September/October 2020 Newsletter
In This Issue:
  • President's Message
  • Board of Director's Update
  • R&E Foundation Update
  • Public Policy Update
  • Pharmacist Continuing Education Article
  • Deliriously Managing Delirium: The Use of Anti-Psychotics for Delirium in the ICU
  • Original Research Article
  • Development of a Cystic Fibrosis-Specific Antibiogram in a Pediatric Health System
  • Featured Clinical Topic: Pediatrics
  • Activation in Pediatric Patients taking Antidepressants  
  • Life at an Expensive Cost: High-Cost Medications for Spinal Muscular Atrophy 
  • Vaccinations in Pediatric Hematopoietic Stem Cell Transplant Recipients  
  • Management of Delirium in the Pediatric Intensive Care Unit 
  • Affiliate Chapter News and Events
  • Upcoming Newsletter Info
  • NOTE: Nov/Dec is FULL
President's Message
By Davina Dell-Steinbeck, PharmD, BCPS; SSM Health St. Mary’s Hospital
This summer we sent out a survey to our membership to gauge interest in attending an in-person celebration for our 50th anniversary. As expected, the survey results showed that our membership is not in favor of having an event at this time. 65% of members did not support an in-person meeting and 75% of members said they would not be comfortable at an in-person event until 2021. Several members commented that holding an in-person meeting sends the wrong message and goes against the actions of multiple national organizations. Others commented that they would not be comfortable gathering until there is a vaccine. Many commented about the state of the economy and the inability to travel because of both work and financial restrictions. 

Board of Director's Update
By Christina Stafford, PharmD, BCPS- MSHP President- Elect; CoxHealth, Springfield 

  • 2020-2021 Budget was approved as presented 
  • 2019-2020 Strategic Plan was reviewed and successes noted 
  • The Board voted to approve MSHP concurrence with ASHP’s letter to make permanent the CMS virtual supervision flexibilities 

  • Board Member Orientation to take place at the Strategic Planning Session or the September meeting 
  • Strategic Planning Session scheduled virtually for October 2nd 
  • Annual Meeting Recap 
  • ~300 attendees 
  • Attendees from 11 US States, India and Ireland 
  • 4.72 out of 5 overall satisfaction score 
  • Meeting was financially profitable 
  • Planning for Spring Meeting 2021 has begun. If you are interested in joining the Education and Programming Committee and be a part of the planning process, please reach out to Becca Nolen  
  • Advocacy 101 Webinar took place on August 6th- well attended by members 
  • Election Results: 
  • Secretary-Elect: Mel Smith 
  • Technician Liaison: Willie Rogers 
R&E Foundation Update
Spotlight on the Best Resident Project Award Winner

By: Jackie A. Harris, PharmD, BCPS; Executive Director, MSHP Research & Education Foundation; Christian Hospital
Resident Project

Dr. Joseph Walter, a PGY2 Ambulatory Care resident at CoxHealth this past residency year, was awarded the Best Resident Project during the Virtual KCHP/MSHP Spring Meeting for his project entitled “Impact of Pharmacist-led Education on Providers’ Prescribing Rates and Perceptions of Naloxone in High-Risk Opioid Patients”. With the number of naloxone prescriptions increasing by 106% from 2017 to 2018, one would expect to see that same correlation in our high-risk patient populations. Unfortunately, that is not the case with only one naloxone prescription for every 69 high-dose opioid prescription.

Coming Soon: MSHP R&E Virtual Programming

Students - Are you ready to start applying for residency programs or jobs?

Residency Program Directors - How will your residency interviews look different now?

The MSHP Research & Education Foundation is planning 4 virtual sessions to discuss the questions above.

Session 1 - Preparing for Interviews - Tips for Students/Residents (CV, Letter of Intent)
Session 2 - Setting up Virtual Interviews Networking Session
Session 3 - General Interview Tips
Session 4 - Virtual Interview Tips

Keep an eye open for the scheduling of these virtual sessions starting in October!
Public Policy Update
Leadership is Influence. Influence Makes an Impact.

By Nathan Hanson, PharmD, MS, BCPS, Health Trust Supply Chain

Pharmacists, interns, and technicians are health care leaders - here are two ways that we can make an impact. 

Do you know how to contact both of your US Senators and your US Representative in one click? If you invest 5 minutes with ASHP you will be able to do just that. The ASHP Action Center is a website where you register to receive updates about pressing legislative issues, making it very simple to send expertly-written form emails at the times when they will have the greatest impact.

Deliriously Managing Delirium: The Use of Anti-Psychotics for Delirium in the ICU  

By: Zachary Moszczenski, PharmD; PGY1 Pharmacy Resident (2019-2020) 

Mentor: Jackie A. Harris, PharmD, BCPS, Christian Hospital – St. Louis, MO
The use of anti-psychotics to treat delirium has been a controversial topic in recent years, owing to the short supply of high-quality trials and a shift in guideline recommendations. However, the debate started earlier in the beginning of the millennium when we began to ask ourselves: does what we’ve simply been doing for years actually work?  

Program Number: 2020-06-03 
Approval Dates: 10/1/2020 to 4/1/2021
Approved Contact Hours: 1 hour 
Original Research Article
Development of a Cystic Fibrosis-Specific Antibiogram in a Pediatric Health System

By: Jamie Sullivan and Brooke Jacobson, PharmD Candidates 2021, UMKC School of Pharmacy

Mentor: E. Claire Elson, PharmD, BCPPS; Children’s Mercy Kansas City
Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by dysfunction in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. As a result, abnormal, viscous secretions primarily affect the gastrointestinal and respiratory system in people with CF.1 These secretions cause a complex respiratory triad of increased inflammation, obstruction, and infection that may eventually lead to bronchiectasis, parenchymal destruction, and increased morbidity and mortality.1

Featured Clinical Topic:
Activation in Pediatric Patients taking Antidepressants  

By: Kathryn Renken, PharmD Candidate 2021 and Morgan Luttschwager Rose, PharmD Candidate 2022; St. Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis

Mentor: Amanda Grapperhaus, PharmD, BCPS; SSM Health DePaul Hospital
 According to the Centers for Disease Control and Prevention, of children age 3 to 17 years old in the United States, 7.1% have diagnosed anxiety and 3.2% have diagnosed depression. Following diagnosis, 78.1% of the children with depression and 59.3% of the children with anxiety received treatment.1 In adults, first-line treatment for both anxiety and depression is antidepressant medication from the drug class of selective serotonin reuptake inhibitors (SSRIs).2 In children, these drugs are often less helpful. When used in pediatric patients, antidepressants can cause a state of hyperarousal known as activation, which can cause an increase in activity, impulsivity, disinhibition, restlessness and insomnia.3 These symptoms typically occur following antidepressant initiation or dose changes, and they can be harmful.

Life at an Expensive Cost: High-Cost Medications for Spinal Muscular Atrophy 

By: Nirali Ragha and Yostena Khalil, PharmD Candidates 2022; St. Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis

Mentor: Nausheen Hasan, PharmD, BCPPS; St. Louis Children’s Hospital
Spinal muscular atrophy, more commonly known as SMA, is a genetic disease. This disease primarily effects muscles; muscles start to get smaller, or atrophy, because nerve cells located in the spinal cord are not stimulating them. This atrophy hinders the patient's ability to eat, walk, or breathe. SMA is characterized by four different categories ranging from type 1 to type 4. The earlier in the age that a baby is diagnosed with SMA, the greater the impact on their motor function. 

Vaccinations in Pediatric Hematopoietic Stem Cell Transplant Recipients  

By: Samira Zantout, PharmD Candidate 2021; UMKC School of Pharmacy

Mentors: Jamie Rouch, PharmD, BCPPS and Jean Freudenthal, PharmD; Children’s Mercy Kansas City
How many vaccines have you received in your lifetime? Following the Centers for Disease Control and Prevention (CDC) recommendations, the average person receives over 30 doses of vaccinations by the age of 18 and that is not counting the annual influenza vaccine.10 Completing and staying up to date on different vaccination series is an investment into building long-term immunity against vaccine-preventable diseases. However, it can be a lengthy time commitment, especially for patients that have to redo their entire vaccination schedules. This is the reality for patients that receive a hematopoietic stem cell transplant (HSCT).2,4

Management of Delirium in the Pediatric Intensive Care Unit 

By: Brooke Jacobson and Kyle Roof, PharmD Candidates 2021; UMKC School of Pharmacy

Mentor: Ekeni Livingston, PharmD, BCPPS; Children’s Mercy Kansas City
Managing patients in the pediatric intensive care unit (PICU) has evolved immensely over the years. While striving to successfully treat the patient’s underlying conditions, providers have often encountered consequences from their own interventions. The goals of caring for critically ill patients not only entails preventing mortality but also avoiding complications associated with prolonged stays in the PICU.1 Delirium is a common consequence addressed in the adult intensive care unit (ICU) population. Conversely, delirium in the pediatric population is often not addressed and rarely studied. 

Greater Kansas City Society of Health-System Pharmacists (GKCSHP) 

President: Ashley Duty, PharmD, MS (

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

Like us on Facebook!  

President:  Sandy McGraw, PharmD, BCPS (

Saint Louis Society of Health-System Pharmacists (STLSHP) 

President: Gabrielle Gibson, PharmD, BCPS, BCCCP (

Southeast Missouri Society of Health-System Pharmacists (SEMSHP) 

President: Janice Wesbecher, PharmD, BCPS (
Upcoming Newsletter Info
Upcoming Featured Clinical Topics 

Nov/Dec 2020 – ID/Vaccines FULL
Jan/Feb 2021 – Endocrinology
Mar/Apr 2021 – Psych/Neuro/Pain
May/June 2021 – CriticalCare/Pulm/EmergencyMed

Submit to: Sarah Cook
Newsletter Submission Deadlines:

Nov/Dec 2020: November 9th
Jan/Feb 2021: January 1st
Mar/Apr 2021: March 1st
May/June 2021: May 1st
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