August 2017 Newsletter
Save the Date

GSHP Fall Meeting

October 13-15, 2017

Brasstown Valley Resort

For more details and to register, go to:  GSHP Fall meeting info 
 
 
Installation Address

Jennifer Sterner-Allison, PharmD
GSHP President 2017-2018

Presented at the GSHP Summer Meeting
Friday, July 7, 2017

Good afternoon
 
Thank you all for coming to the summer GSHP meeting at Amelia Island. I think we can all agree that there is no better meeting than a meeting at the beach.

I want to extend a special welcome to ASHP President Paul Busch. We are excited to have you participating in our meeting and thank you for sharing the ASHP update with us this afternoon.

It is a real privilege to be standing here as President of GSHP. I have learned a lot this year as President-Elect and am grateful to the executive committee for all the support and guidance they have given me this year. The most important thing I've learned is that I have some pretty big shoes to fill. Actually, a whole closet full of shoes to fill if you stop for a moment and reflect on those who have been our past presidents.

A couple months ago as we were getting ready for our residents to present their research at Southeastern Residency Conference, it dawned on me that I finished my residency at Egleston Children's Hospital, now Children's Healthcare of Atlanta, twenty years ago this summer. This should not have come as a big surprise to me since I have slowly come to terms with the fact that all the music I listened to in high school, is now played solely on the Classic Rock Station, new home of the Big Hair Bands.

Thanks to a forward thinking residency director, my friend and mentor Edress Darsey, I was involved in the very beginnings of APRIE (Atlanta Pharmacy Residents Information Exchange), initially held with the Egleston and Dekalb residents at Melton's App and Tap in Decatur. APRIE is a city-wide journal club that allows for great learning and networking among our residents and preceptors in the metro area. I also participated in the predecessor to the GSHP Residency Research Forum, which was maybe 10-15% of the size that it is now. This just shows the tremendous growth of residency programs in Georgia. I also remember rolling in to a gravel parking lot here at Amelia Island (formerly Amelia Island Plantation) and checking in at a building with a thatched roof, I think. The new pool is definitely an improvement!

A lot has changed in 20 years , and I don't mean just the amount of gray hair that I have. Technology and automation advancements - It used to take me 1-2 hours to manually create a list of patients on monitored drugs - now all I do is push a button to generate a report.   Practice setting expansion and all these new opportunities for pharmacist involvement in the emergency department, antimicrobial stewardship, and pharmacogenomics.   Operational and regulatory issues that seem to be ever evolving and ever growing - USP 797, USP 800, JCAHO, 340 B pricing, REMs programs, specialty pharmacies and pharmaceuticals, and the advancing role of pharmacy technicians. Throw in privileging, credentialing, and provider status and we have even more to look forward to. Job security, right?

One thing that has not changed is that GSHP continues to offer support to our members in line with our current vision of being recognized as the voice and resource for Health-System Pharmacy in the state of Georgia. GSHP started in 1952 and we are currently 1259 members strong. Happy 65th Anniversary GSHP!

As President-Elect I attended a state affiliates meeting in November, with representatives from state societies all over the U.S. I'm here to tell you that we have got it going on! Truthfully we are very fortunate to have active membership, three statewide meetings a year, an engaged executive committee, and our executive director Steve Glass working with us.

I wanted to take a few minutes to highlight some things the GSHP Board has been working on. Every October we have a strategic planning meeting before the Fall Meeting. This past year we had a great brainstorming session and some new items that the committees have been hard at work on include: on-demand CE programming on the website; developing more technician-specific programming; continuing legislative efforts (FYI - you can see the legislative updates potentially impact pharmacy on the GSHP website); developing pearls sessions for meetings; participating in the ASHP practice advancement initiative; and working on ways to leverage social media platforms to promote GSHP activities. There's more, but you'll have to wait until the next meeting to find out about them.

I hope that many of you in the room today took the opportunity to complete the member survey that was distributed late Spring. Thank you to those of you that participated - we got great feedback that we will continue to review. I was very excited by the number of folks who responded that they were interested in volunteering with GSHP. Your willingness to be involved by attending meetings, working on committees and other projects is what makes being a part of this organization so fun and fulfilling.

Although my husband Steve is not here today, I am closing with a huge thank you to him. Those of you who have met him know he is incredibly smart, highly entertaining, and frankly the most patient person I have ever met. I would not be able to do what I do without his support.

Thank you.

GSHP Awards 2017


Presented at the GSHP Summer Meeting 
July 7, 2017

 
Best Paper Describing a New Pharmaceutical Care Service

The award for Best Paper Describing a New Pharmaceutical Care Service Is presented based on publications by GSHP members in the pharmaceutical literature. Selection of the recipient is made by the Awards Committee and is based on a review of pharmacy journals and other publications for the 12-month period beginning May 2016 through May 2017.

I am very pleased to present this year's award to two of my colleagues at Grady Health System. Their paper "Highly Successful HCV Treatment Outcomes in HIV/HCV Co-infected patients at a Large Urban, Ryan White Clinic" was published earlier this year in the journal, Open Forum in Infectious Diseases. The paper highlights how clinical pharmacists were integral in the clinical management of complex disease states and critical to obtaining prior authorizations as well as accessing manufacturer patient assistance programs to secure medications for patients with socio economic barriers. Most importantly, our team was able to achieve a 93% cure rate for HCV in this population.

Please join me in congratulating Manish Patel and Saira Rab from Grady Health System in Atlanta as recipients of this year's Best Paper Describing a New Pharmaceutical Care Service.

Outstanding Health System Newsletter

Recipients are selected for the Outstanding Hospital or Health-System Pharmacy Newsletter Award based on submission and review of the three most recent editions of their newsletter. To be eligible for consideration, the newsletter must be hospital generated and not a purchased newsletter.

This year's award goes to Grady Health System for our Newsletter, The Monthly Refill. I want to recognize Kelsey Woods, Sonali Patel, and Ansley Tidwell who served as our co-editors this year. Kelsey, Sonali, and Ansley were three of our PGY1 residents who with a little help from our communications committee, did an outstanding job of resurrecting our newsletter from the dead. 
 

Outstanding Pharmacy Professional Representative

The Outstanding Pharmacy Professional Representative Award is presented to a representative of a pharmaceutical manufacturer or wholesaler who has made outstanding contributions to health-system pharmacy through service to, participation in, and involvement with GSHP and those practicing as health-system pharmacists.

In her role as a hospital account executive, this year's winner has prioritized developing relationships with pharmacists in her territory, ensuring our awareness of key developments with her company's products and providing access to educational programs and services that benefit patients, practitioners and our health systems. Throughout her time with Eli Lilly, she has been an active supporter of GSHP through local and statewide meetings. While she is a consummate professional, for those of us who know her, what distinguishes Ileana is her enthusiasm and her smile and an ability to bring cheerfulness into almost any situation.

Please join me in recognizing Ileana Monts de Oca as our 2017 Outstanding Pharmacy Professional.
 
 
Outstanding Residency Preceptor

The Outstanding Residency Preceptor Award is presented to a health-system pharmacy residency preceptor. The award recognizes a residency preceptor for outstanding service to the profession by serving as a preceptor and mentor to pharmacy residents.

This was a very popular category this year with 6 very deserving candidates receiving nominations. In fact, on reviewing the nominations, the awards committee felt compelled to recognize two of our members with The Outstanding Preceptor Award.

Our first winner is a graduate of The University of Georgia College of Pharmacy and completed their PGY1 and PGY2 residency in critical care at program in Atlanta. They curren
tly work as a Clinical Assistant Professor with UGA and serve as PGY1 Residency Coordinator in Albany Georgia. He is also a Board Certified Critical Care Pharmacist.

One of his nomination letters stated: Dr. Hawkins is passionate about providing excellent rotational experiences for students and residents. He is organized, collaborative, approachable and knowledgeable. He is eager to challenge students and residents to make evidenced based recommendations that promote exceptional patient care. Since his arrival at Phoeby Putney Memorial Hospital, Anthony has established himself as a tremendous asset to our PGY1 residency program. H is a model preceptor.

Ladies and gentlemen, please join me in congratulating Anthony Hawkins on receiving our outstanding residency preceptor award.

Our second winner is a graduate of Wingate University School of Pharmacy and completed her PGY1 residency training with Fresenius Medical Care and Wingate and a PGY2 in Drug Information with Duke University and GlaxoSmithKline.

She currently serves as Drug Information Specialist at Emory Healthcare in Atlanta where she supports
the needs of their multi-hospital system. Her nomination letter stated: She provides several opportunities during her rotation that residents are not exposed to during other experiences. These include but are not limited to creating drug monographs, and performing MUEs, assisting with drug shortage planning and related communications. She uses a creative teaching style which encourages residents to think outside the box which in turn improves their problem solving skills. Residents enjoy this rotation because they are able to see how their projects impact the pharmacy department and health care system. Many of our residents have commented on how Sara molds the rotation to be unique to each of them. She also encourages them to become involved in GSHP and other pharmacy organizations.
She is an exemplary role model as a pharmacist and preceptor.

Please join me in congratulating Sara White from Emory Healthcare on receiving our outstanding residency preceptor award.  
 
Outstanding Pharmacy Intern/Extern Award
 
The Outstanding Pharmacy Intern/Extern Award recognizes excellence in our future pharmacists. Nominations may be presented by preceptors, educators, or any other GSHP member who has had direct contact with an intern or extern who has shown exemplary service in this role.
 
The nominee is a rising P4 student in the PharmD program at UGA and has demonstrated a commitment to h
ealth-system pharmacy as evidenced by their acceptance into and successful completion of the VALOR program, a ten week honors program providing a unique clinical practice and research experience in diverse practice areas. They continuously developed their clinical skills by by actively participating in several hospital research projects, presenting three posters at ASHP Midyear, been a finalist in ASHP clinical skills competition, has published multiple articles in the SCCP newsletter, and volunteers in the Emergency Department of a Georgia hospital.
 
The nominee serves as President of the student chapters of GSHP, Student College of Clinical Pharmacy, and Phi Lambda Sigma Pharmacy Leadership Society, Vice President of American Pharmacists Association of Student Pharmacists and Deans Students Advisory Council. Nationally the nominee serves as the ASHP Student Liaison from UGA, and on the Ambulatory Care PRN Student Committee for the American College of Clinical Pharmacy.
 
During the nominee's leadership of student activities, the UGA chapters have received recognition from ASHP by developing Several new initiatives including monthly student led journal clubs, monthly cardiac rehabilitation medication adherence education services, events promoting student professional development including the annual Residency Dinner with 24 program directors, and many other associated activities which included representing UGA at the 2016 ASHP Midyear SSHP Spotlight Showcase.
 
The nominator states "it has been a pleasure working with the nominee during their time as a student. I am confident they will go far in the profession of pharmacy and I look forward to seeing what the will accomplish..."
 
Please acknowledge the 2017 Outstanding Intern/External recipient and student GSHP board member Justin Moore.
 
Outstanding Pharmacy Technician Award

The Outstanding Health-System Pharmacy Technician Award recognizes a health-system pharmacy technician who has demonstrated practice excellence and leadership in the support of implementing pharmaceutical care.

This year's winner has been a technician at their health system for 8 years and has served in the role of lead te
chnician for the last 3 years. The person nominating her describes her as a quiet but steadfast leader within the department who is respected by her technician and pharmacist colleagues as well as other health care team members.

She juggles many responsibilities during the course of her day including managing 3 technician schedules, training new inpatient hires and assisting with new program and/or system implementations. Despite her many duties she maintains a passion for excellence in completing her work and is not satisfied until she believes she has covered every detail. In addition as a member of the pharmacy leadership team she has willingly participated in multiple Lean training workshops and activities within the department. Examples of the work she has helped with is focusing on improving discharge prescription delivery times, reducing MedCarosuel stocking errors and reducing waste from expired medications.

Ms. Chavez embodies the definition of "leading by example". She takes pride in her job, her department, and her organization. Please join me in congratulating Patricia Chavez as our 2017 Outstanding Pharmacy Technician.

Outstanding Young Health System Pharmacist

Nominees for the Outstanding Young Health-System Pharmacist Award are not limited by age, but by the length of time in the profession. Nominees should have graduated from a pharmacy school within the past five years. The recipient is chosen based on exemplary service and dedication to the field of health-system pharmacy in this time period.

Our winner is a graduate of The University of Georgia College of Pharmacy and completed a PGY1 resi
dency at Memorial University Medical Center in Savannah. He was employed as a clinical pharmacist at Memorial then shifted to the UGA College of Pharmacy as Associate Director of IPPE's where he coordinates and precepts introductory health system practice experiences. He is a member of GSHP's student and resident affairs committee and serves as The GSHP student chapter advisor. He has presented at regional and national meetings on Incorporating Experiential Students into Pharmacy Practice Models.

Please join me in recognizing Andrew Darley as our 2017 Outstanding Young Health System Pharmacist.
 








 
Outstanding Pharmacy Practitioner

The Outstanding Pharmacy Practitioner Award is presented to a health-system pharmacist employed in a staff position. The award recognizes outstanding service to the profession in a non-administrative, non-managerial position.

This nominee completed their PGY1 residency followed by numerous other certifications including BCPS. They are active in local, state and national pharmacy organizations including service on committees for ACCP and GSHP. They have been recognized as Resident of the Year at their
hospital, UGA APPE Preceptor of the Year and serves on many of their hospital's committees such as P&T, Infection Prevention & Control, Antibiotic Subcommittee and coordinates the Teaching & Learning Development Series. Their numerous accomplishments include speaking at a variety of venues including a California State ID association meeting, UGA grand rounds, GSHP and ASHP Midyear. They have co-authored 3 posters for an ASHP Midyear and one for ACCP. In the past year, they have had 5 articles published or accepted for publication. During the past several years, they have been active in the ACCP student CV review program and the ASHP New Practitioners Forum CV review program. For GSHP, they have served on the Education Committee, Membership Committee and is currently the Southeast Georgia District Director.

It is my honor to present the GSHP Outstanding Pharmacy Practitioner Award to Dr. Bruce Jones from St. Joseph Chandler.
 
Community Service Award

The Community Service Award is presented to a GSHP member for Outstanding service to his/her community. Services rendered are not limited to those as a pharmacist, but include any activities which enhance or improve the quality of life of the community.

This year's nominee serves her community and extended communities in many ways, applying both their professional capabilities and leadership skills in outreach activities to positively impact the lives of others. Professionally, they provide education at various state and local meetings, mentoring pharmacy students from multiple Colleges of Pharmacy, and serves on the board of the Atlanta Academy of Institutional Pharmacists, recently recognized as the AAIP Pharmacist of the Year.   Outside the metro Atlanta area they extend their professional knowledge to be a resource for medical mission work in Africa, which was a humbling and life-changing experience. They are an avid fundraiser for many organizations including the Shepherd Center and they mentor young girls who are victims of sex trafficking.

With such wide reaching community impact, it is my honor to present Lindsey Jackson with this year's GSHP Community Service Award.
 
Service to The Society

H.W. "Ted" Matthews retired from Mercer University College of Pharmacy at the end of this past academic year. He was with the University for over four decades and served as dean for nearly 27 years.

In his retirement announcement, he wrote:

There is a season for everything, and it's time for me to move on to my next journey in life.

I have been incredibly blessed to have had such a fulfilling job for so many years. The many opportunities given me to help make our College of Pharmacy a better place have kept me excited and motivated every single day. This has kept the fire that burns within me to be committed to continuous quality improvement and the pursuit of excellence.

I would like to personally thank all of you who have steadfastly supported and encouraged me. Your confidence in me has made me feel good about coming to work every day. I am humbled and honored to have been given the privilege of being dean at my alma mater. I am excited and confident that our College of Pharmacy has a bright future as we continue to value and embrace our motto, "A Tradition of Excellence, A Legacy of Caring."

I'm sure that many of you in the room today trained under Dean Matthews's leadership. I think it's safe to say that after 27 years as Dean his contributions to pharmacy in Georgia and nationally have been immense. It's my pleasure to recognize Dean Matthews with GSHP's Service to The Society Award.
 
Pharmacist of The Year

GSHP Pharmacist of the Year Award is the highest honor GSHP can bestow on any member and is presented to a Georgia health-system pharmacist to honor outstanding service and accomplishments in health-system pharmacy practice as well as participation in GSHP. All GSHP members are eligible for nomination. Nominations should include detailed information concerning the nominee's professional, civic, and other activities. Recipients of the GSHP Pharmacist of the Year Award serve on the Awards Committee for five years following receipt of the award.
 
The nominee received their PharmD from UGA in 1996 and went on to complete a PGY1 Residency at a Veterans Hospital. The nominee was then employed as a critical care pharmacist in a Geo
rgia hospital, transitioning into the clinical coordinator, and ultimately department manager. The nominee has been highly involved in GSHP since their time as a student being named Outstanding Intern/Extern. The nominee served on the GSHP board as a District Director and was named Outstanding District Director and finally was elected to the office of President of GSHP.

Among the nominee's accomplishments while at their hospital, establishing a PGY1 Residency Program serving as the Residency Program Director mentoring over 50 residents in their pursuit advanced training. The nominee is a strong proponent of decentralized pharmacy services being instrumental in establishing a clinical pharmacy position in the Emergency Department Of their hospital. They also worked to establish a Meds to Beds program to promote safer transitions in care. Additionally the nominees was involved in the development of a Medication Safety Committee to analyze inpatient medication safety concerns increasing the safe effective medication use. The nominee is a board certified pharmacotherapy specialist holding faculty appointments at UGA, Mercer, and South.

On a personal note, the nominator would like to say "I would not be where I am without the mentorship and example of the nominee. As one of their former residents and pharmacists, I am honored I had the opportunity to work with a true pharmacy practice leader. Their advocacy for this profession and commitment to this organization are second to none, and there is no one more deserving of this honor"

This description can only belong to the 2017 Pharmacist of the Year Mike Melroy.
 

Clinical Articles
  The Skinny on Weight Loss Drugs: A Blast from the Past
 
Authors:
Thomas 'Judd' Ott, Student Pharmacist Mercer University, Kendra Manigault, Pharm.D., BCPS, BCACP, CDE, Clinical Assistant Professor, Mercer University, Amy Grimsley, Pharm.D. BCOP, Pharmacy Residency Coordinator and Pharmacy Educator, Cheyenne Regional Medical Center
 
Introduction
In the United States (US) and worldwide, the prevalence of obesity continues to increase at alarming rates. The World Health Organization reports the percentage of obese individuals has more than doubled since 1980. 1 Almost two-thirds of the United States population is considered overweight with one-third of the population considered obese. Clinical diagnosis of overweight and obese individuals is an important step to identifying appropriate treatment. Diagnosis is commonly made using body mass index (BMI). A BMI of 18.5 to less than 25 kilograms per meter squared (kg/m2) is categorized as a healthy weight. A BMI between 25 - 29.9 kg/m2 is considered overweight. A BMI ≥ 30 kg/m2 is classified as obesity and further categorized into three additional classes. 2-5 Most weight-loss medications are indicated to treat individuals with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 accompanied by other risk factors such as hypertension, dyslipidemia, or type 2 diabetes.
Several weight management guidelines do not recommend pharmacological treatment as first line therapy for obesity. Instead they suggest the use of United States Food and Drug Administration (FDA) approved weight-loss drugs only as an option after diet, exercise, and behavioral modifications have been attempted or to be used for long-term management to prevent weight regain. 2,4,5 Available drugs with FDA approved indications for weight loss include benzphetamine hydrochloride, phendimetrazine tartrate, diethylpropion hydrochloride, phentermine hydrochloride, orlistat (Xenical®), liraglutide (Saxenda®), lorcaserin hydrochloride (Belviq®), phentermine hydrochloride plus topiramate extended-release (Qysmia®), and naltrexone hydrochloride plus bupropion hydrochloride (Contrave®). In this three-part series a condensed review of the medications approved for the management of obesity will be discussed. This is the first article of a three-article series focused on providing a condensed review of the medications approved for the management of obesity. This article will provide an overview of the older weight loss agents used to combat obesity.
 
Sympathomimetic amines

Benzphetamine Hydrochloride, Phendimetrazine Tartrate, Diethylpropion Hydrochloride, Phentermine Hydrochloride

                The sympathomimetic amines are the oldest of the weight management drugs with FDA approval prior to 1980. The class have mechanisms of actions similar to amphetamines and includes benzphetamine, phendimetrazine, diethylpropion, and phentermine. Their weight loss mechanism is thought to be through central nervous system stimulation by catecholamine release in the hypothalamus which, in turn, can suppress the appetite; however, the primary mechanism for weight loss is not fully understood because the class has other central nervous system actions and metabolic effects. 6-9
                The sympathomimetic amines are indicated for short term treatment for patients with a BMI ≥ 30 kg/m2 or ≥27 kg/m2 accompanied by other risk factors (hypertension, dyslipidemia, and diabetes) who have not responded to diet or exercise. There are various dosing regimens that should be individualized to meet the patients' need. 6-9 Limited up-to-date clinical data is available for this class of medications due to the already established efficacy in weight loss. Medication labeling reports that weight loss in subjects is usually at rate of a fraction of a pound more per week compared to those treated with placebo. 6-9
Meta-analysis of randomized controlled trails (RCTs) concluded patients taking diethylpropion 75 mg/day lost an average of 3.0 kg additional weight when compared to placebo which was considered to be of borderline significance to investigators. 10 The same meta-analysis reported phentermine 15 mg and 30 mg provided an additional average of 3.6 kg weight lost compared to placebo. 10 Diethylpropion was studied more recently in two small Brazilian studies which showed patients treated with diethylpropion 75 mg/day and 50 mg twice a day lost an average of 10 kg and 9.3 kg, respectively, compared to 3.1 kg of weight loss in placebo treated patients in both studies (P < 0.001). 11,12 Limitations of these studies included small sample size and variability in population demographics. Six placebo-controlled RCT from 1975 to 1999 reported phentermine in doses of 15 mg and 30 mg provided an additional average of 3.6 kg weight lost (CI, 0.6 - 6.0 kg) as compared with placebo. 10
Contraindications associated with sympathomimetic amine use includes advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, pulmonary hypertension, hyperthyroidism, glaucoma, agitated states, and history of drug abuse. 7 They are also contraindicated with use of monoamine oxidase inhibitors (MOAIs) or other central nervous system (CNS) stimulants, use of these drugs concomitantly have the potential to produce hypertensive crisis. Typical adverse effects expected include cardiovascular effects (i.e. increased heart rate), CNS stimulation, dry mouth, some gastrointestinal (GI) disturbances and changes in libido. 6-9

Gastrointestinal Lipase Inhibitor

Orlistat
Orlistat, originally approved and marketed as Xenical®, is indicated for obesity management. 13 Orlistat is available, at a lower dose, over-the-counter (OTC) as Alli® making it the most accessible weight loss therapy. Orlistat reversibly inhibits gastrointestinal lipases in the stomach and small intestines. 13 As a result of this mechanism, the ability to hydrolyze dietary fats into absorbable free fatty acids is compromised. Labeling data reports that at therapeutic doses fat absorption can be inhibited by approximately 30%. 13
Prescription strength orlistat is available as a 120 mg capsule and is used in conjunction with a reduced calorie diet to assist in weight loss, weight maintenance, and prevent weight regain for patients with BMI ≥ 30 kg/m2 or ≥27 kg/m2 in the presence of additional risk factors (e.g. hypertension, diabetes, dyslipidemia). 13 Over-the-counter orlistat is manufactured as a 60 mg capsule to be used in overweight adults 18 years and older as a weight loss aid. Both formulations should be taken with each fat containing meal, but not more than three times a day. Orlistat's mechanism of action can affect the absorption of fat-soluble vitamins; therefore, patients should be counseled to include a daily multivitamin in their diets. 13
In a one-year treatment study comparing orlistat 120 mg versus placebo, orlistat patients lost an average of 8.5% initial body weight compared to 5.4% with placebo. Additionally 35% of patients were able to lose at least 5% of their initial body weight compared to 21% of patients in the placebo group (P < 0.05). 14 An 18 month trial with orlistat 120 mg compared to placebo showed an average of 6.5 kg initial weight lost with orlistat versus an average 3.0 kg weight lost with placebo (P=0.0005). In addition, significantly more patients maintained a 10% reduction from their baseline weight after 12 months, 28.1% versus 13.8%, respectively (P < 0.0001). 15 Two other studies that investigated both the 60 mg and 120 mg dose of orlistat also showed similar results. 16,17 A study conducted by Hill et al required patients to lose at least 8% of body weight prior to inclusion in the treatment phase to measure weight maintenance associated with orlistat therapy. 17 Subjects treated with orlistat regained less weight compared to placebo (32.8% vs. 58.7%, respectively, P<0.001)) . 17 Additionally, participants treated with orlistat experienced greater reductions in LDL and total cholesterol levels than placebo (P<0.001). Meta-analysis data found orlistat provided an additional average of 2.59 kg weight lost compared to placebo in 12 studies with 6 month treatment outcomes. 10 In 22 studies with 12 month treatment outcomes of orlistat an additional 2.89 kg of weight loss was observed compared to placebo. 10
The adverse effect profile of orlistat is mostly limited to the gastrointestinal tract. The most common adverse effects include fatty/oily stools, oily spotting, flatus with discharge, fecal urgency, oily evacuation, increased defecation, and fecal incontinence. These adverse effects occurred in the patient population at rates higher than 5% in most clinical trials. 13 Reports of hepatic failure have been reported in postmarked studies that ultimately resulted in liver transplant or death. Patients should be made aware of the symptoms of liver failure (jaundice, abdominal pain, dark colored urine, malaise, fatigue, nausea and vomiting) and to stop the medication immediately when symptoms are present. 13

Discussion

Obesity has an impact on every aspect of healthcare. It continues to increase healthcare cost and risks of comorbid diseases leading to a reduced quality of life for many patients. As discussed, initial treatment for overweight patients consists of diet, exercise, and behavioral modifications. Although lifestyle and behavior modifications, when properly adhered to, can reduce the risk factors associated with a long term state of obesity, many individuals regain the initial lost weight. 5 Other patients find it difficult to lose the initial weight. Pharmacologic options can potentially offer solutions for these patients. It is important to emphasize that the discussed therapies provided participants with weight loss along with a diet and exercise regimen; therefore, proper life style modifications remain vital to patient's success.

Conclusion:
Sympathomimetic amines and orlistat are important contributions to the weight loss medication armamentarium; however, their side effect profiles may make them less attractive options compared to newer agents. The next article in this three-part series will focus on newer medication options available to combat the obesity epidemic.
 
 References:
1.         WHO | Obesity and overweight. http://www.who.int.proxy-s.mercer.edu/mediacentre/factsheets/fs311/en/. Accessed May 24, 2015.
2.         Bonow RO, Carabello BA, Chatterjee K, et al. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults. Circulation. 2008;118:e523-e661.
3.         Sheehan AH, Chen J, Yanovski JA, Calis K. Obesity. Chapter 121. In: Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York: McGraw-Hill; 2014. http://accesspharmacy.mhmedical.com.proxy-s.mercer.edu/content.aspx?bookid=689&sectionid=48811515. Accessed May 24, 2015.
4.         Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(2):342-362. doi:10.1210/jc.2014-3415.
5.         Obesity NAA for the S of, Heart N, Institute B, (US) NI of H, Initiative NOE. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health, National Heart, Lung, and Blood Institute, NHLBI Obesity Education Initiative, North American Association for the Study of Obesity; 2000.
6.         diethylpropion drug information. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=a750a1ef-8f3e-4870-97eb-3697aaca1818&type=pdf&name=a750a1ef-8f3e-4870-97eb-3697aaca1818. Accessed June 3, 2015.
7.         benzphetamine. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=1d1c0666-dfe4-4c98-b345-801eb78b5da8&type=pdf&name=1d1c0666-dfe4-4c98-b345-801eb78b5da8. Accessed July 22, 2015.
8.         phendimetrazine tablet. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=d11411e2-ccfa-49b0-8470-5682053cfb1b&type=pdf&name=d11411e2-ccfa-49b0-8470-5682053cfb1b. Accessed July 22, 2015.
9.         Phentermine HCl drug information. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=851b0ef4-c656-48f4-915f-6289cac3fde4&type=pdf&name=851b0ef4-c656-48f4-915f-6289cac3fde4. Accessed June 3, 2015.
10.       Li Z, Maglione M, Tu W, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142(7):532-546.
11.       Suplicy H, Boguszewski CL, dos Santos CMC, do Desterro de Figueiredo M, Cunha DR, Radominski R. A comparative study of five centrally acting drugs on the pharmacological treatment of obesity. Int J Obes. 2014;38(8):1097-1103. doi:10.1038/ijo.2013.225.
12.       Cercato C, Roizenblatt VA, Leança CC, et al. A randomized double-blind placebo-controlled study of the long-term efficacy and safety of diethylpropion in the treatment of obese subjects. Int J Obes. 2009;33(8):857-865.
13.       Orlistat - Xenical drug information. http://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=5bbdc95b-82a1-4ba5-8185-6504ff68cc06&type=pdf&name=5bbdc95b-82a1-4ba5-8185-6504ff68cc06. Accessed June 3, 2015.
14.       One-year treatment of obesity: a randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. 2000;24(3). doi:10.1038/sj.ijo.0801128.
15.       Krempf M, Louvet J-P, Allanic H, Miloradovich T, Joubert J-M, Attali J-R. Weight reduction and long-term maintenance after 18 months treatment with orlistat for obesity. Int J Obes. 2003;27(5):591-597. doi:10.1038/sj.ijo.0802281.
16.       Rössner S, Sjöström L, Noack R, Meinders A, Noseda G. Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. Obes Res. 2000;8(1):49-61.
17.       Hill JO, Hauptman J, Anderson JW, et al. Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. Am J Clin Nutr. 1999;69(6):1108-1116.

ASHP House of Delegates

The link below provides a summary of the actions taken at the ASHP House of Delegates, June 4 and 6, 2017


Penicillin Allergy Day and Other Resources

The National Quality Partners' Antibiotic Stewardship Action Team recommends penicillin allergy skin testing as an important component of a comprehensive stewardship program.
Read More
As one of the most easily accessible healthcare providers, pharmacists could potentially significantly expand patient access to penicillin allergy testing.   This project describes a pharmacist-provided penicillin allergy testing service implemented at a community hospital.
September 28th is Penicillin Allergy Day! For s tewardship, implementation and training support please contact Kellie Vogel at ALK.  To learn more, visit penallergytest.com

Did you know that if you missed one of our monthly webinars, you can view them on the GSHP website?

Go to:  https://www.gshp.org/development_webinars.aspx 
     


© 2016 All Rights Reserved