January 2017 Newsletter
Scenes from Committee Day-January 14, 2017

Illuminated waterfront Savannah Historic District at night
Save the Date

GSHP Spring Meeting

March 24-26, 2017
Marriott Riverfront
Savannah, GA


Hotel Reservations 

A wall calendar with tear-away pages, and words that read Save the Date
Call for Resolutions for the
2017 ASHP House of Delegates
The Call for Resolutions for the 2017 House of Delegates Session is open. Deadline for submissions is March 6, 2017.
The ASHP policy development process allows professional policies to originate in three ways:
  • from ASHP councils, which meet in July, September and February;
  • from executive committees of sections and forums; and
  • directly from ASHP members via Resolutions.
ASHP's Resolution process offers a mechanism for ASHP members to have input into the House of Delegates. Resolutions require sponsorship by two active members, who need not be delegates. All Resolutions must be submitted 90 days in advance of the House session, which is March 6, 2017. Resolutions must be submitted via the online Resolutions Submission Form.
Before submitting a Resolution, members are encouraged to familiarize themselves with the Guidelines for Submitting Resolutions and existing ASHP policy on the proposed topic. New policy recommendations that resulted from September's ASHP Policy Week and are currently under Board consideration are available on the ASHP Connect House of Delegates Community site.
We appreciate your interest and participation in the policymaking process of ASHP. If you have any questions about the process for submitting a Resolution, you are encouraged to contact the Chair of the House of Delegates at hodchair@ashp.org .

Call for Posters - GSHP Spring Meeting-Sign up NOW!

This is your opportunity to share your results with pharmacy colleagues from around Georgia at the GSHP Spring Meeting Poster Session in Savannah on Saturday, March 25, 2017. Posters highlighting innovative services, evaluations and pharmacy practice model change initiatives are especially encouraged. Encore presentations from national meetings (ASHP, ACCP, etc.) are accepted.  Presenting a peer-reviewed poster is an ideal professional development activity for preceptors, both seasoned and new practitioners, residents and students. The primary (first) poster presenter must be a GSHP member and results must be included on abstract to be accepted.  Research-in-progress abstracts with background and methods only will not be accepted for the poster awards but can present.  Pharmacy students and residents are especially encouraged to participate.   Students and residents presenting posters will receive free meeting registration if they are the primary (first author) on the poster.  Please let us know if you are able to attend the entire program or Saturday only).

The GSHP Education Committee will be evaluating ALL posters submitted for recognition and designation as "Outstanding GSHP Poster".   There will be three categories recognized: 1) Best Pharmacy Student Poster; 2) Best Pharmacy Resident Poster; 3) Best Pharmacy Practitioner Poster based on the credentials of the primary (first) author.  The  scoring rubric by which the posters will be judged will be available on the GSHP website.    
The deadline for submission of abstracts is at 12:00 Noon on March 1st.

To submit your poster abstract, or for questions, contact Marjorie Phillips, GSHP Poster Session Coordinator at:  mphillip@augusta.edu

Each abstract email submission must be entered on the  abstract form (attached) and contain the following:

1)    Brief descriptive title (use title case)
2)    Author information. Include full name, professional credentials and institutional affiliation (i.e., health care organization or college name) author(s), email address for corresponding author/presenter.
3)    Body of the abstract with the following headings: Purpose, Methods, Results and Conclusions.  
4)   The submitted abstract must fit on the attached form and be no more than 300 words.
5)    Abstract should be written using calibri font and should be 11-point font.  Do not include tables, graphs, or illustrations in abstract.  Spell out all pharmaceutical acronyms and special symbols (e.g., < or >).  
6)    Include which poster category applies (should be based only on first author's credentials)
  • Pharmacy Student Poster
  • Pharmacy Resident Poster
  • Pharmacy Practitioner Poster
7)    Include submission type
  • Descriptive report - describes new, improved, or innovative roles or services in pharmacy practice, or case report.
  • Evaluative study report - describes original research including clinical research, drug effects in humans, drug use evaluations, and evaluations of clinical pharmacy services
Clinical Articles
2016 American Diabetes Association Guideline Updates

Authors: Thuy Nguyen Student Pharmacist Mercer University, and Kendra Manigault, PharmD., BCPS, BCACP, CDE, Clinical Assistant Professor, Mercer University
Diabetes mellitus is a common disease state that affects 29.1 million people in the United States.1 Type 1 diabetes is characterized by beta cell destruction in the pancreas leading to a lack of insulin secretion, whereas type 2 diabetes is characterized by insulin resistance. Direct medical cost associated with diabetes accounts for 176 billion dollars in the United States.1 If untreated, diabetes can lead to retinopathy, neuropathy, kidney complications and a reduced quality of life. The American Diabetes Association (ADA) publishes a Standard of Medical Care in Diabetes guideline each year to provide clinicians, patients, researchers, payers and other interested individuals with general treatment goals and updates in diabetes care.2 Selected update changes for the 2016 guidelines are discussed in this article.
         The ADA guidelines removed the term 'diabetic' in reference to individuals with diabetes. This change reflects the ADA's stance not to define patients by their disease state opting to instead use the wording 'patients with diabetes.' The term 'diabetic' has been maintained as a descriptor for complications secondary to diabetes such as diabetic retinopathy and diabetic neuropathy. A new section entitled "Obesity Management for the Treatment of Type 2 Diabetes" was created to provide a central location for recommendations pertaining to bariatric surgery, assessment of weight in diabetes, and treatment of obesity in patients with diabetes. This section includes a table of approved medications used to treat obesity. In addition, the ADA recommends lifestyle management by using technology (e.g. apps, text messages) to prevent diabetes.
New evidence highlights the benefit of using aspirin therapy in women aged 50 or older at risk for atherosclerotic cardiovascular disease (ASCVD); therefore, the new guidelines recommend considering aspirin therapy in at risk women ≥ 50 years of age. This recommendation is in line with the recommendation to consider aspirin therapy in men ≥ 50 years of age with ASCVD risk (i.e. family history, hypertension, smoking, etc.). Clinical judgement should be used in patients with diabetes <50 years of age with multiple risk factors. The addition of ezetimibe to moderate intensity statin therapy is recommended in select individuals for cardiovascular benefit. This recommendation comes from the IMPROVE-IT study which concluded that combination therapy of simvastatin and ezetimibe resulted in a significant reduction of major adverse cardiovascular events in patients with diabetes (absolute risk reduction of 5%) compared to simvastatin alone.1,3 In order to paint a more descriptive and accurate picture of the kidney complications associated with diabetes, the term "nephropathy" was changed to diabetic kidney disease. This change emphasizes the diabetic origin associated with the disease. Additionally, the guidelines provide guidance for the use of intravitreal anti-VEGF agents for the treatment of diabetic macular degeneration.
These changes are reflected in the 2016 ADA Diabetes Guidelines. Physicians, pharmacist and other healthcare providers are advised to follow the guidelines for diagnosis, treatment and management of diabetes. Diabetes continues to affect many patients from various different backgrounds. Treating patients according to evidence-based guidelines may increase health outcomes, quality of life and reduce medical expenses.
1. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.
2. American Diabetes Association Standards of Medical Care in Diabetes 2016. Accessed July 8, 2016. Available from: http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf
Cannon CP, Blazing MA, Giugliano RP, et al.; IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy After Acute Coronary Syndromes. N Engl J Med 2015; 372:2387-2397

Improving Patient Care in Clinical Oncology with Protocol Dispensing of Emergency Pharmacy Packs

Primary Author: Peter J. Enos, PharmD Candidate 2017
Reviewing Author: Aaron Scott Davis, PharmD, Director of Pharmacy

                Initial diagnoses of any cancer can be a difficult process to overcome for many cancer patients. The thought of immediately dying, not being able to complete life goals, or leaving precious family behind often create significant amounts of unnecessary stress. Even when cancer patients agree to undergo chemotherapy cycles, they often have to prepare themselves to receive additional supportive care therapy to mitigate common side effects associated with cytotoxic doses of chemotherapy. Depending on the type of cancer, many patients undergo various chemotherapy combination drugs to treat their specific type of malignancy. Most of the chemotherapy regimens have very similar side effects often requiring EMLA cream to reduce inflammation of a port placement, post chemotherapy administration of Nuelasta® for imminent neutropenia, as well as Compazine® and Decadron® for chemotherapy induced nausea/vomiting2.
                However, upon successful administration of a chemotherapy cycle, instances in which patients experience further common side effects can be unpredictable. Common side effects of post chemotherapy cycles include (but not limited to): anemia, appetite loss, thrombocytopenia, constipation, delirium, diarrhea, edema, fatigue, alopecia, oral infections, nausea/vomiting, pain, peripheral neuropathy, or sleeping problems1. The unpredictability of these side effects can pose an issue in terms of prevention. Providing unnecessary supportive care to patients undermines the purpose of managed care pharmacy. However, not providing a way to support severe side effects can also be detrimental to the clinical management of anti-neoplastic chemotherapy.
                An appropriate solution to such therapy limiting side effects was implemented by Central Georgia Cancer Care (CGCC) in Macon, GA. As a private outpatient cancer center, CGCC understood that predicting post chemotherapy side effects is not plausible. Therefore, in conjunction with the clinical oncology pharmacist (Aaron Scott Davis, PharmD, Director of Pharmacy), CGCC created a protocol in which an emergency pharmacy pack was dispensed to every patient after receiving their first cycle of chemotherapy. During my Hematology/Oncology rotation at CGCC, I was able to participate in assessing the issues with unpredictable side effects of post chemotherapy cycles and implement protocol dispensing of these emergency pharmacy packs.
                The emergency pack protocol follows strict guidelines for patients. They are dispensed in a brightly colored red bag and contains two primary components: a patient handout and individualize mini zip-locked bags of various supportive care medications. The patient handout is written in simple and easy to read language that describes what the pack includes, the purpose of the pack, how to take each medication, and how to contact CGCC in the event a severe side effect was to occur. It is imperative to note that the instructions within the pack clearly states that a patient is not take any of the medications within the pack until they call CGCC to verify the symptoms they are experiencing. CGCC ensures that a mid-level practitioner will always be available for immediate contact during normal business hours. In the event that a side effect warrants the use of the emergency pack after normal business hours, an on call physician will be available to immediately return their call. Upon successfully verifying the symptoms of a patient, the provider will "green-light" the administration of a drug contained in the pack to be taken immediately to mitigate the side effect the patient is currently experiencing. In addition, the healthcare provider will also counsel appropriately for the use of the drug. Lastly, the healthcare provider will also document this information and initiate appropriate protocols to recommend for full dispensing of the medication they allowed the patient to take.
                The second component of the emergency pharmacy pack are the actual medications themselves. Each medication is dispensed in a small, clear zip-locked bag and is labeled appropriately. The labels are actual prescription labels with respective to each medication that includes appropriate naming of drug, dose, route, and complete instructions. The medications chosen to be included in the pack were designed to target the most common post chemotherapy side effects such as nausea/vomiting, diarrhea, constipation, pain, anxiety, or insomnia. The drugs included in the emergency pharmacy pack are as follows:
  • Zofran ODT 8 mg #6 for nausea/vomiting2,3
  • Imodium 2 mg #12 for diarrhea2,4
  • Dulcolax 5 mg #10 for constipation2,5
  • Ultram 40 mg #5 for pain2
  • Ativan 0.5 mg # 5 for anxiety, insomnia, or nausea2,6
The prescribers/pharmacist also follow strict guidelines. Each of the medications have hard copy prescriptions signed by the physicians and dispensed by the pharmacist. In addition, they also follow appropriate protocols to dispense Ultram and Ativan as they are controlled substances. Take note of the limited quantities written for, and dispensed in the emergency pack. It is very clear that these medications were never meant to be full course treatments, but rather used for emergency only.
The significance of these pharmacy packs may be underappreciated. Based on my conversations with my preceptor about other intuition's protocols, the protocol dispensing of emergency pharmacy packs is far and few in between. In essence, CGCC is one of the few cancer centers in the southeast to implement an emergency pharmacy pack of any sort. Many other institutions would simply write a prescription for supportive care medications and expect patients to obtain the drugs at their local community pharmacy. In the current protocol at CGCC, the emergency packs help alleviate symptoms that may affect or limit therapeutic efficacy. The model implemented focuses on improving patient care and ensures patient safety is maintained.
One of the most memorable experiences I had during my Hematology/Oncology rotation was a discussion with a patient's wife. She stated that she was very grateful they received the emergency pharmacy pack. After the first cycle of chemotherapy, her husband was experiencing severe nausea/vomiting and was forced to contact CGCC to find a solution to this problem. She declared the following; Zofran saved her husband's life! I was very fortunate and ecstatic to have played a part in creating this emergency pharmacy pack for this patient and I would hope that that providing emergency pharmacy packs would someday become a standard protocol for all cancer institutions in the near future.
  1. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects. Accessed August 16, 2016.
  2. Central Georgia Cancer Care Supportive Care Protocol. Macon GA. August 02, 2016.
  3. Chemocare. http://chemocare.com/chemotherapy/side-effects/nausea-vomiting-chemotherapy.aspx. Accessed August 3, 2016.
  4. Chemocare. http://chemocare.com/chemotherapy/side-effects/diarrhea-and-chemotherapy.aspx. Accessed August 3, 2016.
  5. Chemocare. http://chemocare.com/chemotherapy/side-effects/constipation-and-chemotherapy.aspx. Accessed August 3, 2016.
  6. Chemocare. http://chemocare.com/chemotherapy/side-effects/anxiety-and-cancer.aspx. Accessed August 4, 2016
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 

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