March/April 2021 Newsletter
In This Issue:
  • President's Message
  • Board of Director's Update
  • R&E Awards Update
  • Public Policy Update
  • Pharmacist Continuing Education Articles
  • Pumped Up About SGLT2 Inhibitor Use in Heart Failure 
  • Continuous Glucose Monitors and the Role they Play in the Management of Diabetes Mellitus 
  • Featured Clinical Topic: Endocrinology
  • Multimodal Pain Relief in Critically Ill Trauma Patients
  • APA Releases New Practice Guideline for the Treatment of Patients with Schizophrenia 
  • Pharmacological Considerations for the Treatment of Insomnia in Older Adults
  • Review of Initial Pharmacotherapy Treatment in those Presenting with Status Epilepticus
  • Affiliate Chapter News and Events
  • Upcoming Newsletter Info
President's Message
By Davina Dell-Steinbeck, PharmD, BCPS; SSM Health St. Mary’s Hospital
“Bloom where you are planted.” - 1 Corinthians 7:20-24

It’s Springtime! I enjoy most everything about Spring. It is a time of renewal. I love the temperatures warming up, the days getting longer, the return of baseball, and everything blooming. Springtime also means Spring Meeting, Match Day, Legislative Day and Residency Research Conferences. These are some of my favorite experiences throughout the year. Spring Meeting means that I get to see my friends (even if it is virtually) and partake in great programming.
Board of Director's Update
By Christina Stafford, PharmD, BCPS- MSHP President- Elect; CoxHealth, Springfield 

January
  • Spring Meeting will be virtual again this year. It is hosted in conjunction with ICHP and will take place March 19th – 20th.
  • Legislative Day will be virtual this year on March 30th. We encourage as much attendance as possible!
  • MPA priorities: Medicaid pharmacy carve-out, extending FRA, pharmacist prescriptive authority (pharmacy practice act expansion), PBMs, PDMPs, Medicaid expansion, COVID liability protection
  • Work with MPA to establish united message to legislators
  • COVID-19 vaccine expansion efforts are happening rapidly. Discussed establishing a task force to help provide guidance to health-systems. The plan is to share information via social media to reach members and the public.
  • The Board voted to sign on to the ASHP letter for Federal Support for Vaccine Distribution.
  • House of Delegates - Ballot was sent out for voting. Need to submit delegate name to ASHP by end of January.
  • Internal audit - Presidents and treasurers will complete two years of audits, due to inability to complete at 2020 Spring Meeting. Should be done by 3/10/21.

February
  • MSHP is signing on to an ASHP letter to DEA regarding safety of provider-administered pain medications.
  • Legislative Day on March 30th is virtual and includes networking time and individual meetings with representatives.
  • Spring Meeting on March 19th – 20th is virtual using vFairs platform. There are 30 registered exhibitors as well as 32 posters.
  • Virtual Game Night social event getting planned for Friday evening to benefit R&E.
  • Requests for sharing things on our social media pages from outside of MSHP
  • Barb and Bethany will work on developing a draft process and bring to future board meeting
  • House of Delegates - Laura Butkievich was elected ASHP delegate. Ashley Duty is the alternate.
R&E Awards Recap
By Jacklyn Harris, PharmD, BCPS, Christian Hospital/St. Louis College of Pharmacy
We had another great virtual Spring Meeting this year! We hope that you enjoyed the programming as much as we did and hope that you were able to view this year’s posters. Our poster presenters did not disappoint- they did a great job completing their research and recording a short 5-minute video review of their poster. Our poster winners this year are listed below. 
Public Policy Update
Standards Based Regulation – The Big Picture

By Nathan Hanson, PharmD, MS, BCPS, Health Trust Supply Chain
Quick Question: Are you compliant with the Board of Pharmacy rule that establishes the minimum size for the pharmacist’s photo that is posted in a pharmacy? 

Next Questions: If you are noncompliant with this rule, will patients be negatively impacted? If you are compliant with the rule, will patients benefit?

Most Important Question: Why is this rule in place?
Pumped Up About SGLT2 Inhibitor Use in Heart Failure 

By Sarah Lothspeich, PharmD, MPH; PGY2 Ambulatory Care Resident, CoxHealth - Springfield 
According to the Centers for Disease Control and Prevention (CDC), more than an estimated 6.2 million adults were diagnosed with heart failure in the United States between 2013 and 2016.1 This number has grown and is predicted to continue to grow. In fact, between 2009 and 2012, the estimated number of adults with heart failure was around 5.7 million.1 The growth is especially concerning considering the significant healthcare costs associated with caring for patients with heart failure. In 2012, it was estimated that heart failure alone cost the nation $30.7 billion dollars.1,2

Program Number: 2021-03-03
Approval Dates: April 7, 2021 to October 1, 2021
Approved Contact Hours: 1 hour
Continuous Glucose Monitors and the Role they Play in the Management of Diabetes Mellitus 

By: Emily Lammers, PharmD, MSLD; PGY2 Ambulatory Care/Academia Resident 

Mentor: Lisa Cillessen, PharmD, BCACP; Clinical Assistant Professor
UMKC School of Pharmacy at MSU 
Diabetes mellitus is a chronic disease that affects over 34 million children and adults in the United States alone and 422 million people worldwide. This equates to a global presence of diabetes in people aged 18 years and older of 8.5%.1 In the United States specifically, 10.5% of the population are diagnosed with diabetes which equates to 1 in 10 Americans. Of the people in the United States diagnosed with diabetes, about 5% of the population, or 1.4 million, are diagnosed with Type 1 Diabetes Mellitus (T1DM) and 90- 95% are diagnosed with Type 2 Diabetes Mellitus (T2DM).2 These statistics show that diabetes mellitus is a common disease state that healthcare providers will encounter in their patients regardless of the environment in which they work.

Program Number: 2021-03-02
Approval Dates: April 7, 2021 to October 1, 2021
Approved Contact Hours: 1 hour
Earn Pharmacy Technician CE Credit! 
This CE credit is available until April 30, 2021.

Learning Objectives:

  • Who is ASHP?
  • Who is PTCB?
  • How is Technician advancement backed by ASHP and PTCB?
  • What is the difference between PTCB credentials?

In order to get the session, and .5 credit hours, you must:

  1. Register to listen to the recording
  2. Listen to the recording all the way through and take the online survey
Featured Clinical Topic: Psych/Neuro/Pain
Multimodal Pain Relief in Critically Ill Trauma Patients

By: Amanda Bernarde, PharmD; PGY1 Pharmacy Resident
University of Missouri Health Care
Uncontrolled pain in the trauma patient population can lead to a variety of long-term, debilitating effects.1,2 Most prominently, patients experience impaired healing due to additional production of inflammatory factors, increased risk of infection, and psychological disorders persisting well past the initial injury.3 Due to the subjectivity of pain assessments and confounding factors, including sedating medications that can mask uncontrolled pain, recent exposure to opioids, and chronic versus acute pain etiologies, pain management remains a challenge in all patient populations.
APA Releases New Practice Guideline for the Treatment of Patients with Schizophrenia 

By: Garrett Shobe; PharmD Candidate 2021

Mentor: Leigh Anne Nelson, PharmD, BCPP; Associate Professor of Pharmacy/Psychiatry, UMKC School of Pharmacy
Schizophrenia is a chronic disabling thought disorder resulting in severe detrimental effects to a person’s health, social, and occupational status. Individuals with schizophrenia can present with hallmark symptoms of psychosis (delusions, hallucinations, disorganized speech), negative symptoms (avolition, anhedonia), catatonic behavior, and cognitive dysfunction. People with schizophrenia have significantly higher rates of mortality as compared to the general population, especially in the presence of other psychiatric or substance use disorders and unfortunately, approximately 10% die of suicide. The American Psychiatric Association (APA) developed a new practice guideline in 2020 focused on the treatment of schizophrenia. The APA recommendations for use of first-generation antipsychotics (FGA), second-generation antipsychotics (SGA), treatment resistant schizophrenia, long-acting injectable antipsychotics (LAIA), and first-episode psychosis will be reviewed.
Pharmacological Considerations for the Treatment of Insomnia in Older Adults

By: Hannah Michael, PGY1 Pharmacy Resident, University of Missouri Health Care
As adults age, observed changes occur in their sleep patterns, resulting in a higher prevalence of insomnia in the older patient population, or those aged 65 years and older. In normal physiologic sleep processes, sleep is divided into non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. NREM sleep is then further divided into three different stages: N1, N2, and N3. N1 and N2 are categorized into light sleep with N2 accounting for around 48% of sleep time when brain waves begin to slow. N3 sleep is composed of very slow brain waves, also referred to as slow wave sleep.1 As patients age, nightly sleep begins to naturally shorten, however, there are other notable sleep changes that develop in older adults.
Review of Initial Pharmacotherapy Treatment in those Presenting with Status Epilepticus

By: Jamie Prashek, PharmD, PGY1 Pharmacy Resident, University of Missouri Health Care 
Status epilepticus broadly refers to a seizure with prolonged activity; historically this was defined as a duration of at least 30 minutes.1-3 Lowenstein et al. further specified this definition as convulsive seizures with at least five minutes of continuous seizure activity or intermittent seizures without recovery of consciousness in-between.4,5 Current recommendation is for prompt initiation of treatment once activity has reached five-minutes.2 A delay in initiation increases the chance for prolonged activity and risk for neuronal injury. Morbidity and mortality increases as seizure time lengthens, with seizures lasting greater than 30 minutes having an increased risk for worse outcomes.2,5-7 
Greater Kansas City Society of Health-System Pharmacists (GKCSHP) 

President: Ashley Duty, PharmD, MS (ashleymduty@gmail.com)


Mid-Missouri Society of Health-System Pharmacists (MMSHP) 

Like us on Facebook! www.facebook.com/mymmshp/  

President:  Sandy McGraw, PharmD, BCPS (mcgrawa@health.missouri.edu


Saint Louis Society of Health-System Pharmacists (STLSHP) 

President: Gabrielle Gibson, PharmD, BCPS, BCCCP (gabrielle.gibson@bjc.org


Southeast Missouri Society of Health-System Pharmacists (SEMSHP) 


President: Janice Wesbecher, PharmD, BCPS (jbueter@sehealth.org
Upcoming Newsletter Info
Upcoming Featured Clinical Topics 

  • May/June 2021 – CriticalCare/Pulm/EmergencyMed
  • July/Aug 2021 - Cardiology/Anticoagulation
  • Sept/Oct 2021 - Transitions of Care/Geriatrics
  • Nov/Dec 2021 - Infectious Diseases/Vaccines

Submit to: Sarah Cook
Newsletter Submission Deadlines:

May/June 2021 - April 26th, 2021
July/Aug 2021 - Jun 21st, 2021
Sept/Oct 2021 - August 23rd, 2021
Nov/Dec 2021 - October 25th, 2021
Newsletter Submission Guidelines

  • Pharmacists, pharmacy technicians, and pharmacy students in Missouri are eligible to submit content for publication in the MSHP Newsletter. Student submissions need to include pharmacist oversight.

  • Submit content to the current Newsletter Committee Chair on or before the established deadlines.

  • CE and Featured Clinical Topics must be approved by the Newsletter Committee Chair in advance of article submission, to prevent duplicates. Duplicate articles submitted without advanced approval may not be published.

  • Recommended length of submissions for committee, affiliate, college/schools of pharmacy, and student chapter reports is half to one page in length.

  • Recommended length of submissions for featured clinical topics is 1 to 2 pages, without references.

  • Recommended length of CE articles is individualized, based on the amount of CE provided.

  • Recommended length of submission for other categories is 1 to 2 pages.
MSHP Board of Directors & Committee Chairs
2020-2021 Board Members

President:  Davina Dell-Steinbeck

President-Elect: Christina Stafford

Immediate Past President: Alex Oschman

Secretary: Barb Kasper

Treasurer: Elaine Ogden
2020-2021 Committee Chairs

Vendor Relations Board Liaison - Evanna Shopoff

Membership Committee - Kristen Petersen

Public Policy Committee - Nathan Hanson

Newsletter Committee - Sarah Cook

Education and Programming - Rebecca Nolen

Website & Social Media - Bethany Baker
Questions & Comments
If you have any questions, comments, or wish to submit an article to for MSHP Newsletter, please contact the Newsletter Committee Chair (Sarah Cook) or another Newsletter Committee member.

2020-2020 MSHP Newsletter Committee Members
Sarah Cook, PharmD, BCPS (Chair)
Laura Challen, PharmD, MBA, BCPS, BCACP (Vice-Chair)
Yvonne Burnett, PharmD, BCIDP
Gabrielle Gibson, PharmD, BCPS, BCCCP
Rebecca Nolen, PharmD, BCPS, BCIDP, AAHIVP
Hannah Pope, PharmD, BCPS
Emily Shor, PharmD