Out of the Gates 
  E-Newsletter from Gates Healthcare Associates
February 2014
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Results of last month's question, "What will have the greatest impact on pharmacy practice in 2014?"

38% Drug Quality and Security Act
25% Health Plan Changes
25% U.S. Economy
13%
Affordable Care Act
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It was wonderful to see so many friends and colleagues, and to make new connections, at the third annual ACA IACP ACVP Educational Conference earlier this month.

I've always found conferences such as these are a great way to gauge how much I've grown as a professional and how much the pharmacy profession is evolving -- especially with so many changes afoot at the federal level.

Most important, we all had an opportunity to learn from one another so that we can improve our pharmacy or consulting practices and better serve patients and providers.
 
Sincerely,
Ernest P. Gates Jr., R.Ph, FASCP, FIACP, FACA
IACP Fellows, ACA Member of Year
FINE FELLOWS: Speidel and Latta (from left) were inducted as IACP Fellows. Gates (below) was honored as ACA Member of the Year.


Ken Speidel and Ken Latta, Senior Associates at Gates Healthcare, were inducted as Fellows of the International Academy of Com
pounding Pharmacists on Feb. 6 at the IACP's Educational Conference in Fort Lauderdale, Fla. The IACP's fellowship program distinguishes pharmacists who are exemplary in their commitment and professionalism to the practice of pharmaceutical compounding.

The following evening at the same conference, Gates Healthcare founder Ernie Gates was honored as "Member of the Year" by the American College of Apothecaries.

The Science Behind Beyond Use Dates

We are often asked, How can I confirm that the Beyond Use Date (BUD) that I assign a particular formulation is appropriate?

   

The United States Pharmacopeia has provided compounding pharmacists with some general guidelines, spelled out in USP 795, for assigning BUDs. The following are some general rules of thumb when assigning a BUD, regardless of whether it is within or outside of USP guidelines: 

  • Consult and apply drug-specific and general stability documentation and literature when available.
  • Check the methodology of the analytical lab if you are using potency over time studies to establish your BUDs. Stability indicating is the recommended methodology.
  • Document the rationale for an extended BUD by using literature. But compounders must confirm that the references take into account any additional ingredients, quality control testing, the dispensing container and closure system, and storage conditions at your pharmacy.
  • Demonstrate that a preparation is stable in a specific proprietary base by seeking information beyond the literature provided by a vendor or other source. Compounders can consult USP Chapter 1161 for additional stability considerations.
  • Ensure proper chemical management procedures in your pharmacy. 

It can be easier for pharmacists to eschew the science -- stability indicating assays, advanced testing and the like - and keep all of your their BUDs within the established guidelines of USP.

 

Yet, as well-educated and highly trained compounding pharmacists, you can tap into your well of chemistry knowledge and determine your BUDs with attention and respect to science and, most importantly, your patients.

 

-- Ken Speidel, R.Ph, PharmD, FACA, FIACP, Senior Associate

 

Did You Know?

There is a way to get past narcotics' notorious constipation problem. Certain opioids can be swished rather than swallowed to achieve similar absorption rates and avoid a total assault upon the bowel.

 

According to a 1988 study, sublingual absorption of certain opioids is similar to oral absorption, and bypasses the liver's first-pass effect. For example, hydromorphone with a pH of 6.5 had absorption of about 28%, which is similar to the swallowed oral absorption rate of 30%. Levorphanol with a pH of 9.1 had absorption approaching 40%. Methadone at pH 8.5 had absorption of about 75%.

 

This route can result in significantly less constipation with rapid absorption and good analgesic effect. The method would be to swish for about 2� minutes, allowing most of the absorption to occur, and then to expectorate the remainder to avoid swallowing and affecting the bowel.

 

-- Ken Latta, BS, RPh, FIACP, FACA, Senior Associate

   

Gates Healthcare Associates is a pharmaceutical and healthcare consulting firm that provides extensive clinical, programmatic, and regulatory knowledge and insight to an array of organizations nationally and abroad. We help our clients confront and overcome challenges and obstacles to growth, positioning them for long term business success.

 

 

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