VSHP CONDUCTING MEMBER SURVEY-INPUT REQUESTED

VSHP is a member-driven organization and as such our success is dependent on meeting the diverse needs of our colleagues practicing in various settings across the state. The VSHP Board of Directors would like to solicit your ideas and opinions on current programming offered by VSHP as well as identify new opportunities to enhance the organization's value to our membership.   

Below is a link to a member survey which is designed to help us better understand your needs.  Please visit the link below.

https://www.surveymonkey.com/r/L7SXJY2 

Please take a few minutes of your time to provide us with this important input.  

We kindly request your response by  June 5, 2020.   The first 50 members to complete the survey will be entered into a drawing for a $25 Amazon gift card.

Thank you for your participation and your support of VSHP

Virginia Board of Pharmacy Update

The Virginia Board of Pharmacy convened a virtual meeting on May 18, 2020 (virtual meetings of government bodies during the COVID-19 public health emergency have been allowed by the Governor and General Assembly). The agenda packet can be found here.

Public Hearings and Adoption of Minutes

All Board members were present. There was no public comment for the Public Hearing on Placement of Chemicals into Schedule I and Conforming Drug Schedules to Actions Taken by DEA.

All minutes from the previous Board of Pharmacy meetings listed on the agenda were approved.

Christina Barille, VPhA, stated that pharmacists are prepared to offer COVID-19 testing and vaccinations. She mentioned HB 1506 (Sickles) from the 2020 General Assembly Session regarding pharmacist scope of practice as a positive initial step (more on HB 1506 below).

Three representatives spoke on behalf of Covetrus Maine, an internet and mail delivery pharmacy that provides pharmacy services to veterinarians and is licensed in Virginia as a non-resident pharmacy. See p. 150 in the agenda packet and the New Business section below for more information.

Department of Health Professions (DHP) Director's Report

Dr. David Brown mentioned that the Board of Pharmacy has issued various waivers to address COVID-19. DHP's various other regulatory boards have also issued waivers to address licensure and continuing education, and the Governor issued an executive order to increase the healthcare workforce during the COVID-19 public health emergency.

DHP is working on electronic participation for regulatory board members and members of the public when in-person meetings resume, provided that an in-person quorum of the Board will be required.

Some teleworking among DHP staff will likely continue after the public health emergency.

Legislative/Regulatory/Guidance

Elaine Yeatts, DHP Senior Policy Analyst, reviewed the list of General Assembly Post Session Studies/Reports on p. 43 of the agenda packet, particularly the extensive "rewrite of pharmacist scope" required by HB 1506. Board member Kristofer Ratcliffe stated that he wants to make sure frontline pharmacists are involved in the pharmacist scope study. VSHP is sending a letter to the Board regarding the various stakeholder groups we will engage in.

At the Reconvened Session on April 22, 2020, the General Assembly accepted the Governor's amendments to SB 976 (Marsden) pertaining to pharmaceutical processors and cannabis dispensing facilities. The major change was to replace the two definitions of CBD and THC-A oils with a single definition of cannabis oil.

As a result of COVID-19, study reporting deadlines may be extended if requested by DHP. No activity has been conducted on the various studies, and staff will likely ask for an extension on the 2020 deadlines.

The Virginia Joint Commission on Health Care request on statewide standing protocols is similar to the stakeholder group created by HB 1506. Staff will determine if both studies can be addressed in the same work group, which is expected to begin this summer.

Chart of Regulatory Actions (p. 60). Ms. Yeatts stated that the adopted fee increase was approved by the Secretary of Health and Human Resources and is now awaiting action at the Governor's office. The fee increase needs to go into effect by this fall in order to avoid a possible budget deficit at the Board of Pharmacy.

Adoption of Exempt Regulation to Schedule Certain Chemicals into Schedule I (pp. 61-70) - Adopted.

Adoption of Exempt Regulation to Conform Drug Schedules to Actions Taken by DEA (pp. 71-83) - Adopted.

Adoption of Final Regulations for Delivery of Prescription Devices (pp. 84-88) - Adopted.

Adoption of Final Regulations for Delivery of Dispensed Prescriptions, Labeling (pp. 89-93).Chair Cynthia Warriner stated that she remains concerned about the lack of certain contact information on the label for the pharmacy where the prescription is picked up that could lead to confusion, especially for senior citizens. She also stated that the public comment period for the proposed regulations was during the height of the COVID-19 emergency, which may have deterred public input.

Ms. Juran stated that she received a message from a lobbyist requesting that the public comment period be extended. Ms. Yeatts stated that the Board can vote to extend the public comment period, and that notice is required. The public hearing for this matter was canceled as part of the March Board meeting that was canceled due to the public health emergency.

The Board voted to extend the public comment period to, and schedule a public hearing at, the June Board meeting for this item.

Adoption of Proposed Regulations for Pharmaceutical Processors (pp. 94-125) - Adopted.

Adoption of Final Regulations for White Bagging and Brown Bagging (pp. 126-135) - Adopted.

Adoption of Regulatory Amendments for Handling Fee for Returned Check (pp. 137-149) - Adopted. Raises the fee to $50 from $35 consistent with other regulatory boards.

New Business

Consideration of certification from a substantially similar program approved by the Board for nonresident pharmacies (§ 54.1-3434.1(A)(4)) (pp. 150-156) - The Board voted to waive the VIPPS certification but require an approved credential. Staff will draft a Guidance Document on acceptable credentials for consideration at the June Board meeting.

Chairman's Report

Chairman Warriner stated that the 2 years of experience requirement for PIC eligibility went into effect on December 11, 2019 and has created some confusion and questions to the Board. The Board can grant an exemption for good cause shown. Staff will draft guidance for the June meeting formalizing the process for exemption requests, including for when a PIC moves to a new store vs. staying at the same store when the PIC has less than 2 years of experience.

Board of Health Professions Report

Board member Ryan Logan reported that there were 50% more bills related to healthcare this General Assembly session. He highlighted the pharmaceutical processor program and licensing of dispensaries, Art Therapists which will now be licensed under the Board of Counseling, and Music Therapists which will now be licensed under the Board of Social Work.

Other items

There were no presentations on the remaining agenda items. Please refer to the agenda packet for any written documentation provided.

Caroline Juran has been elected President-Elect of the National Association of Board of Pharmacy (NABP). Please congratulate her in this exciting accomplishment!   https://nabp.pharmacy/newsroom/news/nabp-2020-2021-executive-committee-inaugurated-at-associations-116th-annual-meeting

NOTE: This virtual Board of Pharmacy meeting was not eligible for live CE credit.

 

The next Board meeting is scheduled for June 16, 2020 at 9:00 AM.

FREE CE for VSHP Members! 

Webinar-Wednesday, June 3, 2020 - 7:00pm- 8:00 pm

One hour of live CE

Sponsored by VSHP Region 2

Title:  Optimizing Medication Safety Among Culturally Diverse Patients

 

Presenter:

Nkem Nonyel, Pharm.D., MPH, BCPS

Assistant Professor of Pharmacy Practice

UMES School of Pharmacy

 

Learning Objectives:

• Explain at least two medication safety issues among culturally diverse patient populations.
• Describe at least two strategies for promoting medication safety among patients form diverse cultural backgrounds.
• Given a case scenario with patient-related cultural variables, provide patient education to optimize medication safety.-Characterize postpartum depression and its impact

Virginia Society of Health-System Pharmacists is accredited by the Acc reditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 1.0 contact hours (0.10 CEU) submitted to CPE Monitor as early as 1 days after the event and no later than 60 days after the event. The participant is accountable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days.

UAN # 0108-0000-20-030-L05-P; 0108-0000-20-030-L05-T

This is a member service of VSHP.  There is no charge for members to attend.   Dues must be current to receive CE credit.

Non-members will be charged $20.

Members:
To register: https://us02web.zoom.us/webinar/register/WN_4kmnB6JESbyN4fgGAWdDLg

 

FREE CE for VSHP Members! 

Webinar-Thursday, June 18, 2020 - 12:00pm- 1:00 pm

One hour live CE

Title:  A Tale of Two Antivenins

Presenter:

Lorrie LeClair, PharmD, BCPS

Clinical Pharmacy Specialist, Emergency Medicine

Inova Fairfax Medical Campus

Learning Objectives-Pharmacists and Pharmacy Technicians:

1. Identify basic first-aid and wound management principles that should be applied to all patients with snakebites.

2. Compare and contrast characteristics and venom profiles of common venomous snakes found in the United States.

3. Describe differences between the two antivenins currently available in the United States.

Virginia Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 1.0 contact hours (0.10 CEU) submitted to CPE Monitor as early as 1 day after the event and no later than 60 days after the event. The participant is accountable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days.

UAN # 0108-0000-20-029-L01-P; 0108-0000-20-029-L01-T

This is a member service of VSHP.  There is no charge for members to attend.   Dues must be current to receive CE credit.

Non-members will be charged $20.

Members:
To register: https://us02web.zoom.us/webinar/register/WN_mEFhxwM_Ri61B0Ej8FRJog

 

 

After registering, you will receive a confirmation email containing information about joining the webinar.

VSHP Leadership Profile

Matthew Morrisette

 

What is your current leadership position in VSHP?

President elect of Region 1

 

What benefits do you see in being active in a professional association such as VSHP?  

 

I believe I have benefited most from learning directly from the leaders in our profession. Having the opportunity to work with such a motivated and dedicated group of people has influenced my work ethic and professional growth in a positive way.

 

What initially motivated you to get involved in VSHP?

 

I became involved in VSHP as a PGY-2 resident when I was recruited by the current Region 1 president to attend a meeting. I appreciated the idea of getting to interact with my pharmacy colleagues outside of the hospital setting, working towards bigger, career changing goals.

 

Where did you go to pharmacy school?

 

I attended the Medical University of South Carolina College of Pharmacy from 2010-2014.

 

Where have you trained or worked?  

I completed PGY-1 training at Carolinas Medical Center in Charlotte, NC and PGY-2 training in Critical Care at the University of Virginia Health System (UVHS). I accepted a clinical position at UVHS following residency and remain in that position today.

 

Describe your current area of practice and practice setting:

 

I am a critical care clinical pharmacist working primarily in a thoracic and cardiovascular surgical ICU.

 

What advice would you give to student pharmacists?

 

Take advantage of every opportunity you can while in a dedicated learning environment. The more exposure to different practice settings you can obtain will only influence your perspectives in a positive way. Discovering and maintaining a high level of intellectual curiosity will set you up for success in whichever path your career leads.  

 

What pharmacy related issues keep you up at night?

 

Inappropriate angiotensin II usage.

 

Do you have any special interests or hobbies outside of work?

 

Sailing, snowboarding, and hanging outside with my family.

 

What is your favorite place to vacation?

 

BVI's

 

What 3 adjectives would people use to best describe you?

 

Easy-going

Curious

Motivated

Dueling with Antiplatelet Therapy:

Which Medication Should We Choose and For How Long?

 

Lana Lyon, PharmD, PGY1 Sentara Healthcare Hampton Roads Resident

 

Dual antiplatelet therapy (DAPT) has a variety of indications for patients in the hospital setting including stable ischemic heart disease (SIHD), acute coronary syndrome (ACS), and stroke. ¹ For the purposes of this article the focus will be on coronary artery disease (CAD) and DAPT, as this subject has the most emerging evidence available.

 

DAPT consists of low dose aspirin, usually less than 100 mg daily, and a P2Y12 inhibitor. ¹ Aspirin inhibits platelet activation by irreversibly binding to cycloxygenase-1 (COX-1). ² P2Y12 inhibitors consist of reversible and irreversible inhibitors that block adenosine diphosphate (ADP) from binding to the P2Y12 receptor which stops the activation of platelets. ³ A further look into the differences between P2Y12 inhibitors can be found in Table 1.

 

DAPT Drug Comparisons

 

When placing a patient on DAPT, practitioners often inquire which P2Y12 inhibitor is best for each particular patient. Multiple factors need to be considered when selecting a P2Y12 inhibitor. For example, clopidogrel is a prodrug that must be activated by the cytochrome P450 (CYP) CYP2C19 enzyme. If the patient happens to be a poor metabolizer of CYP2C19, then clopidogrel may seldom reach the active form and, therefore, will not work effectively in those patients. Prasugrel is also a prodrug, but a patients' genetic differences will not affect this medication like clopidogrel. ³ However, prasugrel should not be used in patients who have had a stroke or transient ischemic attack (TIA) in the past, whereas clopidogrel does not carry the same warning. ^1,3 Cangrelor is the only P2Y12 inhibitor available in intravenous (IV) form and has a fast onset of action with steady state being reached within 30 minutes. ³

 

There have been multiple major trials comparing P2Y12 inhibitors in patients experiencing ACS, including the TRITON-TIMI 38 Trial, the TRILOGY ACS Trial and the PLATO trial. ^4,5,6 In the TRITON-TIMI 38 Trial, the authors wanted to compare prasugrel against clopidogrel in patients undergoing percutaneous coronary intervention (PCI). Prior to this trial, it was expected that prasugrel would be superior to clopidogrel in this population because prasugrel has been shown to inhibit platelet aggregation on a more consistent basis than clopidogrel. In this trial prasugrel was found to have a statistically significant lower incidence of the primary composite endpoint of cardiovascular causes, nonfatal myocardial infarction (MI), or nonfatal stroke, when compared to clopidogrel. However, prasugrel was found to have a statistically significant higher incidence of non-coronary artery bypass graft (CABG) related thrombolysis in myocardial infarction (TIMI) major bleeding when compared to clopidogrel. ⁴

 

In the TRILOGY ACS Trial, prasugrel was compared to clopidogrel in patients who did not undergo PCI but were medically managed only for ACS. In this trial prasugrel was not found to be any better than clopidogrel for the primary outcome of cardiovascular death, MI, or stroke. There was also no difference between clopidogrel or prasugrel for severe or life-threatening bleeding. ⁵ In general, the evidence has shown mixed results whether prasugrel or clopidogrel is superior to one another.

 

However, there has been evidence that suggests ticagrelor is superior to clopidogrel in the PLATO trial. ⁶ In the PLATO trial, ticagrelor was compared to clopidogrel for patients with ACS. In this study ticagrelor was found to have a statistically significant decrease in the primary outcome of death from vascular causes, MI or stroke. There was no difference in major bleeding between the two medications, but ticagrelor was found to have a statistically significant higher rate of fatal intracranial bleeding and dyspnea. ⁶ The choice of the most appropriate P2Y12 inhibitor for a particular patient still remains unclear and must be based on individual patient risk factors and history.

 

Duration of DAPT

 

Practitioners are also faced with how long to keep a patient on DAPT. Current literature suggests that shorter durations of DAPT therapy are equally effective as longer duration therapy, and also have less incidents of bleeding side effects. ^7,8 For example, in the SMART-CHOICE Trial, patients who had undergone PCI were randomized to either 3 months of DAPT followed by 9 months of monotherapy with a P2Y12 inhibitor or 12 months of DAPT. This study found the 3 months of DAPT followed by 9 months of monotherapy with a P2Y12 inhibitor was non-inferior to 12 months of DAPT for the primary outcome of a composite of all-cause mortality, MI, or stroke. Adverse bleeding events were found to be statistically lower in the group treated with 3 months of DAPT followed by P2Y12 inhibitor monotherapy when compared to the group treated with 12 months of DAPT. ⁷

 

The STOPDAPT-2 Trial also focused on duration of therapy of DAPT after an ACS. This trial similarly focused on patients who had undergone PCI and were either randomized to 1 month of DAPT followed by monotherapy with clopidogrel, or 12 months solely of DAPT. This trial found that one month of DAPT followed by monotherapy with clopidogrel had less incidence of the primary end point of composite of cardiovascular death, MI, definite stent thrombosis, ischemic or hemorrhagic stroke, or TIMI major or minor bleeding compared to 12 months of DAPT. Bleeding adverse events were also less likely to occur in the 1 month DAPT group followed by clopidogrel therapy compared to the group exposed to 12 months of DAPT. ⁸

 

Although the data suggests there is no difference in shorter duration of DAPT, the 2016 ACC/AHA guidelines still recommend 12 months of DAPT after PCI in ACS. ¹ However, these guidelines do not address the concern for patients who are at high ischemic risk and low bleeding risk after ACS that may require longer duration of DAPT. ⁸ Conversely, recent data is promising for high bleed risk patients who may need only a short duration of DAPT. ^7,8

 

Scores have been developed to help practitioners determine whether their patient is at high bleeding risk or high ischemia risk. The DAPT score, outlined in the 2016 ACC/AHA guideline, is a scoring tool to help decide whether a patient is a high bleeding risk or high ischemia risk. A score greater than or equal to 2 suggests that the patient is at a high thrombosis risk, and longer DAPT would be beneficial. Scores less than 2 suggests that the patient is at a high bleeding risk and a short duration of DAPT is more favorable for the patient. ¹ Another scoring tool called the PRECISE-DAPT score was created to determine risk of out-of-hospital bleeding while on DAPT. This score accounts for the patients' age, creatinine clearance, hemoglobin, white blood cell count, and previous spontaneous bleeding. The PRECISE-DAPT score suggests that high bleeding risk is a score greater than or equal to 25, and a low bleeding risk score is less than 25. If the patient is at a high risk of bleeding, then it has been shown that less than 12 months of DAPT may be beneficial in this group of patients. Patients who are not a high risk for bleeding according to their PRECISE-DAPT score are able to receive the standard length of therapy of DAPT. ⁹

 

As healthcare practitioners, we should always look at a patient as a whole when deciding medical therapy and making recommendations. For DAPT, this principle is especially important when deciding which P2Y12 inhibitor to initiate for a patient and for determining the length of therapy. Genetics, cost, and past medical history should all be taken into account when deciding the right P2Y12 inhibitor for a patient. Ischemic risk as well as bleeding risk should be weighed when determining the length of therapy for DAPT. Not every patient fits exactly into the guidelines that are written, and this is why we develop our clinical judgement to determine the best course of action for our patient.

 

Table 1:

*hx: history, TIA: transient ischemic attack, IV: intravenous

   

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