the arkansas pharmacist winter 2009

TheArkansasPharmacist

2009 Fall2009 Fall

Quarterly EditionQuarterly Edition

Arkansas State Board of Pharmacy

President ......................................................Bob Dufour, R.Ph., Bentonville

Vice President ........................................Lenora Newsome, P.D., Smackover

Secretary ............................................................Benji Post, P.D., Pine Bluff

Member................................................................Marilyn Sitzes, P.D., Hope

Member..........................................................Ronnie Norris, P.D., McGehee

Member ..........................................................Steve Bryant, P.D., Batesville

Sr. Citizen Public Member ..................................Ross Holiman, Little Rock

Public Member ................................................Sharon Capps, R.N., England

Arkansas Association of Health System Pharmacists

President ..............................................Maggie Miller, Pharm.D., Batesville

President Elect............................................Jason Derden, Pharm.D., Benton

Past President ............................................Justin Boyd, Pharm.D., Ft. Smith

Executive Director................................Dennis Moore, Pharm.D., Batesville

Treasurer ..............................................Sharon Vire, Pharm.D., Jacksonville

Secretary ..................................................Paula Price, Pharm.D., Sherwood

Member at Large......................................Brandy Owen, Pharm.D., Conway

Member at Large ............................Jody Smotherman, Pharm.D., Batesville

Member at Large ................................Jennifer Priest, Pharm.D., Little Rock

District 1

Kenny Harrison, Pharm.D.

Cornerstone Pharmacy

4220 N. Rodney Parham

Little Rock, AR 72212

District 2

Brandon Cooper, Pharm.D.

Soo’s Drug &

Compounding Center

2905 E. Nettleton Ave.

Jonesboro, AR 72401

District 3

Danny Ponder, P.D.

Ponder Economy Drug, Inc.

400 S College St,

Mountain Home, AR 72653

District 4

Cliff Robertson, P.D.

Robertson’s N. Heights Pharmacy

1201 E. 35th St.

Texarkana, AR 71854

District 5

Lynn Crouse, Pharm.D.

Eudora Drug Store

140 S. Main St.

Eudora, AR 71640

District 6

Michael Butler, Pharm.D.

Village Health Mart Drug #1

4440 N. Highway 7

Hot Springs, AR 71909

District 7

John Vinson, Pharm.D.

Area Health Education Center

612 South 12th Street

Fort Smith, Arkansas 72901

District 8

Christy Campbell, P.D.

Lowery Drug Mart #2

123 Central Ave.

Searcy, AR 72143

2008 - 2009 Officers

President ................................................Paul Holifield, Pharm.D., Batesville

President Elect ............................................Jan Hastings, Pharm.D., Benton

Vice President ..................................................Mike Smets, P.D., Fort Smith

Past President..................................Stephanie Goodart O’Neal, P.D., Wynne

Area Representatives

Area 1 (Northwest)....................................Gary “Buzz” Garner, P.D., Mena

Area 2 (Northeast) ..............................Dennis Moore, Pharm.D., Batesville

Area 3 (Central) .......................................Gary Bass, Pharm.D., Little Rock

Area 4 (Southwest/Southeast) ......................Mike Stover, Pharm.D., Rison

Ex-Officio MembersAPA Executive Vice President ................................................................................................................................................ Mark Riley, Pharm.D., Little Rock

Board of Health Member ...................................................................................................................................................................John Page, P.D., Fayetteville

Board of Pharmacy Representative ..............................................................................................................................Charles Campbell, Pharm.D., Little Rock

UAMS College of Pharmacy Representative (Dean)........................................................................................Stephanie Gardner, Pharm.D., Ed.D., Little Rock

Harding College of Pharmacy Representative (Dean) ....................................................................................................Julie Hixson-Wallace, Pharm.D., Searcy

UAMS College of Pharmacy Student Representative ..........................................................................................................................Cristina Easterling, Bryant

Harding College of Pharmacy Student Representative ..........................................................................................................................Celia Proctor, Little Rock

District Presidents

APA’s Academy of Consultant Pharmacists

President ................................................Muncy Zuber, P.D., Heber Springs

President Elect ................................................Jim Griggs, P.D., Fayetteville

APA’s Academy of Compounding Pharmacists

President ..........................................Gary Butler, P.D., Hot Springs Village

President Elect ..................................................................To Be Announced

APA Board of Directors

The Arkansas Pharmacist2

Contents

The Arkansas Pharmacist 3

Mark S. Riley, Pharm.D.

Executive Vice President

[email protected]

Barbara McMillan

Director of Administrative

Services & Meetings

[email protected]

Scott Pace, Pharm.D.

Associate Executive Vice President

[email protected]

Debra Wolfe

Director of Public Affairs

[email protected]

Helen Hooks

Communications Specialist

[email protected]

Celeste Reid

Administrative Assistant

[email protected]

APA StaffOffice E-mail Address

[email protected]

PharmacistThe ArkansasArkansas Pharmacists Association

417 South Victory

Little Rock, AR 72201

501-372-5250

501-372-0546 Fax

The Arkansas Pharmacist (ISSN 0199-3763) is

published quarterly by the Arkansas Pharmacists As-

socia tion, Inc. It is distributed to members as a reg-

ular service paid for through allocation of

membership dues ($5.00). Non-members subscrip-

tion rate is $30.00 annually. Periodical rate postage

paid at Little Rock, AR 72201.

Editorial Staff:

Editor:

Mark Riley, Pharm.D.

Executive Vice President

Art & Design Editor:

Helen Hooks

Communications Specialist

Opinions and statements made by contributors, car-

toonists or columnists do not necessarily reflect the

attitude of the Association, nor is it responsible for

them. All advertisements placed in this publication

are subject to the approval of the APA Executive

Committee.

POSTMASTER:

Send address changes to

The Arkansas Pharmacist

417 South Victory

Little Rock, AR 72201.

From the President......................................................................................4

The Executive’s Perspective ......................................................................5

AAHP Report ..........................................................................................13

Safety Nets................................................................................................14

In Memoriam............................................................................................15

Compounding Report ..............................................................................17

UAMS Report ..........................................................................................22

Calendar of Events ..................................................................................25

Rx and the Law ........................................................................................26

Medicaid Alert ..........................................................................................27

Harding Report ........................................................................................28

Member Classified Advertising................................................................30

Board of Directors Minutes ......................................................................33

Pace Alliance ............................................................................................8

Arkansas Pharmacy Support Group ........................................................15

Pharmacy Partners of America ................................................................16

Pharmacists Mutual ................................................................................23

APF Legacy ............................................................................................24

Pharmacy Quality Commitment ..............................................................25

State Board Elections ................................................................................6

Call for Nominations ..................................................................................6

Awards Solicitation ....................................................................................7

Golden Certificate CE ................................................................................9

Medicating the Elderly ............................................................................10

Wholesale Partners ..................................................................................18

Message from APA Board ........................................................................20

Pharmacy in Arkansas Print......................................................................29

APF Pharmacy Walkway of Honor ..........................................................31

Pharmacy Time Capsules ........................................................................32

APF Golf Tournament ..............................................................................32

Features

Departments

Index to AdvertisersCover photo

courtesy of

Arkansas

Secretary Of

State Charlie

Daniels.

From the President


Band of Brothers

I met with a few of my pharmacy buddies the other evening. We

have a small group that gets together once a month or so to discuss

whatever concerns we have at the time. They are, for the most part,

independent store owners like me. But others are employee pharma-

cists and sometimes a chain or hospital pharmacist will join us. We

find that the issues are similar for us all.

As we talked about the many issues that affect our practices, sev-

eral things became obvious. Our professional and personal relation-

ships had evolved greatly. Where we once thought of each other as

competitors, we are now colleagues. And where there were once

petty differences, we now have become close friends. We have come

to the further realization that our individual practices and pharmacy in

general face many challenges, but they are not with each other.

Our more serious threats come from the PBMs with their ridicu-

lously low reimbursement rates that not only threaten our existence,

but cost the consumer plenty. Also from mail order pharmacy that

promises savings that never materialize. The complexity of pharmacy

practice is another issue that is often a topic for discussion. It is not

just prior authorizations and extensions of benefits anymore. It’s ac-

creditation issues required to bill Medicare, fraud waste and abuse

training required for all employees each year, and now point-of-sale

upgrades to facilitate federal savings accounts.

These are the just some of the many challenges facing pharmacy

today. They create a need for pharmacists to establish relationships

with each other that will help us cope with the demands that we con-

tend with each day. We must encourage our cohorts to upgrade their

pharmacies and embrace the technology that will help them remain vi-

able in this competitive environment.

Therefore our small band of brothers will continue to come to-

gether in our monthly meetings and address these and other pressing

issues that we all must face. We will share our ideas and alert each

other about what we have found that works as well as what does not.

And more importantly, we may simply lend moral support and a sense

that if we stay true to values and our mission, we as pharmacists will

prevail.

Paul Holifield, Pharm.D.

Econo Mart Pharmacy

Batesville, AR

The Executive’s Perspective


Start of a New Year, New State Legislature, New

Congress, and New President

The American system of democracy is an interesting animal. “The

people” (“…of the people, for by the people, and by for the people”)

have the privilege of deciding the direction of this great country every

two years, to a certain extent, and more completely every four years.

It has always been amazing to me that we can shift directions so dra-

matically in four years, but just maybe that is the beauty of the system

and is ultimately what makes it work. If our leaders go off into “left

field” (or “right field”, in terms of political direction) too far, then

“the people” tend to make marked changes in the other direction.

The point I am making is that we will see a distinctly different Con-

gress and administration at the national level and healthcare has been

listed as one of the top three issues to tackle (along with the economy

and Iraq). We have reason to believe the Arkansas delegation in Con-

gress will be in a better position to fix some of the problems that have

been thrust on pharmacy. We have broad support across our delega-

tion, and both Senators and our four House members have signed on

to most, if not all, of the national pharmacy legislation that has been

introduced over the last several years. Congressman Marion Berry

has plans to run a bill which will exempt pharmacists and pharmacies

from the burdensome DME accreditation provisions. Please support

him in every way you can in this endeavor. I feel confident that the

other members of our delegation will join him. Of course, none of us

can be sure that this legislative initiative will pass, therefore you

should still do what you need to do to protect your business and pa-

tients as far as DMEPOS credentialing is concerned. But by getting

behind Congressman Berry’s leadership, we have a chance for this

issue to be fixed for the future.

At the state level, about thirty percent of the legislators will be new-

comers. Because of your help and support, I believe that we have a

lot of friends in the state legislature. We will be calling on you to

contact your Representatives and Senators when appropriate. The

most powerful lobbying voice that we have as an association is our

membership and I encourage all of you to make sure you communi-

cate with your Representatives and Senators.

In the end, all legislative battles are hard fought and there are no guar-

antees, but I believe there are many in the process who understand

that pharmacy has been “beat up” in the last few years, and, after sig-

nificant victories last year in Congress, I think we have reason to be

optimistic.

I hope that you and yours are doing well as this New Year begins.

Certainly the pharmacy community has much to be thankful for and

patients consistently show that pharmacists are highly respected and

much needed. And, as always, please contact us if you have a need.

Mark Riley, Pharm.D.


CALL FOR NOMINATIONS

Nominations are invited for each of the following positionson the Arkansas Pharmacists Association Board of Directors.

NOMINATIONS WILL CLOSE AT NOON,

MARCH 31, 2009.

ARKANSAS STATE BOARD OF PHARMACY ELECTIONS

APA BY-LAWS: ARTICLE IV-NOMINEES AND DELEGATES

Section 1. BOARD OF PHARMACY NOMINEES. Only Arkansas registered pharmacists primarily engaged inan active practice of profession in Arkansas for the past five (5) years and who for the past five (5) years shall havebeen an active member in good standing in the Arkansas Pharmacists Association shall be eligible as a candidatefor Association nomination to the Arkansas State Board of Pharmacy for a six (6) year term. Candidates for the StateBoard election shall be nominated from the statewide APA membership and elections for each position shall be ona statewide basis.

APA will submit the names of the three nominees receiving the most votes to the Governor for his considera-tion. Governor Beebe will evaluate the nominees recommended by APA and make the appointment to the ArkansasState Board of Pharmacy.

NOMINATIONS WILL CLOSE AT NOON, MARCH 15, 2009.

Vice President APA

Statewide(Term-One year VP – Four years

Board Member)

Area III Representative APA Board Member

Central - District - 1 (Four year term)

Area III Counties: Faulkner, Lonoke, Prairie, Pulaski, Saline and Monroe

District I President

Central District (Two year term)Central Counties: Faulkner, Lonoke, Prairie,

Saline, Pulaski, and Monroe

District 2 President

Eastern District (Two year term)Eastern Counties: Clay, Craighead, Crittenden,

Cross, Green, Lawrence, Lee, Mississippi, Phillips,Poinsett, Randolph, and St. Francis


Southwest District (Two year term)Southwest Counties: Crawford, Franklin, Logan,

Polk, Scott, and Sebastian


Southeast District (Two year term)Southeast Counties: Arkansas, Ashley, Bradley,

Chicot, Cleveland, Desha, Drew, Grant, Jefferson,and Lincoln

APA OFFICERS AND BOARD OF DIRECTORS

The requirements for nominees of the APA Officersare as follows: Arkansas licensed pharmacist whohas been a member of this Association in goodstanding for the past three (3) consecutive years.No elected member of the APA Board of Directorsshall serve for more than eight (8) consecutive yearsor more than two (2) consecutive terms in the samecapacity.


APA AWARDS SOLICITATION

Award Nominations

Each year APA asks the membership to submit the names of individuals who are deserving of special recognitionfor their professional activities during the past year. Any active APA member is eligible to nominate a person for theawards. Award recipients are chosen by an APA committee following a review of all nominees. Nominations arenow being accepted for the following annual awards to be presented by the Association:

Please mark your nomination with an X. If you have more than one nomination, please feel free to photocopy this form.

� Pharmacist of the Year

The Pharmacist of the Year Award is given to recognize the pharmacist for his/her outstanding contributions to theprofession of pharmacy and activities in the advancement of pharmacy during the year.

� Young Pharmacist of the Year

Nominee must have an entry degree in Pharmacy, received nine or less years ago, and be a member of the APA.Nominee must be in the active practice of pharmacy in the year selected, and actively involved in the profession ofpharmacy, displaying an interest in the future of the profession.

� APA Community Service Award and Bowl of Hygeia Award

This award was established by the A.H. Robbins Company to honor pharmacists who have contributed to theprogress of their community. Criteria include: 1) Pharmacist licensed in the State of Arkansas; 2) Recipient must beliving and must not be previous recipient of award; 3) Recipient must not be currently serving, nor has he/sheserved within the immediate past two years, as an officer of the APA in other than an ex-officio capacity or on itsawards committee; 4) Recipient must have compiled an outstanding record of community service, which, apart fromhis/her specific identification as a pharmacist, reflects well on the profession.

� Innovative Pharmacy Practice Award

This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy, Associ-ation Executives and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a promi-nent spirit of innovation and entrepreneurship in the practice of pharmacy.

Name of Nominee__________________________________________________________________________

Address__________________________________________________________________________________

City/State/Zip ____________________________________________________________________________

Phone __________________________________________________________________________________

Reasons for selecting nominee ______________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Nominator’s Name ________________________________________________________________________

Phone_____________________________ Date ________________________________________________

Attach resume if available

Return to: Awards Committee, Arkansas Pharmacists Association, 417 So. Victory, Little Rock, AR 72201

NOMINATIONS WILL CLOSE AT NOON, APRIL 15, 2009.

Golden Certificate CE


The 5th Annual Golden Certificate CE

Program was held on Thursday, October

9th at the UAMS College of Pharmacy.

Over 30 pharmacists who have been

licensed by the Arkansas State Board of

Pharmacy for over 50 years gathered to

earn six hours of continuing education

credit. Attendees participated in CE on

diabetes, medication therapy

management, over-the-counter

medications, and breast cancer. APA

would like to thank the speakers and the

attendees for making the 2008 Golden

CE Program a success.


Advancing age is associated with a greater incidence of acute ill-

ness, chronic diseases, and a corresponding increase in the num-

ber of medications taken by an individual. Use of prescription

and over-the-counter medications can cause GI symptoms, loss of

appetite, and malabsorption of nutrients. Additionally, a large

number of community-dwelling elderly individuals take herbal

remedies or supplements and these are often not documented on

their medication profiles. While complex regimens may be indi-

cated for coexisting medical conditions, all of this increases the

risk for drug-drug interactions, drug-nutrient interactions, and ad-

verse reactions.

Drug-induced nutritional problems often

develop slowly and occur most fre-

quently with the long-term administra-

tion of medications for chronic diseases.

Altered taste sensation (dysguesia), ap-

petite suppression, altered sense of

smell (dysosmia), gastric irritation, al-

tered GI motility, and altered nutrient

metabolism and function are all nutri-

tion-related adverse effects of medica-

tions. Decreased calorie intake and ensuing weight loss can also

be a result of medications that cause adverse gastrointestinal ef-

fects, sedation and confusion, or a decrease in functional abilities.

Any of these can have a dramatic impact on nutritional intake on

a population that is already compromised.

Nutrient Malabsorption

There are a variety of ways in which medications can alter nutri-

ent metabolism and function. The first of these is decreased ab-

sorption. When the medication acts as a mechanical barrier, ac-

cess of nutrients to the gastric and intestinal mucosal surfaces is

prevented. A prime example of this would be mineral oil, which

decreases absorption of the fat-soluble vitamins (A, D, E, and K),

calcium, and phosphorus.

A second mechanism for decreased absorption is exhibited when

medications and nutrients undergo a complexation or chelation

reaction. This is illustrated by the classic reaction of divalent

cations, such as Ca, Mg, Zn, and Fe, with fluoroquinolones or

tetracyclines.

Yet another mechanism is to increase the rate of

transit and decrease the amount of time available

for absorption of nutrients. For example, chronic

use of stimulant laxatives and laxative abuse lead

to general malabsorption, steatorrhea, and dehydra-

tion which results in reduced absorption of glucose,

protein, calcium, sodium, potassium, and fat-solu-

ble vitamins.

Decreased absorption of nutrients is also seen with changes in

pH. For example, risk of vitamin B12 deficiency is greater with

medications that increase gastric pH, such as histamine-2 (H2)

blockers and proton pump inhibitors. An acidic gastric environ-

ment is necessary for the release of cyanocobalamin from dietary

protein. Because there are usually ample stores of cyanocobal-

amin in the body, the combination of acid suppression and age-re-

lated atrophic gastritis may take years of chronic administration

Medicating the Elderly

( )Advancing age is

associated with a greaterincidence of acute

illness, chronic diseases,and a corresponding

increase in the numberof medications taken by

an individual.

MEDICATION-INDUCED

NUTRITIONAL PROBLEMS

By Christina Minden, Pharm.D.Central Arkansas Veterans Health SystemLittle Rock, AR


of medications, like ranitidine or omeprazole, to result in the de-

velopment of B12 deficiency. Synthetic B12 supplements are not

affected by pH of the stomach and oral replacement is often ef-

fective. Intramuscular injections are needed only when there is a

deficiency of intrinsic factor which is essential for absorption of

vitamin B12 in the ileum.

A final mechanism of action for reducing absorption of micronu-

trients is seen with antibiotic-associated destruction of normal GI

flora. Intestinal flora is responsible for the synthesis of vitamin K

and for the production of vitamins B1, B2, B6, and B12. A de-

crease in normal GI flora also interferes with enterohepatic recir-

culation and reabsorption of folic acid.

Administration of products such that contain

acidophilus or saccharomyces might be bene-

ficial in inhibiting the loss of intestinal flora,

but even these seemingly harmless products

may carry risks to older adults with impaired

immune function.

Increased Nutrient Utilization and Metab-

olism

Medications can alter nutrient utilization by

increasing demand. Oral contraceptives in-

crease pyridoxine and ascorbic acid require-

ments. Corticosteroids increase pyridoxine

and vitamin D requirements. Isoniazid ac-

celerates the metabolism of pyridoxine.

There is an increase in catabolism of vitamin

D 25-hydroxy seen with the anticonvulsants

phenytoin, phenobarbital, and primidone.

Also, there is a reduction in conversion of folic acid to its active

form, tetrahydrofolate, commonly seen with methotrexate, nitro-

furantoin, and trimethoprim. Other medications that antagonize

folic acid include oral contraceptives, primidone, phenobarbital,

phenytoin, sulfasalazine, triamterene, and isoniazid.

Increased Nutrient Excretion

Nutritional problems can also be caused by medications that in-

crease the excretion of vitamins and minerals by the kidney or

liver. There are numerous examples of this. Furosemide, caf-

feine, and corticosteroids

increase urinary excretion

of calcium. Diuretics and

corticosteroids both in-

crease urinary excretion

of zinc. And although

rarely seen in high doses

in current practice,

chronic administration of

4-5 gm/day of aspirin in-

creases vitamin C and

potassium excretion.

Medication-Induced

Anorexia and Gastroin-

testinal Effects

Nausea and anorexia are common with digoxin, selective sero-

tonin reuptake inhibitors, cholinesterase inhibitors, antibiotics,

bisphosphonates, and a variety of other medications. Oral iron

and calcium supplements will also frequently induce nausea or

gastric upset. Non-steroidal anti-inflammatory agents affect the

mucosal lining by both local irritation and through systemic ef-

fects on prostaglandin synthesis. (Table 2)

Medication-Induced Dysguesia and Dysosmia

Effects on olfaction and taste can also decrease appetite. Smell

and taste disturbances are often induced by cardiovascular med-

ications, like angiotensin-converting enzyme (ACE) inhibitors,

diltiazem, and antiarrhythmics. Several antibiotics have adverse

effects of taste perversion, often described as a bitter or metallic

taste.

Antiepileptics

and anti-

cholinergic

agents have

also been re-

ported to have

adverse ef-

fects of dys-

guesia or

dysosmia.

(Table 3)

Drug-Related Physical and Cognitive Impairment

Any medication that has an adverse effect that could potentially

decrease an older person’s ability to perform ADLs and IADLs

independently could place them at nutritional risk depending on

their living situation and support system. Anticholinergic effects

of medications include dry mouth which can worsen appetite and

swallowing problems. In addition, anticholinergics can cause

delirium and confusion. Hypnotics, opioid analgesics, and anxi-

olytics all have significant effects on confusion and daytime seda-

tion. Lithium can cause a

tremor which can impair func-

tion. Antipsychotics and med-

ications with dopamine

antagonist properties increase

the likelihood of movement dis-

orders. Antihypertensives are

associated with dizziness, or-

thostasis, and syncope. Diuret-

ics and laxatives may limit

ability to shop because of fear

of incontinence. Anticonvul-

sants and dopamine agonists

may worsen gait impairments.

Anorexiogenic Medications (Table 2)

Selective Serotonin Reuptake Inhibitors (Fluoxetine, Paroxetine, Sertra-

line)

Digoxin

Dopamine agonists (carbidopa/levodopa, pramipexole)

Valproic acid, Divalproex

Cholinesterase Inhibitors (Galantamine, Donepezil, Rivastigmine)

Theophylline

Non-Steroidal Anti-Inflammatory Drugs

Antibiotics

Bisphosphonates (Alendronate)

Ferrous Sulfate

Calcium Carbonate

Medications Associated with Smell and Taste Disturbances

(Table 3)

Anticholinergic Agents (Tricyclic Antidepressants,

Antihistamines)

Cardiovascular Medications

ACE Inhibitors (Captopril, Enalapril)

Beta Blockers (Labetalol, Propranolol)

Diltiazem

Antiarrhythmics (Mexiletine, Procainamide, Propafenone)

Lithium

Antibiotics (Ampicillin, Azithromycin, Clarithromycin, Ciprofloxacin,

Metronidazole)

Antiepileptics (Carbamazepine, Phenytoin)

Colchicine

Corticosteroids (Beclomethasone, Fluticasone, Flunisolide)


SUMMARY

Optimal caloric and micronutrient intake is essential for overall well being, maintenance of physical and functional capacities, and

prevention of chronic disease in the elderly. Unintended weight loss in this population increases both morbidity and mortality. Med-

ications can play a significant role in the cause of anorexia and malnutrition in the elderly. In addition, medications can alter vitamin

and mineral absorption and utilization.

Success nutritional intervention necessitates a multidisciplinary approach with the pharmacist as an essential team member. With the

increased use of medications and prevalence of chronic and multiple diseases after age 65, it is crucial that the pharmacist review med-

ication profiles for potential adverse effects, drug-drug interactions, and drug-nutrient interactions. Adjusting medication regimens to

minimize adverse effects on appetite, taste perception, cognition, and functional ability is a vital part of any nutritional intervention.

As the elderly population continues to rise, evaluation of the medication-related risks for malnutrition becomes a significant area for

pharmacist involvement.

References1. Johnson LE and Sullivan DH. Nutrition and Failure to Thrive.

Current Geriatric Diagnosis and Treatment. 2004:391-406.2. Zizza C, Herring A, Domino M, et al. The effect of weight change

on nursing care facility admission in the NHANES: Epidemiologic Follow-up Survey. J Clin Epidemiol. 2003;56:906-13.

3. Baker H. Nutrition in the elderly: an overview. Geriatrics. 2007;62(7):28-31.

4. Baker H. Nutrition in the elderly: nutritional aspects of chronic diseases. Geriatrics. 2007;62(9):21-25.

5. Baker H. Nutrition in the elderly: hypovitaminosis and its implications. Geriatrics. 2007;62(8):22-6.

6 Roe DA. Medications and Nutrition in the Elderly. Primary Care. 1994;21(1):135-147.

7 Akamine D, Filho MK, Peres CM. Drug-nutrient interactionsin elderly people. Curr Opin Clin Nutr Metab Care. 2007;10(3):304-10.

8. Zervakis J, Schiffman SS. Adverse Taste Side Effects of Cardiovascular Medications. Geriatric Times. 2002;3(1).

9. Doty RL, Bromley SM. Effects of drugs on olfaction and taste. Otolaryngologic Clinics of North America. 2004;37(6).

10. Micromedex (www.thomsonhc.com) 11. Lexi-comp (http://online.lexi.com)12. Merck Manual (www.merckmedicus.com) 13. Harrison's Practice (www.merckmedicus.com)

Drug Nutrient Interactions (Table 1)

Nutrient deficient Interacting medications

Vitamin D Phenytoin, Primidone, Phenobarbital, Corticosteroids, Orlistat, Cholestryamine, Laxative Abuse

Folic acidPhenytoin, Primidone, Cholestyramine, Oral contraceptives, Broad-spectrum antibiotics, Methotrexate,

Trimethoprim, Nitrofurantoin, Sulfasalazine

Iron Antacids, H2 blockers, Proton pump inhibitors, levodopa, tetracycline, cholestryamine

Vitamins A&E Orlistat, Cholestryamine, Laxative Abuse

CalciumCholestryamine, Laxative abuse, Furosemide, Caffeine, H2 blockers, Proton pump inhibitors, Corticos-

teroids

Vitamin B12 Cholestryamine, Proton pump inhibitors, H2 blockers, Broad-spectrum antibiotics

Thiamine Broad spectrum antibiotics, Aspirin, Black tea

Riboflavin Antiretroviral agents, Chlorpromazine

Niacin Isoniazid

Vitamin K Broad-spectrum antibiotics, Orlistat, Cholestryamine, Laxative Abuse

Vitamin C High dose aspirin (4-5 gm/day), Corticosteroids, Oral contraceptives

Pyridoxine Broad-spectrum antibiotics, Corticosteroids, Oral contraceptives

Zinc Diuretics, Corticosteroids, Zinc

AAHP Report


Fall Seminar 2008

The AAHP Fall Seminar was held October 9-10, 2008 at the Harrah’s Casino and Resort in Tunica, Missis-

sippi. The program offered approximately 11 hours of continuing education for pharmacists with an esti-

mate of 130 pharmacists, pharmacy students, and technicians attending the educational event. AAHP

appreciates the hard work of Drs. Brandy Owen and Kimberly Watson along with their Committee which

served as the primary catalyst for the success of the event.

The following individuals were honored with awards at the Fall Seminar luncheon on Friday October 10:

• New Practitioner of the Year - Dr. Marsha Crader (St. Bernard’s Medical Center)

• Staff Pharmacist of the Year - Dr. Rena Lacheen (Central Arkansas Veterans Healthcare System)

• Clinical Pharmacist of the Year - Dr. Sharon Vire (Central Arkansas Veterans Healthcare System)

• Manager of the Year - Dr. Jim Parks (Arkansas Children’s Hospital)

• Technician of the Year - Mrs. Pat Wiley (Central Arkansas Veterans Healthcare System)

AAHP congratulates each of these individuals for their outstanding contributions to Health-System Phar-

macy in Arkansas.

Fall Seminar 2009

Planning continues for the AAHP 2009 Fall Seminar. Drs. Jennifer Priest and Lanita Shaverd are serving

as the Fall Seminar Committee Chairs. The event will be held in the Little Rock area in October 2009. We

look forward to another successful seminar.

APA 127th APA Annual Convention at the DoubleTree Hotel

Drs. Brandy Owen and Kimberly Watson are working with APA for the AAHP sponsored educational

event to be held at the Annual APA Convention. Three live continuing education hours are being planned

for the attendees.

Advisory Committee for Hospital Pharmacies

This Committee under the leadership of Dr. Susan Newton has successfully implemented a policy that no

longer requires a daily signature from nurses for narcotic activity nor a discrepancy log as it relates to the

usage of automated dispensing machines. The committee worked closely with the State Board of Phar-

macy and the Arkansas Health Department. An example of the policy can be found on AAHP website

www.aahponline.org

Technician Memorandum of Understanding

AAHP has signed a memorandum of understanding in conjunction with our national organization: the

American Society of Health-System Pharmacists (ASHP). This agreement reflects our commitment to

work collaboratively with ASHP in advancing the quality of the pharmacy technician workforce. There

will be a survey distributed state-wide to assess current needs and to gather information from pharmacists

in regard to this endeavor.

Communication with Members

Over the next year AAHP will be contacting health-system pharmacists in Arkansas hoping to improve

communication within our profession across the state. The goal is to develop an email list of active mem-

bers and hospital directors throughout Arkansas for networking and advisement.

AAHP Board Meeting

The next AAHP Board Meeting will be held at the Lester E. Hosto Conference Center in Little Rock,

Arkansas, on January 16, 2009, at noon.

AAHP January 2009 Report

by: Maggie Miller, President

Safety Nets


In today’s fast-paced world, many people become frustrated – or

even angry – when forced to wait. This is especially true in a com-

munity pharmacy. At some locations, it is not uncommon for pa-

tients to have to wait one hour, or longer, for a prescription to be

filled. Pharmacists are struggling to keep up with ever-increasing

prescription volumes, and they too are becoming

frustrated. They realize that wait times in their

pharmacy are unacceptable, but requests for ad-

ditional pharmacist and/or support staff are

often denied at the corporate level.

In order to keep patient wait times as short as

possible, pharmacists must strive for an effi-

cient workflow. Sometimes, however, even the

most efficient pharmacy workflow can be in-

terrupted when patients present carelessly writ-

ten or illegible prescriptions. Workflow

interruptions frequently translate into even longer patient wait

times. The following two near-miss cases clearly illustrate this

point.

In the first case, the prescription illustrated in Figure One was pre-

sented to the pharmacist by a patient suffering from nausea and

vomiting. Even

though the pharma-

cist examined the

prescription for

several minutes, he

could not interpret the order. He realized the patient was nause-

ated and needed immediate relief. However, he simply had no al-

ternative but to call the prescriber for clarification. The prescriber’s

nurse stated the prescription was written for Reglan® (metoclo-

pramide) 10 mg tablets. After this, the pharmacist quickly filled

the prescription and counseled the patient.

In the second case, a pharmacy technician in Eastern Arkansas

was presented with the pre-

scription illustrated in Fig-

ure Two. As the technician

entered the prescription in-

formation into the com-

puter, she noticed the quantity

of Cefzil® (cefprozil) 250 mg/5 mL to be administered per dose

could be interpreted as either “3 cc’s” or “7 cc’s”. [all our readers

know the hazards of “cc” as an abbreviation. They also know that

is no longer official in the eyes of the United States Pharmacopeia].

When informed about the problem, the phar-

macist decided to call the prescriber for

clarification. Unfortunately, the nurse stated

the prescriber was unavailable and she

would have to call the pharmacist back.

When the pharmacist explained the prob-

lem to the patient’s mother, she said she un-

derstood and would return later that day.

Several hours later, the prescriber’s nurse

telephoned the pharmacist and said the pre-

scribed quantity of Cefzil® per dose was 7

“cc’s”. After this, the pharmacist correctly

filled the prescription for a ten-day supply [7 mL per dose] and

placed it in the “will call” bin. When the patient’s mother picked

up the prescription that evening, she was appropriately counseled.

Fortunately for the patient in the first case, the pharmacist was able

to clarify the prescription in a reasonably short period of time. The

patient in the second case was not so fortunate. The illegibly writ-

ten prescription caused the start of the child’s antibiotic therapy to

be delayed several hours. It also created an inconvenience for the

child’s mother.

Poor prescriber handwriting has the potential to create problems

not only for pharmacists but also for caregivers and patients. This

old problem produces longer patient wait times. Sometimes, phar-

macists receive illegible prescriptions at night after a prescriber’s

office has closed. In some instances, the prescriber can be quickly

Figure One

Figure Two

We are all familiar with the term “road rage”. This SafetyNet indicates that we may see a good deal of “counter rage”in our own practices. Thank you for your continued supportof this column – John Wolfe and Eddie Dunn.

Pharmacists are

struggling to keep up

with ever-increasing

prescription volumes,

and they too are

becoming frustrated.

Dr. Jon Wolfe Dr. Eddie Dunn

Safety Nets


reached through an emergency number. In others, we reach an on

call physician who did not examine the patient and is unwilling to

attempt to clarify the prescription. In these cases, patients are forced

to wait until the prescribing physician can be contacted the next

day. The pharmacist is always caught in the middle. Tempers may

flare. Regardless of the situation, pharmacists must never fill an

illegible prescription unless absolute confirmation has been ob-

tained.

In the end there is no absolute solution. The practical matter is that

pharmacists will continue to demonstrate their concern for the well-

being of patients. We will make the unwelcome and difficult tele-

phone calls. We will – for no extra compensation – exert ourselves

and our staffs to accommodate the patient. When 95% or more of

prescriptions are generated with computer systems, we will see

fewer problems with poor handwriting. We know, however, that a

computer system devised by humans and used by humans will not

solve every problem associated with prescription orders. We un-

derstand that we will have to create new Safety Nets to ensure that

new kinds of errors still only reach ISMP Levels A or B (opportu-

nity for error, or error occurred but did not reach the patient).

In Memoriam

Harvey Ham, Jr., P.D.Lewisville, AR

Joe D. Fenwick, P.D.Fort Smith, AR

A PHARMACY PURCHASING COOPERATIVE

Board of Directors Membership Tony Bari, Jonesboro, AR President Richard Hanry, El Dorado, AR Vice President Arkansas: 89 stores C.A. Kuykendall, Ozark, AR Secretary/Treasurer Missouri: 7 stores Buzz Garner, Mena, AR Eddie Glover, Conway, AR Gayle Fowlkes, Director of Member Services & Recruitment

Pharmacy Partners of America is part of the Compliant Pharmacy Alliance Cooperative(CPA)-the most successful and profitable buying cooperative in the United States- and it’s available exclusively to independent pharmacies. CPA has more than 650 members nationwide that represents over $1.7 billion in annual purchases. CPA is managed by Ed Heckman R.Ph.

“The contributing Arkansas members of PPA recognize the value of a strong pharmacy association. We are very pleased that our members have made the decision to financially support the Arkansas Pharmacists Association (APA). We are confident APA will continue to represent our best interest on political and professional issues if given the financial and moral support of Arkansas pharmacists.” Tony Bari, President PPA

Compounding Report


The last APA Journal had an excellent article by Don R. McGuire

in the Rx and the Law section giving the history and an update on

the legal jousting between the FDA and compounding pharmacists

over the legality of a part of our profession that has existed since

the profession began. Which is right? Obviously we think our

side is and the recent court rulings seem to verify that. I found an

article of “facts” about the FDA view published by P2C2, a public

advocacy branch of the International Academy of Compounding

Pharmacists, that I would like to share with you. For those of you

who do not know, IACP is compounder’s strongest advocate in

both Congress and in the courts system. They deserve our mem-

bership and financial support. The article is quite lengthy so I will

offer it as a series over the next few journals.

Over the past 15 years, there has been a fundamental disagreement between the U.S. Food & Drug Administration (FDA) and the pro-

fession of pharmacy over the legality of compounding. The view espoused by the FDA is that compounding has been illegal since

Federal Food, Drug, and Cosmetic (FDC) Act was passed in 1938. The compounding profession disagrees, and the facts concur. Re-

cently, a landmark ruling in Midland, Texas, reinforced the view of the pharmacy profession that compounded medicines are not new,

unapproved drugs and, subsequently, it is legal to prescribe and dispense them. The FDA’s lengthy legal briefs against compounding

can be boiled down to a very simple argument: that every compounded drug is a new, unapproved drug and, hence subject to FDA

oversight. FDA’s argument primarily hinges on one statutory provision in the FDC Act. This provision defines a new drug as “any”

drug that is not generally recognized as safe and effective by experts. FDA argues that the word “any” is clear, simple, and unambigu-

ous, and precludes examining any historical facts.

The problem with FDA’s argument is that the courts have repeatedly rejected it even before the Midland decision. Recently, the U.S.

Supreme Court reviewed a federal statute that imposed restrictions on individuals who had been convicted by “any” court. The gov-

ernment argued there, as the FDA argues here, that “any” means “every” and there are no exceptions. The Supreme Court rejected the

government’s argument in that case, ruling that a Japanese court was not “any” court for purposed of interpreting the law. In other

words, the Court said that courts should not read the word “any” literally as meaning each and every, and should not ignore, as the

government wanted, Congress’ objectives and the historical context. This is not a new concept. The U.S. Supreme Court in this deci-

sion cited another Supreme Court decision involving the word “any”. Thus, FDA’s central argument about how statutes must be inter-

preted that the phrase “any drug” means every single drug, without qualification flies in the face of judicial precedent going back two

centuries.

FDS has cited no facts to support its position. Instead, FDA relies completely on this statutory argument. However, the facts refute

FDS’s view.

Fact: In 1938, when Congress passed the FDC Act, hundreds of millions of medications were compounded annually. In fact, the

health care system could not have functioned without compounded drugs. As the executive director or the Missouri Board of Phar-

macy stated before Congress in 2003, “in fact, until after World War II when drug manufacturing became more prominent, compound-

ing was one of the principle practices use to provide needed drugs to patients.” FDA’s interpretation of the law would have meant a

complete breakdown in the delivery of health care in the United States in 1938, when Congress passed the law.

(Stay tuned. I think you will really enjoy these “Facts” that will continue next time)

Pharmacy Compounding Subject to FDA Approval?

The Facts just Don’t Fit

by: Gary Butler, President, APA Compounding Academy


APA App

Our Wholes

ppreciates

sale Partners

Happy New Year


President-ElectJan Hastings, Pharm.D.

Benton

District IV PresidentCliff Robertson, P.D.

Texarkana

District VIII PresidentChristy Campbell, P.D.

Batesville

Area IV RepresentativeMike Stover, Pharm.D.

Rison

District III PresidentDanny Ponder, P.D.

Mountain Home

District VII PresidentJohn Vinson, Pharm.D.

Fort Smith

Area III RepresentativeGary Bass, Pharm.D.

Little Rock

District II PresidentBrandon Cooper, Pharm.D.

Jonesboro

District VI PresidentMichael Butler, Pharm.D.

Hot Springs Village

Area II RepresentativeDennis Moore, Pharm.D.

Batesville

District I PresidentKenny Harrison, Pharm.D.

Little Rock

District V PresidentLynn Crouse, Pharm.D.

Eudora

Area I RepresentativeGary “Buzz” Garner, P.D.

Mena

PresidentPaul Holifield, Pharm.D.

Batesville

From the Board of Directors


Vice PresidentMike Smets, P.D.

Fort Smith

Board of Health MemberJohn Page, P.D.

Fayettevile

ASP President - Student MemberCristina Easterling

Bryant

Compounding Academy PresidentGary Butler, P.D.

Hot Springs Village

Harding College of PharmacyDean Julie Hixson-Wallace

Searcy

APA Executive DirectorMark Riley, Pharm.D.

Little Rock

Health-System Academy PresidentMaggie Miller, Pharm.D.

Batesville

UAMS College of PharmacyDean Stephanie Gardner

Little Rock

Consultant Academy PresidentMuncy Zuber, P.D.

Heber Springs

AR State Board of PharmacyCharles Campbell, Pharm.D.

Little Rock

TreasurerRichard Hanry, P.D.

El Dorado

Past PresidentStephanie Goodart O’Neal, P.D.

Wynne

Legal CounselHarold Simpson

Little Rock

UAMS Report


Instilling Professionalism is a Constant, Deliberate Process A Message from UAMS College of Pharmacy Dean Stephanie F. Gardner, Pharm.D., Ed.D.

Educating pharmacy students includes not only providing instruction in the basic and clinical sciences, but also includes promoting

their professional development. Professionalism embodies a number of factors: providing patient care in a way that respects and fos-

ters dignity and compassion; developing appropriate relationships with patients and other team members; presenting an appropriate

appearance and attitudes, and being actively involved in promoting the profession.

Our students must be able to collaborate with professionals from many disciplines and cultural backgrounds. It is important for them

to have skills required in the modern business environment. The attitudes and behaviors that comprise professionalism cannot be

learned from a textbook or a single lecture. Rather, they must be actively acquired through the process of professional socialization.

The UAMS College of Pharmacy is responding with professional development initiatives that begin in the first year and continue

throughout the students’ course of study. Professional education begins when first-year students receive their white coats, take the

Pharmacy Student Oath and are inducted into their Class at the annual White Coat Ceremony. The ceremony is attended by family

members, faculty and other pharmacy professionals.

With the establishment of the Business Etiquette Dinner program in the second year, pharmacy students are gaining a necessary under-

standing of many social skills. Consultants lead the dinner and teach communication and business meal etiquette, appropriate profes-

sional dress, and effective introduction techniques. Further topics include business travel, parties, convention and meeting conduct.

The first Business Etiquette Dinner was held last January in Little Rock. Each student received a detailed packet of information and a

book of business etiquette for future reference.

A Professional Pinning Ceremony and Luncheon is held annually for third-year students. At the final assembly before entering the ex-

periential rotations that comprise their senior year, students receive lapel pins unique to the UAMS College of Pharmacy. This denotes

the students’ advancement from didactic learning to direct patient care. Leaders of the Arkansas Pharmacists Association, the Associa-

tion of Health Systems Pharmacists and the National Pharmacists Association participate in this milestone event.

Along with professional events, Introductory Pharmacy Practice Experiences (IPPEs) at the College of Pharmacy help students con-

nect the classroom to practice. These structured experiences in the first through third years get students out of the classroom and into

the pharmacy earlier, providing 300 hours of experiential education within the curriculum before the fourth year. In addition to dis-

pensing, the IPPE focuses on communication and professionalism.

By modeling professional behavior, our preceptors are a vital component to our curricular focus on professionalism. Students who are

exposed to a patient-centered environment early in their education quickly learn how important their communication skills and the de-

velopment of a pharmacist-patient relationship are in their role as health care providers.

During their fourth year at the UAMS College of Pharmacy, students participate in Advanced Pharmacy Practice Experiences

(APPEs). The program consists of nine one-month rotations led by volunteer preceptors. It is during their advanced experiential edu-

cation that students begin to more fully understand their unique contributions to the healthcare team. The faculty and preceptors are

responsible for developing professionals who recognize and support the individual contributions of all team members in achieving op-

timal patient outcomes.

On the day before commencement, seniors come to campus for a final convocation and luncheon. They receive a one-year member-

ship in the Arkansas Pharmacists Association and are inducted into the Alumni Association. That evening, in a highly meaningful Sen-

ior Awards Ceremony, they receive and present awards. They then are symbolically “hooded” with their doctoral regalia by selected

faculty members, and take the Oath of a Pharmacist. The convocation ceremony marks the culmination of not only their education,

but it also marks their entry into a dynamic profession.

Developing professionalism among future pharmacists is one of the most important and most challenging aspects of pharmacy educa-

tion. It can only occur if promoted across the curriculum, and made part of every day’s work. That’s why we make it a constant, delib-

erate process at the UAMS College of Pharmacy.

Calendar of Events


February 18, 2009

APA Legislative Day

Arkanas State Capitol

Little Rock, AR

APA Legislative Reception

Trapnall Hall

Little Rock, AR

April 3 - 6, 2009

The APhA Annual Meeting &

Exposition Henry B. Gonzalez

Convention Center

San Antonio, TX

May 11 - 13, 2009

NCPA Legislative Conference

Hyatt Regency Washington on Capitol

Hill

June 11 - 13, 2009

127th APA Annual Convention

DoubleTree Hotel

Little Rock, AR

September 8 - 30, 2009

APA District Meetings

October 17 - 21, 2009

NCPA 111th Annual Convention and

Trade Exposition

Ernest N. Morial Convention

Center, New Orleans

2009 APA Annual ConventionMark your calendar now for the

127th APA Annual Convention

June 11-13, 2009

The newly renovatedDoubleTree

Hotel

Little Rock

Rx and the Law


PHARMACY MARKETING GROUP, INC

AND THE LAW By Don. R. McGuire Jr., R.Ph., J.D.

This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State PharmacyAssociation through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services tothe pharmacy community.

COMPARATIVE FAULT

A prior article in this series discussed the elements ofnegligence which a plaintiff must prove in order to wintheir case. This article will discuss what occurs whenthe plaintiff themselves are also at fault in the case.

Under an older theory, this concept was called Con-tributory Negligence. This is when the plaintiff failedto act as a reasonable person and contributed to theirown injury. We could see this occurring in pharmacycases when the patient clearly recognizes that thetablets in the vial are incorrect, but takes them any-way. The impact that Contributory Negligence has ona case is dramatic. If the plaintiff contributed in anyway to their injury, then they are entitled to no dam-ages at all. There are 4 states and the District of Co-lumbia that still use Contributory Negligence in someform. This harsh result may have been modified inthose states.

The harshness of the Contributory Negligence con-cept has led the rest of the states to adopt a Compar-ative Negligence, or Comparative Fault, system.Under this concept, each party is assigned a percent-age of fault with the total being 100%. If our patientabove was assessed 10% of the fault in their case,then the verdict would be reduced by 10% and theycould only collect 90% of their verdict. This is calledPure Comparative Negligence and is the law in 13states. Remember the previous result under Contrib-utory Negligence would be that the plaintiff would getnothing in this scenario.

One of the possible results under Pure ComparativeFault is that the plaintiff could be 95% at fault, but stillrecover 5% of the verdict in their case. This possibil-ity has led some legislatures to modify ComparativeFault. This modification can take several differentforms, but essentially bars recovery by the plaintiff if

their percentage of fault meets or exceeds a certainthreshold. In 11 states, this threshold is 49%, while itis 50% in 21 other states.1 In these jurisdictions, aplaintiff who is assigned 51% or more of fault will re-cover nothing. This is reminiscent of the results underContributory Negligence.

In many ways, Modified Comparative Fault is a bal-ancing act. The potential results under ContributoryNegligence can be seen as unfair to the plaintiff whohas only a small percentage of fault. On the otherhand, allowing plaintiffs to proceed with cases wherethey have a high percentage of fault can be seen asunfair to defendants. Modified Comparative Fault at-tempts to balance the legal system by not encourag-ing potentially spurious claims, while at the sametime, not discouraging legitimate claims.

In many pharmacy cases, the pharmacy or pharma-cist wants to highlight the fact that the patient shouldhave recognized that the tablets in the vial appeareddifferent. This is an attempt to place some fault onthe patient. While this argument is theoretically agood one, it does not work well in the real world.First, patients are almost trained to accept, withoutquestion, the endless sequence of different genericbrands that are dispensed. Secondly, the plaintiff at-torney is always quick to point out that if the plaintiffcould have recognized the difference, then the trainedprofessional should have been able to recognize thedifference also.

Comparative Fault is not always important in phar-macy cases because patients are seldom in a positionto seriously contribute to their own injury. However, itcan be important in cases where the prescribing1. This does not include South Dakota. South Dakota permits re-covery by the plaintiff when their fault is slight in comparison to thefault of the defendant, but doesn’t assign a percentage to “slight”.


physician is a co-defendant. In these cases, fault can be apportioned between the patient, the pharmacy,and/or the prescriber. An example would be a case where the patient is prescribed a drug to which they are al-lergic. There could be fault apportioned to both the prescriber for prescribing inappropriately and the pharmacyfor dispensing inappropriately.

The lesson for the pharmacist here is not that they know if Contributory Negligence or Comparative Fault ap-plies in their state. They need to be aware that this concept exists and that in cases where negligence can beproved, there may be additional factors that will deny the plaintiff recovery or that may allow the pharmacy de-fendant to pay less than the total verdict. Also, be aware that the claims examiner and/or attorney working onyour case will take these factors into account as they work to resolve your case.

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consulttheir own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of theiremployers and insurance companies, and act accordingly.

E-Prescribing

Arkansas Medicaid has recently implemented the E-prescribing solution. E-Prescribing gives providers of

Arkansas Medicaid, including hospital systems, access to a Medicaid recipient’s

eligibility for Arkansas Medicaid paid pharmacy benefits. E-prescribing allows real-time analysis of the

Arkansas Medicaid recipient’s medication history. The medication history provides a true

compliance picture for the provider. The history shows what other providers have ordered for the

recipient through Arkansas Medicaid. It also allows the provider to see whether previous prescriptions were

filled and whether refills were requested at the appropriate time. Each recipient’s medication history includes

up to the two years of Arkansas Medicaid history.

The Arkansas Medicaid prescriber will also have the ability to electronically send a prescription

directly to the pharmacy of the recipient’s choice. Before sending the prescription a prescriber can

determine Arkansas Medicaid’s coverage restrictions. These restrictions include drugs which require prior au-

thorization, quantity limits, age limits, or gender limits. Coverage restriction information is

detailed through resource links which is a direct link to criteria documents found on the Arkansas Medicaid

Website. Arkansas Medicaid providers will be able to resolve issues at the time they are writing the prescrip-

tion. The benefits of E-prescribing allow these issues to be identified before the prescription is presented to

the pharmacy.

The practice of pharmacy for Arkansas Medicaid providers will be greatly enhanced with the use of

E-prescribing through an increase in patient safety, quality of care, and cost effectiveness.

Medicaid Alert

Harding Report


Fall 2008 Students and Events

The first semester of the first year for the inaugural class is now behind them. During the semester the students have spent many

hours in the classroom, but they have participated in other learning opportunities outside the classroom as well. In October, students

formed a team and participated in the Susan G. Komen Race for the Cure in Little Rock. For stress relief after their first major exam,

students organized an afternoon of bowling. If you check out Facebook, you will find students involved in flag football. On October

24, 2008, Harding University held a building dedication ceremony for the new Center for Health Sciences. Dean, Dr. Julie Hixson-

Wallace, and student, Janice McKean, spoke on behalf of the College of Pharmacy at this inspiring ceremony. The Board of Visitors,

an advisory board, comprised of 16 individuals from various aspects of the pharmacy community, were on campus for the dedication.

A luncheon was held for the board members, faculty, staff, and students. In November, students, faculty and staff spent time together

at the first annual HUCOP Hotfire Cookout. Thanks to Senator Percy Malone for sponsoring this event and Dr. Jeanie Smith for host-

ing.

Students have also been involved in providing service throughout the community. When you see them in their white coats, you know

they are up to good deeds. Some of those activities included: encouraging high school students in the Upward Bound program by pro-

viding education regarding the dangers of caffeine and high sugar levels in soda, serving at the Christian Health Ministry on Sunday

afternoons, assisting volunteer physicians, pharmacists and other healthcare providers by ministering to the health needs of White

County residents without medical coverage, and various county and city festivals including Homecoming at Harding University.

The inaugural class students are involved with establishing student governance and the first student organization. Student elections for

student governance, the Council of Students (COS), will be on December 11. The first professional student organization will be a

chapter of the national organization APhA-ASP (American Pharmacists Association- Academy of Student Pharmacists) with election

of officers also on December 11.

It has been a smooth and productive beginning for the inaugural class. As they press on to the new semester, we anticipate many good

things for and from this group of talented students.

Ms. Carol Kell, Director of Admissions and Dr. Julie Hixson-Wallace, Dean receive the first annualstudent scholarship from Joe Baker of Pharmacists Mutual.

Dr. Jeff Mercer observes several students performing blood pressure checks.

Students, Faculty, Staff and the Board of Visitors enjoy a luncheon in celebration of the Center for Health Sciences Building dedication.

Dr. Hixson-Wallace spoke on behalf of the College of Pharmacy at the building dedication.

Searcy Mayor, Belinda LaForce, signed a proclamation deeming October 2008 as Pharmacists Month.

Pharmacy and PA students work together on a dissection during an Anatomy and Physiology lab.


Pharmacy in ArkansasOn June 7, 1990, the Arkansas Pharmacists Association Board of Directors commissioned an oil painting to be createdby artist Judith Boody of Little Rock. The painting was planned to express both the nostalgic reminiscence of Pharmacyand a feeling of the present, combined with a unique feeling of Arkansas Pharmacy. Only 1,000 limited edition lithographs(paper size: 22” x 28” – image size: 18 1/4 x 23”) will be available. All are hand-numbered and signed by the artist.

Please use the form below when ordering.

Quantity Price plus Shipping/Handling Net Price Total

__________ $35.00 + $4.00 $39.00 _______________

Name ______________________________________

Address ____________________________________

City_____________________State______Zip ______

Make checks payable to: Arkansas Pharmacists Association

Mail to: Arkansas Pharmacists Association � 417 South Victory � Little Rock, Arkansas 72201

Great

Gift Idea


Pharmacist Needed

Assessing appropriate and cost-effective use of medications,

committee service, patient rounds, drug information, pharmacoki-

netics, educational presentations, and decentralized order entry.

Contact Romona McLean, Washington Regional, Fayetteville,

479-463-1102.

Pharmacist Needed

Pharmacist needed to work Saturdays 9am-3pm (or even 2

Saturdays/month)!! Independent pharmacy in Van Buren, AR

with great tech help, great atmosphere and great extra cash!

E-mail resume to [email protected], fax

479-474-3131 or call 479-462-1269.

Pharmacist Needed

Independant closed door pharmacy in Little Rock. For

information call 501-888-7514 or email resume to

[email protected].

Technician Needed

Independent pharmacy in Little Rock looking for pharmacy

technician with experience in compounding. Position is full time

Monday - Friday. Contact Kenny at 501-223-2224

Independent Pharmacies Wanted

Independent pharmacist interested in purchasing independent

pharmacies in Arkansas. Pharmacies will remain independent

after purchase. Purchaser has solid independent pharmacy

background.

If interested in selling your pharmacy, please contact Vance at

870 - 897-1204 or via e-mail at [email protected].

Technician Needed

Immediate opening for full time compounding technician.

Monday - Friday 9:00 a.m. - 5:30 p.m., benefits included. Please

call Lynn at 501-374-2207.

Volunteer Pharmacists Needed

Shepherd’s Hope Neighbornood Health Clinic is a ministry of

Fellowship Bible Church and Oak Forrest United Methodist

Church serving uninsured and indigent patients in the South

Midtown area of Little Rock. The Clinic is located at 2404 Tyler

Street (behind Oak Forrest). The hours of operation are 6:00pm to

8:30pm every Thursday night. Current needs are pharmacists

willing to volunteer every 4, 6, or 8 weeks. If you are available to

volunteer and help with this ministry, please contact Trey

Gardner at 501-425-2469. Thank you!

Pharmacists Needed

Full time pharmacists needed in the Hot Springs, Little Rock, and

Mt. Home areas. Central Arkansas Veterans Healthcare System

has immediate openings for full-time pharmacists in Hot Springs,

Little Rock, and Mt. Home, AR. Competitive salary and federal

employee benefits. Applicants are eligible for a sign on bonus

and to apply for the Employee Debt Reduction Program (school

loan reimbursement). For more information and to apply, go to

www.usajobs.gov. You may call the VA pharmacy office at 501-

257-6330, ask for Gigi or Jane for questions.

For Sale

Laminar Flow Glove Box/Isolator made by Germfree Labs, Inc.

Six foot stainless steel 1 or 2 person unit. Certified on 6/12/2008.

Call Jim, Layton or Stan at 501-315-7700 for more information.

IVANRX4U, Inc.,

Pharmacist Relief Services, Career Placements.

Relief pharmacists needed - FT or PT. Based in Springfield, MO

and now in Arkansas. Staffing in Missouri, Arkansas, Eastern

Kansas and Oklahoma. We provide relief pharmacists for an

occasional day off, vacations, emergencies -- ALL your staffing

needs. Also seeking pharmacists for full or part-time situations.

Please contact Tracy Byrd, Marketing and Recruiting Director, or

Mike Geeslin, President for information regarding current

openings throughout Arkansas - temporary as well as permanent

placements. Let IvanRx4u help staff your pharmacy, call

417-888-5166. We welcome your email inquiries, please feel free

to contact us at: [email protected] or

[email protected].

Pharmacist in Charge Wanted

Competitive salary with up to 3 weeks paid vacation and major

medical coverage plus 401K plan. Great schedule - Monday thru

Friday, hours 9:00 a.m. to 6:00 p.m. Contact Alan Tweddell at

870-931-2881 or send resume to:

Country Mart Pharmacy,

208 Lincoln Dr., Fredericktown, MO 63645

Positions to be filled in N.E. Arkansas and S.E. Missouri.

Pharmacists Needed

Part time pharmacist needed in Danville. Full time pharmacists

needed in Hot Springs. Competitive salary with excellent benefit

package. No nights or Sundays. Contact Alvin Groves at

479-619-6343.

Relief staffing available through Staff RPh, Inc.

We provide quality pharmacists and technicians that you can trust

for all your staffing needs. Our current service area includes AR,

TX, OK and TN. For more information call Rick Van Zandt at

501-847-5010 or email [email protected].

Pharmacists Needed

Kroger is looking for part-time pharmacist in Hot Springs and a

full time pharmacist in Russellville. Please contact Jamie Shoe-

maker at 501-650-1715 or Julie Dean at 901-765-4204.

Pharmacy for Sale

In beautiful North Arkansas. Established in 1974. Family owned

with exceptional reputation in dynamic community. Excellent

schools, recreational & retirement center, golf courses, lakes,

rivers, 2.5 hours from Little Rock, AR; Memphis, TN; and

Springfield, MO. Pharmacy is ideally located: a) across from

doctor’s complex and new treatment, diagnostic, and emergency

facility, b) next door to ophthalmologist and optometrist. Contact

Mike Sprague at 512-799-5265.

Pharmacy for Sale

North Central Arkansas, owner retiring. Clinic setting next to two

MDs & one nurse practioner. Call Charlie at 870-895-2143 days

and 870-895-2361 nights.

Member Classifieds


The Arkansas Pharmacy Foundation is pleased to announce the beginning of our Pharmacy Walkway of Honor. The walkway will be

composed of bricks on which the names of pharmacists, pharmacies, and other business-related companies (i.e. wholesale, drug, design,

computer, etc.) can be placed to show appreciation for the profession of pharmacy. The walkway will be located outside the entrance to

the Lester E. Hosto Conference Center. The Foundation will place the first brick in memory of Dr. Lester Hosto.

Please use the form below to personalize your brick(s). Make copies as necessary. Print the name and other information as you would

like it to appear on your brick. You have a maximum of three lines per brick with up to 18 characters per line, including spaces.

Please use the ampersand (&) instead of “and” and omit periods.

Name: ___________________________________________________________________

Address __________________________________________________________________

City ______________________ State ____________________ Zip _________________

Phone (_______)___________________________________________________________

I wish to order ________________ bricks @ $125.00 each for a total of $ ______________

Method of Payment

_____ Check, payable to APF

_____ Visa ______ Mastercard _____ Discover _____American Express

Credit card number _____________________________________________________

Expiration Date _______________ Signature ____________________________________________

Your support is sincerely appreciated. Please mail to APF, 417 South Victory, Little Rock, AR 72201 or fax to

501-372-0546 or visit www.arpharmacists.org to order.

Proceeds will help provide funds to sponsor, support and conduct educational programs, thereby promoting the Foundation to effi-

ciently perform the objectives for which it is organized.

Personalize your brick here.

1

2

3

Show your pride on the


Pharmacy Time Capsules

Arkansas PharmacyFoundation

Corporate Sponsor...Corporate Sponsor...

Thursday April 16, 2009

Mountain RanchGolf Club

Fairfield Bay, AR

Proceeds willbe used to

endow a UAMSCollege of Pharmacy

Scholarshipand present

theCharles M.West Award

FFOOUURR

PPLLAAYYEERR

SSCCRRAAMMBBLLEE

Pharmacy Time Capsules

2009 (First Quarter)

1984—Twenty-five years ago:

• Drug Price Competition and Patent Term

Restoration passed.

The major provisions of the law:

o expedited the availability of less costly generic drugs

by permitting FDA to approve applications to market

generic versions of brand-name drugs without

repeating the research done to prove them safe and

effective.

o provided brand-name companies up to five years

additional patent protection for new medicines to

make up for time in FDA's approval process.

• Schering Corporation budgeted $4 million for first

“Ask Your Pharmacist” campaign to encourage the

public to ask their pharmacists about their medicines.

1959—Fifty years ago

• American Hospital Formulary Service launched by

American Society of Hospital (now Health-Systems)

Pharmacists.

1934—Seventy-five years ago

• The American Pharmaceutical (now Pharmacists)

Association headquarters building, the American

Institute of Pharmacy, on the National Mall in

Washington, DC. was dedicated.

1909—One hundred years ago

• Opium Exclusion Act of 1909 prohibited the

importation of opium to the United States.

By: Dennis B. Worthen Lloyd Scholar, Lloyd Library and

Museum, Cincinnati, OH

One of a series contributed by theAmerican Institute of the History ofPharmacy, a unique non-profit society dedicated to assuring that thecontributions of your profession endure as a part of America's history. Membership offers the satisfaction of helping continue thiswork on behalf of pharmacy, andbrings five or more historical publications to your door each year.To learn more, check out:www.aihp.org

APA Board of Directors Minutes


Minutes

Arkansas Pharmacists Association Board of Directors

August 7, 2008

Holiday Inn – Fort Smith

Members Guests and Staff

Dr. Paul Holifield-presiding Dr. Gary Bass Dr. Richard Hanry - treasurer

Dr. Kenny Harrison Dr. Dennis Moore Harold Simpson – legal counsel

Dr. Brandon Cooper Dr. Michael Butler Ms. Barbara McMillan

Dr. John Page Dr. Stephanie Gardner Dr. Scott Pace

Dr. Julie Hixson-Wallace Dr. Mark Riley Ms. Debra Wolfe

Dr. Jan Hastings Dr. Cliff Robertson Dr. Billy Gammel

Dr. Stephanie Goodart-O’Neal Dr. Mike Smets

Dr. Lynn Crouse Dr. Justin Boyd

Dr. Charlie Campbell Dr. Muncy Zuber

Dr. Mike Stover Mrs. Christina Easterling

CONSENT ITEMS

President Paul Holifield called the meeting to order at 7:30 p.m.

President Holifield asked Dr. Richard Hanry to lead the invocation.

Dr. Jan Hastings made a motion to approve minutes with changes. The motion passed.

Mr. Harold Simpson suggested that he review the Conflict of Interest Policy and the Antitrust Policy of the APA.

Dr. Mark Riley reported that the phone-a-thon raised $49,555 for the PAC. The PAC money is used to assist in the associ-

ation’s lobbying activities.

DISCUSSION ITEMS

Convention Report & Program Update

Barbara McMillan reported that attendance at the 126th Annual APA Convention was down from the previous year in

Rogers. However, she noted that the convention was still a success.

Dr. Scott Pace reported that the Golden Certificate Program will be held Thursday, October 9th at the UAMS College of

Pharmacy. The program will provide 6 hrs of continuing education to pharmacists who have held their Arkansas pharma-

cists license for more than 50 years.

UAMS College of Pharmacy Report

Dean Stephanie Gardner reported that 120 new pharmacy students will begin school this fall. The college will have a

White Coat Ceremony to welcome the new students. Eight new faculty members have been hired. Dean Gardner also re-

ported that Dr. Donna West has accepted a position to become the department chair at Ole Miss.

Dean Gardner proposed the creation of a committee of practicing pharmacists and the two colleges of pharmacy to review

the experiential rotation process to attempt to create standardization between the experiential portions of the two college’s

curriculum.

Harding School of Pharmacy Report

Dean Julie Hixson-Wallace reported that the school moved into their new building in July. The school has admitted 60

students who will begin classes in August. Forty-seven percent of the students are from Arkansas. Harding will have

their next ACPE site visit in March 2009.


Arkansas Academy of Health-System Pharmacists (AAHP) Report

Dr. Justin Boyd reported that the AAHP Fall Seminar will be held October 9th and 10th at the Grand Casino in Tunica,

MS. Dr. Maggie Miller will become the new AAHP president in October.

Dr. Boyd also stated that AAHP has been working on creating a narcotic discrepancy log with the Department of Health

and the State Board of Pharmacy.

Arkansas State Board of Pharmacy Report

Dr. Charlie Campbell reported that the Board is considering modifying the consultant pharmacist requirements during the

next legislative session. Dr. Campbell also noted that the disease state management rules are being reviewed and may be

modified to modernize the rule, but would still operate under a protocol with a physician.

Dr. Campbell also reported that the concept of consolidating all state regulatory boards into a “Superboard” has been pro-

posed. Dr. Campbell was not supportive of the idea and felt individual boards were necessary to ensure the best possible

regulation of the profession and protection of the public safety.

Arkansas Academy of Consultant Pharmacists

Dr. Muncy Zuber reported that Dr. Jim Griggs has been elected as president-elect of the Consultant Academy.

Arkansas Board of Health Report

Dr. John Page provided statistics reported at the last Board of Health Meeting. He noted that the US ranks 45th in the

world in life expectancy and Arkansas ranks 48th in the nation in health rankings.

Dental Dispensing Update

Dr. Mark Riley reported that the Arkansas Dental Board has modified their regulations to ensure that a dentist must go be-

fore the dental board and demonstrate a need in their community before a permit to dispense would be issued. This lan-

guage mirrors the rules that the Arkansas Medical Board has in place.

Medicaid Dispensing Fee Update

The Centers for Medicare and Medicaid Services has still not provided an answer to the change in the Arkansas Medicaid

dispensing fee State Plan Amendment. Dr. Riley reported that Governor Beebe intervened on this issue and sent a letter to

acting CMS administrator Kerry Weems supporting the approval of the dispensing fee increase.

CCRx

Dr. Riley announced that there will be some changes to their plan designes in 2009. Dr. Riley noted that APA continues to

monitor the status of Medicare Part D programs in Arkansas and is currently conducting a survey to evaluate the plans op-

erating in Arkansas.

H.R. 6331

Dr. Riley reported that H.R. 6331 was passed by both the U.S. House and U.S. Senate and vetoed by President Bush.

Congress subsequently overrode the president’s veto to enact the law. The new law provides Prompt Payment for pharma-

cists under Medicare Part D plans, delays the implementation of Medicare DME Competitive Bidding, and delayed the

implementation of the Medicaid AMP pricing. The prompt payment provisions will become effective in January 2010.

PBM Strategy

Dr. Riley shared some of his thoughts about pros and cons of running a PBM regulation bill during the 2009 Arkansas

Legislative Session. Dr. Riley suggested that the Board discuss further during their discussion of the APA Action Plan.

ACTION ITEMS

Financial Report

Dr. Richard Hanry reported on the financials of the APA. Dr. Hanry stated the financials of APA were in good shape.


Dr. Riley also reported on the APA wholesaler income.

Dr. Hastings made a motion to approve the financials. The motions passed.

Miscellaneous

Mr. Harold Simpson, APA legal counsel, reviewed the APA anti-trust and conflict of interest policies.

Mr. Simpson made a recommendation to the Board to strike item VI of the APA Antitrust Policy.

Dr. Crouse made a motion to amend the antitrust policy, per Mr. Simpson’s recommendation. Motion passed.

Mr. Simpson also recommended modifications to the APA Conflict of Interest Policy to streamline the policy. Dr. Moore

made a motion to amend the conflict of interest policy per Mr. Simpson’s recommendations. The motion passed.

Adjournment

A motion was made and seconded to adjourn the meeting at 9:15p.m. The motion passed.

APA Foundation Board

August 9, 2008

Dr. Paul Holifield convenes the Foundation Board at 8:35am on 8/9/08.

The Board wished happy birthday to Dr. Stephanie Goodart O’Neal.

The Board made a motion to accept the actions of the Foundation Board. The motion was passed.

A motion was made to adjourn the meeting, motion passed.

the arkansas pharmacist winter 2009

Documents