the georgia pharmacy journal: august 2011

2011-2012 GPhA �eme

*This is not a claims reporting site. You cannot electronically report a claim to us. To report a claim, call 800.247.5930.**Compensated endorsement.Not all products available in every state. The Pharmacists Life is licensed in the District of Columbia and all states except AK, FL, HI, MA, ME, NH, NJ, NY and VT. Check with your representative or the company for details on coverages and carriers.

For more information, contact your local representative:

www.phmic.com*

Guarantee a better

Quality of Life for your family.Life Insurance can provide for your loved ones by:

Paying outstanding debtsCreating an estate for those you care aboutProviding college funding

Life insurance solutions from The Pharmacists Life Insurance Company.

Endorsed by:**

Hutton Madden800.247.5930 ext. 7149

678.714.9198

Q

Quality

y of Life

Life Ins

Q

Providing colleg Creating an esta Paying outstand

surance can p

Quality

ge funding ate for those you c

ding debts

provide for you

y of Life

e about car

r loved ones bfor your faf y f

l d b

by: amily.

b

Insuranc Life insu

.ce Company urance solutio

008

H

om The ons fr

amroffonnfieromroF

8919417876.txe0395.742.0ddaMnottuH

e Pharmacists

colruoytcatnoc,noit

9417

ned

s Life

:evitatneserperla

representative or the company for details on coverages and carriers.al and Columbia

a products all Not Compensated endorsement.**

a claim, call 800.247.5930.claim a not is This *

the company for details on coverages and carriers.NH, ME, MA, HI, FL, AK, except states ll

Pharmacis The state. every in available endorsement.

247.5930.electronically cannot You site. reporting ms

8919.417.876

c.cimhp.www

and carriers.your with Check VT. and NY NJ,

of District the in licensed is Life sts

report To us. to claim a report ally

*moc

The Georgia Pharmacy Journal August 20113

F E A T U R E A R T I C L E S

6 Pharmacy Time Capsule 2011

8 New GPhA Member Benefit: Be a Mentor, Get a Mentor

12 Pharmacists for the Future

15 Valuation Research the Right Prescription for Entrepreneurial Pharmacists

17 GPhA EVP Named to Alliance for Patient Medication Safety Board of Directors

22 Rx and the Law: Where Have you Gone, Perry?

23 Pamala Marquess, Pharm.D., Participates in McKesson Public Policy Forum

24 CPE Opportunity: Multiple Sclerosis: Emerging Oral Therapy

C O L U M N S

4 President’s Message

7 Editorial

182012 GPhA Convention:

Save the Date

Departments9 GPhA New Members10 Pharm PAC Contributors16 GPhA Members in the News30 GPhA Board of Directors

Advertisers2 Pharmacists Mutual Companies5 GPhA Career Center6 Pharmacy Quality Commitment8 Financial Network Associates11 Logix, Inc.11 Melvin Goldstein, P.C.17 Custom Pharmacy Design19 AIP20 GPhA Workers’ Compensation21 NCPA Convention Information32 UBS

For an up-to-date calendarof events, log ontowww.gpha.org.

P R E S I D E N T ’ S M E S S A G E


Ihope everyone has had a great summer. I know the childrenare getting ready for school. For those of you who made itto Convention, I hope you had a great time and enjoyed the

fellowship with your colleagues. I hope you received new ideasfrom the continuing pharmacy education classes to carry backto your pharmacies.

I feel honored to be the president of your association. I also feelvery fortunate to have the members of the executive committeepresent for my tenure at your association. This group is workingreal hard to prepare for this upcoming year. Two weeks ago,your executive committee spent 3 days in Hartwell establishinggoals for this upcoming year. This year will be like every year inthat there will be new problems arising that your associationwill have to manage. Your executive committee will stay on topof things as they arise.

To those of you who were at the Convention, I hope yourealized that your association had two national presidents inattendance. These two presidents, Bob Greenwood, Presidentof NCPA, and Tom Menighan, President of APhA, both spokeat the convention. I want you to know that this is an enormousfeat as these two gentlemen usually converse with only twostate conventions per year. The fact that we had both presidentsspeaking at this year’s convention speaks very highly for yourassociation.

I hope those who attended the Convention had time to listen tothe keynote speaker, Steve Gilliland. I feel pharmacy is in atransitional time and Steve provided the association with somethoughts about you and your profession. Steve did anoutstanding job by bringing this association back to reality. Hemade us realize that we are in our communities to provide aservice and that we can “make a difference.” Steve has two

quotes that I would like you to carry with you in yourprofession, “Sometimes the things we are most passionateabout escape us not because lack of talent, but rather becausewe lack the resolve necessary to pursue them.” The other quoteis, “A lone person you influence positively today has theprobability to influence thousands of people tomorrow.” I hopeyou remember these two quotes and prosper from them in youreveryday lives.

As your association president, I look forward to working for youthis year. The executive committee and I will do everythinghumanly possible to ensure a great year for your profession.

L. Jack Dunn, Jr., R.Ph.GPhA President

GPhA 2011-2012:New Beginnings

Find the best jobs and highly qualified pharmacists Georgia has to offer.

SUPPORTING PHARMACISTS.ADVANCING CAREERS.

ONLINE CAREER CENTERwww.gpha.org/jobs

1986—Twenty-five years ago:

72 accredited US colleges of pharmacy graduated 10,685

students with entry level professional degrees (9,501 B.S.

and 1184 Pharm.D.)

1961—Fifty Years Ago:

75 accredited US colleges of pharmacy graduated 3,497

students with entry level professional degrees (3,395 B.S.

and 102 Pharm.D.).

1936—Seventy-five Years Ago:

Pentothal (thiopental sodium) is introduced by Abbott

Laboratories. Ernest Volwiler, one of the inventors, went

on to become president of Abbott. The American

Association of Colleges of Pharmacy’s premier research

award is given annually in his name. Hospital Pharmacists

of Minnesota (HPM formed with the objective of

extending and promoting hospital pharmacy.

1911—One hundred Years Ago:

Pharmacy education resumed its operation as The

University of Tennessee School of Pharmacy, upon the

transfer of the UT medical and dental schools to Memphis.

1886—One hundred twenty-five years ago:

John Pemberton, an Atlanta pharmacist, concocted a

flavorful syrup which was added to carbonated water at

Jacobs Pharmacy and Coke cola was born.

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

Museum, Cincinnati, OH

One of a series contributed by the American Institute of the

History of Pharmacy, a unique non-profit society dedicated

to assuring that the contributions of your profession endure

as a part of America’s history. Membership offers the

satisfaction of helping continue this work on behalf of

pharmacy, and brings five or more historical publications to

your door each year. To learn more, check out: www.aihp.org

Pharmacy Time Capsules2011 (Third Quarter)

Pharmacy Quality Commitment® (PQC) is what you need!

PQC is a continuous quality improvement (CQI) program that supports you inresponding to issues with provider network contracts, Medicare Part D requirements

under federal law, and mandates for CQI programs under state law.

When PQC is implemented in your pharmacy, you will immediately improve your abilityto assure quality and increase patient safety. Do you have a CQI program in place?

Call toll free (866) 365-7472 or go to www.pqc.net for more information.

PQC is brought to you by your state pharmacy association.

“We implemented PQC in our pharmacy fourmonths ago – it was easy. I have noticed an

enhanced effort from the staff to work together to avoid and eliminate quality-related events.”

Have you ever had the opportunity to walk on the beachthis time of year along the Georgia coast and notice thatcertain areas are closed off by fences and signs that say,“Sea Turtle Eggs”?

I have read that female sea turtles swim to shore betweenMay and August to dig nests in the sand and lay their eggs.Months later, the eggs hatch and the baby turtles followthe pure light of the moon back to the surf.

In a perfect world, the pure light of the moon guides everyturtle back safely to the ocean. However, as we all know,we don’t live in a perfect world.

Sea yurtle hatchlings instinctively crawl toward thebrightest light. On an undeveloped beach, the brightestlight is the moon. On a developed beach, the brightestlight can be an artificial light source coming fromrestaurants, homes and condominiums along the coast.

Unfortunately, these powerful artificial sources of lightoften attract the hatchlings and cause them to move in thewrong direction when they are born.

Rather than follow the pure light of the moon to the oceanthe sea turtles follow the wrong light to a less thandesirable outcome.

It occurred to me that young pharmacists face similarchallenges.

Rather than following the path they originally desired tofollow, they are too often distracted by things that movethem in different directions.

The pressure of college loans, the feeling and need tomaterially succeed leads many to make career decisions

based on short term needs rather than long term careersatisfaction.

Instead of following the pure light of the pharmacyprofession they often allow bright and shiny artificialthings to sabotage their journey.

So, what about you GPhA member?

Are you following your priorities and pure light to the rightdestination or did you allow artificial distractions to leadyou in the wrong direction?

Are you following the path you wanted to follow or didyou let unimportant things keep you from being thehealthcare professional you wanted to be?

The great news is that unlike sea turtles we have the abilityto think, adapt and change direction when we realize weare following the wrong path and that is much of what theGeorgia Pharmacy Association is about helping --pharmacists be successful in their career.

We can tune out the distractions and focus on ourpriorities and let the pure light of our chosen professionlead you to an ocean of possibilities and a great future!

GPhA will be launching a mentorship program this fall.This will be a great opportunity to share your life andcareer experiences with anxious and energetic newpractitioners. Look for our email notice and get involvedin helping young colleagues choose the right course to asuccessful and fulfilling career in pharmacy.

*Much of the description of the Sea Turtle analogy wastaken from Jon Gordon’s Weekly Newsletter withpermission.

E X E C U T I V E V I C E P R E S I D E N T ’ S E D I T O R I A L

Jim BracewellExecutive Vice President / CEO

7The Georgia Pharmacy Journal August 2011

Distractions that can Lead Pharmacistsin the Wrong Direction


G P h A M E M B E R B E N E F I T

Be a MentorAs a Mentor, you will be sharing your knowledge with a pharmacy professional in a similar discipline in your region. Indoing so, you will make an impact on the career path of an individual at the beginning of their career or at a crossroads.

Based upon your responses to the questionnaire that follows, we will match you up with a Mentee that suites you.

Mentor Criteria:

• Your address

• Your years of experience

• Your field of experience

You and the person you are mentoring will be provided resources to helpyou in building your relationship.

To be a mentor got to GPhA and click “Be a Mentor, Find a Mentor” atthe bottom of the Member Benefits Page.

Get a MentorThe “Be a Mentor, Find a Mentor” program is designed to help pharmacyprofessionals learn and grow in their profession, in addition to helpingexecutives at any level increase their skill set by signing up for a Mentor. Asa Mentee, you will be given an opportunity to gain knowledge andexperience from pharmacy professionals that can help guide your career.

Based upon your responses to the questionnaire that follows, we willmatch you up with a Mentor that suits you.

Mentee Criteria:

• Your address

• Your years of experience

• Your current practice area

• Your desired practice area

You and your mentor will be provided resources to help you in buildingyour relationship.

To be a mentor or mentee go to www.gpha.org and click “Be a Mentor,Find a Mentor” at the bottom of the Member Benefits Page.

New GPhA Member Benefit:Be a Mentor, Get a Mentor

Concerned about Taxes

& Financial Planning?

Join in for timely information on Financial Network Associates

Third Thursday

Conference Calls

Dial our complimentary conference line on the Third Thursday of May, Sept, Oct, & Nov.

800-391-1709, PIN 582280

Calls begin at 4:00 and end promptly at 4:30.

Compliments of

Michael T. Tarrant Financial Network Associates

1117 Perimeter Center West, Suite N-307

Atlanta, GA 30338 • 770-350-2455

[email protected] www.fnaplanners.com

An Independent Financial Planner since 1992

Focusing on Pharmacy since 2002

Securities, certain advisory services and insurance products are offered through INVEST Financial Corporation (INVEST),

member FINRA/SIPC, a federally registered Investment Adviser, and affiliated insurance agencies. INVEST is not affiliated with

Financial Network Associates, Inc. Other advisory services may be offered through Financial Network Associates, Inc., a registered

investment adviser.

Individual Pharmacist Members

Thomas E. Lovett, R.Ph., NewnanSally A. Huston, Ph.D., AthensSuzanne Lipe, R.Ph., Atlanta

Charles Perry Kemp, Pharm.D., AcworthKatherine H. Patterson, AlpharettaDeborah C. Hobbs, Pharm.D., DublinWendy Bearden Cook, Pharm.D., DallasAshley Lynn Maples, Pharm.D., LeesburgDeirdre Brooker Fanning, Pharm.D., LilburnYolanda L. Rivers, Pharm.D., Jacksonville, FLBradford Lee Upchurch, Pharm.D., AthensLaurence Broome, Jr., R.Ph., Peachtree City

Joint Pharmacist Members

Yancy Max Witt, Pharm.D., FayettevilleMaurice Bernard Gray, R.Ph., Centerville

New Graduate Pharmacist Members

Jamie Lynn Shockley, Pharm.D., MariettaNatalie Nielsen, Pharm.D., Douglasville

Pharmacist Technician Members

Jason E. Smith, CPhT, Fort Valley

Associate Members

Peter Oloff, Fletcher, NC

GPhA Needs You and YourPharmacy Knowledge

We are looking for a fewgood writers to write CPEarticles for the GPhAJournal. If you are interestedin building your resume andhelping GPhA create thepremier CPE program in thestate of Georgia pleasecontact us at 404-231-5074.


G P h A M E M B E R N E W S

Welcome to GPhA!The following is a list of new members who have joined Georgia’s premier

professional pharmacy association! If you or someone you know would like to joinGPhA go to www.gpha.org and click “Join” under the GPhA logo.


Titanium Level($2400 minimum pledge)Michael E. Farmer, R.Ph.David B. Graves, R.Ph.Robert A. Ledbetter, R.Ph.Jeffrey L. Lurey, R.Ph.Marvin O. McCord, R.Ph.Judson L. Mullican, R.Ph.William A Murray, R.Ph.Mark L. Parris, Pharm.D.Fred F. Sharpe, R.Ph.Jeff Sikes, R.Ph.Dean Stone, R.Ph., CDMT.M. Bridges, R.Ph.

Platinum Level($1200 minimum pledge)Robert Bowles, Jr., R.Ph., CDM, CftsJim R. BracewellLarry L. Braden, R.Ph.Thomas E. Bryan, Jr., R.Ph.James W. Bartling, Pharm.D., ADC, CACIIBarry M. Bilbro, R.Ph.William G. Cagle, R.Ph.Hugh M. Chancy, R.Ph.Keith E. Chapman, R.Ph.Dale M. Coker, R.Ph., FIACPJohn Ashley Dukes, R.Ph.Patrick DunhamJack Dunn, Jr. R.Ph.Stewart Flanagin, R.Ph.Neal Florence, R.Ph.Andy FreemanMartin T. Grizzard, R.Ph.John T. Hansford, R.Ph.Robert M. Hatton, Pharm.D.Alan M. Jones, R.Ph.Ira Katz, R.Ph.Hal M. Kemp, Pharm.D.J. Thomas Lindsey, R.Ph.

Brandall S. Lovvorn, Pharm.D.Eddie M. Madden, R.Ph.Jonathan Marquess, Pharm.D., CDE, CPTPam Marquess, Pharm.D.Kenneth A. McCarthey, R.Ph.Scott Meeks, R.Ph.Drew Miller, R.Ph., CDMLaird Miller, R.Ph.Jay Mosley, R.Ph.Allen Partridge, R.Ph.Houston Lee Rogers, Pharm.D., CDMTime Short, R.Ph.Michael T. TarrantChristoher R. Thurmond, Pharm.D.Floyd MoonDanny Toth, R.Ph.

Gold Level($600 minimum pledge)Larry Batten, R.Ph.Liza G. Chapman, Pharm.D.Patrick M. Cook, Pharm.D.Mahlon Davidson, R.Ph., CDMJames Gordon Elrod, R.Ph.Kevin M. Florence, Pharm.D.Ted M. Hunt, R.Ph.Robert B. Moody, R.Ph.Sherri S. Moody, Pharm.D.Jeffrey Grady Richardson, R.Ph.Andy Rogers, R.Ph.Sharon Mills Sherrer, Pharm.D., CDM

Silver Level($300 minimum pledge)Renee D. Adamson, Pharm.D.John L. Colvard, R.Ph.Terry Dunn, R.Ph.Marshall L. Frost, Pharm.D.James E. Jordan, Pharm.D.John D. Kalvelage

Willie O. Latch, R.Ph.W. Lon Lewis, R.Ph.Michael L. McGee, R.Ph.William J. McLeer, R.Ph.Albert B. Noell, R.Ph.Richard Noell, R.Ph.Sara W. Reece, Pharm.D., BC-ADM, CDEEdward Franklin Reynolds, R.Ph.David J. Simpson, R.Ph.Richard Brian Smith, R.Ph.James N. Thomas, R.Ph.Alex S, Tucker, Pharm.D.Allan Mitchell Voges, R.Ph.Flynn W. Warren, M.S., R.Ph.Oliver C. Whipple, R.Ph.Walter Alan White, R.Ph.William T. Wolfe, R.Ph.

Bronze Level($150 minimum pledge)Monica M. Ali-Warren, R.Ph.Fred W. Barber, R.Ph.John R. Bowen, R.Ph.James R. Brown, R.Ph.Henry H. Cobb, R.Ph.Michael A. Crooks, Pharm.D.William Crowley, R.Ph.Charles Alan Earnest, R.Ph.Randall W. Ellison, R.Ph.Mary Ashley Faulk, Pharm.D.Amanda R. Gaddy, R.Ph.Amy S. Galloway, R.Ph.Johnathan Wyndell Hamrick, Pharm.D.Raymond G. Hickman, R.Ph.Ed KalvelageSteve D. KalvelageMarsha C. Kapiloff, R.Ph.Joshua D. Kinsey, Pharm.D.Brenton Lake, R.Ph.William E. Lee, R.Ph.

Pharm PAC EnrollmentPledge Year 2010-2011

If you made a gift or pledge to Pharm PAC in the last 12 months and your name does not appear above, please, contactAndy Freeman at [email protected] or 404-419-8118. Donations made to Pharm PAC are not considered charitabledonations and are not tax deductible.


Pharm PAC Contributors’ List ContinuedAshley Sherwood LondonCharles Robert Lott, R.Ph.Earl W. Marbut, R.Ph.Randall T. Maret, R.Ph.Max A. Mason, R.Ph.Amanda McCall, Pharm.D.Susan W. McLeer, R.Ph.Mary P. Meredith, R.Ph.Leslie Ernest Ponder, R.Ph.Kalen Beauchamp Porter, Pharm.D.William Lee Prather, R.Ph.Kristy Lanford Pucylowski, Pharm.D.Leonard Franklin Reynolds, R.Ph.Archie R. Thomason, R.Ph.Marion J. Wainright, R.Ph.Jackie WhiteSteve Wilson, Pharm.D.Sharon B. Zerillo, R.Ph.

Members(no minimum pledge)Jill AugustineMark T. Barnes, R.Ph.Walter A. Clark, R.Ph.Carleton C. Crabill, R.Ph.Wendy A. Dorminey, Pharm.D., CDMDavid M. Eldridge, Pharm.D.Charles C. Gass, R.Ph.Christina GonzalezAnn R. Hansford, R.Ph.Joel Andrew Hill, R.Ph.Gina Ryan Johnson, Pharm.D., BCPS, CDECarey B. Jones, R.Ph.Susan M Kane, R.Ph.Carroll Mack Lowrey, R.Ph.Roy W. McClendon, R.Ph.Tom E. Menighan, R.Ph., MBA, ScD, FAPhADarby R. Norman, R.Ph.Christoher Brown Painter, R.Ph.Steve Gordon Perry, R.Ph.Whitney B. Pickett, R.Ph.Donald Joseph Piela, Pharm.D.Rose Ann Pinkstaff, R.Ph.Michael Roland Reagan, R.Ph.James L. Riggs, R.Ph.Victor Serafy, R.Ph.Harry A. Shurley, R.Ph.James E. Stowe, R.Ph.James R. Stirckland, R.Ph.Celia M. Taylor, Pharm.D.

Leonard E. Templeton, R.Ph.Heatwole C. Thomas, R.Ph.Erica Lynn Veasley, R.Ph.William D. Whitaker, R.Ph.Elizabeth Williams, R.Ph.


M E M B E R S I N T H E N E W S

Pharmacists for the FutureReprinted from Georgia Trends August 2011

Increasingly, Georgia pharmacy schools are preparing theirstudents for more patient-oriented jobs in settings outsidetraditional drugstores.The aging baby boomer population

will likely keep them busy.

Neal Florence, R.Ph., estimates about 150 people a day comeby the Medi-Thrift Pharmacy he and wife Carolyn Florence,R.Ph., operate in LaFayette, a fast growing community in theGeorgia suburbs of Chattanooga. Florence says he never knowsif his customers are in the store to discuss prescriptions orpotholes.

“When they come in and say, ‘I need to talk to Neal,’ I don’tknow if they have a city problem or a drug problem or if theyowe me money,” says Florence, who is also the mayor ofLafayette and has been since 1989. Neal and Carolyn areindependent pharmacists, a resilient breed who survived thetime when big-box stores and national chains pressed thedemand for pharmacists during the 1990s by growingexponentially.

“A couple of years ago, Walgreens was opening a new pharmacyEvery 19 hours in the United States,” says Jim Bracewell,executive vice president of the Georgia Pharmacy Association(GPhA), “And every time you open one of those pharmacies,you’re creating a demand for about a half-dozen pharmacistsbecause of the longer hours and the seven-days-aweek service.We’re seeing the [pharmacy] schools increase the size of theirclasses. So now we’re at the junction where the number of newpharmacies has slowed down and the number of new school ofpharmacy graduates has increased.” But at the same time, careerpaths for those graduates have multiplied.

“What we see is a downward trend in our students going to thetraditional community pharmacy or the chain drugstores,” saysDr. Svein Øie, (pronounced Oy-ah), dean of the University ofGeorgia College of Pharmacy.

“We see an increasing trend toward much more clinical, thespecialty that can be in the hospital, in ambulatory care; it canbe in a number of different settings where our graduates arenow working. In contrast to where we were 30 years ago, when

we educated our students [primarily] to be knowledge-basedabout various compounds and drugs, we now are training themto be more patient-oriented.”

At UGA that training can last six years and result in a doctor ofpharmacy degree. “That’s a professional doctorate, not aresearch degree,” Øie says. “But many [students] will have a lotmore than six years [of study]. We encourage our students tolook at advanced education pharmacy.”

Kevin Florence, Pharm.D., son of Neal and Carolyn, fits Øie’sdescription of the trend toward specialty pharmacy by recentUGA graduates. The younger Florence is a 2009 graduate ofUGA’s College of Pharmacy who decided to work neither in hisparents’ community pharmacy nor in a chain drugstore.“WhenI went to college, I said I wanted to do anything but pharmacy,”he says. Now he works for two pharmaceutical companies inthe Athens area, where he assists in compounding drugs orpackaging specialty drugs for use in the treatment of cysticfibrosis, hepatitis and other illnesses and for patients of long-term care facilities and assisted-living homes.

“There is a lot more counseling, monitoring, mixing andmaking than working with insurance companies,” he says.“I’mdoing a lot of different things, and I like that.”

More Variety

More career variety in the pharmaceutical field opened up sixyears ago when UGA’s College of Pharmacy began itsRegulatory Affairs Program in response to pleas from membersof the Georgia Biomedical Partnership (GBP, now GeorgiaBio), an economic development group seeking to land lifescience companies in Georgia. “I was and am a member of thatorganization,” says Dr. David Mullis, UGA College ofPharmacy director of Regulatory Affairs graduate program.“Back in the late ‘90s, it became very clear, as Atlanta andGeorgia tried to establish a life science industry, and as more ofthe [Georgia Bio] members were coming from establishedcompanies in the pharmaceutical industry, medical devices andanimal health [companies] were having a hard time recruitingtalented people in regulatory affairs.”

by Ed LightseyGeorgia Trends

In the past, regulatory affairs Specialists were often recruitedfrom a company’s research and development labs and werelikely to get their training on the job, Mullis says. But navigatingthe regulatory maze of agencies like the Food and DrugAdministration required far greater skills, according to Mullis.So UGA’s Regulatory Affairs Program was established to meet anew need in the state’s workforce for people who could assistcompanies in maintaining regulatory compliance in thedevelopment of new drugs and medical devices.

“It takes 12 to 15 years for a new molecular entity to traverse allthe phases that are involved with new drug development, and itcan be anywhere from $700 million to $1.25 billion to do that,”Mullis says. “The key to that whole thing is having theseregulatory affairs professionals, individuals who come from avery strong science background and different walks of life. Mostof our students are full-time professionals.”

The Regulatory Affairs Professional Program offers bothcertificate and master’s studies and normally takes two years tocomplete; the program is growing in popularity. “There are farmore job openings for regulatory affairs professionals thanthere are people to fill them,” Mullis says. “We have a numberof students who have Ph.D.s in other areas but they want tochange careers. And we are finding companies that will sendemployees to us for further education or training.”

Numbers Growing

In 2000, there were 6,020 registered pharmacists in Georgia,and today there are about 13,000 pharmacy licenses held inGeorgia, according to a report by the U.S. Department ofHealth and Human Services. But there are mixed opinions onwhether the next generation of pharmacists will have thenumbers to meet the rising demand for their services comingfrom the aging baby boomer generation and the accompanyingrise in prescriptions.

“About 3,000 of the Georgia licenses belong to people living inother states and holding dual licenses, so we have roughly10,000 licensed pharmacists living in Georgia,” GPhA’sBracewell says, adding another significant number in thehighest prescription user demographic. “There are 10,000people in America turning 65 every day,” he says.

In the past six years, the number of schools of pharmacy inGeorgia has doubled from two – the public University ofGeorgia and the private Mercer University – to four, but thetwo most recent pharmacy schools to open in the state, oneprivate and one proprietary, have come from outside theUniversity System of Georgia or the traditional in-state privatecollege sphere.

Their administrators say they see a current shortage ofpharmacists in the state with the very real possibility of thatshortage widening as the economy improves. There areindications in surrounding states that more pharmacy schoolshave been added to meet anticipated needs of the future,according to Alan Wolfgang, assistant dean for student affairsat the University of Georgia’s College of Pharmacy.

“Tennessee has opened probably five or six more in the lasthalf-dozen years,” Wolfgang says. “And the University ofFlorida has four campuses now where they teach pharmacy;South Carolina has added two more in the last couple of years.Even if we do have a greater demand in the future, and I thinkwe will, I still think we’re going to be fine because the[pharmacy graduate] capacity has increased somuch.”Wolfgang says there are and will continue to be“pockets” of shortages in the rural areas.

Dr. Mark Okamoto, is founding dean and a professor atGeorgia’s newest school of pharmacy at the private PhiladelphiaCollege of Osteopathic Medicine (PCOM) in Suwanee. Thepharmacy school started last year with 79 students and expects90 this year. PCOM administrators were itching to add apharmacy school to its main Philadelphia campus, but therewas already one at Temple University in the City of BrotherlyLove.

“So they started looking down South at our campus inSuwanee,” says Okamoto. “We started doing the [needs]analysis, and at the time the school was conceived, about 2005or 2006, pharmacy was the No. 2 needed profession, Right afternursing. They talked to the pharmacy organizations in the state,and they all supported the idea; that’s how it came to be.”

In 2003, South College in Savannah, a proprietary or for-profitinstitution, added a School of Pharmacy and became SouthUniversity (SU). According to a pharmacy schooladministrator, the school filled a void.

“[Founder] John South’s business model has been to focus oncareer paths for individuals in basically underserved types ofpopulations, especially where there is a need. And pharmacy,especially over the past 10 years or so, has developed asignificant shortage of pharmacists,” says Curtis Jones, SU’spharmacy school associate dean for Administration andAcademic Affairs. South has an accelerated program, allowingstudents to receive their pharmacy degree, a Pharm.D., in threeyears instead of four, according to Jones. In most cases, thedoctor of pharmacy is earned with two to four years of studyfollowing the baccalaureate degree award. “The program is fullyaccredited by SACS, the Southern Association of Colleges andSchools,” Jones says. “And our school is accredited by the



Accreditation Council for Pharmacy Education, ACPE.”The Changes

UGA’s Wolfgang has perhaps had the best vantage point toobserve the changes in Georgia’s pharmacy schools over thepast 30 years or so, first as a pharmacy student in the late 1970sand now as the assistant dean of student affairs at UGA’sCollege of Pharmacy. He’s seen the most dramatic change inthe composition of pharmacy students in what could be calledthe pharmacy gender switch. “We have more females inpharmacy than ever before, though that has kind of leveledout,” says Wolfgang. “We’ve been around 65 percent [femalepharmacy student population] for about the last 10 years,whereas 30 years ago it was about a 65 to 75 percent malepopulation.”

The reason for the growth in the number of female pharmacystudents has more to do with the marketplace demand and jobflexibility than the evolution of social mores, Wolfgang says. “Itis one profession in Georgia that is so easy to move in and outof,” he says. “The salaries are so much higher, so if you want tostart a family and focus on that, you can leave the profession orhave your hours reduced and Then come back full time whenyou’re ready. There are always plenty of jobs available.”

Meanwhile, the curriculum and training has slowly changed inthe 32 years since Wolfgang finished his studies.

“The biggest change in the coursework to me is that when wewere in school we were taught to fill prescriptions correctly, andthat is about as far as it went,”he recalls. “We really didn’t talkabout how you interacted with other health professionals; wedidn’t talk a whole lot about helping people manage their healthlike pharmacists do now. Now pharmacists give immunizations,and we would never have dreamed of a pharmacist doing thatwhen I was in school.”

Present shortages or surpluses of pharmacists aside, there seemsto be a consensus that the future will hold a demand for theprofession’s dispensers of drugs. “The number of opportunitiesis increasing for graduates,” says PCOM’sOkamoto.“Predominately, the economy is going to have amajor impact on that. Jobs in the urban areas are really thinningout, but there are still jobs in the more rural sites. We’re goingto be sending our students down to those rural sites so they canlearn more about rural practice and decide if that is somethingthey want to invest in.”

More pharmacists-in-training will get an opportunity to take alook at life in rural Georgia when UGA students begin arrivingin Albany in 2012 for their clinical training. The community’sPhoebe Putney Memorial Hospital has expanded its clinicalteaching environment to include UGA’s College of PharmacySouthwest Georgia Pharmacy Program. The announcement of

the new clinical training facility was seen as a milestonereflecting a dramatic shift in the duties of the pharmacist,notably those of the hospital pharmacist who often toiled inanonymity in the lower regions of the hospital.“We’ve been ableto experience the migration of the pharmacist from thebasement to the bedside,” says Dr. Doug Patten, senior vicepresident of medical affairs at Phoebe Putney.

Dr. Ted Matthews, dean of the College of Pharmacy andHealth Sciences at Mercer University, sees the modernpharmacist as requiring more training in bedside manner thanever before. “Our entire curriculum is now being modified to betotally patient-focused,” Matthews says. “Social skills haveentered the curriculum. I think that is one of the major Changesover the last 10 years that has occurred in pharmacy education.”

Another change in the marketplace being reflected in theclassroom is the arrival of specialty drugs, Matthews says. “Ithink we’re going to see more specialties in drugs, drugs used ingene therapy, for instance, and very potent drugs used in cancertreatment,” he says.“I think that will require more specializationin managing those patients, and we have genomics, drugsspecialized for a specific patient.

“But it is not enough to just have a knowledge base about drugsand therapy,” he says. “What you also have to have is all thecommunications skills in order to effectively counsel the patientabout the medication, because one of the biggest problems isnot the medication, it is the compliance with the medication.Allof this is changing what is going on in the classroom.”

M E M B E R N E W S

Laird Miller, R.Ph., and Butch Bowling, R.Ph.,have been partners in Medical Park Pharmacy ofGainesville for nearly 30 years. Their wives, Amy

Miller, R.Ph., and Karen Bowling, R.Ph., fillprescriptions at the Lula Pharmacy.

As former chairman of the Georgia PharmacyAssociation’s Academy of Independent Pharmacy, Lairdagrees in the importance of keeping independentpharmacies independent. “I always said that when Istepped down as chair, I’d buy another pharmacy," hesays.

He did, but only after Amy and Karen beat him to it.About four years ago, the Lula store’s owner decided tosell her business. Amy thought it would be a smartpurchase, but they needed help determining its true value.So the Millers contacted Jeff Sanford, the Georgia SBDCNetwork’s director of Entrepreneurial Studies.

“Jeff often comes to our association meetings to offer helpfrom the SBDC,” says Laird. “He and his students conductvaluation research to determine whether it makes goodbusiness sense to purchase a store. Amy was buying fromher employer and her friend. We needed an objective thirdparty to come in and tell us what this store was worth.”

Sanford created a validation tool he uses specifically forpharmacies. He and two pharmacy students from theUniversity of Georgia spend two weeks analyzing themarket, financial and other performance data for the store.

“The standard pharmacy valuation models use industry‘rules of thumb’ to determine fair market value,” saysSanford. “It assumes that all pharmacies work on a levelplaying field with no consideration of market growth ordecline, the diversity of products and services offered, orthe pharmacy’s management, financial trends, and thecondition of its equipment and inventory. Using mymodel, the students and I conducted a more thorough duediligence, incorporating all considerations, so the Millerscould make a more objective decision.”

“The valuation was really important to us,” says Laird. “Itconfirmed that the numbers the Lula owner showed uswere not pulled out of thin air.” Amy and Karen purchasedthe Lula Pharmacy.

Laird, Butch and a third partner quickly followed, recentlyclosing on the purchase of the Jennings Pharmacy inDemorest, but only after Sanford and his studentsconducted a valuation of that store.

“I hope we haven’t bought our last pharmacy. Ideally, we’dlike to find stores ready to transition, bring in juniorpartners and eventually allow the junior partner to buy usout,” says Laird. “If we buy any more stores, Jeff and hisgroup will be involved in the process.”

“We’ve developed a ‘keeping independent’ program tohelp young pharmacists understand that ownership is theway to improve their financial future, and it’s great whenJeff visits our meetings,” Laird says. “His enthusiasm iscontagious as he gives an upbeat message about theadvantages of owning and operating your own business.People leave his sessions feeling like the little engine thatcould.”

“Laird Miller is an outstanding advocate for keepingindependent pharmacies independent in Georgia,” saysSanford. “His and Amy’s dedication to their patients andto the profession have resulted in a successful, growingenterprise.”

Valuation Research the Right Prescription forEntrepreneurial Pharmacists


By Jennifer GiarratanoReprinted from GEORGIA TREND’s Small Business Guide


M E M B E R N E W S

James Bruckner, R.Ph., University of Georgia College ofPharmacy professor, was appointed a member of the FoodQuality Protection Act (FRACP) Scientific Advisory Board ofthe US EPA.

Three students at the University of Georgia College ofPharmacy, along with their faculty mentors, were named 2011Walmart Scholars at the national meeting of the AmericanAssociation of Colleges of Pharmacy (AACP) in July. A total of75 student/mentor teams were chosen nationwide.

The College of Pharmacy teams were Tara Fogleman, R.Ph.,and clinical professor Henry Cobb, III, CDM, R.Ph.; BryanWhite, R.Ph., and clinical associate professor Keith Herist,Pharm.D., AAHIVE, CPA; and Allison Young, Pharm.D.and associate dean George Francisco, R.Ph.

The Walmart Scholarships, which began in 2005, aim tostrengthen the recipients’ skills and commitment to careers inacademic pharmacy through their participation at the AACPAnnual Meeting and Seminars. Each student-mentor pairreceived $1,000 to help cover registration and travel expensesfor the AACP Annual Meeting and Seminars in San Antonio,Texas.

Kyle Burcher, University of Georgia College of PharmacyThird-year Student, received the June Walmart/PHARMACY

TIMES RESPy (Respect, Excellence, and Service in Pharmacy)award for demonstrating excellence in patient care; eightRESPy award winners are chosen each year and featured inPHARMACY TIMES along with their respective college ofpharmacy. RESPy winners receive a cash award and are offereda summer internship with Walmart.

Beth Phillips, R.Ph., BCPS,University of Georgia College ofPharmacy clinical associate professor, published journal article:Haines SL, DeHart RM, Flynn AA, Hess KM, Marciniak MW,Mount JK, Phillips BB, Saseen JJ, Zatzkin SW. Academicpharmacy and patient-centered healthcare: A model to preparethe next generation of pharmacists. J Am Pharm Assoc2011;51:194–202.

She also Presented “Residency Learning System Workshop:PGY1 and PGY2 New and Existing Programs.” AmericanSociety of Health System Pharmacists Summer Meeting.

Workshop Presenter and Facilitator. Denver, CO. June 11,2011.

Trina von Waldner, University of Georgia public serviceassociate and director of postgraduate continuing education,served as faculty advisor and preceptor for 13 rising third-yearpharmacy students from June 12 to 24 at the Farm WorkerFamily Health Program in Moultrie, with Dee Dee McEwen,Pharm.D., Public Service Assistant.

Matthew Perri, University Georgia College of Pharmacyprofessor, published a book, with Keith Herist, clinical associateprofessor, and Brent Rollins, former grad student, entitledFinancial Analysis in Pharmacy Practice.

Whitney Unterwagner, Pharm.D., University of GeorgiaCollege of Pharmacy public service associate, presented“Building Community Partnerships through IPPE ServiceLearning” at the American Association of Colleges of Pharmacy(AACP) Annual Meeting in San Antonio, Texas.

Lindsey Welch, Pharm.D., University of Georgia College ofPharmacy public service assistant, presented two posters at theAmerican Association of Colleges of Pharmacy (AACP) annualmeeting in San Antonio: “A Two-Campus Model for Providingan Influenza Immunization Introductory Pharmacy PracticeExperience (IPPE)” with Dianne Williams May, Pharm.D.,Dee Dee McEwen, Lori Duke, and Whitney Unterwagner and“Providing Sustainable Immunization Introductory PharmacyPractice Experiences (IPPEs) through Entrepreneurship andCommunity Partners” with Dee Dee McEwen, Lori Duke,Whitney Unterwagner, and Charles McDuffie, Pharm.D..

Lindsey Welch, Pharm.D., University of Georgia College ofPharmacy Public Service Assistant, accepted to the 2011-12UGA Writing Fellows Program which works with the UGAWriting Initiative Program to foster greater attention to andpractice of writing on campus.

GPhA Members in the NewsIf you have news that you would like to share with your pharmacy colleagues please email [email protected] andtell us all about it. We will add you to the member news section of the GPhA Journal


S T A F F N E W S

Jim Bracewell has beenelected to the Alliance forPatient Medication Safety

(APMS) Board of Directorseffective July 2011.

His term will end in March 2013.

APMS was established by theNational Alliance of State

Pharmacy Associations (NASPA) and is listed as a PatientSafety Organization with the Agency for Health Researchand Quality (AHRQ). The mission of APMS is to foster a

culture of quality within the profession of pharmacy thatpromotes a continuous systems analysis to develop bestpractices that will reduce medication errors, improvemedication use and enhance patient care.

Learn more about programs offered by APMS, visitwww.medicationsafety.org.

GPhA EVP Jim Bracewell Named to Alliance forPatient Medication Safety Board of Directors


Please save the date for our 137th AnnualConvention!Georgia Pharmacy Association137th Annual ConventionHilton Head Marriott Resort & SpaHilton Head Island, SCJuly 7-11, 2012

ARE YOU COMING?

LEARN TO IMPROVE YOUR BUSINE$$

1. 3 hour CE course on Pharmacy Law for Certified Technicians and Registered Technicians (pharmacists may also attend for CE credit) 2. Multiple programs on business management A. How to evaluate your Pharmacy B. How to generate additional revenue outside the prescription department C. Financial planning and retirement plans 3. Afternoon business meeting (includes an update from the PBM Task Force and the GPhA Governmental Affairs team) BRING YOUR STAFF AND NETWORK WITH YOUR COLLEAGUES

1. Come meet and network with fellow independent pharmacists 2. Bring your staff to network with other technicians and get CE 3. Join us for a continental breakfast and lunch 4. Visit with our AIP partners during breaks and lunch

SHOW YOUR SUPPORT ATTEND THIS

AIP Fall Meeting Sunday, October 23, 2011

Macon Marriott & Centreplex Macon, GA


As the owner of a community pharmacy you make important decisions daily regarding the health of your patients and your business, the well being of your staff and a host of issues that come from your involvement in the community. There comes a time when you are faced with another important decision – how and when to sell the business you have nurtured and grown. This program is designed to help you with that process:

Financial planning and preparation for retirement Normalizing Your Books Sellers Checklist – The details of sale Contracts and the legalities Accounting Guidelines for Sale The Bankers perspective - Valuation Should I do this myself or rely on a broker – Tools for Decision Ask the Experts Panel

All registrants receive a copy of “Selling A Pharmacy: A How To Guide” ($90 value!) The first 50 registrants will receive a 25% discount on a listing on the NCPA site, www.pharmacymatching.com, linking independent pharmacy owners preparing to sell, existing owners looking to buy additional stores, and entrepreneurs searching for the right opportunity to become a pharmacy owner. Registration fee: NCPA members: $225 Non-Members: $325

Register today at http://www.ncpanet.org/index.php/events/2011-convention For more information, contact the NCPA Convention Department at 1.800.544.7447

Selling a Pharmacy: The Community Pharmacist’s Roadmap toSuccessful Transition

Saturda , October 8, 1 6:30 .m. Se arate re istration fee

As the owner of a community pharmacy you make important decisions daily regarding the health of your patients and your business, the well being of your staff and a host of issues that come from your involvement in the community. There comes a time when you are faced with another important decision – how and when to sell the business you have nurtured and grown. This program is designed to help you with that process:

Financial planning and preparation for retirement Normalizing Your Books Sellers Checklist – The details of sale Contracts and the legalities Accounting Guidelines for Sale The Bankers perspective - Valuation Should I do this myself or rely on a broker – Tools for Decision Ask the Experts Panel

All registrants receive a copy of “Selling A Pharmacy: A How To Guide” ($90 value!) The first 50 registrants will receive a 25% discount on a listing on the NCPA site, www.pharmacymatching.com, linking independent pharmacy owners preparing to sell, existing owners looking to buy additional stores, and entrepreneurs searching for the right opportunity to become a pharmacy owner. Registration fee: NCPA members: $225 Non-Members: $325

Register today at http://www.ncpanet.org/index.php/events/2011-convention For more information, contact the NCPA Convention Department at 1.800.544.7447

Selling a Pharmacy: The Community Pharmacist’s Roadmap toSuccessful Transition

Saturda , October 8, 1 6:30 .m. Se arate re istration fee

Get Ready to Meet. Learn. Succeed. Registration is Now Open!Meeting friends, learning from experts, and succeeding back home with new ideas and knowledge.These are the top reasons pharmacists tell us why they attend NCPA's Annual Convention and TradeExposition. Join us October 8-12 this year in Nashville and we're sure you'll agree.

Welcome to NashvilleIn the heart of Nashville, the Gaylord Opryland Resort and Convention Center is located on the banksof the Cumberland River. Centrally located and close to everything, this resort won the 2010 Toast ofMusic City, The Tennessean award, and many more. You'll find everything you need inside theOpryland complex and nearby. Featured attractions right outside the complex include the Grand OleOpry (celebrating 86 years October 7-8) and the General Jackson Showboat cruise. Twelve miles fromGaylord Opryland, the Country Music Hall of Fame and Museum offers a visceral experience.Preserving the evolving history and traditions of country music and to educating its audiences, thisinternational arts organization serves fans, students, scholars, and the music industry. The collection ismanaged from this location, as it travels the 8,000 museums nationwide. Elvis, Hank Williams, andGene Autry are among the many inductees. A must see!

Sneak Peek at Educational Programming•The PBM Landscape: A Critical Update •In-Depth PBM Briefing: Generics First and MAC Prices and Reimbursement •340B Opportunity Knocks—Should You Answer? •Opportunities in Diabetes: The Pharmacist's Guide to Insulin Pumps and Training Your Patients•Opportunities in Long-Term Care •A Critical Guide to Audit Survival for the Community Pharmacy •Closing the Image Gap: Merchandising With a Critical Difference •Mastering Your Message: Crystal Communication of Your Pharmacy's Value •A Lesson in 5-Star Leadership: 7 Principles to Fully Engage Your Pharmacy Staff


Pharmacy Marketing Group, Inc. Presents:

Rx and the Law: Where Have you Gone, Perry?

Do you remember Perry Mason? How aboutMatlock? OK then, Denny Crane? Depending onyour age, you should be familiar with at least one

of these famous TV attorneys and their courtroomperformances. This makes for entertaining TV, but in reallife, the story is a little bit different. In most jurisdictions,the number of civil cases filed has been steady orincreasing, but the number of trials has been decreasing.Why is this so?

The first reason is the discovery process. Discovery is thephase of the litigation process where the opponents shareor exchange information and evidence. This includesdocuments, oral testimony (depositions), and writtenquestions & answers (interrogatories). This exchange ismandated by the court rules. When discovery is complete,both parties should have all of the information that theyneed to evaluate the case and evaluate their chances ofprevailing at trial. This typically makes at least one partyreluctant to take the case to trial because they know whattheir chances are. No more surprise piece of evidence orlast minute, surprise witness. These Perry Mason staplesare virtually unheard of today. There are still somesurprises at trial, but they tend to be smaller issues ratherthan earth-shattering ones.

The second reason is alternative dispute resolution(ADR). This ADR is different from the acronym thatpharmacists are familiar with. ADR in the legal sense is aprocess of resolving cases without a trial. The mostcommon forms are arbitration and mediation. Inarbitration, the issues are presented to a neutral arbitratorwho issues a ruling on the case. The process is greatlystreamlined from that of a trial. For instance, in mostcases, arbitration will not have live witness testimony. It isquicker and less expensive than a trial. The ruling can bebinding or non-binding. In the non-binding situation, theparties can evaluate the ruling and compare it to their ownpredictions, but are not forced to accept it. Bindingarbitration is considered a final ruling.

Mediation has no third party decision maker. A neutralmediator works to get both sides to agree to a mutuallyacceptable settlement of the case. The mediator does thatby moving between the parties, sharing information wherenecessary, and listening to the strengths and weaknesses ofeach side. If no agreement is reached, the parties move onin the litigation process. Nothing that is said or offered at amediation is admissible at trial, so parties are motivated tobe as open and honest as possible with the mediator. Inmany jurisdictions, at least one round of ADR is requiredbefore any case can go to trial. It is not uncommon for ajudge to order the parties to a second, or even a third,mediation.

In today’s legal environment, the possibility, ordesirability, of trial is quite different from TV lawyers.They try a case almost every week. Non-TV lawyers mighthave as few as two or three civil trials per year. Somecommentators have actually expressed concern that wedon’t have enough trials. Case law is built on appellatedecisions and with fewer trials, there are fewer appeals.But with all of our cards on the table and court rules thatfavor ADR, we shouldn’t be surprised that there are moresettlements and fewer trials. Maybe that is a good thingbecause it puts the parties in control of the ultimateresolution of their case and reduces the emotional toll onthe parties. It won’t be as entertaining to watch Matlocktake more depositions.

© Don McGuire, R.Ph., J.D., is a Professional Liability ClaimsAttorney at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and riskmanagement. It is not intended as legal advice. Pharmacistsshould consult their own attorneys and insurance companiesfor specific advice. Pharmacists should be familiar with thepolicies and procedures of their employers and insurancecompanies, and act accordingly.

Kenneth R. Baker, B.S., Pharm, J.D.

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


G P h A M E M B E R N E W S

Thousands of independent pharmacy owners joinedMcKesson, the nation’s largest healthcare servicescompany, to share in the success of independent

pharmacy at the McKesson ideaShare Conference whichtook place in San Francisco on June 29-July 2, 2011. Atthe annual business gathering, retail independentpharmacy owners learned about new pharmacy solutionsand technology from McKesson and its partners, as well asshared best practices with peers to strengthen their abilityto compete and grow in today’s market.

As part of ideaShare, McKesson hosted a Public PolicyForum to help attendees learn about the deep forceschanging healthcare in the U.S. and the opportunity forpharmacy. The forum was hosted by Ann Berkey,McKesson’s Senior Vice President of Public Affairs, whoprovided an update on key federal and state policy issuesimpacting pharmacy, and also included a keynotepresentation by Joe Flower, world-renowned healthcarefuturist and author.

Berkey also moderated a panel discussion with thefollowing policy experts and pharmacy owners who sharedinsights and best practices on how policy is shapingcommunity pharmacy, and how to thrive in the evolvinglandscape:

• Health Mart Pharmacist, Pam Marquess, Pharm.D.,East Marietta Drugs, GA

• Health Mart Pharmacist Amber Woehl, Cith PharmacyHealth Mart, KS

• Mark Kinney, VP, Government Affairs, IPC

“Pam Marquess shared practical ideas and solutions withher pharmacy peers that can be implemented to help theirbusinesses thrive now and into the future,” said AnnBerkey, senior vice president, McKesson Public Affairs.“Every year we continue to generate rich dialogue withour pharmacy customers to explore how their businessescan continuously take on the challenges in healthcare.”

GA Health Mart pharmacist, Pam Marquess sharedspecific examples of how she has engaged with local, state

and federal legislators to navigate positive change forindependent pharmacy, including:

• Participating and supporting state events that introducelegislators to the value of independent pharmacy. Pam wasvery involved with “Georgia VIP (Very ImportantPharmacists)”, an event that connected pharmacists fromacross the state with state and federal legislators.

• Advocating and promoting clinical services likeMedication Therapy Management (MTM), as anadditional source of revenue for independent pharmacy.Pam helped distribute flyers to all the communitypharmacies in her area educating them on the importanceof MTM to a community pharmacy business.

• Staying current with the policy landscape in other statesand how it affects pharmacy, and learning from it andidentifying pitfalls to avoid as it applies to Georgia.

Pam’s husband and co-owner/pharmacist of fourindependent pharmacies, Jonathan Marquess, participatedon the Public Policy Forum in 2010.

Pamala Marquess, Pharm.D., Participates in PublicPolicy Forum at McKesson ideaShare 2011

7

Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio andJ. Richard Wuest, R.Ph., PharmD, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio

continuing educat ion for pharmacists

Mult iple Sclerosis : Emerging Oral TherapyVolume XXIX, No. 6

Dr. Thomas A. Gossel and Dr. J. Richard -

ships to disclose.

Goal. The goal of this lesson is to describe emerging oral therapy for treatment of multiple sclerosis.

Objectives. At the conclusion of this lesson, successful participants should be able to:

1. identify factors known to reduce adherence with parenter-ally administered drugs in mul-tiple sclerosis, and the factors that enhance adherence;

2. recognize the pharmacologic

therapy discussed in this lesson;3. demonstrate an understand-

ing of the mechanism of action, major adverse events and thera-peutic applications associated with the drugs; and

4. exhibit knowledge of infor-mation relative to multiple sclero-sis pharmacotherapy to convey to patients.

Multiple sclerosis (MS) is a chronic, potentially debilitating immune-mediated disease of the central nervous system (CNS) that affects about 400,000 people in the United States, with another 200-plus new cases diagnosed each week. It is not an homogeneous disease entity and, therefore, as new pharmaco-therapies emerge, it will require individual therapy regimens. As a chronic and so far incurable dis-

ease, therapy is required for an

of time.The current concept of MS

treatment entails use of drugs that

These therapies alter the course of this pathology and reduce the grade of disability. There are no

individual course of disease in its early stages, and the individual grade of disability in the future cannot be anticipated with certain-ly. Consequently, ideal treatment

cure), minimal adverse effects (ideal: none), maximal patient adherence (ideal: 100 percent), and easy dosing regimens.

Current disease modifying therapy (DMT) [Table 1] for the chronic treatment of relapsing-remitting multiple sclerosis (RRMS), such as interferon-beta

-ramer (Copaxone), mitoxantrone (Novantrone, and others) and na-

or glatiramer acetate have become

for modifying the course of RRMS, with mitoxantrone or natalizumab

to provide suitable relief or when adverse events prevail. In random-ized controlled Phase III trials, all of these parenterally-administered agents demonstrate superiority to placebo regarding clinical end points. Recently published compar-ative trials failed to provide evi-dence for superiority of one or the

are opportunities for additional improvements by further reduc-ing relapse rates, slowing disease progression and providing more convenient treatments that do not rely on administration by injection.

in September 2010 for treating RRMS.

Clinical Benefit with Disease-Modifying Therapy

to most patients with MS. At the same time, certain patients re-

suggests there may be genetically-based differences in drug response (pharmacogenomics) and perhaps also, based on recent pathologic studies in MS, immunopathologic disease subtypes that may require different therapeutic approaches. Approval of new drugs that have different physicochemical proper-

The Georgia Pharmacy Journal August 201124 8

Table 1Approved disease-modifying therapy for treatment

of multiple sclerosis

First-line Trade names Dosage form Recommended dose

Second-line Mitoxantrone Novantrone, IV injection 12 mg/m2 given as a short

months Natalizumab Tysabri IV injection 300 mg infused over 1 hour

every 4 weeksSC, subcutaneous; IM, intramuscular; IV, intravenous

ties and different mechanisms of action compared to currently available DMTs may offer a means to achieve treatment goals in a broader spectrum of patients.

Shortcomings of Parenteral DMT

currently approved DMTs must be delivered parenterally. Paren-teral administration necessitates frequent injections, which may be uncomfortable and/or inconvenient for patients. Although self-adminis-tration is an option with the inter-ferons and glatiramer, giving the patient greater freedom, this can also be a constant reminder of their chronic disease. Regular hospital or clinic visits are needed for intrave-nous infusions of natalizumab or mitoxantrone for relapsing forms of MS that continue to worsen.

-eral population suffers from injec-tion anxiety (needle phobia). This anxiety may prevent those with MS

-er factors (Table 2), such as mis-understanding concerning risks of self-injection or a lack of knowledge about how best to manage injection pain and side effects, can contrib-ute to inability to self-administer injections. Many patients view injections as a bothersome burden, rather than a means to manage

their disease.Patient acceptance of treat-

ment may be negatively affected by injection-site reactions. These local reactions such as edema, red-ness and pain may be initiated by subcutaneous administration and to less extent, with intramuscu-lar injection. They are a common reason for switching from subcu-

therapy. Usually mild, injection-site reactions are reported to occur in up to 80 percent of patients

discomfort during and after injec-tions contributes to treatment dis-satisfaction and is a known factor

percent of patients who switch or

of injection-site reactions. Although uncommon, injection-site necrosis has also been reported.

The Importance of Adher-ence. Poor adherence with DMT regimens correlates with poor

of drugs used to treat MS requires close adherence to DMT protocols. Poor adherence to treatment regi-mens is associated with increased patient morbidity, poorer quality of

on healthcare programs and insti-tutions.

MS is a chronic disease that requires treatment lasting over many years, often a lifetime. This

places a burden on patients to adhere closely to their therapy in-

months of treatment. A long-term, follow-up study over 4.2 years found that discontinuation rates were as high as 46 percent. Twen-ty-eight percent of these patients suspended therapy because of a

Studies in patients with MS support the contention that the same principles underlying adher-ence to treatment in other chronic disease states such as hypertension and diabetes mellitus also apply to MS. Potential barriers to therapeu-tic adherence with DMTs include denial of illness especially early in its course, interference in lifestyle by treatment requirements, ad-verse effects of treatment, cost of

-ties with self-injection techniques, cognitive impairment, unrealistic expectations for the drugs, depres-

-through relapse in MS following a long period without visible symp-toms may convince the patient that the therapy is ineffective, which can lead to a perception that the costly medicine is not effective, and lead to missed doses or other actions that amount to poor adher-ence.

It has also been reported that many patients have unrealistic

lead to poor adherence. An inter-view with 99 MS patients who

-alistically optimistic expectations regarding reduction in relapse

outcomes of therapy lowered that percentage to 33 percent. Among patients who discontinued therapy, 64 percent had overly optimistic expectations. In contrast, only 28 percent of the patients who were compliant with therapy expressed overly optimistic expectations.


Table 1Approved disease-modifying therapy for treatment

of multiple sclerosis

First-line Trade names Dosage form Recommended dose

Second-line Mitoxantrone Novantrone, IV injection 12 mg/m2 given as a short

months Natalizumab Tysabri IV injection 300 mg infused over 1 hour

every 4 weeksSC, subcutaneous; IM, intramuscular; IV, intravenous

ties and different mechanisms of action compared to currently available DMTs may offer a means to achieve treatment goals in a broader spectrum of patients.

Shortcomings of Parenteral DMT

currently approved DMTs must be delivered parenterally. Paren-teral administration necessitates frequent injections, which may be uncomfortable and/or inconvenient for patients. Although self-adminis-tration is an option with the inter-ferons and glatiramer, giving the patient greater freedom, this can also be a constant reminder of their chronic disease. Regular hospital or clinic visits are needed for intrave-nous infusions of natalizumab or mitoxantrone for relapsing forms of MS that continue to worsen.

-eral population suffers from injec-tion anxiety (needle phobia). This anxiety may prevent those with MS

-er factors (Table 2), such as mis-understanding concerning risks of self-injection or a lack of knowledge about how best to manage injection pain and side effects, can contrib-ute to inability to self-administer injections. Many patients view injections as a bothersome burden, rather than a means to manage

their disease.Patient acceptance of treat-

ment may be negatively affected by injection-site reactions. These local reactions such as edema, red-ness and pain may be initiated by subcutaneous administration and to less extent, with intramuscu-lar injection. They are a common reason for switching from subcu-

therapy. Usually mild, injection-site reactions are reported to occur in up to 80 percent of patients

discomfort during and after injec-tions contributes to treatment dis-satisfaction and is a known factor

percent of patients who switch or

of injection-site reactions. Although uncommon, injection-site necrosis has also been reported.

The Importance of Adher-ence. Poor adherence with DMT regimens correlates with poor

of drugs used to treat MS requires close adherence to DMT protocols. Poor adherence to treatment regi-mens is associated with increased patient morbidity, poorer quality of

on healthcare programs and insti-tutions.

MS is a chronic disease that requires treatment lasting over many years, often a lifetime. This

places a burden on patients to adhere closely to their therapy in-

months of treatment. A long-term, follow-up study over 4.2 years found that discontinuation rates were as high as 46 percent. Twen-ty-eight percent of these patients suspended therapy because of a

Studies in patients with MS support the contention that the same principles underlying adher-ence to treatment in other chronic disease states such as hypertension and diabetes mellitus also apply to MS. Potential barriers to therapeu-tic adherence with DMTs include denial of illness especially early in its course, interference in lifestyle by treatment requirements, ad-verse effects of treatment, cost of

-ties with self-injection techniques, cognitive impairment, unrealistic expectations for the drugs, depres-

-through relapse in MS following a long period without visible symp-toms may convince the patient that the therapy is ineffective, which can lead to a perception that the costly medicine is not effective, and lead to missed doses or other actions that amount to poor adher-ence.

It has also been reported that many patients have unrealistic

lead to poor adherence. An inter-view with 99 MS patients who

-alistically optimistic expectations regarding reduction in relapse

outcomes of therapy lowered that percentage to 33 percent. Among patients who discontinued therapy, 64 percent had overly optimistic expectations. In contrast, only 28 percent of the patients who were compliant with therapy expressed overly optimistic expectations.


Achieving Optimal Adher-ence. Helping patients achieve optimal adherence to their medi-cal treatment protocol is an area where pharmacists can play a

that patients who have positive feelings toward prescribed therapy adhere more closely to their regi-men than those who have more negative feelings. Adherence,

-sion process on the part of patients,

-tively with pharmacist counseling. Advising against skipping doses or discontinuing therapy is certainly within the realm of counseling in-formation to convey to patients. To counter non-adherence, the patient must understand the purpose of the therapy and have reasonable

-stand the potential adverse effects and perceive value in taking the therapy correctly to control or pre-vent disease manifestations that outweigh inconvenience or negative effects.

It is anticipated that the development of drugs with easier means for administration, such as oral agents, would further promote strong patient adherence. There are examples of disease requiring long-term therapy where a move towards non-injected agents has been a valuable and important addition to the treatment regimen. The availability of effective oral DMTs does not eradicate non-ad-herence, but represents improved

in treatment of patients with re-lapsing forms of MS compared with parenterally-administered drugs.

The Floodgate for Oral Therapies Has Opened Fingolimod.

treating relapsing forms of MS is welcome news for patients. For-merly known as FTY720, the drug is a synthetic structural analog of sphingosine 1-phosphate (S1P), which is an endogenous lysophos-pholipid, a potent signaling lipid that targets sphingosine 1-phos-

phate receptors. S1P interacts with -

tors (S1P ) distributed throughout the body. S1P1-3 are found through-out the immune, cardiovascular and central nervous systems. Their activation on smooth muscle and endothelial cells regulates vascu-lar homeostasis and permeability. Activation of S1P1 receptors on atrial muscle regulates heart rate. S1P4to the hematopoietic and lymphoid tissues, and S1P is expressed in the white matter of the CNS.

Fingolimod undergoes rapid phosphorylation in vivo within the CNS by sphingosine kinase into

-cally active compound. Fingolimod-phosphate is a nonselective S1P agonist that binds with four of the

1, S1P3, S1P4 and S1P ) to modify their signaling pathways. The drug readily crosses the blood-brain-barrier to interact with S1P receptors that are widely expressed

S1P1 receptors that are highly

is responsible for regulating their egress from lymphoid tissue. This egress is essential for normal im-

1 down-regulates the receptor with subsequent sequestration (isola-tion) of lymphocytes in the lymph tissue, to prevent their recircula-tion, and reduce peripheral lym-phocyte counts. Fingolimod is not believed to destroy lymphocytes; therefore, many immune functions including activation, proliferation

lymphocytes remain undisturbed during treatment. However, im-mune function that relies on naïve T cells and central memory cells, such as activity that is necessary to combat viral infections, may be re-

that aggressive lymphocyte pen-etration into the CNS contributes

-eration via demyelination found in

be due to its ability to sequester lymphocytes within the lymphoid

Table 2Non-adherence to

treatment: contributory factors, strategies adopted in MS therapy to address adherence, and currently

unmet needs for improvement

Factors that have a negative effect on adherence to treatment for chronic disease

treatment

Approaches that have been applied to improve treatment adherence in MS

(e.g., acetaminophen, ibuprofen) that

with DMTs

injection easier

not require refrigeration and recon-stitution

-tions to improve understanding of rationale, expectations and potential adverse effects, including nurse train-ing programs to optimize injection techniques at treatment initiation

regular basis to encourage use as directed

Unmet needs for improving treatment adherence in MS*

*Unmet needs were decreased with the

MS, Multiple sclerosis; DMT, disease-modifying therapy

Int J Clin Pract. 2007;61:1922-1930.


tissues. Moreover, S1P1 receptors expressed in the CNS are known to modulate neurogenesis (production of neurons) and neural function. Fingolimod may, therefore, be able to facilitate restoration of nerve cell function and supplement endog-enous CNS repair.

The most common adverse events reported in 10 to 20 per-

in pre-marketing trials included fatigue, melanocytic nevus (moles),

respiratory tract or lung infection, back pain, diarrhea, cough and ab-

occurring in more than 20 percent

nasopharyngitis and headache. Serious adverse events occurred in 7 to 11 percent of patients and included MS relapse, basal cell carcinoma and transient sinus bradycardia.

observed during these trials are no-table. Macular edema was reported in a small percentage of patients. Six of seven cases resolved within six months upon drug discontinu-ation. Skin cancer was reported in Phase II testing. In two trials,

were found to have skin cancer, all

abnormalities included decreased lymphocyte count, mild decrease in mean forced expiratory volume in

1), and a reversible increase of alanine transferase to greater than three times the upper limit of normal.

The product’s manufacturer lists four drugs or drug classes that should be used cautiously, if at

class Ia (e.g., quinidine) or Class III (e.g., amiodarone) antiarrhythmics, beta-adrenergic blockers, ketocon-azole and vaccines.

Emerging Options for Oral Therapy in MS The new generation of MS thera-pies will continue to expand. Intensive research into the com-plex interplay of biochemical and physiological processes involved

in the pathophysiologic cascade of -

ety of potentially new targets for oral therapeutic strategies. Data

agents are impressive, and reveal they have the potential to eventu-ally replace injectable DMT op-tions. Any new treatment regimen, however, brings concerns relating to safety and cost. In addition as noted above, patients with MS have poor treatment adherence to the currently available parenteral therapies, and it remains uncertain whether the introduction of oral agents will improve patient adher-ence. Moreover, advancement into Phase III trials may not always result in a new therapy, as was recently shown when an oral ver-sion of glatiramer failed to improve the rate of relapses in a clinical

RRMS.Cladribine. Cladribine (2-chlo-

rodeoxyadenosine) is a purine nucleoside analogue prodrug. It is selectively toxic for lymphocytes and monocytes, appears to cross the blood-brain-barrier with ease, and has preferential lymphocyte-depleting properties. It is currently used in an intravenous formulation

-proved therapy for hairy cell leuke-mia and other hematologic malig-nancies, in patients unresponsive to other therapy. It has also been assessed in clinical trials for treat-ment of a variety of autoimmune diseases. Administered orally, the drug has been shown to be effective in treatment of RRMS.

The mechanism by which cladribine acts in MS is not fully known; however, there is evidence that it is phosphorylated intracel-lularly by deoxycytidine kinase to 2-chlorodeoxyadenosine triphos-phate, which accumulates within cells to disrupt cellular metabolism and inhibit DNA synthesis and repair, and subsequently induce apoptosis (natural or programmed cell death). This occurs preferen-tially in lymphocytes, thus deplet-ing the level of activated lympho-cytes that induce central neuron

demyelination in MS. It also spares other hematologic and immune

killer cells. The primary effect of cladribine is immune cell depletion, and the drug depletes both prolifer-ating and inactive lymphocytes.

Results of Phase II and III tri-als in MS employing an injectable formulation of cladribine demon-strated suppression of gadolinium-enhancing lesions in patients with RRMS who received cladribine for six months compared with pla-cebo. Cladribine also reduced the frequency and severity of relapses compared with placebo at the 12- and 18-month time points. The sustained immunosuppressive effects of cladribine would make it ideal for intermittent dosing, which should improve patient adherence and tolerability. Current trials are evaluating oral cladribine for use as monotherapy or in combina-

A standard dosing regimen for oral cladribine has yet to be estab-lished and two possible dosing regi-mens are being explored in these studies. These doses have been as-sociated with a good safety and tol-

is the dose-limiting toxicity, and culture-negative fever is the most common adverse effect. No events related to cardiotoxicity, nephro-toxicity or neurotoxicity have been reported. While lymphopenia that occurs following a single course of cladribine may be considered a risk factor for infection, opportunistic infection has occurred in only a few patients with cases limited to mild herpes zoster along with one fatal

BG00012. This is an oral formulation of dimethylfumarate

neuroprotective properties, and is used for treatment of psoriasis in

is being evaluated in two Phase III trials. Studies in psoriasis patients indicate that it decreases peripher-al counts of CD4+ and CD8+ lym-phocytes, particularly the latter.


in the total number of gadolinium-enhancing brain lesions, as mea-sured by MRI over six months of treatment. The most commonly reported adverse events included

headache and nasopharyngitis.

percent in the placebo group.Its exact mechanism of action

is still unclear, but it appears the drug has a novel mechanism of action as potential therapy for MS. It possesses both cytoprotective

through inhibiting expression of

cell adhesion molecules. Studies have demonstrated that dimethyl fumarate treatment may suppress peripheral CD4+ and CD8+ lym-phocytes and may also shift the predominant T lymphocyte popula-tion from a T helper (Th1) to a Th2 phenotype. This is also one of the presumed mechanisms of action of glatiramer.

Firategrast. --

rin antagonist that interferes with 4 1 4 7 inte-

grins to its ligand, VCAM-1. This prevents the migration of immune cells into the CNS. Clinical tri-als have shown a decrease in new lesions with a trend toward fewer relapses with increasing doses.

Firategrast was generally well tolerated in clinical trials. Adverse events included vomiting; infec-tions, particularly of the urinary and respiratory tract; and rash. At this time, there are no reports of progressive multifocal leukoen-cephalopathy (disease of the white substance of the brain).

Unlike natalizumab, it is a small molecule in the form of an oral preparation. This confers the

of delivery along with improved patient adherence to therapy.

Laquinimod.quinoline-3-carboxamide deriva-tive, is chemically distinct from

the oral treatment of MS but is associated with substantial adverse

at inhibiting MS symptoms than its parent compound and reportedly causes fewer adverse effects.

Although its pharmacologic

CD4+ T cells and macrophages

believed to be at least partially due to shifting the balance of the T lymphocyte population in favor of cells expressing Th2/Th3 cyto-

transforming growth factor-beta. This novel action produces an im-munomodulatory response (altered immune response) without causing immunosuppression. The T cell

of laquinimod occur because of a deviation of the immune response, rather than suppression. Results of a recently published study that compared the effects of laquinimod in the peripheral blood mononu-clear cells of healthy subjects and patients with RRMS showed that the drug induced suppression of genes associated with antigen pre-

-matory pathways.

to suppress active lesions on MRI scans in patients with RRMS. In a Phase II trial in patients with RRMS, laquinimod showed a favor-

-cant clinical or laboratory signs of

--

tion of serous membranes) or myo-cardial infarction. In a 24-month open-label extension trial, laquini-mod was well tolerated. The most frequently reported adverse events

-cent), back pain (12.4 percent), and headache (8.1 percent).

-mide is the active metabolite of

treatment for rheumatoid ar-

cell activation through reversible

inhibition of dihydroorotate dehy-drogenase, the rate-limiting step in the de novo synthesis of pyrimi-dine, leading to decreased DNA synthesis. This novel action during the induction of cellular immune responses is thought to contribute to its clinical effectiveness in dis-eases characterized by exaggerated immune reactions. Further effects

and other in vivo immunomodula-tory processes are postulated. In a

RRMS and 22 with progressive MS, -

crease the number of unique, active MRI lesions.

The treatment seems to be well tolerated and the frequency of adverse events was similar across groups. This drug has entered Phase III trials as monotherapy, and is also being investigated in

glatiramer in Phase II trials. Dalfampridine. Also known

as fampridine, dalfampridine (Ampyra) is an old drug in new clothing. Its active ingredient is 4-aminopyridine (4-AP), a com-pound developed initially as a bird poison. For more than three decades, 4-AP has enjoyed off-label use in humans for treatment of MS. At the same time, it remained a niche drug because of limited effec-tiveness, limited availability only through specialized compounding pharmacies, and a substantial seizure risk. It is a selective potas-sium channel antagonist that is believed to relieve MS symptoms by restoring conduction in demyeli-nated axons via voltage-dependent potassium channel blockade. The drug was approved for treatment of patients with MS in January 2010, and is unique among MS pharma-cotherapy in being indicated specif-ically for improving walking ability and lower leg strength (as opposed to reducing relapses or improving disability). The drug is not a DMT,

other domain apart from improved walking.

Dalfampridine is an extended-release formulation of 4-AP that


Program 0129-0000-11-006-H01-P

The authors, the Ohio Pharmacists Founda-tion and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the infor-mation contained herein. Bibliography for additional reading and inquiry is available upon request.

is targeted to pharmacists in all practice settings.

accredited by the Accreditation Council

continuing pharmacy education.

has favorable pharmacologic prop-erties compared with its generic forebear, including twice-daily instead of three-times-daily dosing without regard to meals. In pre-liminary trials, seizures were still a problem at doses of 20 mg twice daily and above. Therefore, a dose of 10 mg twice daily was chosen

low safety factor for the drug, it is likely that seizures will ultimately emerge as an expected adverse ef-fect with continued use.

To date, no formal drug inter-action studies with dalfampridine

may lower the seizure threshold, precaution should be taken in patients who are concomitantly taking medications that may also induce seizures, such as tricyclic antidepressants, phenothiazines and venlafaxine. Ampyra is distrib-uted exclusively through a network of specialty pharmacies, which are coordinated by Ampyra Patient Support Services.

Side Note Several monoclonal antibodies are under study as possible treatments for RRMS. These therapies will not be orally administered; however, they do target different sites on immune cells and may offer alter-natives for patients who have not responded adequately to current treatment options.

Alemtuzumab (Campath). Alemtuzumab is currently ap-

chronic lymphocytic leukemia. The drug was given an FDA Fast Track designation in 2010 for study in RRMS, and Phase III trials are underway.

Daclizumab (Zenapax). This appears to increase numbers of

Phase II clinical trial reduced the number of new or enlarging gad-olinium-enhancing lesions by 72

The drug is currently approved for prophylaxis against acute rejection in renal transplant patients.

Rituximab (Rituxan). Ap-

proved for treatment of non-Hodgkin’s lymphoma, rheumatoid arthritis and chronic lymphocytic leukemia, rituximab, which targets and depletes CD20+

reduced lesion burden and relapse rate compared with placebo, and reduced relapses when used as an add-on to conventional inject-able therapies in Phase II trials of patients with RRMS.

Overview and Summary Newer treatment options for patients with MS have improved

-pies; however, they still necessitate the use of weekly or monthly injec-

-tion of oral MS agents would, in theory, not only eliminate the need for painful injections and provide patients with a more user friendly alternative to currently approved choices, but these compounds also show promise in reducing the number and volume of brain lesions. Although the results of Phase II and III oral therapy trials are encouraging, all agents have

individuals. These oral therapies may, therefore, not displace the existing platform therapies, but be used along with them.


The Georgia Pharmacy JournalEditor: Jim Bracewell

[email protected]

Managing Editor & Designer: Kelly [email protected]

The Georgia Pharmacy Journal® (GPJ) is the official publication of theGeorgia Pharmacy Association, Inc. (GPhA). Copyright © 2011, GeorgiaPharmacy Association, Inc. All rights reserved. No part of this publicationmay be reproduced or transmitted in any form or by any means, electronicor mechanical including by photocopy, recording or information storageretrieval systems, without prior written permission from the publisher andmanaging editor.

All views expressed in bylined articles are the opinions of the author anddo not necessarily express the views or policies of the editors, officers ormembers of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose who are interested in writing for this publication are encouraged torequest the official GPJ Guidelines for Writers. Artists or photographerswishing to submit artwork for use on the cover should call, write or e-mailthe editorial offices as listed above.

SUBSCRIPTIONS AND CHANGE OF ADDRESSThe Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed asa regular membership service, paid for through allocation of membershipdues. Subscription rate for non-members is $50.00 per year domestic and$10.00 per single copy; international rates $65.00 per year and $20.00single copy. Subscriptions are not available for non-GPhA memberpharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is publishedmonthly by the GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324.Periodicals postage paid at Atlanta, GA and additional offices.POSTMASTER: Send address changes to The Georgia PharmacyJournal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

ADVERTISINGAdvertising copy deadline and rates are available at www.gpha.org uponrequest. All advertising and production orders should be sent to the GPhAheadquarters as listed above.

GPHA HEADQUARTERS50 Lenox Pointe, NEAtlanta, Georgia 30324Office: 404.231.5074Fax: 404.237.8435 www.gpha.org

Print: Star Printing - 770.974.6195

2011 - 2012 GPhA BOARD OF DIRECTORS

Name PositionDale Coker Chairman of the BoardJack Dunn PresidentRobert Hatton President-ElectPam Marquess First Vice PresidentBobby Moody Second Vice PresidentRobert Bowles State At LargeHugh Chancy State At LargeKeith Herist State At LargeEddie Madden State At LargeJonathan Marquess State At LargeTim Short State At LargeRichard Smith State At LargeChristine Somers 1st Region PresidentFred Sharpe 2nd Region PresidentRenee Adamson 3rd Region PresidentAmanda Gaddy 4th Region PresidentJulie Bierster 5th Region PresidentAshley Faulk 6th Region PresidentAmanda McCall 7th Region PresidentLarry Batten 8th Region PresidentKristy Pucylowski 9th Region President Christopher Thurmond 10th Region PresidentAshley London 11th Region President Ken Eiland 12th Region PresidentThomas Jeter ACP ChairmanJosh Kinsey AEP RepresentativeSonny Rader AHP ChairmanIra Katz AIP ChairmanGail Lowney APT ChairmanChristina Gonzalez ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael Farmer Insurance Trust ChairmanSteve Wilson Georgia State Board of Pharmacy

RepresentativePatricia Knowles Georgia Society of Health Systems

PharmacistsAmy Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeSukh Sarao UGA Faculty Rep.Negin Sovaidi ASP Mercer University Rep.Annie Tran ASP South University Rep.David Bray ASP UGA Rep.Jim Bracewell Executive Vice President

june 2011

continuing educat ion quiz Mult iple Sclerosis : Emerging Oral Therapy

Program 0129-0000-11-006-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________Return quiz and payment (check or money order) to

Correspondence Course, OPA,2674 Federated Blvd, Columbus, OH 43235-4990

To receive CE credit, your quiz must be postmarked no later than June 15, 2014. A passing grade of 80% must be attained. CE state-ments of credit are mailed February, April, June, August, October, and December. Send inquiries to [email protected].

your answer.1. [a] [b] [c] [d] 6. [a] [b] [c] [d] 11. [a] [b] [c] [d]2. [a] [b] [c] [d] 7. [a] [b] [c] 12. [a] [b] [c] [d] 3. [a] [b] [c] [d] 8. [a] [b] [c] 13. [a] [b] 4. [a] [b] [c] [d] 9. [a] [b] [c] [d] 14. [a] [b] [c] [d] 5. [a] [b] [c] [d] 10. [a] [b] [c] [d] 15. [a] [b] [c] [d]

I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. All of the following are correct descriptions of mul-tiple sclerosis (MS) EXCEPT: a. chronic. c. heterogeneous. b. debilitating. d. immune-mediated. 2. Which of the following types of interferon (IFN) has become the gold standard of care for modifying the course of relapsing-remitting multiple sclerosis (RRMS)? a. Alpha c. Gamma b. Beta d. Delta

therapy (DMT) for treating patients with MS is:

b. glatiramer. d. natalizumab. 4. The intramuscularly administered DMT product for treating patients with MS is: a. Rebif. c. Betaseron.

5. It has been reported that more than half (57 percent) of patients with poor adherence for MS therapy have

b. feeling they will ever get better. c. high incidence of injection site reactions. d. reduction in relapse rate.

6. The type of sphingosine 1-phosphate receptor targeted by Gilenya that is located on atrial muscles that regu-lates heart rate is: a. S1P1. c. S1P3. b. S1P2. d. S1P4.

7. By hindering S1P1, Gilenya causes all of the following EXCEPT: a. prevention of recirculation of lymphocytes. b. increased peripheral lymphocyte count. c. sequestration of lymphocytes in the lymph tissue.

-ity to cause: a. prevention of recirculation of lymphocytes. b. increased peripheral lymphocyte count. c. sequestration of lymphocytes in the lymph tissue.

9. The manufacturer of Gilenya warns that all of the following drugs should be used cautiously, if at all, with Gilenya EXCEPT: a. amiodarone. c. mirtazapine. b. ketoconazole. d. quinidine.

a. erythrocytes. c. leukocytes. b. granulocytes. d. monocytes.11. By inhibiting DNA synthesis and repair, cladribine subsequently induces natural or programmed cell death, a process referred to as:

b. biodegradation. d. necrosis.

12. Firategrast: a. decreases DNA synthesis by affecting the synthesis of pyrimidine. b. prevents migration of immune cells into the CNS. c. regenerates neuronal tissue into its functioning form. d. stimulates the production of myelin in central neurons.

13. Laquinimod produces an: a. immunosuppressant response. b. immunomodulatory response.

a. decreases DNA synthesis by affecting the synthesis of pyrimidine. b. prevents migration of immune cells into the CNS. c. regenerates neuronal tissue into its functioning form. d. stimulates the production of myelin in central neurons.

15. Dalfampridine was developed initially as a: a. rat poison. c. insecticide. b. fungicide. d. bird poison.

31The Georgia Pharmacy Journal August 201131 june 2011

continuing educat ion quiz Mult iple Sclerosis : Emerging Oral Therapy

Program 0129-0000-11-006-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________Return quiz and payment (check or money order) to

Correspondence Course, OPA,2674 Federated Blvd, Columbus, OH 43235-4990

To receive CE credit, your quiz must be postmarked no later than June 15, 2014. A passing grade of 80% must be attained. CE state-ments of credit are mailed February, April, June, August, October, and December. Send inquiries to [email protected].

your answer.1. [a] [b] [c] [d] 6. [a] [b] [c] [d] 11. [a] [b] [c] [d]2. [a] [b] [c] [d] 7. [a] [b] [c] 12. [a] [b] [c] [d] 3. [a] [b] [c] [d] 8. [a] [b] [c] 13. [a] [b] 4. [a] [b] [c] [d] 9. [a] [b] [c] [d] 14. [a] [b] [c] [d] 5. [a] [b] [c] [d] 10. [a] [b] [c] [d] 15. [a] [b] [c] [d]

I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. All of the following are correct descriptions of mul-tiple sclerosis (MS) EXCEPT: a. chronic. c. heterogeneous. b. debilitating. d. immune-mediated. 2. Which of the following types of interferon (IFN) has become the gold standard of care for modifying the course of relapsing-remitting multiple sclerosis (RRMS)? a. Alpha c. Gamma b. Beta d. Delta

therapy (DMT) for treating patients with MS is:

b. glatiramer. d. natalizumab. 4. The intramuscularly administered DMT product for treating patients with MS is: a. Rebif. c. Betaseron.

5. It has been reported that more than half (57 percent) of patients with poor adherence for MS therapy have

b. feeling they will ever get better. c. high incidence of injection site reactions. d. reduction in relapse rate.

6. The type of sphingosine 1-phosphate receptor targeted by Gilenya that is located on atrial muscles that regu-lates heart rate is: a. S1P1. c. S1P3. b. S1P2. d. S1P4.

7. By hindering S1P1, Gilenya causes all of the following EXCEPT: a. prevention of recirculation of lymphocytes. b. increased peripheral lymphocyte count. c. sequestration of lymphocytes in the lymph tissue.

-ity to cause: a. prevention of recirculation of lymphocytes. b. increased peripheral lymphocyte count. c. sequestration of lymphocytes in the lymph tissue.

9. The manufacturer of Gilenya warns that all of the following drugs should be used cautiously, if at all, with Gilenya EXCEPT: a. amiodarone. c. mirtazapine. b. ketoconazole. d. quinidine.

a. erythrocytes. c. leukocytes. b. granulocytes. d. monocytes.11. By inhibiting DNA synthesis and repair, cladribine subsequently induces natural or programmed cell death, a process referred to as:

b. biodegradation. d. necrosis.

12. Firategrast: a. decreases DNA synthesis by affecting the synthesis of pyrimidine. b. prevents migration of immune cells into the CNS. c. regenerates neuronal tissue into its functioning form. d. stimulates the production of myelin in central neurons.

13. Laquinimod produces an: a. immunosuppressant response. b. immunomodulatory response.

a. decreases DNA synthesis by affecting the synthesis of pyrimidine. b. prevents migration of immune cells into the CNS. c. regenerates neuronal tissue into its functioning form. d. stimulates the production of myelin in central neurons.

15. Dalfampridine was developed initially as a: a. rat poison. c. insecticide. b. fungicide. d. bird poison.

Introducing the GPhA/UBS Wealth Management Program

UBS has agreed to provide all members of the Georgia Pharmacy Association with exclusive access

been recognized as one of Barron’sGroup is the endorsed wealth management provider for the Georgia Dental Association and also

Harris Gignilliat, CRPS®

Vice President–Investments

ubs.com/team/wile

exclusively for GPhA members at a group discount rate

discount rate

income replacement system

– Lending capabilities with competitive interest rates

Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®.

UBS Financial Services Inc. is a subsidiary of UBS AG. Financial Services Inc. All rights reserved. Member SIPC.

UBS has agreed to provide

Introducing the GPhA/UBS

members of the Georgia Pharmacy Association all UBS has agreed to provide

Introducing the GPhA/UBS

members of the Georgia Pharmacy Association

Wealth Management ProgramIntroducing the GPhA/UBS

access exclusive with members of the Georgia Pharmacy Association

Wealth Management Program

access

Wealth Management Program

is the endorsed wealth management provider Group been recognized

is the endorsed wealth management provider sBarron’Barron’sof as one been recognized

ice VHarris

for the Georgia Dental Association is the endorsed wealth management provider

President–Investmentsice

®CRPSGignilliat, Harris

and for the Georgia Dental Association

also

Lending capabilities with competitive interest rates–


discount rate


Lending capabilities with competitive interest rates


discount rate


Lending capabilities with competitive interest rates


ubs.com/team/wile

ice V

ubs.com/team/wile

President–Investmentsice

eserved. Member SIPC. Financial Services Inc. All rights r

and CRPSSMement Plans Specialisted RetirCharter

eserved. Member SIPC.

ed service marks of the College for Financial Planningegistere r ar® and CRPS

.®ed service marks of the College for Financial Planning

UBS Financial Services Inc. is a subsidiary of UBS AG.

UBS Financial Services Inc. is a subsidiary of UBS AG.

Georgia Pharmacy Association50 Lenox Pointe, NEAtlanta, GA 30324

the georgia pharmacy journal: august 2011

Documents