September 2016 Newsletter
NOTICE OF RENEWALS OF PHARMACIST AND NUCLEAR PHARMACIST LICENSES AND NOTICE REGARDING ACTIVE - RENEWAL PENDING STATUS

The Georgia Board of Pharmacy has begun the online renewal process for active pharmacist and nuclear pharmacist licenses. Licensees interested in license renewal should consult the Board's website at https://gadch.mylicense.com/eGov/. All pharmacist and nuclear pharmacist licenses expire on December31,2016.
 
If a licensee has submitted a timely and complete renewal application on or before December31,2016, the licensee's license status online will change from "active"to"active-renewal pending"after submission of the renewal application."Active-Renewal Pending"does not mean that the license has lapsed, is inactive, is deficient,or invalid in anyway. Rather, "Active-Renewal Pending" status merely reflects that the licensee has submitted a timely renewal application. A licensee should save the receipt generated after submission of a timely and complete application as additional proof of renewal during the period in which the application is reviewed.
 
Please be reminded that licensees will not receive pocket license cards in the mail. Pocket license cards may now be printed, free of charge,on the Georgia Board of Pharmacy website: http://gadch.mylicense.com/ PocketCards/ . Pocket license cards may be also ordered using the" Duplicate Pharmacy License-License Verification Order Form" that appears under "Applications and Forms" on the website of the Georgia Board of Pharmacy : http://gbp.georgia.gov/
NOMINATION AND ELECTION OF GEORGIA DELEGATES TO THE ASHP HOUSE OF DELEGATES

All pharmacist ASHP members from Georgia are eligible to nominate, be nominated, and vote for delegates and alternates to represent Georgia at the American Society of Health-System Pharmacists (ASHP) 2016 House of Delegates. Individuals wishing to nominate themselves or another ASHP member for the slate of candidates are invited to submit names by email, by October 6, 2016, to: Steve Glass ( sglass@gshp.org) Executive Director.

During the GSHP Annual Business Meeting (when: Saturday, October 22, 2016 where: Brasstown Valley Resort, Young Harris, Georgia), a slate of nominees will be presented and additional nominations will be taken from the floor. Three (3) delegates and up to three (3) alternate delegates will be elected during this meeting. Only Georgia pharmacist ASHP members present at the meeting may vote, with 15 members required for a quorum.  Each individual may vote for three delegate candidates.  The three candidates receiving the most votes will become delegates, with the remainder being elected as alternates.  A simple majority is required for election. For further information, please contact the GSHP office at (800) 913-4747 or email sglass@gshp.org .

Information on the GSHP Annual meeting:

GSHP Fall meeting
October 21-23, 2016
Our statewide educational calendar concludes in October each year at the wonderful Brasstown Valley Resort.  The meeting contains 14.5 hours of continuing education and exhibit program.  The location is an ideal Fall weather venue with crisp air, fireplaces, beautiful sunset view and a wide variety of activities.
 
  Directions 
Young Harris, GA


 


  
Agenda 
DATE/TIME
TALK
SPEAKER
FRIDAY  10/21
 (6 HOURS)
7:45am- 8:40am
(1 hour)
General Care of the Pediatric Burn Patient (with a focus on inpatient and outpatient medication management
Objectives:
1.        Describe different types and depths of burns
2.        Discuss pain management strategies for the pediatric burn patient
3.        Review pharmacological management of itching in the pediatric burn patient
4.        Review topical agents used for burn wound care
5.        Discuss pharmacological attenuation of the hypermetabolic state in large burns 
Rita M. Gayed, PharmD, BCCCP
 
Critical Care Pharmacist Specialist- Burn Center
 
8:45am-9:40am
(1 hour)
New Drug Update 2015: A Formulary Approach
Objectives:
1.     Compare and contrast newly approved drugs with older agents regarding their pharmacology, pharmacokinetics, efficacy, safety, dosage and cost.
2.     Apply the "formulary approach" to evaluating new drugs.
Analyze potential utility of drugs in the pipeline for possible release in the next two years.
Rusty May, Pharm.D., FASHP
Clinical Professor
UGA College of Pharmacy
 
Break
9:45am - 10:00am
___
______
10:00am-10:55am
(1 hour)
Law Update 
Objectives:
1)       Understand the changes and updates related to the Prescription Drug Monitoring Program (PDMP) under HB900.
2)       Identify the changes in drug repository guidelines as described in the Drug Repository for Unused Meds for Indigent and Elderly bill under HB897.
3)       Recall the updates to Immunization Protocol Agreements as outlined under HB1043.
4)       Understand the role biosimilar medications play in today's pharmaceutical market and the laws that involve this class of medications.
5)       Describe recent updates and changes by the Georgia Board of Pharmacy to the Rules and Regulations of the State of Georgia.
Joshua D. Kinsey, Pharm.D.
Department of Pharmacy Practice
Clinical Assistant Professor, Community Pharmacy
Director, Community Pharmacy Residency Program
 
11:00am-1pm 
Lunch w/ exhibit
------
 
1:00pm -1:55pm
(1 hour)
Best Practices in Controlled Substance Management 
Objective:
  1. 1.       Highlight key state, federal, and regulatory requirements for the management of controlled substances.
  2. 2.       Review ASHP Guidelines for successful development of a drug diversion prevention program.
  3. 3.       Discuss best practices for personnel management and investigation/reporting requirements when drug diversion has been detected or confirmed. 
Christy M. Norman, PharmD, MS, BCPS
Administrative Director of Pharmacy
AU Medical Center
 
2:00-2:15
Break
 
2:15pm -3:10pm
(1 hour)
 
Observational analysis and its use in contemporary pharmacy practice
Objectives:
1. List various types of observational trials.
2. Explain the usefulness of observational trials when compared to randomized controlled trials.
3. Identify methods to reduce bias in observational trials.
4. Compare observational trials to randomized controlled trials.
5. Explain how data from observational trials can provide answers regarding effectiveness. 
Anthony Compton, PharmD
Principal, Research Initiatives
Premier Research Services
 
3:15pm - 4:15pm
(1 hour)
Medical Marjuana: A New Therapeutic High Point?
Objectives:
  1. 1.       Identify the active components of medical marijuana and the specific products approved by the FDA.
  2. 2.       Discuss the indications medical marijuana.
  3. 3.       Identify side effects associated with medical marijuana
  4. 4.       Differentiate between medical marijuana and synthetic THC
  5. 5.       Discuss common myths and misperceptions regarding medical marijuana.
  6. 6.       Discuss problems and solutions concerning proper monitoring of medical marijuana use.
 
Randy Tackett
UGA College of Pharmacy
 
4:30pm - 6:30pm
Reception/Exhibits
------
 
 
 
 
 
 
SATURDAY 10/22  (5.5 HOURS)
8:00am - 8:55am      (1 hour)
 
Building Pharmacist-Physician Collaborative Rounds With Limited Resources in a Community Setting 
Objectives:
1.        Describe a stepwise method of establishing pharmacist-physician collaborative rounds
2.        Design a limited resource coverage model and workflow
3.        Analyze pilot phase summary data and current success 
Derek A. Gaul, PharmD, MBA, BCPS
 
9:00am - 10:30am
Exhibits/Breakfast
------
10:30am - 11:55am (1.5 hours)
Are We Any Closer to Taming the Ketamine Tiger? 
Objectives:
1.      Discuss the pharmacology of ketamine when used in the ED or ICU
2.     Review the safety and efficacy of ketamine in the intensive care unit
3.     Select the ideal patient to receive ketamine
4.  List potential uses for ketamine in the ED
5.     Discuss ketamine dosing recommendations for moderate sedation, pain, and agitation
6.     Describe monitoring parameters recommended with ketamine administration
 
Chris Paciullo, Pharm.D. - Emory
John Patka, Pharm.D. - Grady
 
12:00pm - 1:00pm
Lunch, Business Meeting
------
1:00pm - 1:55pm
(1 hour)
Treatment of Severe Alcohol Withdrawal
Objectives:
1. Discuss the pathophysiology of alcohol withdrawal
2. Describe the pharmacologic treatment options for alcohol withdrawal
3. Review literature related to pharmacologic therapy for alcohol withdrawal 
Stacey Folse
Emory University Hopsital
 
2:00pm - 2:55pm
(1 hour)
Obstetrics Update- There's a Bun in the Oven: What Pharmacists Need to Know
1.      Discuss the changes to Pregnancy and Lactation labeling, implications of retiring the FDA Pregnancy Risk Categories, and useful references.
2.      Summarize the physiologic changes in pregnancy and their effects on medication dosing.
3.      Review over the counter and prescription medications used for relief of nausea and vomiting in pregnancy.
4.       Describe medication protocols for the management of acute-onset, severe hypertension during pregnancy and post-partum. 
Eliza Hoernle, BSPharm, Pharm D
OB Clinical Pharmacy Specialist - High Risk Perinatal
Northside Hospital
 
3:00pm-3:55pm
(1 hour)
Obstetrics Update Part 2- Preterm Labor Prevention and Treatment
1.  Explain the mechanism, dosing, adverse effects, and monitoring parameters of the tocolytic agents. 
2.  Describe pharmacotherapy interventions performed in the preterm labor setting in order to have neonatal benefits.
3.  Identify appropriate antibiotic therapy for Group B Strep prophylaxis.
4.  Distinguish between the agents used for labor induction and identify dosing and adverse effects of these agents.
 
Lindsey Jackson, Pharm D, BCPS
Labor and Delivery Clinical Pharmacist
Northside Hospital Pharmacy
 
7:00pm - 10:00pm
 
SEC Football and Dinner
 
------
SUNDAY 10/23 (3 HOURS)
7:30am - 8:00am
 
BREAKFAST
 
------
8:00am-8:55am         (1 hour)
Incorporating MTM Services into Your Practice 
Objectives:
Define medication therapy management (MTM)
Discuss practice considerations for providing MTM services
Conduct a medication therapy review for a patient case
Identify resources available for providing MTM services
 
Ashley Hannings, PharmD, BCACP
Division of Experience Programs
UGA College of Pharmacy
 
9:00am-9:55am
(1 hour)
Standing in the Analgesic Gap:  Pharmacist's Role in Pain Management and Opioid Stewardship 
Objectives: 
1.        Explain the impact of pain on individuals, health care institutions and society.
2.        Review the evidence supporting pharmacy-based pain management and opioid stewardship.
3.        Describe a model pharmacy-based pain management and analgesic stewardship program
4.        Describe the experience and process for development and implementation of a pharmacy-based pain consult service
5.        Identify educational resources for assessing and enhancing clinician's knowledge base in pain management and analgesic stewardship 
Jasmine Jones, Pharm.D., CGP
Clinical Pharmacist-Pain Specialist
Wellstar Health System
Kennestone Hospital
 
10:00am - 10:55am
(1 hour)
An Update on the Use of Pre-Reperfusion Beta-Blocker Therapy in ST-Elevation Myocardial Infarction 
Objectives:
1)         Review the pathophysiology of myocardial infarction
2)        Elucidate the proposed mechanism of beta-blockers in myocardial infarction
3)        Identify relevant guideline recommendations regarding early beta-blocker use
4)        Analyze pertinent primary literature regarding the use of early beta-blockers
Hannah Dills, Pharm.D.
 




 
 
 
 
 
  
Hotel Reservations
To make your hotel reservation, call  1.800.201.3205 or 706.379.9900.  To book online reservations through the    Brasstown Valley Resort website, enter block code GAS1019_001  .   The website will show sold out unless you enter the group code.  Rate is $170 + Tax and a $10 + tax resort fee per night. 
 
 Exhibit information                                                                                                                                                                                                                                                          
                                    
 


Congratulations to our student chapters who were recently recognized by ASHP.

ASHP offers Student Societies of Health-system Pharmacy (SSHPs) nationwide the opportunity for official "ASHP-SSHP Recognition".  Criteria for recognition encourage SSHP activities that:
  1. Promote membership in local, state, and national health-system organizations;
  2. Stimulate interest in health-system pharmacy careers;
  3. Encourage career development and professionalism among students aspiring to careers in health-system pharmacy. 
SSHPs that meet the criteria for recognition will receive tangible benefits and acknowledgment (see "Annual Recognition Benefits" below).  SSHPs must complete the required activities each year to receive annual benefits from ASHP.

This official recognition serves as the completion of the "triad" relationship between ASHP, the ASHP state affiliate organization, and the SSHP, as well as provides a direct relationship between ASHP and the SSHP. ASHP encourages developing SSHPs to become a chapter or affiliate of the ASHP state affiliate organization.

We congratulate our student chapters at Mercer University College of Pharmacy, PCOM School of Pharmacy, South University School of Pharmacy and the University of Georgia College of Pharmacy.

ASHP Call for Recommendations for Appointments

 
Recommendations for appointments to ASHP committees are currently being accepted for the June
2017 - May 2018 term. The deadline for recommendations is November 14, 2016.
 
ASHP President-elect Paul W. Bush, with the approval of the Board of Directors, appoints members of ASHP Committees. ASHP members are encouraged to recommend themselves or other members for appointment.
 
In making recommendations for appointments, the President-elect takes into consideration geographic distribution, personal qualifications, and previous experience in ASHP and affiliated state societies. ASHP is especially interested in having recommendations that help ensure sufficient diversity in appointments. ASHP is also interested in identifying new practitioners, residents, and students who are well equipped to serve ASHP through an appointment to one of these bodies.
 
Members may recommend more than one individual for any particular body. The number of recommendations usually far exceeds the number of appointments. Members who have previously been appointed and who would like to continue serving must also submit recommendation materials.
 
To recommend someone for appointment, an ASHP member must complete the online Appointment Recommendation Submission Form. The form allows members to provide comments on the candidate's (1) qualifications, (2) experience, (3) areas of special expertise, (4) previous involvement with ASHP or state affiliates, and (5) any special characteristics that will help ASHP achieve a balance of perspectives and diversity. Note that the candidate's curriculum vitae must be attached to the form when it is submitted.
 
If you have any questions, please contact the ASHP Executive Office at ashpeo@ashp.org .


FREE CE for GSHP Members! 
Webinar-

October 13, 2016 - 12 noon-1:00 pm

How Low Can You Go? An Evaluation of Very Low LDL-C

Learning Objectives:
  • Review the pathophysiology of hyperlipidemia and how it impacts cardiovascular risk
  • Describe the pharmacology and pharmacokinetics of PCSK9 inhibitors
  • Analyze literature evaluating the efficacy and safety of PCSK9 inhibitors
  • Identify how genetic mutations can impact response to various lipid lowering therapies
  • Analyze literature evaluating the impact of very low LDL-C levels
Speaker: 
Julianne Jones, Pharm.D.
PGY-2 Ambulatory Care Pharmacy Resident
Grady Health System
 
Georgia Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy
Educ
ation (ACPE) as a provider of continuing pharmacy education. This program is approved for 1 hour (0.1 CEUs) of continuing pharmacy education credit.  Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test.   Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.  UAN  # 0228-0000-16-133-L01-P; 0228-0000-16-133-L01-T

This is a member service of GSHP.  There is no charge for members to attend.  Non-members will be charged $20.
Non-member registration: Email sglass@gshp.org

Announcements:

GSHP member Lauryn McCalley Niday was recently inducted into the Georgia Aquatic Hall of Fame.
McCalley Niday was the Georgia Diver of the Year from 1995-1999 and was a two-time state high school champion.

She won 3-meter diving championships at the Senior National Championships in 2000 and 2001 and qualified for the World Championships.

She also won three Senior National championships in 3-meter synchronized diving with partner - and Moss Farms Diving teammate - Lane Bassham Winchester.

At Tennessee, she was the SEC Freshman Diver of the Year and went on to become a five-time All-American.
She had four top-eight finishes at the NCAA Championships and was fifth on 1-meter in 2003.

After graduating from Tennessee with a degree in microbiology, she attended pharmacy school at the University of Georgia, where she was honored as the R.C. Wilson Outstanding Student in 2009.

McCalley Niday lives in Colquitt County where she works part-time with the Colquitt Regional Medical Center pharmacy.

Clinical Article
 
Thiamine dosing in patients with suspected alcohol withdrawal syndrome
 
Tiffany Somereville, PharmD candidate, Class of 2018
Joshua Patterson, PharmD candidate, Class of 2018
Tyler Young, PharmD candidate, Class of 2018
Valana Vannoy, PharmD, PGY1 Pharmacy Practice Resident, Phoebe Putney Memorial Hospital
Anthony Hawkins, PharmD, BCCCP, Clinical Assistant Professor, University of Georgia College of Pharmacy
 
Background
 
Approximately 20% of patients admitted to the hospital suffer from alcohol dependency; many of which will experience acute withdrawal syndrome while receiving care for other conditions.1 In providing supportive and preventative care for these patients, a major cause of concern continues to be the dosing of thiamine in alcohol-induced thiamine deficiency.2

Thiamine is an essential dietary nutrient and is heavily utilized as a cofactor in reactions essential to the catabolism of carbohydrates.2 For patients with alcohol dependency, excessive consumption of alcohol disrupts the diffusion of thiamine from the gastrointestinal tract, putting the patient at risk for developing numerous neurological issues, most notably Wernicke's encephalopathy. It has been shown that both alcohol and thiamine utilize diffusion in the small intestines as its method of transport into the bloodstream. Excess ethanol overloads the diffusion process, thereby slowing the rate of absorption in the intestines. This impairs the conversion of thiamine to its useable form and causes the accumulation of ethanol in the body.2-4
 
Presentation
 
Alcohol withdrawal typically presents as a 'cluster of symptoms' which usually occurs after a person significantly reduces or stops long-term alcohol consumption.The patient can present with autonomic dysreflexia, anxiety, agitation, tremors, and irritability. If the withdrawal is severe enough, the patient's symptoms may worsen to include seizures, delirium tremens, and hallucinations. These symptoms can begin to manifest after only a few hours of alcohol abstinence5.

Another condition that can present during alcohol withdrawal is Wernicke's syndrome, due to an acquired thiamine deficiency. Wernicke's is characterized by three conditions: ataxia, confusion, and opthalmoplegia. However, it is important to note that these three symptoms are rarely seen all at once. This leads to Wernicke's often going unrecognized, undiagnosed, and improperly treated. If left untreated, Wernicke's syndrome can progress into permanent memory loss and neurologic damage.6
 
Treatment
 
Generally, treatment is focused on symptomatic and supportive care. It is important to keep the patient comfortable and as relaxed as possible. Sedation with benzodiazepines and fluid replacement are often utilized.

To prevent the development of neurological disorders such as Wernicke's encephalopathy, thiamine has historically been administered at 100mg daily as a standard ingredient included in a banana bag.7 This dose was arbitrarily chosen over half a century ago with no supportive evidence. Recent evidence states that less than 20% of patients with Wernicke's encephalopathy achieve complete recovery with this commonly prescribed dose.3,7 This subtherapeutic thiamine dosing results in severe sequelae, with more than 80% of patients suffering permanent neurologic impairments.3 If Wernicke's encephalopathy is suspected, higher doses of up to 500mg of intravenous thiamine every eight to twelve hours are now recommended for three to five days.2,3 Benefits of the neurological preservation by these higher doses outweigh the risks associated with any adverse effects associated with thiamine.1

The earlier thiamine supplementation is initiated, the more likely severe neurological complications can be avoided. Some studies suggest that initiation of therapy within two hours is optimal. Oral thiamine is not recommended in critically ill patients due to the rate limited absorption of thiamine which is further decreased in alcoholics. However, continuation of oral thiamine in the outpatient setting of 100mg daily for 30 days after the acute withdrawal phase is recommended.6

Due to the supporting evidence of the inadequacy of traditional thiamine dosing strategies, it is recommended for patients suffering from alcohol withdrawal to receive intravenous thiamine 500 mg two to three times daily for 3 to 5 days.3,7 Subsequent tapering strategies should be individualized to the clinical response of the patient.

References
1.       Jarvis, S. D., DNP, ACNP-BC, & Blad, K. D., DNP, ACNP-BC, FCCM. (2010, December 6). Nursing Care of Patients with Alcohol Withdrawal Syndrome. Retrieved
June 10, 2016, from
 
2.       Hoyumpa, AM, Jr. (2012) Mechanisms of Thiamin Deficiency in Chronic Alcoholism. The American Journal of Clinical Nutrition. 33(12): 2750-61. http://ajcn.nutrition.org/content/33/12/2750.abstract
 
3.       Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial Psychiatry Journal, 22(2), 100-108. http://doi.org/10.4103/0972-6748.132914
 
4.       Thiamin - Health Professional Fact Sheet. (2016). Retrieved June, 2016, from https://ods.od.nih.gov/factsheets/Thiamin-HealthProfessional/
 
5.       Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical and Diagnostic Research: JCDR, 9(9), VE01-VE07. http://doi.org/10.7860/JCDR/2015/13407.6538
 
6.       Talbot, P. A. (2011). Timing of Efficacy of Thiamine in Wernicke's Disease in Alcoholics at Risk. Journal of Correctional Health Care, 17(1), 46-50. doi:10.1177/1078345810385913
 
7.       Flannery, A. H., Adkins, D. A., & Cook, A. M. (2016). Unpeeling the Evidence for the Banana Bag. Critical Care Medicine, 1. doi:10.1097/ccm.0000000000001659

     


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