Fall 2014 • arizona Journal oF Pharmacy • 1

Fall 2014 Vol. 6, No. 3

arizoNa JourNal oF Pharmacy THE OFFICIAL PUBLICATION OF THE ARIZONA PHARMACY ASSOCIATION

BROUgHT TO YOU BY PHARMACY NETwORk OF ARIZONA

Ann Sears, R.Ph.AzPA President 2014-2015

AEROSPAN Inhalation Aerosol is indicated for the maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients 6 years of age and older. AEROSPAN Inhalation Aerosol is also indicated for asthma patients requiring oral corticosteroid therapy, where adding AEROSPAN Inhalation Aerosol may reduce or eliminate the need for oral corticosteroids.Important Limitations of Use: AEROSPAN Inhalation Aerosol is NOT indicated for the relief of acute bronchospasm. AEROSPAN Inhalation Aerosol is NOT indicated in children less than 6 years of age.Important Safety Information

AEROSPAN Inhalation Aerosol is contraindicated as a primary treatment of status asthmaticus or other acute episodes of asthma requiring intensive measures. AEROSPAN Inhalation Aerosol is not a bronchodilator and is not indicated for rapid relief of bronchospasm. In clinical studies with flunisolide, localized fungal infections of the mouth, pharynx, and larynx have occurred. If oropharyngeal candidiasis develops, AEROSPAN Inhalation Aerosol therapy may need to be interrupted under close medical supervision. Patients should be instructed to contact their physician immediately when episodes of asthma that are not responsive to bronchodilators occur during the course of treatment with AEROSPAN Inhalation Aerosol. During such episodes, patients may require therapy with systemic corticosteroids.

Patients who are on drugs that suppress the immune system, such as corticosteroids, are more susceptible to infections than healthy individuals and should avoid exposure to chicken pox or measles. Inhaled corticosteroids should be used with caution, if at all, in patients with untreated active or quiescent tuberculosis infection of the respiratory tract; untreated systemic fungal, bacterial, parasitic, or viral infections; or ocular herpes simplex. During reduction and withdrawal of oral corticosteroid doses, patients should be carefully monitored for asthma instability, including objective measures of airway function, and for adrenal insufficiency. Patients should taper slowly from systemic corticosteroids if switching to AEROSPAN Inhalation Aerosol.

It is possible that systemic corticosteroid effects such as hypercorticism and adrenal suppression may appear in a small number of patients, particularly at higher doses. If such changes occur, reduce the AEROSPAN Inhalation Aerosol dose slowly, consistent with accepted procedures for management of asthma symptoms and for tapering of systemic corticosteroids. Decreases in bone mineral density have been observed with long-term administration of products containing inhaled corticosteroids, including flunisolide. Patients with major risk factors for decreased bone mineral content should be monitored and treated with established standards of care. Orally inhaled corticosteroids, including flunisolide, may cause a reduction in growth velocity when administered to pediatric patients. Monitor the growth of children and adolescents receiving AEROSPAN Inhalation Aerosol. To minimize the systemic effects, patients should be titrated to the lowest dosage that effectively controls symptoms. Glaucoma, increased intraocular pressure, and cataracts have been reported in patients following the long-term administration of inhaled corticosteroids, including flunisolide. Therefore, close monitoring is warranted in patients with a change in vision or with a history of intraocular pressure, glaucoma, and/or cataracts. Bronchospasm may occur with an immediate increase in wheezing after dosing. If bronchospasm occurs following dosing with AEROSPAN Inhalation Aerosol, treat immediately with a fast-acting inhaled bronchodilator. Discontinue AEROSPAN treatment immediately and institute alternative therapy.

The most common adverse reactions seen in two 12-week, pivotal, double-blind, placebo-controlled, clinical trials performed with AEROSPAN (160 mcg BID) were pharyngitis (16.6%), rhinitis (15.7%), headache (13.8%), cough increased (5.5%), allergic reaction (4.6%), and vomiting (4.6%).

Indications

Please see Full AEROSPAN Prescribing Information available at this booth.

Contact Meda Pharmaceuticals Inc. at 855-653-6325©2014 Meda Pharmaceuticals Inc. 03/14 AER-14-0048

ICS=Inhaled corticosteroid.

Introducing The only ICS available with a built-in spacer

inhalation aerosol(flunisolide)

Fall 2014 • arizona Journal oF Pharmacy • 3

AEROSPAN Inhalation Aerosol is indicated for the maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients 6 years of age and older. AEROSPAN Inhalation Aerosol is also indicated for asthma patients requiring oral corticosteroid therapy, where adding AEROSPAN Inhalation Aerosol may reduce or eliminate the need for oral corticosteroids.Important Limitations of Use: AEROSPAN Inhalation Aerosol is NOT indicated for the relief of acute bronchospasm. AEROSPAN Inhalation Aerosol is NOT indicated in children less than 6 years of age.Important Safety Information

AEROSPAN Inhalation Aerosol is contraindicated as a primary treatment of status asthmaticus or other acute episodes of asthma requiring intensive measures. AEROSPAN Inhalation Aerosol is not a bronchodilator and is not indicated for rapid relief of bronchospasm. In clinical studies with flunisolide, localized fungal infections of the mouth, pharynx, and larynx have occurred. If oropharyngeal candidiasis develops, AEROSPAN Inhalation Aerosol therapy may need to be interrupted under close medical supervision. Patients should be instructed to contact their physician immediately when episodes of asthma that are not responsive to bronchodilators occur during the course of treatment with AEROSPAN Inhalation Aerosol. During such episodes, patients may require therapy with systemic corticosteroids.

Patients who are on drugs that suppress the immune system, such as corticosteroids, are more susceptible to infections than healthy individuals and should avoid exposure to chicken pox or measles. Inhaled corticosteroids should be used with caution, if at all, in patients with untreated active or quiescent tuberculosis infection of the respiratory tract; untreated systemic fungal, bacterial, parasitic, or viral infections; or ocular herpes simplex. During reduction and withdrawal of oral corticosteroid doses, patients should be carefully monitored for asthma instability, including objective measures of airway function, and for adrenal insufficiency. Patients should taper slowly from systemic corticosteroids if switching to AEROSPAN Inhalation Aerosol.

It is possible that systemic corticosteroid effects such as hypercorticism and adrenal suppression may appear in a small number of patients, particularly at higher doses. If such changes occur, reduce the AEROSPAN Inhalation Aerosol dose slowly, consistent with accepted procedures for management of asthma symptoms and for tapering of systemic corticosteroids. Decreases in bone mineral density have been observed with long-term administration of products containing inhaled corticosteroids, including flunisolide. Patients with major risk factors for decreased bone mineral content should be monitored and treated with established standards of care. Orally inhaled corticosteroids, including flunisolide, may cause a reduction in growth velocity when administered to pediatric patients. Monitor the growth of children and adolescents receiving AEROSPAN Inhalation Aerosol. To minimize the systemic effects, patients should be titrated to the lowest dosage that effectively controls symptoms. Glaucoma, increased intraocular pressure, and cataracts have been reported in patients following the long-term administration of inhaled corticosteroids, including flunisolide. Therefore, close monitoring is warranted in patients with a change in vision or with a history of intraocular pressure, glaucoma, and/or cataracts. Bronchospasm may occur with an immediate increase in wheezing after dosing. If bronchospasm occurs following dosing with AEROSPAN Inhalation Aerosol, treat immediately with a fast-acting inhaled bronchodilator. Discontinue AEROSPAN treatment immediately and institute alternative therapy.

The most common adverse reactions seen in two 12-week, pivotal, double-blind, placebo-controlled, clinical trials performed with AEROSPAN (160 mcg BID) were pharyngitis (16.6%), rhinitis (15.7%), headache (13.8%), cough increased (5.5%), allergic reaction (4.6%), and vomiting (4.6%).

Indications

Please see Full AEROSPAN Prescribing Information available at this booth.

Contact Meda Pharmaceuticals Inc. at 855-653-6325©2014 Meda Pharmaceuticals Inc. 03/14 AER-14-0048

ICS=Inhaled corticosteroid.

Introducing The only ICS available with a built-in spacer

inhalation aerosol(flunisolide)arizoNa JourNal oF Pharmacy

THE OFFICIAL PUBLICATION OF THE ARIZONA PHARMACY ASSOCIATIONBROUgHT TO YOU BY PHARMACY NETwORk OF ARIZONA

Vol. 6, no. 3 FALL 2014

www.azpharmacy.org

President’s Message 4CEO’s Message 5

A Look Back - Antacid Container 13Time Capsule 13CASE REPORT: Breathalyzers + Inhalers = the Potential for False-Positives 14Risk of Serotonin Syndrome with ConcomitantUse of SSRI/SNRI and Triptans 17Roundtable on Continous Quality Assurance 20Arizona Delegates Report on 66th Annual Session 25

Association News 6 New Members 6 Annual Convention Recap 8 PAPA 9Legislative Update 10Arizona State Board of Pharmacy 11Technician Spotlight 12Drug Information Question 27 Academy News • Community Practice Academy 30• Geriatric Care Academy 30 • Health-System Academy 31• Managed Care Academy 31• Student Pharmacist Academy 32• Technician Academy 32Continuing Education 33 Pharmacotherapy for Weight Loss 33 New Rules for CPE Monitor Reporting 37 Geriatric Patient Care: Systematic Review 38

Meda PharMaceuticals 2 PtcB 11clearant 16Paas 26PharMacy Quality coMMitMent 26PharMacists life insurance 47rx relief 48

EditorKelly Ridgway, R.Ph.ChiefExecutiveOfficer

Editorial BoardWhitney Rice, Pharm.D. Andrea Burns, Pharm.D.Christi Jen, Pharm.D. Jaime Baily, Pharm.D. Scott Hardy, Pharm.D. Kalani Anderson, C.Ph.T.

iN this issuE ....

FEaturEd articlEs

dEPartmENts

maNagiNg EditorRachel Jimenez Marketing and Communications Mgr

adVErtisErs

President’s Message It’s an honor and privilege for me to serve as the President of AzPA for 2014-2015, thank you to everyone for making me feel so welcome. I would also like to specifically thank Kelly - our CEO - the amazing AzPA staff, and the outgoing and incoming boards for their commitment to AzPA. We are truly blessed.

My vision for next year: Cooperation

When I was 12 years old, I wanted to become a pharmacist. That goal never changed. I am one of the lucky ones, because I am living my dream. Somtimes it is easy to forget about dreams when we are living the day to day.

It doesn’t matter whether we are students, technicians, or pharmacists. It doesn’t matter where we work. Most of us joined pharmacy or healthcare, because we wanted to make a difference. We wanted to help improve patients’ lives. Our last convention’s theme was Pharmacists as Providers, Changing the Game. I submit to you that pharmacy and playing games actually have some similarities.

Games boil down to two types: competitive and cooperative. Pharmacy, healthcare, and life for that matter, falls into these same two categories. I believe that we make conscious and unconscious choices to be competitive or cooperative every day. We see this in our relationships at home and with our friends, on the job, in our profession and in our communities. There is nothing wrong with healthy competition; especially, if we let it bring out the best in us or make positive strides for our patients. The AzPA mission is to educate, advocate for, protect and advance the profession of pharmacy in this state. We made great strides this last year in moving forward on the Pharmacists as Providers issue, but we have a lot more work to do on many issues still ahead. The staff of AzPA, Kelly as CEO, and the Board cannot effect change in this state alone.

My mission this year is to change the game to one of cooperation, but I need your help. Join me. Become a member of AzPA if you aren’t already. If you are a member, get involved. Share your unique talents with us, so we can utilize your abilities in the best possible area. Members, link your Fry’s card to the AzPA code. Buy your gift cards from the AzPA office. Do you need something from Amazon? Go to azpharmacy.org and click on the amazon link before you shop. Those few things cost you nothing extra, but go a long way to helping the AzPA mission. Go further and support pharmacy political action by making a contribution to PharmPAC. Invite others to join AzPA. Ask them to contribute to our team. Already doing all of these things – I thank you. Let’s always remind each other that we all matter and we all have something important to contribute.

Protecting the future of pharmacy in this state is in all of our hands and I hope that you feel empowered, excited, and welcome to be a part of our cooperative team. I look forward to this year and all that we can do together.

Ann Sears, R.Ph.President

AzPA Board of Directors2014-2015

Fall 2014 • arizona Journal oF Pharmacy • 5

CEO’s Message As we approach a new fiscal year at AzPA, and charge forward with our new President, Ann Sears, the message of leadership seems to be a timely one. The pharmacy profession is reaching a tipping point. We are expanding and changing more rapidly than any other health profession and we need leaders now more than ever. Our profession is embarking on a quest to obtain national provider status for pharmacists under Medicare Part B. Most states are also modifying state practice acts to coincide with the national efforts. This requires time, money, resources, perseverance and leaders to champion this effort in our local communities.

Leadership does not require serving as a pharmacy director or on the board at a state or national pharmacy association - although those positions are important - being a leader in pharmacy starts with your daily interactions with your patients, coworkers and community. You represent our profession and you impact how people perceive pharmacists. Pharmacy leaders do all they can do to protect their patients, improve patient care, advance and protect their profession no matter what practice setting they work in, no matter their title, and no matter the years of experience, residency training, etc.

Although you have taken the important step participating in your state pharmacy association, how many of your colleagues have? I genuinely believe that involvement and engagement in your state and respective national association is essential in order to preserve and advance our profession. This is not a one way relationship. Active involvement allows you to stay connected and keeps the “pharmacy fire” burning, the fire that was started when you stepped onto your college of pharmacy campus for the first time, the fire that fuels the desire you feel to make a difference, the fire that produces change and innovation in our profession. Something happens when you are involved and surrounded by others who are committed to the same goal of advancing the profession; it keeps you energized and motivated about the profession of pharmacy.

One of my favorite quotes on leadership: “One of two things will happen if we do not lead: Either no one will lead and there will be chaos or someone will fill the vacuum who doesn’t share our values,” - Condoleezza Rice

Leadership entails the ability to lead and grow your own ambitions while others, but it also means serving first. True leaders bring others along to help them grow, so that they can one day be leaders too.

I stand here, not as your state association CEO, but as a fellow pharmacist. I, like all of you, have a desire to serve and advance the profession. I need your help and expertise to make provider status for pharmacists a reality at the state level. Your national association CEOs need your help to make it happen. Get involved, bring along a friend, find a mentor and share what pharmacists can and are doing in the lives of our patients.

Kelly Ridgway, R.Ph.Chief Executive Officer

Arizona Pharmacy Association

Arizona Pharmacy Association