid as defi ned under Georgia laws, rules and regulations.

Additionally, if any pharmacy, pharmacist, or practitioner is in receipt of medication which has been dispensed and labeled for a specifi c pa-tient, that medication cannot be lawfully utilized, administered, or dis-pensed to any patient except the one whose name appears on the pre-scription label (O.C.G.A. 16-13, 26-4).

Further, Georgia laws (O.C.G.A. 26-4-113, 115) and Rules (480-7, -11) prohibit compounding pharmacies from distributing bulk compounded medications to other health care providers without having a drug whole-sale permit. Th ese same laws and rules prohibit any pharmacy or med-

ical practitioner in this state from purchasing drugs from any fi rm except one licensed in Georgia as a Drug Wholesaler and/or Manufacturer.

Board licensees are advised to review USP standards and Board Rule Chapter 480-11 to assure that compounding pharmacy practice is conducted in accordance with state and federal laws and regulations, as required by Th e Georgia Pharmacy Practice Act (O.C.G.A. 26-4) and Board Rules and Regulations (Chapter 480-5).

Th e Board advises that all compounding pharmacies and pharmacists should obtain and complete the respective USP Gap Analysis Tool(s) (®International Journal of Pharmaceu-tical Compounding) for USP <795> and <797> as provided below, to determine prelim-inary compliance with the above-referenced USP standards. http://www.ijpc.com/USP/

Th e Board appreciates your prompt attention to this important advisory.

12 Th e Georgia Pharmacy Journal

“Medications can only be dispensed pursuant to the receipt of a valid prescription from

an authorized practitioner for a specifi c patient.”

Southeastern of

Leadership WeekendPharmacy

January 11- 13, 2013 Grove Park Inn, Asheville, NC

Register today at www.scrx.org

Girls Indulge.

The North Carolina Association of Pharmacists presents

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

CE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest Weekend

Save the Date: January 25 - 27, 2013Chetola Mountain Resort, Blowing Rock, NC

Compounding Pharmacies and Pharmacists

ADVISORYGeorgia State Board of Pharmacy

Page 15: December 2012 GPhA Journal

October 30, 2012

The Georgia State Board of Pharmacy reminds pharmacies, pharmacists and medical practitioners who engage in compounding in this state that Board Rule 480-11 requires that all actions be performed in accordance with United States Pharmacopeia (USP) Stan-dards. USP<795> addresses the practice for Non-Sterile Compounding and USP Standard <797> addresses the practice for Sterile Compounding Preparations.

Georgia Pharmacies, Pharmacists and Practitioners are also reminded that Georgia law (O.C.G.A. Title 26, Chapter 4, Section 80) and Georgia State Board of Pharmacy Rules and Regulations (Chapter 480) require that medications can only be dispensed pursuant to the

receipt of a valid prescription from an authorized practitioner for a spe-cifi c patient. Th is prescription must be valid as defi ned under Georgia laws, rules and regulations.

Additionally, if any pharmacy, pharmacist, or practitioner is in receipt of medication which has been dispensed and labeled for a specifi c pa-tient, that medication cannot be lawfully utilized, administered, or dis-pensed to any patient except the one whose name appears on the pre-scription label (O.C.G.A. 16-13, 26-4).

Further, Georgia laws (O.C.G.A. 26-4-113, 115) and Rules (480-7, -11) prohibit compounding pharmacies from distributing bulk compounded medications to other health care providers without having a drug whole-sale permit. Th ese same laws and rules prohibit any pharmacy or med-

ical practitioner in this state from purchasing drugs from any fi rm except one licensed in Georgia as a Drug Wholesaler and/or Manufacturer.

Board licensees are advised to review USP standards and Board Rule Chapter 480-11 to assure that compounding pharmacy practice is conducted in accordance with state and federal laws and regulations, as required by Th e Georgia Pharmacy Practice Act (O.C.G.A. 26-4) and Board Rules and Regulations (Chapter 480-5).

Th e Board advises that all compounding pharmacies and pharmacists should obtain and complete the respective USP Gap Analysis Tool(s) (®International Journal of Pharmaceu-tical Compounding) for USP <795> and <797> as provided below, to determine prelim-inary compliance with the above-referenced USP standards. http://www.ijpc.com/USP/

Th e Board appreciates your prompt attention to this important advisory.

12 Th e Georgia Pharmacy Journal

“Medications can only be dispensed pursuant to the receipt of a valid prescription from

an authorized practitioner for a specifi c patient.”

Southeastern of

Leadership WeekendPharmacy

January 11- 13, 2013 Grove Park Inn, Asheville, NC

Register today at www.scrx.org

Girls Indulge.

The North Carolina Association of Pharmacists presents

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

CE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiCE & SkiWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest WeekendWinterfest Weekend

Save the Date: January 25 - 27, 2013Chetola Mountain Resort, Blowing Rock, NC

Compounding Pharmacies and Pharmacists

ADVISORYGeorgia State Board of Pharmacy

Page 16: December 2012 GPhA Journal

14 The Georgia Pharmacy Journal

H o w t o r o c k

E n r o l lAt RxAlly, we believe that personalized pharmacist care can lead to better health outcomes. You are a pivotal player in the health of patients, particularly those facing chronic illnesses and taking multiple medications.

RxAlly offers you the opportunity to:

• Enhance your role as a health care provider • Access market opportunities through a

national network• Participate in clinical service programs • Expand into new patient care niches• Be compensated for an array of professional services • Transform pharmacy practice in the U.S.

RxAlly has brought together the nation’s leading independent pharmacy organizations, regional chains and Walgreens, to form a performance network of community pharmacies nationwide.

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

How do I Enroll?• Go to www.rxAlly.com/enroll.• Enter your contact information.• Select your role as “Pharmacy owner/officer”.

Enter your NCPDP number.• Then, you will see another box with your affiliation(s)

listed. If you have more than one affiliation, select “AIP”.• Click “submit” button.• Review and confirm your acceptance of the Pharmacy

Network Agreement by checking the box at the bottom of the agreement and clicking the “confirm” button.

• You will see a Network Enrollment Confirmation screen indicating that you have successfully enrolled.

• Within a few days you will receive an enrollment confirmation email that includes your pharmacy name, NCPDP number and selected affiliation.

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

Visit RxAlly.com Email [email protected] Call 1-855-RxAlly-1

GEORGIA PHARMACY FOUNDATION ANNUAL GIVING CAMPAIGN

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

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

By giving to the Annual Campaign you are contributing to the continuity of the pharmacy profession, in turn strengthening the future of pharmacy. These gifts are vitally important to the continued success of the Foundation because they offer the flexibility to support emerging opportunities and unmet needs when often no other source of funding is available. Acknowledging the difference that pharmacy has made in your life will ensure that the profession remains the place where thinkers become leaders.

If you have not yet made your tax-deductible* gift for the current campaign, please do so today. Your support, at any level, is important. It will have an impact! Remember, many companies will match your contribution, doubling or even tripling the value of your gift! The success of our fundraising depends on donations and grants from foundations, government, corporations, and manygenerous individuals. Often contributions are made “In Memory/Honor” of someone or for a Special Occasion in lieu of sending flowers. Contributions are acknowledged with a Charitable Donation receipt for tax purposes, and names will appear on our website. Checksshould be made payable to the Georgia Pharmacy Foundation, a 501(c)(3) organization.

(*As provided by law)

Giving back is the best way to keep our profession going forward!

Yes! I want to help support the good work of the Georgia Pharmacy Foundat ion by contr ibut ing to the 11t h Annual Giv ing Campaign with my pledge of :

[ ] President’s Circle = $5,000 or more [ ] Eagle = $2,500 - $4,999 [ ] Centurion = $1,000 - $2,499[ ] Gold Partner = $500 - $999 [ ] Silver Partner = $250 - $499 [ ] Bronze Partner = $100 - $249[ ] Partner = $____ - $99

Name (Please Print): ____________________________________________________________________________________________________ Company (if applicable): ______________________________________________________________________________________Address: _____________________________________________________________________________________________________________ City: ______________________________________________________________________ ST _________ Zip _________________ Telephone: (_____) ___________________ Email: __________________________________________________________

[ ] Please check here if you prefer to be listed as an Anonymous contributor. Please indicate if you would like to make your donation a gift “In Memory or Honor of.” If so, please provide name and address where the gift card/notification should be sent:

(Please Print) [ ] In Memory of _______________________________________________________________________________ [ ] In Honor of _________________________________________________________________________________

Send notification to: __________________________________________________________________________________________ Address: __________________________________________________________________________________________ __________________________________________________________________________________________

DON’T FORGET, you can also make your gift online at WWW.GPHA.ORG.

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

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

Please circle one: AmEx Visa M/C Disc.) Card #:_____________________________________________ Security #: _____ Exp.Date: _____If name on credit card and/or the billing address are different from above, please provide that information below:

Name ______________________________________________________________________________________________________________________

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

Signature: ________________________________________________________________________ Today’s Date: ______________

50 LENOX POINTE, NE ATLANTA, GA 30324

404.231.5074 WWW.GPHA.ORG

Page 17: December 2012 GPhA Journal

14 The Georgia Pharmacy Journal

H o w t o r o c k

E n r o l lAt RxAlly, we believe that personalized pharmacist care can lead to better health outcomes. You are a pivotal player in the health of patients, particularly those facing chronic illnesses and taking multiple medications.

RxAlly offers you the opportunity to:

• Enhance your role as a health care provider • Access market opportunities through a

national network• Participate in clinical service programs • Expand into new patient care niches• Be compensated for an array of professional services • Transform pharmacy practice in the U.S.

RxAlly has brought together the nation’s leading independent pharmacy organizations, regional chains and Walgreens, to form a performance network of community pharmacies nationwide.

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

How do I Enroll?• Go to www.rxAlly.com/enroll.• Enter your contact information.• Select your role as “Pharmacy owner/officer”.

Enter your NCPDP number.• Then, you will see another box with your affiliation(s)

listed. If you have more than one affiliation, select “AIP”.• Click “submit” button.• Review and confirm your acceptance of the Pharmacy

Network Agreement by checking the box at the bottom of the agreement and clicking the “confirm” button.

• You will see a Network Enrollment Confirmation screen indicating that you have successfully enrolled.

• Within a few days you will receive an enrollment confirmation email that includes your pharmacy name, NCPDP number and selected affiliation.

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

Visit RxAlly.com Email [email protected] Call 1-855-RxAlly-1

GEORGIA PHARMACY FOUNDATION ANNUAL GIVING CAMPAIGN

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

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

By giving to the Annual Campaign you are contributing to the continuity of the pharmacy profession, in turn strengthening the future of pharmacy. These gifts are vitally important to the continued success of the Foundation because they offer the flexibility to support emerging opportunities and unmet needs when often no other source of funding is available. Acknowledging the difference that pharmacy has made in your life will ensure that the profession remains the place where thinkers become leaders.

If you have not yet made your tax-deductible* gift for the current campaign, please do so today. Your support, at any level, is important. It will have an impact! Remember, many companies will match your contribution, doubling or even tripling the value of your gift! The success of our fundraising depends on donations and grants from foundations, government, corporations, and manygenerous individuals. Often contributions are made “In Memory/Honor” of someone or for a Special Occasion in lieu of sending flowers. Contributions are acknowledged with a Charitable Donation receipt for tax purposes, and names will appear on our website. Checksshould be made payable to the Georgia Pharmacy Foundation, a 501(c)(3) organization.

(*As provided by law)

Giving back is the best way to keep our profession going forward!

Yes! I want to help support the good work of the Georgia Pharmacy Foundat ion by contr ibut ing to the 11t h Annual Giv ing Campaign with my pledge of :

[ ] President’s Circle = $5,000 or more [ ] Eagle = $2,500 - $4,999 [ ] Centurion = $1,000 - $2,499[ ] Gold Partner = $500 - $999 [ ] Silver Partner = $250 - $499 [ ] Bronze Partner = $100 - $249[ ] Partner = $____ - $99

Name (Please Print): ____________________________________________________________________________________________________ Company (if applicable): ______________________________________________________________________________________Address: _____________________________________________________________________________________________________________ City: ______________________________________________________________________ ST _________ Zip _________________ Telephone: (_____) ___________________ Email: __________________________________________________________

[ ] Please check here if you prefer to be listed as an Anonymous contributor. Please indicate if you would like to make your donation a gift “In Memory or Honor of.” If so, please provide name and address where the gift card/notification should be sent:

(Please Print) [ ] In Memory of _______________________________________________________________________________ [ ] In Honor of _________________________________________________________________________________

Send notification to: __________________________________________________________________________________________ Address: __________________________________________________________________________________________ __________________________________________________________________________________________

DON’T FORGET, you can also make your gift online at WWW.GPHA.ORG.

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

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

Please circle one: AmEx Visa M/C Disc.) Card #:_____________________________________________ Security #: _____ Exp.Date: _____If name on credit card and/or the billing address are different from above, please provide that information below:

Name ______________________________________________________________________________________________________________________

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

Signature: ________________________________________________________________________ Today’s Date: ______________

50 LENOX POINTE, NE ATLANTA, GA 30324

404.231.5074 WWW.GPHA.ORG

Page 18: December 2012 GPhA Journal

16 Th e Georgia Pharmacy Journal

Join Us For VIP Day

Th ursday, February 14, 2013

Th e Georgia Railroad Freight Depot - Freight Room (Across from the Capitol Building)

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

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

6:00 am - Registration and Exhibit Hall Opens with Coff ee 6:30 am - GPhA Attendee Orientation

7:00 am - Breakfast with Your Legislator(s) 8:00 am - Presentation of GPhA Legislator of the Year Award and Closing Remarks

9:15 am - Group Photo on the Capitol Steps 10:00 am - Tour of the Georgia Capitol Building

Special GPhA Recognitions to Be Made by Georgia House and Senate Members Plan to wear white coat and make your presence known at the Capitol. Parking directions available online.

Registration Coming Soon!

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

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

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

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

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

Generation Rx Champions AwardTh is award is presented annually to a pharmacist who has demonstrated work with prescription drug abuse. Th is award gives honor the recipient with a plaque and a $500 to the charity of the recipients choice.Selection Criteria: 1) Nominee must a have demonstrated a committed eff ort to reduce prescription drug abuse2) Nominee must be a licensed Georgia Pharmacist.3) Nominee must be a member of the Georgia Pharmacy Association in the year of the selection.

2013 Awards Nomination FormBowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Generation Rx Champions

Nominee’s Full Name Nickname Home Address City State Zip Practice Site Work Address City State Zip College/School of Pharmacy List of professional activities, state/national pharmacy organization affi liations, and/or local civic church activities:

Supporting information:

Submitted by (optional):

Submit this form completed by March 1, 2013 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324

or complete this form online at www.gpha.org.

Page 19: December 2012 GPhA Journal

16 Th e Georgia Pharmacy Journal

Join Us For VIP Day

Th ursday, February 14, 2013

Th e Georgia Railroad Freight Depot - Freight Room (Across from the Capitol Building)

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

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

6:00 am - Registration and Exhibit Hall Opens with Coff ee 6:30 am - GPhA Attendee Orientation

7:00 am - Breakfast with Your Legislator(s) 8:00 am - Presentation of GPhA Legislator of the Year Award and Closing Remarks

9:15 am - Group Photo on the Capitol Steps 10:00 am - Tour of the Georgia Capitol Building

Special GPhA Recognitions to Be Made by Georgia House and Senate Members Plan to wear white coat and make your presence known at the Capitol. Parking directions available online.

Registration Coming Soon!

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

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

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

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

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

Generation Rx Champions AwardTh is award is presented annually to a pharmacist who has demonstrated work with prescription drug abuse. Th is award gives honor the recipient with a plaque and a $500 to the charity of the recipients choice.Selection Criteria: 1) Nominee must a have demonstrated a committed eff ort to reduce prescription drug abuse2) Nominee must be a licensed Georgia Pharmacist.3) Nominee must be a member of the Georgia Pharmacy Association in the year of the selection.

2013 Awards Nomination FormBowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Generation Rx Champions

Nominee’s Full Name Nickname Home Address City State Zip Practice Site Work Address City State Zip College/School of Pharmacy List of professional activities, state/national pharmacy organization affi liations, and/or local civic church activities:

Supporting information:

Submitted by (optional):

Submit this form completed by March 1, 2013 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324

or complete this form online at www.gpha.org.

Page 20: December 2012 GPhA Journal

18 The Georgia Pharmacy Journal 19The Georgia Pharmacy Journal

Diamond Level$4,800 minimum pledgeCynthia K. Moon

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

Platinum Level$1,200 minimum pledgeRalph W. Balchin, R.Ph.Robert Bowles, Jr., R.Ph.,CDM, CftsJim R. BracewellThomas E. Bryan Jr., R.Ph.William G. Cagle, R.Ph.Hugh M. Chancy, R.Ph.Keith E. Chapman, R.Ph.Dale M. Coker, R.Ph., FIACPJohn Ashley Dukes, R.Ph.Jack Dunn, Jr. R.Ph.

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

Gold Level$600 minimum pledgeJames Bartling, Pharm.D.,ADC, CACIIWilliam F. Brewster, R.Ph.Bruce L. Broadrick, Sr., R.Ph.Liza G. Chapman, Pharm.D.

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

Silver Level$300 minimum pledgeRenee D. Adamson, Pharm.D.Ed Stevens Dozier, R.Ph.Terry Dunn, R.Ph.Charles Alan Earnest, R.Ph.Marshall L. Frost, Pharm.D.Johnathan Wyndell Hamrick, Pharm.D.James A. Harris, Jr., R.Ph.

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

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

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

MembersNo minimum pledgeG.M. Atkinson, R.Ph.

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

Thanks To All Our SupportersNew Contributors are Highlighted in Yellow.

Page 21: December 2012 GPhA Journal

18 The Georgia Pharmacy Journal 19The Georgia Pharmacy Journal

Diamond Level$4,800 minimum pledgeCynthia K. Moon

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

Platinum Level$1,200 minimum pledgeRalph W. Balchin, R.Ph.Robert Bowles, Jr., R.Ph.,CDM, CftsJim R. BracewellThomas E. Bryan Jr., R.Ph.William G. Cagle, R.Ph.Hugh M. Chancy, R.Ph.Keith E. Chapman, R.Ph.Dale M. Coker, R.Ph., FIACPJohn Ashley Dukes, R.Ph.Jack Dunn, Jr. R.Ph.

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

Gold Level$600 minimum pledgeJames Bartling, Pharm.D.,ADC, CACIIWilliam F. Brewster, R.Ph.Bruce L. Broadrick, Sr., R.Ph.Liza G. Chapman, Pharm.D.

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

Silver Level$300 minimum pledgeRenee D. Adamson, Pharm.D.Ed Stevens Dozier, R.Ph.Terry Dunn, R.Ph.Charles Alan Earnest, R.Ph.Marshall L. Frost, Pharm.D.Johnathan Wyndell Hamrick, Pharm.D.James A. Harris, Jr., R.Ph.

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

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

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

MembersNo minimum pledgeG.M. Atkinson, R.Ph.

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

Thanks To All Our SupportersNew Contributors are Highlighted in Yellow.

Page 22: December 2012 GPhA Journal

Association Plans Are DIFFERENT (between ordinary and extraordinary)

Experience the difference with us...

Chosen by your associationAM Best “A” rating

Dividend plans for members*Superior claims handling

Personal customer service representativeFree Safety Gear Package

Free Safety Meeting Library CDAccess to Loss Control Services and much more!

Put our expertise to work for you!

*Members must meet eligibility requirements

Georgia Pharmacy Associationproudly sponsors

Meadowbrook Insurance Group for your Worker’s Compensation

insurance needs.

For more information about this program, please contact:

Ruth Ann McGeheep 404-419-8173 f 404-237-8435

email: [email protected]

10% Workers’ Compensation dividends paid to GPhA

members in 2012

21The Georgia Pharmacy Journal

Mona T. Thompson, R.Ph., PharmD

continuing educat ion for pharmacists

Adult Community-Acquired PneumoniaVolume XXX, No. 10

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

Goal. The goal of this lesson is to provide a review of adult commu-nity-acquired pneumonia (CAP) to include a disease state overview, outpatient treatment recommen-dations, and vaccine prevention information.

Objectives. At the completion of this activity, the participant will be able to:

1. demonstrate an understand-ing of basic pathophysiology of pneumonia and the pathogens that are most often responsible for CAP;

2. list antibiotics prescribed for empiric outpatient treatment of CAP; and identify key patient counseling points associated with them;

3. recognize measures that may be taken to reduce the risk of pneumonia, including vaccines; and

4. compare and contrast pneu-mococcal vaccines and recommen-dations for use in adults.

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

48 hours before the development of respiratory symptoms, because it is likely that pathogen exposure occurred prior to admission. The other two types of pneumonia are considered to be hospital-acquired. Healthcare-associated pneumonia (HCAP) is reserved for patients who have been previously hospital-ized for at least two days within 90 days before infection; patients from nursing homes who received intra-venous antibiotic therapy, chemo-therapy, or wound care within the past 30 days; and patients from he-modialysis centers. The third type, ventilator-associated pneumonia (VAP), is designated for patients who develop disease more than 48 hours after placement of endotra-cheal intubation and mechanical ventilation. The remainder of this lesson will focus on adult CAP and outpatient management. EpidemiologyCommunity-acquired pneumonia is the seventh leading cause of death in the U.S., as well as the leading cause of death from infectious dis-ease. Most cases of CAP are man-aged in the outpatient setting. Mor-tality rates range from less than 5 percent in mild cases to greater than 12 percent in hospitalized pa-tients. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia, and more than 50,000 people died from the disease. The majority of these deaths occurred in elderly or immunosuppressed patients.

The incidence of pneumonia is expected to increase as the percent-age of the population older than

age 65 years continues to rise. The number of individuals taking im-munosuppressive drugs is also on the rise and contributory. PathophysiologyHealthy lungs are extremely resistant to infection and virtually sterile due to numerous innate host defenses. This is evident as approximately 10,000 liters of air containing hundreds to thousands of microorganisms per cubic meter pass through the respiratory tract daily and fail to cause disease. Host defenses include an epithelial barrier and cough and laryngeal re-flexes that prevent the introduction of pathogens, as well as phagocytes that respond by removing patho-gens and their products from the lungs.

The development of clini-cal pneumonia requires a failure in host defenses, along with the presence of virulent organisms, followed by the introduction of these organisms into the lungs. If the infectious organism reaches the alveoli and begins replicating, a series of host immune responses occurs that lead to the development of clinical pneumonia. In patients who have weak host defenses, only a minimal challenge is needed to develop pneumonia.

Microaspiration of oropharyn-geal contents during sleep, in otherwise healthy individuals, is a common mechanism for inoculating the lungs with pathogenic organ-isms. Streptococcus pneumoniae is the most common aerobic organ-ism found in the mouth. It is often colonized in the oral pharynx and, thus, has the potential to infect the lungs. S. pneumoniae is the most

Page 23: December 2012 GPhA Journal

Association Plans Are DIFFERENT (between ordinary and extraordinary)

Experience the difference with us...

Chosen by your associationAM Best “A” rating

Dividend plans for members*Superior claims handling

Personal customer service representativeFree Safety Gear Package

Free Safety Meeting Library CDAccess to Loss Control Services and much more!

Put our expertise to work for you!

*Members must meet eligibility requirements

Georgia Pharmacy Associationproudly sponsors

Meadowbrook Insurance Group for your Worker’s Compensation

insurance needs.

For more information about this program, please contact:

Ruth Ann McGeheep 404-419-8173 f 404-237-8435

email: [email protected]

10% Workers’ Compensation dividends paid to GPhA

members in 2012

21The Georgia Pharmacy Journal

Mona T. Thompson, R.Ph., PharmD

continuing educat ion for pharmacists

Adult Community-Acquired PneumoniaVolume XXX, No. 10

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

Goal. The goal of this lesson is to provide a review of adult commu-nity-acquired pneumonia (CAP) to include a disease state overview, outpatient treatment recommen-dations, and vaccine prevention information.

Objectives. At the completion of this activity, the participant will be able to:

1. demonstrate an understand-ing of basic pathophysiology of pneumonia and the pathogens that are most often responsible for CAP;

2. list antibiotics prescribed for empiric outpatient treatment of CAP; and identify key patient counseling points associated with them;

3. recognize measures that may be taken to reduce the risk of pneumonia, including vaccines; and

4. compare and contrast pneu-mococcal vaccines and recommen-dations for use in adults.

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

48 hours before the development of respiratory symptoms, because it is likely that pathogen exposure occurred prior to admission. The other two types of pneumonia are considered to be hospital-acquired. Healthcare-associated pneumonia (HCAP) is reserved for patients who have been previously hospital-ized for at least two days within 90 days before infection; patients from nursing homes who received intra-venous antibiotic therapy, chemo-therapy, or wound care within the past 30 days; and patients from he-modialysis centers. The third type, ventilator-associated pneumonia (VAP), is designated for patients who develop disease more than 48 hours after placement of endotra-cheal intubation and mechanical ventilation. The remainder of this lesson will focus on adult CAP and outpatient management. EpidemiologyCommunity-acquired pneumonia is the seventh leading cause of death in the U.S., as well as the leading cause of death from infectious dis-ease. Most cases of CAP are man-aged in the outpatient setting. Mor-tality rates range from less than 5 percent in mild cases to greater than 12 percent in hospitalized pa-tients. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia, and more than 50,000 people died from the disease. The majority of these deaths occurred in elderly or immunosuppressed patients.

The incidence of pneumonia is expected to increase as the percent-age of the population older than

age 65 years continues to rise. The number of individuals taking im-munosuppressive drugs is also on the rise and contributory. PathophysiologyHealthy lungs are extremely resistant to infection and virtually sterile due to numerous innate host defenses. This is evident as approximately 10,000 liters of air containing hundreds to thousands of microorganisms per cubic meter pass through the respiratory tract daily and fail to cause disease. Host defenses include an epithelial barrier and cough and laryngeal re-flexes that prevent the introduction of pathogens, as well as phagocytes that respond by removing patho-gens and their products from the lungs.

The development of clini-cal pneumonia requires a failure in host defenses, along with the presence of virulent organisms, followed by the introduction of these organisms into the lungs. If the infectious organism reaches the alveoli and begins replicating, a series of host immune responses occurs that lead to the development of clinical pneumonia. In patients who have weak host defenses, only a minimal challenge is needed to develop pneumonia.

Microaspiration of oropharyn-geal contents during sleep, in otherwise healthy individuals, is a common mechanism for inoculating the lungs with pathogenic organ-isms. Streptococcus pneumoniae is the most common aerobic organ-ism found in the mouth. It is often colonized in the oral pharynx and, thus, has the potential to infect the lungs. S. pneumoniae is the most

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22 The Georgia Pharmacy Journal 23The Georgia Pharmacy Journal

Table 1Most common etiologies of

community-acquired pneumonia*Patient Population Etiology

Outpatient Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydophila pneumoniae Respiratory viruses** Inpatient (non-ICU) Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydophila pneumoniae Haemophilus influenzae Legionella species Aspiration Respiratory viruses**

Inpatient (ICU) Streptococcus pneumoniae Staphylococcus aureus Legionella species Gram-negative bacilli Haemophilus influenzae

*listed by decreasing frequency of occurrence**Influenza A and B, adenovirus, RSV, and parainfluenza From IDSA/ATS Guidelines for CAP in Adults 2007

common blood culture isolate in all CAP studies. Staphylococci, Hae-mophilus sp, Moraxella catarrhalis, and Neisseria sp are also aerobic organisms found in the mouth. Bacteroides and Fusobacterium spp are the most common anaerobic organisms.

Alternatively, gross aspiration may occur in patients with altered levels of consciousness (i.e., intoxi-cation, stroke, seizure, and anes-thesia) due to suppressed protec-tive airway reflexes. Interventions that bypass the usual defenses, such as endotracheal intubation, nasogastric intubation, and respi-ratory therapy devices, also predis-pose the lower tract to infection.

Hospitalized patients with severe CAP are more likely to be infected with pathogens other than S. pneumoniae, including S. aureus, P. aeruginosa, and other gram-negative bacilli.

The second most common mechanism for lung infections is the inhalation of small aero-solized droplets that may contain

microorganisms. These pathogens include Mycobacte-rium tuberculosis, Legionella pneu-mophila, Yersinia pestis (plague), and Bacillus anthracis (anthrax). Viral pneumonia is also transmitted in this way. The pre-dominant respira-tory viruses include various influenza viruses and respira-tory syncytial virus (RSV). In addition, viral infections of the respiratory tract may destroy the epithelial barrier and predispose the lungs to secondary bacterial infection. The increased risk of bacterial pneumonia following influenza infection is well es-

tablished. (See Table 1.)There are also specific epidemi-

ologic conditions and/or risk factors that have been found to be related to specific pathogens in CAP. For instance, patients with alcohol-ism are commonly infected with S. pneumoniae, oral anaerobes, Klebsiella pneumoniae, Acineto-bacter species, and Mycobacterium tuberculosis. Pathogens associated with patients who smoke or have COPD are Haemophilus influenzae, Pseudomonas aeruginosa, Legionel-la species, S. pneumoniae, Moraxel-la catarrhalis, and Chlamydophila pneumoniae. Correlations have also been made in patients with HIV, recent travel, or exposure to certain animals (e.g., bats, birds, rabbits, or other farm animals).

Symptoms and Diagnosis of Pneumonia The classical symptoms seen with acute CAP are cough, dyspnea and fever. Other symptoms include sputum production and pleuritic chest pain. In addition to sugges-tive clinical features, an infiltrate

by chest radiograph or other imaging technique is needed to confirm a diagnosis of pneumonia. Upon physical examination, rales or bronchial breath sounds may be heard, but are not specific to a diagnosis of pneumonia. Elderly patients often present with confu-sion and nonspecific findings.

Additional diagnostic testing such as blood and sputum cultures is optional when treating outpa-tients. However, guidelines estab-lished by the Infectious Diseases Society of America (IDSA)/Ameri-can Thoracic Society (ATS) specify testing to be conducted in hospital-ized patients, and is most strongly indicated in those with severe CAP.

Testing for influenza is logical when the symptoms are present during the proper season and in the company of an epidemic. Influ-enza testing is justifiable consid-ering availability of point of care diagnostic testing and antiviral therapies.

Clinicians utilize the initial as-sessment of the severity of disease to consider whether the patient diagnosed with CAP should be treated as an outpatient or inpa-tient. Tools such as the CURB-65 (confusion, uremia, respiratory rate, low blood pressure, and 65 years or greater) or Pneumonia Severity Index (PSI) can be used to identify patients who are candi-dates for outpatient treatment. In addition to these objective mea-surement tools, physicians consid-ering outpatient treatment must also consider the patient’s ability to take oral medication and the availability of outpatient support resources.

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

Table 2Empirical outpatient

treatment of CAP*

Previously healthy and no risk fac-tors for DRSP infection: 1. A macrolide (azithromycin, clarithromycin, or erythromycin) or 2. Doxycycline Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcohol-ism; malignancies; asplenia; im-munosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous three months (in which case an alter-native from a different class should be selected); or other risk factors for DRSP infection: 1. A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levo-floxacin 750mg) or 2. A beta-lactam plus a macrolide (amoxicillin 1 gram three times a day or amoxicillin-clavulanate 2 grams two times a day is preferred; alterna-tives include ceftriaxone, cefpodoxi-me, and cefuroxime). Doxycycline is an alternative to the macrolide.

*Chart adapted from IDSA/ATS Guidelines for CAP in Adults 2007

one drug. For outpatient CAP, the recom-

mendations were established based on the presence or absence of drug resistant S. pneumoniae (DRSP). While drug-resistant pneumococ-cal isolates are well documented, the resistance patterns vary by geography. Therefore, practitio-ners should be aware of their local resistance patterns when select-ing antibiotic therapy. In addition, in this 2007 guideline document, IDSA/ATS state that resistance to penicillin and cephalosporins may be decreasing, while macrolide resistance continues to rise.

In regions with a high rate (>25 percent) of infection with high-level (MIC>16 mcg/mL) macrolide-resis-tant S. pneumoniae, the alternative agents are recommended for all patients, including those who do not have comorbidities.

According to the IDSA/ATS

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

Review of Select Antibiotics Commonly Prescribed for the Treatment of CAP Macrolides are commonly pre-scribed for CAP due to their activ-ity against S. pneumoniae and the atypical pathogens (M. pneumo-niae, C. pneumoniae, Legionella pneumophila). This class includes erythromycin, clarithromycin, and azithromycin. Erythromycin is the least expensive, but is not often used due to gastrointestinal intolerance and lack of activity against H. influenzae. Azithromy-cin is preferred for outpatients with comorbidities such as COPD because of its activity against H. influenzae. All three antibiotics in this class have been associated with QT prolongation and should be used with caution in patients with an increased risk of arrhyth-mia or taking multiple medications that can prolong the QT interval.

For CAP, azithromycin is commonly prescribed as a Z-pak® which is a regimen consisting of 500mg on day 1, followed by 250mg on days 2 to 5. Alternatively, ex-tended-release suspension formula-tion (Zmax®) is also approved as a 2 gram single dose. While the 250mg and 500mg tablets are

bioequivalent and interchange-able, the 2 gram extended-release suspension is not, and should not be substituted for tablets. The tab-lets may be administered without regard to food. The oral suspension should be taken on an empty stom-ach (at least one hour before or two hours following a meal). Azithro-mycin does not generally require dosing adjustments in the presence of renal impairment. Specific guide-lines are not available for dosing in hepatic impairment; however, rare hepatotoxicity has occurred. It is classified as pregnancy Cat-egory B. Azithromycin does enter breastmilk and should be used with caution. Limited literature reports indicate that the amount excreted is minimal and has not resulted in adverse events.

The recommended regimen for clarithromycin (Biaxin®) when treating CAP due to C. pneumoni-ae, M. pneumoniae, and S. pneumo-niae is 250mg (immediate-release tablet) every 12 hours for seven to 14 days or 1000mg (extended-release tablet) once daily for seven days. For H. influenzae, either formulation may be used and treatment is needed for seven days only. When treating H. parainflu-enzae and M. catarrhalis, 1000mg (extended-release tablet) once daily for seven days is approved. The immediate-release tablets and oral suspension may be given with or without food, and should be given every 12 hours rather than twice daily to avoid peak and trough concentration variations. The extended-release tablets should be given with food, and should not be crushed or chewed. Renal dosing adjustments are required when the creatinine clearance (CrCl) is <30mL/min (or less than 60mL/min when given in combination with atazanavir or ritonavir). Clarithro-mycin is a strong CYP3A4 inhibitor and has several major drug in-teractions rendering a thorough medication profile review when it is prescribed. It is classified as preg-nancy Category C, and should be used with caution with breastfeed-ing as excretion is unknown.

Continuing Education Continuing Education

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22 The Georgia Pharmacy Journal 23The Georgia Pharmacy Journal

Table 1Most common etiologies of

community-acquired pneumonia*Patient Population Etiology

Outpatient Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydophila pneumoniae Respiratory viruses** Inpatient (non-ICU) Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydophila pneumoniae Haemophilus influenzae Legionella species Aspiration Respiratory viruses**

Inpatient (ICU) Streptococcus pneumoniae Staphylococcus aureus Legionella species Gram-negative bacilli Haemophilus influenzae

*listed by decreasing frequency of occurrence**Influenza A and B, adenovirus, RSV, and parainfluenza From IDSA/ATS Guidelines for CAP in Adults 2007

common blood culture isolate in all CAP studies. Staphylococci, Hae-mophilus sp, Moraxella catarrhalis, and Neisseria sp are also aerobic organisms found in the mouth. Bacteroides and Fusobacterium spp are the most common anaerobic organisms.

Alternatively, gross aspiration may occur in patients with altered levels of consciousness (i.e., intoxi-cation, stroke, seizure, and anes-thesia) due to suppressed protec-tive airway reflexes. Interventions that bypass the usual defenses, such as endotracheal intubation, nasogastric intubation, and respi-ratory therapy devices, also predis-pose the lower tract to infection.

Hospitalized patients with severe CAP are more likely to be infected with pathogens other than S. pneumoniae, including S. aureus, P. aeruginosa, and other gram-negative bacilli.

The second most common mechanism for lung infections is the inhalation of small aero-solized droplets that may contain

microorganisms. These pathogens include Mycobacte-rium tuberculosis, Legionella pneu-mophila, Yersinia pestis (plague), and Bacillus anthracis (anthrax). Viral pneumonia is also transmitted in this way. The pre-dominant respira-tory viruses include various influenza viruses and respira-tory syncytial virus (RSV). In addition, viral infections of the respiratory tract may destroy the epithelial barrier and predispose the lungs to secondary bacterial infection. The increased risk of bacterial pneumonia following influenza infection is well es-

tablished. (See Table 1.)There are also specific epidemi-

ologic conditions and/or risk factors that have been found to be related to specific pathogens in CAP. For instance, patients with alcohol-ism are commonly infected with S. pneumoniae, oral anaerobes, Klebsiella pneumoniae, Acineto-bacter species, and Mycobacterium tuberculosis. Pathogens associated with patients who smoke or have COPD are Haemophilus influenzae, Pseudomonas aeruginosa, Legionel-la species, S. pneumoniae, Moraxel-la catarrhalis, and Chlamydophila pneumoniae. Correlations have also been made in patients with HIV, recent travel, or exposure to certain animals (e.g., bats, birds, rabbits, or other farm animals).

Symptoms and Diagnosis of Pneumonia The classical symptoms seen with acute CAP are cough, dyspnea and fever. Other symptoms include sputum production and pleuritic chest pain. In addition to sugges-tive clinical features, an infiltrate

by chest radiograph or other imaging technique is needed to confirm a diagnosis of pneumonia. Upon physical examination, rales or bronchial breath sounds may be heard, but are not specific to a diagnosis of pneumonia. Elderly patients often present with confu-sion and nonspecific findings.

Additional diagnostic testing such as blood and sputum cultures is optional when treating outpa-tients. However, guidelines estab-lished by the Infectious Diseases Society of America (IDSA)/Ameri-can Thoracic Society (ATS) specify testing to be conducted in hospital-ized patients, and is most strongly indicated in those with severe CAP.

Testing for influenza is logical when the symptoms are present during the proper season and in the company of an epidemic. Influ-enza testing is justifiable consid-ering availability of point of care diagnostic testing and antiviral therapies.

Clinicians utilize the initial as-sessment of the severity of disease to consider whether the patient diagnosed with CAP should be treated as an outpatient or inpa-tient. Tools such as the CURB-65 (confusion, uremia, respiratory rate, low blood pressure, and 65 years or greater) or Pneumonia Severity Index (PSI) can be used to identify patients who are candi-dates for outpatient treatment. In addition to these objective mea-surement tools, physicians consid-ering outpatient treatment must also consider the patient’s ability to take oral medication and the availability of outpatient support resources.

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

Table 2Empirical outpatient

treatment of CAP*

Previously healthy and no risk fac-tors for DRSP infection: 1. A macrolide (azithromycin, clarithromycin, or erythromycin) or 2. Doxycycline Presence of comorbidities, such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcohol-ism; malignancies; asplenia; im-munosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous three months (in which case an alter-native from a different class should be selected); or other risk factors for DRSP infection: 1. A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levo-floxacin 750mg) or 2. A beta-lactam plus a macrolide (amoxicillin 1 gram three times a day or amoxicillin-clavulanate 2 grams two times a day is preferred; alterna-tives include ceftriaxone, cefpodoxi-me, and cefuroxime). Doxycycline is an alternative to the macrolide.

*Chart adapted from IDSA/ATS Guidelines for CAP in Adults 2007

one drug. For outpatient CAP, the recom-

mendations were established based on the presence or absence of drug resistant S. pneumoniae (DRSP). While drug-resistant pneumococ-cal isolates are well documented, the resistance patterns vary by geography. Therefore, practitio-ners should be aware of their local resistance patterns when select-ing antibiotic therapy. In addition, in this 2007 guideline document, IDSA/ATS state that resistance to penicillin and cephalosporins may be decreasing, while macrolide resistance continues to rise.

In regions with a high rate (>25 percent) of infection with high-level (MIC>16 mcg/mL) macrolide-resis-tant S. pneumoniae, the alternative agents are recommended for all patients, including those who do not have comorbidities.

According to the IDSA/ATS

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

Review of Select Antibiotics Commonly Prescribed for the Treatment of CAP Macrolides are commonly pre-scribed for CAP due to their activ-ity against S. pneumoniae and the atypical pathogens (M. pneumo-niae, C. pneumoniae, Legionella pneumophila). This class includes erythromycin, clarithromycin, and azithromycin. Erythromycin is the least expensive, but is not often used due to gastrointestinal intolerance and lack of activity against H. influenzae. Azithromy-cin is preferred for outpatients with comorbidities such as COPD because of its activity against H. influenzae. All three antibiotics in this class have been associated with QT prolongation and should be used with caution in patients with an increased risk of arrhyth-mia or taking multiple medications that can prolong the QT interval.

For CAP, azithromycin is commonly prescribed as a Z-pak® which is a regimen consisting of 500mg on day 1, followed by 250mg on days 2 to 5. Alternatively, ex-tended-release suspension formula-tion (Zmax®) is also approved as a 2 gram single dose. While the 250mg and 500mg tablets are

bioequivalent and interchange-able, the 2 gram extended-release suspension is not, and should not be substituted for tablets. The tab-lets may be administered without regard to food. The oral suspension should be taken on an empty stom-ach (at least one hour before or two hours following a meal). Azithro-mycin does not generally require dosing adjustments in the presence of renal impairment. Specific guide-lines are not available for dosing in hepatic impairment; however, rare hepatotoxicity has occurred. It is classified as pregnancy Cat-egory B. Azithromycin does enter breastmilk and should be used with caution. Limited literature reports indicate that the amount excreted is minimal and has not resulted in adverse events.

The recommended regimen for clarithromycin (Biaxin®) when treating CAP due to C. pneumoni-ae, M. pneumoniae, and S. pneumo-niae is 250mg (immediate-release tablet) every 12 hours for seven to 14 days or 1000mg (extended-release tablet) once daily for seven days. For H. influenzae, either formulation may be used and treatment is needed for seven days only. When treating H. parainflu-enzae and M. catarrhalis, 1000mg (extended-release tablet) once daily for seven days is approved. The immediate-release tablets and oral suspension may be given with or without food, and should be given every 12 hours rather than twice daily to avoid peak and trough concentration variations. The extended-release tablets should be given with food, and should not be crushed or chewed. Renal dosing adjustments are required when the creatinine clearance (CrCl) is <30mL/min (or less than 60mL/min when given in combination with atazanavir or ritonavir). Clarithro-mycin is a strong CYP3A4 inhibitor and has several major drug in-teractions rendering a thorough medication profile review when it is prescribed. It is classified as preg-nancy Category C, and should be used with caution with breastfeed-ing as excretion is unknown.

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Doxycycline is a cost-effective alternative to a macrolide and is prescribed as 100mg twice daily. When administered with food, absorption may be decreased by up to 20 percent, but administra-tion on an empty stomach is not recommended due to gastrointes-tinal intolerance. Doxycycline is classified as pregnancy Category D (may cause fetal harm), and is not recommended with breastfeeding. Patients should be advised to avoid prolonged exposure to sunlight or use of tanning beds since photosen-sitivity reactions may occur. Renal dosing adjustments are not neces-sary.

Amoxicillin, a beta-lactam antibiotic, is dosed at 1 gram three times a day when treating CAP. It may be taken with food, and should be administered every eight hours to reduce fluctuations in the peak and trough concentrations. Renal dosing adjustments are necessary with CrCl <30mL/min. It is clas-sified as pregnancy Category B, and is considered compatible with breastfeeding by the American Academy of Pediatrics (AAP) and World Health Organization (WHO). While a minimal amount is ex-creted into breastmilk, the concen-tration is not considered clinically significant.

The recommended dose of amoxicillin-clavulanate (Aug-mentin®) for CAP is 2 grams (ex-tended-release tablet) orally every 12 hours for seven to 10 days. The extended-release tablet should be taken with food to increase absorp-tion and minimize stomach upset. It should not be used in patients with CrCl <30mL/min. Similar to amoxicillin, it is classified as pregnancy Category B, and is con-sidered compatible with breastfeed-ing according to WHO. However, infants should be monitored for dose-dependent gastrointestinal side effects (thrush, diarrhea) or allergic reactions.

Cefpodoxime (Vantin®) is a third generation cephalosporin. The recommended dose is 200mg orally every 12 hours for 14 days, and may be taken with food. In

patients with CrCl <30mL/min, the medication should be reduced to 200mg every 24 hours. It is classi-fied as pregnancy Category B, and is not recommended with breast-feeding as small amounts of drug are excreted into milk and infant risk has not been ruled out.

Cefdinir (Omnicef®), also a third generation cephalosporin, is prescribed as 300mg twice daily (every 12 hours) for 10 days. Cef-dinir may be administered with or without food. The manufacturer recommends that it be separated from antacids or iron supplements by two hours. In patients with CrCl <30mL/min, the dose is reduced to 300mg once daily. No adjustments are required in the presence of hepatic impairment. It is classi-fied as pregnancy Category B, and the excretion into breast milk is unknown.

Cefuroxine (Ceftin®) is a sec-ond generation cephalosporin that has been effective in treating CAP. It is dosed at 500mg twice daily. Renal dosing adjustments are nec-essary when the CrCl is less than 10mL/min. It is also classified as pregnancy Category B. It has been found to enter into breastmilk and should be used with caution.

The respiratory fluoroqui-nolones that are recommended for CAP include moxifloxacin, gemifloxacin, and levofloxacin. All three of these have also been associated with QT prolongation, tendon inflammation and/or tendon rupture, and the development of serious hypoglycemia. They are all classified as pregnancy Category C, and are not recommended with breastfeeding.

Moxifloxacin (Avelox®) is prescribed as 400mg orally once daily for seven to 14 days. It may be taken without regard to food, but should be given either four hours before or eight hours after products containing magnesium, aluminum, iron, or zinc. Renal and hepatic dosage adjustments are not necessary. Caution should be exercised in patients with hepatic impairment due to the risk of QT prolongation.

Gemifloxacin (Factive®) is dosed as 320mg orally once daily for five to seven days (seven days recommended for multi-drug re-sistant S. pneumoniae (MDRSP), K. pneumoniae, or M. catarrha-lis). Patients with CrCl <40mL/min or on dialysis should receive only 160mg once daily. No dosage adjustments are required in the presence of hepatic impairment. Gemifloxacin may be taken with or without food, milk, or calcium supplements. It should be taken three hours before or two hours after supplements containing iron, zinc, or magnesium.

Levofloxacin (Levaquin®) for CAP may be prescribed as 500mg every 24 hours for seven to 14 days, or 750mg every 24 hours for five days (five-day regimen for MDRSP not established). Product information should be referred to for renal dosing recommendations when CrCl <50mL/min. Levofloxa-cin tablets may be taken without regard to meals. It should be taken two hours before or two hours after products containing magnesium, aluminum, iron, or zinc.

The use of fluoroquinolones to treat outpatients without comorbid conditions or risk factors for DRSP is discouraged due to concern that widespread use may lead to the development of resistance. Many trials and meta-analyses have been conducted comparing fluoroquino-lones to standard antibiotics which have resulted in either non-com-pelling superiority or inconsistent data. Therefore, it is suggested that antibiotic selection be based on side-effects, patient preferences, availability, and cost.

Telithromycin (Ketek®) is the first of the ketolide antibiotics, which is derived from the mac-rolide family. It is active against S. pneumoniae that is resistant to other antibiotics often used for CAP. Trials have demonstrated equivalency to amoxicillin and clarithromycin. However, it has been associated with postmarket-ing reports of life-threatening hepatotoxicity. This antibiotic was not included in the IDSA/

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

Prevention of Pneumonia Several measures may be taken to reduce the risk of lung infection. These include smoking cessation; avoidance of illicit drugs or excess alcohol consumption (may impair consciousness); and optimizing nutritional status, as distinctly underweight or obese patients are also at an increased risk. Follow-ing good hygiene practices, such as hand washing, cleaning of surfaces that are touched often, and cough-ing or sneezing into a tissue or into an elbow or sleeve can also help prevent the spread of respiratory infections. Preventing and treating chronic conditions such as diabe-tes and HIV/AIDS can also reduce pneumonia risk.

In the U.S., there are several vaccines available that prevent bacterial or viral infections that may cause pneumonia. While the remainder of this lesson will focus on the pneumococcal vaccine, other vaccines include influenza (flu), H. influenzae (Hib), pertussis (whoop-ing cough), varicella (chickenpox), and measles.

Pneumococcal Disease Vaccine Prevention In addition to pneumococcal pneu-monia (caused by Streptococcus pneumoniae), this bacterium is also

capable of causing invasive disease such as meningitis or bacteremia. Bacteremia occurs in 25 to 30 percent of patients with pneumo-coccal pneumonia. Pneumococci cause 13 to 19 percent of all cases of bacterial meningitis in the U.S. While there are over 90 serotypes of pneumococci, the 10 most com-mon types cause over 60 percent of invasive disease. Some pneumococ-ci are encapsulated with a complex polysaccharide surface enabling them to be pathogenic to humans. Protective type specific antibodies are produced in response to the capsular polysaccharide. These antibodies may cross-react with related types, as well as other bac-teria, providing protection against additional serotypes.

Pneumococcal Polysaccha-ride Vaccine. The pneumococcal polysaccharide vaccine (PPSV) is made of purified preparations of pneumococcal capsular. The first U.S. vaccine was licensed in 1977 and contained antigen from 14 different types of pneumococcal bacteria. In 1983, the 23-valent polysaccharide vaccine (PPSV23) was licensed and replaced the 14-valent vaccine. The U.S. vac-cine is marketed as Pneumovax®-23 by Merck and contains 25mcg of each antigen per 0.5ml dose which is administered either intramuscu-larly or subcutaneously.

More than 80 percent of healthy adults who receive PPSV23 develop antibodies against the se-rotypes within two to three weeks of vaccination. However, older adults and persons with chronic illnesses or immunodeficiency may not respond as well. The antibod-ies remain elevated in healthy adults for at least five years, but may decline faster in persons with certain underlying disease. The efficacy may vary based on under-lying illnesses, but is overall 60 to 70 percent effective in preventing invasive disease. While it provides protection from invasive pneu-monia complications, it has not demonstrated protection against pneumococcal pneumonia. Hence, it should not be referred to as the

“pneumonia vaccine.” Pneumococcal polysaccharide

vaccine is recommended for all adults who are 65-years-old and older. It is also recommended for adults age 19 years and older who smoke cigarettes; and for persons between the age of two and 64 years who have chronic illnesses specifically associated with in-creased risk from pneumococcal infection or who are candidates for or recipients of a cochlear implant. Chronic illnesses include cardiovas-cular disease, pulmonary disease (including asthma in adults age 19 years and older), diabetes mellitus, alcoholism, cirrhosis, or cerebrospi-nal fluid leaks. In addition, persons with asymptomatic or symptomatic HIV infection and immunocom-promised adults with chronic ill-nesses specifically associated with increased risk from pneumocccal infection (splenic dysfunction, ana-tomic asplenia, Hodgkin’s disease, lymphoma, multiple myeloma, chronic renal failure, nephrotic syndrome, or organ transplanta-tion) should receive the vaccine. Lastly, residents of nursing homes or long-term care facilities should also be vaccinated.

It is not recommended for patients who have recurrent acute upper respiratory tract infections such as otitis media and sinusitis. The vaccine should not be with-held if the immunization record is unobtainable or patient’s verbal history is uncertain. Persons with uncertain or unknown vaccination status should be vaccinated.

Because the relationship be-tween antibody titers and protec-tion from invasive disease is un-certain, the need for revaccination based on serology is inadequate. Also, there is lack of evidence to support improved protection with multiple doses of pneumococcal vaccine. Consequently, the Advi-sory Committee on Immunization Practices (ACIP) has established the following recommendations for revaccination: routine revaccina-tion of immunocompetent persons is not recommended; a single revac-cination five or more years after

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24 The Georgia Pharmacy Journal 25The Georgia Pharmacy Journal

Doxycycline is a cost-effective alternative to a macrolide and is prescribed as 100mg twice daily. When administered with food, absorption may be decreased by up to 20 percent, but administra-tion on an empty stomach is not recommended due to gastrointes-tinal intolerance. Doxycycline is classified as pregnancy Category D (may cause fetal harm), and is not recommended with breastfeeding. Patients should be advised to avoid prolonged exposure to sunlight or use of tanning beds since photosen-sitivity reactions may occur. Renal dosing adjustments are not neces-sary.

Amoxicillin, a beta-lactam antibiotic, is dosed at 1 gram three times a day when treating CAP. It may be taken with food, and should be administered every eight hours to reduce fluctuations in the peak and trough concentrations. Renal dosing adjustments are necessary with CrCl <30mL/min. It is clas-sified as pregnancy Category B, and is considered compatible with breastfeeding by the American Academy of Pediatrics (AAP) and World Health Organization (WHO). While a minimal amount is ex-creted into breastmilk, the concen-tration is not considered clinically significant.

The recommended dose of amoxicillin-clavulanate (Aug-mentin®) for CAP is 2 grams (ex-tended-release tablet) orally every 12 hours for seven to 10 days. The extended-release tablet should be taken with food to increase absorp-tion and minimize stomach upset. It should not be used in patients with CrCl <30mL/min. Similar to amoxicillin, it is classified as pregnancy Category B, and is con-sidered compatible with breastfeed-ing according to WHO. However, infants should be monitored for dose-dependent gastrointestinal side effects (thrush, diarrhea) or allergic reactions.

Cefpodoxime (Vantin®) is a third generation cephalosporin. The recommended dose is 200mg orally every 12 hours for 14 days, and may be taken with food. In

patients with CrCl <30mL/min, the medication should be reduced to 200mg every 24 hours. It is classi-fied as pregnancy Category B, and is not recommended with breast-feeding as small amounts of drug are excreted into milk and infant risk has not been ruled out.

Cefdinir (Omnicef®), also a third generation cephalosporin, is prescribed as 300mg twice daily (every 12 hours) for 10 days. Cef-dinir may be administered with or without food. The manufacturer recommends that it be separated from antacids or iron supplements by two hours. In patients with CrCl <30mL/min, the dose is reduced to 300mg once daily. No adjustments are required in the presence of hepatic impairment. It is classi-fied as pregnancy Category B, and the excretion into breast milk is unknown.

Cefuroxine (Ceftin®) is a sec-ond generation cephalosporin that has been effective in treating CAP. It is dosed at 500mg twice daily. Renal dosing adjustments are nec-essary when the CrCl is less than 10mL/min. It is also classified as pregnancy Category B. It has been found to enter into breastmilk and should be used with caution.

The respiratory fluoroqui-nolones that are recommended for CAP include moxifloxacin, gemifloxacin, and levofloxacin. All three of these have also been associated with QT prolongation, tendon inflammation and/or tendon rupture, and the development of serious hypoglycemia. They are all classified as pregnancy Category C, and are not recommended with breastfeeding.

Moxifloxacin (Avelox®) is prescribed as 400mg orally once daily for seven to 14 days. It may be taken without regard to food, but should be given either four hours before or eight hours after products containing magnesium, aluminum, iron, or zinc. Renal and hepatic dosage adjustments are not necessary. Caution should be exercised in patients with hepatic impairment due to the risk of QT prolongation.

Gemifloxacin (Factive®) is dosed as 320mg orally once daily for five to seven days (seven days recommended for multi-drug re-sistant S. pneumoniae (MDRSP), K. pneumoniae, or M. catarrha-lis). Patients with CrCl <40mL/min or on dialysis should receive only 160mg once daily. No dosage adjustments are required in the presence of hepatic impairment. Gemifloxacin may be taken with or without food, milk, or calcium supplements. It should be taken three hours before or two hours after supplements containing iron, zinc, or magnesium.

Levofloxacin (Levaquin®) for CAP may be prescribed as 500mg every 24 hours for seven to 14 days, or 750mg every 24 hours for five days (five-day regimen for MDRSP not established). Product information should be referred to for renal dosing recommendations when CrCl <50mL/min. Levofloxa-cin tablets may be taken without regard to meals. It should be taken two hours before or two hours after products containing magnesium, aluminum, iron, or zinc.

The use of fluoroquinolones to treat outpatients without comorbid conditions or risk factors for DRSP is discouraged due to concern that widespread use may lead to the development of resistance. Many trials and meta-analyses have been conducted comparing fluoroquino-lones to standard antibiotics which have resulted in either non-com-pelling superiority or inconsistent data. Therefore, it is suggested that antibiotic selection be based on side-effects, patient preferences, availability, and cost.

Telithromycin (Ketek®) is the first of the ketolide antibiotics, which is derived from the mac-rolide family. It is active against S. pneumoniae that is resistant to other antibiotics often used for CAP. Trials have demonstrated equivalency to amoxicillin and clarithromycin. However, it has been associated with postmarket-ing reports of life-threatening hepatotoxicity. This antibiotic was not included in the IDSA/

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

Prevention of Pneumonia Several measures may be taken to reduce the risk of lung infection. These include smoking cessation; avoidance of illicit drugs or excess alcohol consumption (may impair consciousness); and optimizing nutritional status, as distinctly underweight or obese patients are also at an increased risk. Follow-ing good hygiene practices, such as hand washing, cleaning of surfaces that are touched often, and cough-ing or sneezing into a tissue or into an elbow or sleeve can also help prevent the spread of respiratory infections. Preventing and treating chronic conditions such as diabe-tes and HIV/AIDS can also reduce pneumonia risk.

In the U.S., there are several vaccines available that prevent bacterial or viral infections that may cause pneumonia. While the remainder of this lesson will focus on the pneumococcal vaccine, other vaccines include influenza (flu), H. influenzae (Hib), pertussis (whoop-ing cough), varicella (chickenpox), and measles.

Pneumococcal Disease Vaccine Prevention In addition to pneumococcal pneu-monia (caused by Streptococcus pneumoniae), this bacterium is also

capable of causing invasive disease such as meningitis or bacteremia. Bacteremia occurs in 25 to 30 percent of patients with pneumo-coccal pneumonia. Pneumococci cause 13 to 19 percent of all cases of bacterial meningitis in the U.S. While there are over 90 serotypes of pneumococci, the 10 most com-mon types cause over 60 percent of invasive disease. Some pneumococ-ci are encapsulated with a complex polysaccharide surface enabling them to be pathogenic to humans. Protective type specific antibodies are produced in response to the capsular polysaccharide. These antibodies may cross-react with related types, as well as other bac-teria, providing protection against additional serotypes.

Pneumococcal Polysaccha-ride Vaccine. The pneumococcal polysaccharide vaccine (PPSV) is made of purified preparations of pneumococcal capsular. The first U.S. vaccine was licensed in 1977 and contained antigen from 14 different types of pneumococcal bacteria. In 1983, the 23-valent polysaccharide vaccine (PPSV23) was licensed and replaced the 14-valent vaccine. The U.S. vac-cine is marketed as Pneumovax®-23 by Merck and contains 25mcg of each antigen per 0.5ml dose which is administered either intramuscu-larly or subcutaneously.

More than 80 percent of healthy adults who receive PPSV23 develop antibodies against the se-rotypes within two to three weeks of vaccination. However, older adults and persons with chronic illnesses or immunodeficiency may not respond as well. The antibod-ies remain elevated in healthy adults for at least five years, but may decline faster in persons with certain underlying disease. The efficacy may vary based on under-lying illnesses, but is overall 60 to 70 percent effective in preventing invasive disease. While it provides protection from invasive pneu-monia complications, it has not demonstrated protection against pneumococcal pneumonia. Hence, it should not be referred to as the

“pneumonia vaccine.” Pneumococcal polysaccharide

vaccine is recommended for all adults who are 65-years-old and older. It is also recommended for adults age 19 years and older who smoke cigarettes; and for persons between the age of two and 64 years who have chronic illnesses specifically associated with in-creased risk from pneumococcal infection or who are candidates for or recipients of a cochlear implant. Chronic illnesses include cardiovas-cular disease, pulmonary disease (including asthma in adults age 19 years and older), diabetes mellitus, alcoholism, cirrhosis, or cerebrospi-nal fluid leaks. In addition, persons with asymptomatic or symptomatic HIV infection and immunocom-promised adults with chronic ill-nesses specifically associated with increased risk from pneumocccal infection (splenic dysfunction, ana-tomic asplenia, Hodgkin’s disease, lymphoma, multiple myeloma, chronic renal failure, nephrotic syndrome, or organ transplanta-tion) should receive the vaccine. Lastly, residents of nursing homes or long-term care facilities should also be vaccinated.

It is not recommended for patients who have recurrent acute upper respiratory tract infections such as otitis media and sinusitis. The vaccine should not be with-held if the immunization record is unobtainable or patient’s verbal history is uncertain. Persons with uncertain or unknown vaccination status should be vaccinated.

Because the relationship be-tween antibody titers and protec-tion from invasive disease is un-certain, the need for revaccination based on serology is inadequate. Also, there is lack of evidence to support improved protection with multiple doses of pneumococcal vaccine. Consequently, the Advi-sory Committee on Immunization Practices (ACIP) has established the following recommendations for revaccination: routine revaccina-tion of immunocompetent persons is not recommended; a single revac-cination five or more years after

Continuing Education Continuing Education

Page 28: December 2012 GPhA Journal

26 The Georgia Pharmacy Journal 27The Georgia Pharmacy Journal

Program 0129-0000-12-010-H01-PRelease date: 10-15-12

Expiration date: 10-15-15CE Hours: 1.5 (0.15 CEU)

The author, the Ohio Pharmacists Founda-tion and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the infor-mation contained herein. Bibliography for additional reading and inquiry is available upon request.

This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

the first dose is recommended for persons age two years and older who are at the highest risk of seri-ous pneumococcal infection; and persons aged 65 years and older if they received the first dose more than five years previously and were younger than 65 years of age at the time it was given.

Pneumococcal Conjugate Vaccine. The first pneumococcal conjugate vaccine (PCV7) was li-censed in the U.S. in 2000, and was comprised of purified capsular poly-saccharide of seven serotypes of S. pneumoniae conjugated to a non-toxic variant of diphtheria toxin. In 2010, Prevnar 13® (PCV13) was approved for children six weeks of age through five years as a three-dose primary series, followed by a fourth dose booster. This vaccine replaced the previous version as this product contains the same seven serotypes, in addition to six more which are all conjugated. According to 2008 data from the Active Bacterial Core Surveillance (ABCS), 61 percent of the invasive pneumococcal disease cases in children younger than five years were attributable to the serotypes in PCV13, while PCV7 serotypes caused less than 2 percent.

On December 30, 2011, the Food and Drug Administration (FDA) expanded approval of PCV13 for prevention of pneumonia and invasive disease among adults aged 50 years and older. However, it was not until June 2012 that ACIP adopted vaccination recom-mendations for PCV13 in adults. At the time of writing this lesson, however, the ACIP recommenda-tion is considered “provisional.” The recommendations will become official when published in CDC’s (Centers for Disease Control and Prevention) Morbidity and Mortal-ity Weekly Report. The proposal advises that PCV13 should be ad-ministered to adults aged 19 years or older who are at a high risk of invasive pneumococcal disease, which includes those who are im-munosuppressed. If these patients have never received a pneumococ-cal vaccine, ACIP is recommend-

ing that PCV13 be administered first, followed by PPSV eight weeks later, and then PPSV five years later. If the high risk patient has already received PPSV, providers should wait one year after the last PPSV dose before giving PCV13, to avoid interference between the vac-cines.

Pharmacists are encouraged to visit the CDC website (www.cdc.gov) for the most up-to-date information regarding PCV13 and PPSV recommendations for ini-tial and revaccination, as well as updated vaccine information sheets (VISs). Federal law requires that VISs be distributed to the adult recipient or the child’s parent/legal guardian when certain vaccines are administered.

Pfizer is conducting the Com-munity-Acquired Pneumonia Im-munization Trial in Adults (CAP-iTA), a trial involving more than 84,000 subjects, 65 years of age and older, designed to determine if PCV13 is effective in preventing the first episode of CAP caused by one of the 13 serotypes in the vac-cine. Pfizer will share the results with ACIP, in order to consider a recommendation for routine use of Prevnar 13® in adults aged 50 years and older. It is estimated that the primary outcome mea-sures for this event-driven study will be available in 2013.

The most common adverse reactions to both vaccines are lo-cal. For PPSV, 30 to 50 percent of recipients report pain, swelling, or erythema at the site of injection, which may persist for 48 hours. The local reactions have been reported more frequently after the second dose. Fewer than 1 percent of patients report moderate system-ic reactions such as fever or myal-gia. For PCV13, local reactions are reported in 5 to 49 percent of those vaccinated, and 8 percent may be severe. A fever within seven days of vaccination was reported in 24 to 35 percent of children receiving their primary three-dose series. Severe reactions are rare for both vaccines.

Anaphylaxis is a contraindica-

tion for further doses. Persons with moderate to severe illness should not be vaccinated until their condi-tion improves. Minor illnesses (up-per respiratory infections) are not a contraindication to vaccination.

Patient populations eligible for both the pneumococcal vaccine and influenza vaccine often overlap. Both of these vaccines are impor-tant for optimal protection, and may be given at the same time, but should be administered at different sites. Unlike pneumococcal vaccine which may be given year round, the influenza vaccine is recommended only during the influenza season.

Summary CAP is a leading cause of death due to infectious disease in the United States. Treatment guidelines have been established for proper anti-biotic selection. Pharmacists play a crucial role in identifying key safety and administration counsel-ing information to patients initiat-ing antibiotic therapy. In addition, pharmacists can be vaccination advocates by encouraging patients who are candidates for pneumococ-cal vaccination to obtain it, thus reducing the risk of pneumonia complications and invasive disease. Recommendations and guidelines change; pharmacists are encour-aged to keep current.

continuing educat ion quiz Adult Community-Acquired Pneumonia

Program 0129-0000-12-010-H01-P0.15 CEU

Please print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

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

Birthdate____________ (MMDD) Return quiz and payment (check or money order) to

Correspondence Course, OPA,2674 Federated Blvd, Columbus, OH 43235-4990

Completely fill in the lettered box corresponding to your answer.1. [a] [b] [c] 6. [a] [b] [c] [d] 11. [a] [b] [c] [d] 2. [a] [b] [c] [d] 7. [a] [b] 12. [a] [b] [c] [d] 3. [a] [b] [c] [d] 8. [a] [b] [c] 13. [a] [b] 4. [a] [b] [c] [d] 9. [a] [b] [c] [d] 14. [a] [b] [c] 5. [a] [b] [c] [d] 10. [a] [b] [c] [d] 15. [a] [b]

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

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. CAP is defined as pneumonia diagnosed in patients: a. who received IV antibiotics in nursing homes. b. who live independently in the community. c. who come from hemodialysis centers. 2. Host defenses that prevent development of pneumo-nia include all of the following EXCEPT: a. epithelial barrier. c. laryngeal reflex. b. cough reflex. d. esophageal spasm.

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

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

6. According to IDSA/ATS guidelines, previously healthy patients with no risk factors for DRSP infection may be treated with which of the following for CAP? a. Moxifloxacin c. Amoxicillin b. Ceftriaxone d. Azithromycin 7. The 2007 IDSA/ATS guidelines document states that: a. resistance to penicillin and cephalosporins may be decreasing. b. resistance to penicillin and cephalosporins may be increasing.

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

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

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

12. The risk of lung infection can be reduced with all of the following EXCEPT: a. good hygiene. c. optimizing nutritional status. b. smoking cessation. d. antibiotic prophylaxis.

13. Persons with uncertain or unknown pneumococcal vaccination status should not be vaccinated. a. True b. False

14. ACIP recommends pneumococcal revaccination with PPSV in which of the following circumstances? a. Immunocompetent persons b. Persons age two and older with previous pneumo-coccal infection c. Persons aged 65 years and older if they received the first dose more than 5 years ago and were younger than 65 years of age at the time

15. Pneumococcal and influenza vaccines may be admin-istered at the same time. a. True b. False

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

october 2012

Continuing Education Continuing Education

Page 29: December 2012 GPhA Journal

26 The Georgia Pharmacy Journal 27The Georgia Pharmacy Journal

Program 0129-0000-12-010-H01-PRelease date: 10-15-12

Expiration date: 10-15-15CE Hours: 1.5 (0.15 CEU)

The author, the Ohio Pharmacists Founda-tion and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the infor-mation contained herein. Bibliography for additional reading and inquiry is available upon request.

This lesson is a knowledge-based CE activity and is targeted to pharmacists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

the first dose is recommended for persons age two years and older who are at the highest risk of seri-ous pneumococcal infection; and persons aged 65 years and older if they received the first dose more than five years previously and were younger than 65 years of age at the time it was given.

Pneumococcal Conjugate Vaccine. The first pneumococcal conjugate vaccine (PCV7) was li-censed in the U.S. in 2000, and was comprised of purified capsular poly-saccharide of seven serotypes of S. pneumoniae conjugated to a non-toxic variant of diphtheria toxin. In 2010, Prevnar 13® (PCV13) was approved for children six weeks of age through five years as a three-dose primary series, followed by a fourth dose booster. This vaccine replaced the previous version as this product contains the same seven serotypes, in addition to six more which are all conjugated. According to 2008 data from the Active Bacterial Core Surveillance (ABCS), 61 percent of the invasive pneumococcal disease cases in children younger than five years were attributable to the serotypes in PCV13, while PCV7 serotypes caused less than 2 percent.

On December 30, 2011, the Food and Drug Administration (FDA) expanded approval of PCV13 for prevention of pneumonia and invasive disease among adults aged 50 years and older. However, it was not until June 2012 that ACIP adopted vaccination recom-mendations for PCV13 in adults. At the time of writing this lesson, however, the ACIP recommenda-tion is considered “provisional.” The recommendations will become official when published in CDC’s (Centers for Disease Control and Prevention) Morbidity and Mortal-ity Weekly Report. The proposal advises that PCV13 should be ad-ministered to adults aged 19 years or older who are at a high risk of invasive pneumococcal disease, which includes those who are im-munosuppressed. If these patients have never received a pneumococ-cal vaccine, ACIP is recommend-

ing that PCV13 be administered first, followed by PPSV eight weeks later, and then PPSV five years later. If the high risk patient has already received PPSV, providers should wait one year after the last PPSV dose before giving PCV13, to avoid interference between the vac-cines.

Pharmacists are encouraged to visit the CDC website (www.cdc.gov) for the most up-to-date information regarding PCV13 and PPSV recommendations for ini-tial and revaccination, as well as updated vaccine information sheets (VISs). Federal law requires that VISs be distributed to the adult recipient or the child’s parent/legal guardian when certain vaccines are administered.

Pfizer is conducting the Com-munity-Acquired Pneumonia Im-munization Trial in Adults (CAP-iTA), a trial involving more than 84,000 subjects, 65 years of age and older, designed to determine if PCV13 is effective in preventing the first episode of CAP caused by one of the 13 serotypes in the vac-cine. Pfizer will share the results with ACIP, in order to consider a recommendation for routine use of Prevnar 13® in adults aged 50 years and older. It is estimated that the primary outcome mea-sures for this event-driven study will be available in 2013.

The most common adverse reactions to both vaccines are lo-cal. For PPSV, 30 to 50 percent of recipients report pain, swelling, or erythema at the site of injection, which may persist for 48 hours. The local reactions have been reported more frequently after the second dose. Fewer than 1 percent of patients report moderate system-ic reactions such as fever or myal-gia. For PCV13, local reactions are reported in 5 to 49 percent of those vaccinated, and 8 percent may be severe. A fever within seven days of vaccination was reported in 24 to 35 percent of children receiving their primary three-dose series. Severe reactions are rare for both vaccines.

Anaphylaxis is a contraindica-

tion for further doses. Persons with moderate to severe illness should not be vaccinated until their condi-tion improves. Minor illnesses (up-per respiratory infections) are not a contraindication to vaccination.

Patient populations eligible for both the pneumococcal vaccine and influenza vaccine often overlap. Both of these vaccines are impor-tant for optimal protection, and may be given at the same time, but should be administered at different sites. Unlike pneumococcal vaccine which may be given year round, the influenza vaccine is recommended only during the influenza season.

Summary CAP is a leading cause of death due to infectious disease in the United States. Treatment guidelines have been established for proper anti-biotic selection. Pharmacists play a crucial role in identifying key safety and administration counsel-ing information to patients initiat-ing antibiotic therapy. In addition, pharmacists can be vaccination advocates by encouraging patients who are candidates for pneumococ-cal vaccination to obtain it, thus reducing the risk of pneumonia complications and invasive disease. Recommendations and guidelines change; pharmacists are encour-aged to keep current.

continuing educat ion quiz Adult Community-Acquired Pneumonia

Program 0129-0000-12-010-H01-P0.15 CEU

Please print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

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

Birthdate____________ (MMDD) Return quiz and payment (check or money order) to

Correspondence Course, OPA,2674 Federated Blvd, Columbus, OH 43235-4990

Completely fill in the lettered box corresponding to your answer.1. [a] [b] [c] 6. [a] [b] [c] [d] 11. [a] [b] [c] [d] 2. [a] [b] [c] [d] 7. [a] [b] 12. [a] [b] [c] [d] 3. [a] [b] [c] [d] 8. [a] [b] [c] 13. [a] [b] 4. [a] [b] [c] [d] 9. [a] [b] [c] [d] 14. [a] [b] [c] 5. [a] [b] [c] [d] 10. [a] [b] [c] [d] 15. [a] [b]

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

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. CAP is defined as pneumonia diagnosed in patients: a. who received IV antibiotics in nursing homes. b. who live independently in the community. c. who come from hemodialysis centers. 2. Host defenses that prevent development of pneumo-nia include all of the following EXCEPT: a. epithelial barrier. c. laryngeal reflex. b. cough reflex. d. esophageal spasm.

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

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

6. According to IDSA/ATS guidelines, previously healthy patients with no risk factors for DRSP infection may be treated with which of the following for CAP? a. Moxifloxacin c. Amoxicillin b. Ceftriaxone d. Azithromycin 7. The 2007 IDSA/ATS guidelines document states that: a. resistance to penicillin and cephalosporins may be decreasing. b. resistance to penicillin and cephalosporins may be increasing.

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

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

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

12. The risk of lung infection can be reduced with all of the following EXCEPT: a. good hygiene. c. optimizing nutritional status. b. smoking cessation. d. antibiotic prophylaxis.

13. Persons with uncertain or unknown pneumococcal vaccination status should not be vaccinated. a. True b. False

14. ACIP recommends pneumococcal revaccination with PPSV in which of the following circumstances? a. Immunocompetent persons b. Persons age two and older with previous pneumo-coccal infection c. Persons aged 65 years and older if they received the first dose more than 5 years ago and were younger than 65 years of age at the time

15. Pneumococcal and influenza vaccines may be admin-istered at the same time. a. True b. False

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

october 2012

Continuing Education Continuing Education

Page 30: December 2012 GPhA Journal

28

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Name PositionL. Jack Dunn Chairman of the BoardRobert M. Hatton PresidentPamala S. Marquess President-ElectRobert B. Moody First Vice President� omas H. Whitworth Second Vice PresidentHugh M. Chancy State At LargeLiza G. Chapman State At LargeKeith N. Herist State At LargeJoshua D. Kinsey State At LargeTracie D. Lunde State At LargeEddie M. Madden State At LargeJonathan G. Marquess State At LargeChristine Somers 1st Region PresidentEd S. Dozier 2nd Region PresidentRenee D. Adamson 3rd Region PresidentNicholas O. Bland 4th Region PresidentJulie W. Bierster 5th Region PresidentSherri S. Moody 6th Region PresidentAmanda McCall 7th Region PresidentMichael Lewis 8th Region PresidentKristy L. Pucylowski 9th Region President Lance P. Boles 10th Region PresidentAshley London 11th Region President Ken Von Eiland 12th Region President� omas R. Jeter ACP ChairmanSharon B. Zerillo AEP ChairmanArchie R. � ompson AHP ChairmanDrew Miller AIP ChairmanLinda Gail Lowney APT ChairmanRobert Bentley ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael E. Farmer Insurance Trust ChairmanBill Prather Georgia Board of Pharmacy CharimanKenneth G Jozefcyk Georgia Society of Health Systems PharmacistsAmy C. Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeSukhmani K. Sarao UGA Faculty RepresentativeNegin Sovaidi Moon ASP, Mercer University Amanda Brown ASP, South University James William Spence ASP President, UGA Jim Bracewell Executive Vice President

2012-2013 BOARD OF DIRECTORS

Georgia Pharmacy Association

T J

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

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

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

Price and location to be determined.

Please call or email Verouschka Betancourt-Whigham at [email protected] to receive additional information.

Do you want to work for an Independent Pharmacy? Do you want to own your own pharmacy?

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 [email protected]

Dear Jeff,

Jennie and I want to thank you for your recent intervention

to help us retire and to keep our pharmacy independent.

When we made our decision to sell Warwick Drugs, you were

our first contact. You acted quickly and professionally to find

a buyer in 5 days!

We joined AIP at its inception. We have participated in its

programs, utilized the extensive information network and

treasured our relationships with exceptional people, like you.

We wish the best for all of you and the role you all play in our

healthcare future. If we can ever be of assistance, please call

on us.

Thanks again; our best regards to all.

Sincerely yours,

Cliff Hilliard, RPH, PHD

Keeping Independents Independent

Page 31: December 2012 GPhA Journal

28

Pharmacists Need Time for Financial Planning

This ad entitles you to:

A cup of coffee, and asecond opinion.

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

obligation.

Either way, the coffee is on me.

Michael T. Tarrant

• Independent Financial Planner since 1992

• Focusing on Pharmacy since 2002

• PharmPAC Supporter • Speaker & Author

Financial Network Associates 1117 Perimeter Center West, Suite N-307

Atlanta, GA 30338 ● 770-350-2455 [email protected] www.fnaplanners.com

♦Securities, certain advisory services and insurance products are offered through

INVEST Financial Corporation (INVEST), member FINRA/SIPC, a federally registered Investment Adviser, and affiliated insurance agencies. INVEST is not affiliated with Financial Network Associates, Inc. Other

advisory services may be offered through Financial Network Associates, Inc., a registered investment adviser.

Name PositionL. Jack Dunn Chairman of the BoardRobert M. Hatton PresidentPamala S. Marquess President-ElectRobert B. Moody First Vice President� omas H. Whitworth Second Vice PresidentHugh M. Chancy State At LargeLiza G. Chapman State At LargeKeith N. Herist State At LargeJoshua D. Kinsey State At LargeTracie D. Lunde State At LargeEddie M. Madden State At LargeJonathan G. Marquess State At LargeChristine Somers 1st Region PresidentEd S. Dozier 2nd Region PresidentRenee D. Adamson 3rd Region PresidentNicholas O. Bland 4th Region PresidentJulie W. Bierster 5th Region PresidentSherri S. Moody 6th Region PresidentAmanda McCall 7th Region PresidentMichael Lewis 8th Region PresidentKristy L. Pucylowski 9th Region President Lance P. Boles 10th Region PresidentAshley London 11th Region President Ken Von Eiland 12th Region President� omas R. Jeter ACP ChairmanSharon B. Zerillo AEP ChairmanArchie R. � ompson AHP ChairmanDrew Miller AIP ChairmanLinda Gail Lowney APT ChairmanRobert Bentley ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael E. Farmer Insurance Trust ChairmanBill Prather Georgia Board of Pharmacy CharimanKenneth G Jozefcyk Georgia Society of Health Systems PharmacistsAmy C. Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeSukhmani K. Sarao UGA Faculty RepresentativeNegin Sovaidi Moon ASP, Mercer University Amanda Brown ASP, South University James William Spence ASP President, UGA Jim Bracewell Executive Vice President

2012-2013 BOARD OF DIRECTORS

Georgia Pharmacy Association

T J

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

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

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

Price and location to be determined.

Please call or email Verouschka Betancourt-Whigham at [email protected] to receive additional information.

Do you want to work for an Independent Pharmacy? Do you want to own your own pharmacy?

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 [email protected]

Dear Jeff,

Jennie and I want to thank you for your recent intervention

to help us retire and to keep our pharmacy independent.

When we made our decision to sell Warwick Drugs, you were

our first contact. You acted quickly and professionally to find

a buyer in 5 days!

We joined AIP at its inception. We have participated in its

programs, utilized the extensive information network and

treasured our relationships with exceptional people, like you.

We wish the best for all of you and the role you all play in our

healthcare future. If we can ever be of assistance, please call

on us.

Thanks again; our best regards to all.

Sincerely yours,

Cliff Hilliard, RPH, PHD

Keeping Independents Independent

Page 32: December 2012 GPhA Journal

Georgia Pharmacy Association

50 Lenox Point NE Atlanta, GA 30324