June 2014voluMe 36, issue 6

Rising to the

ChallengeMeet Bobby Moody GPhA President 2014-15“I think my leadership style would be considered very hands-on.”

Challenge“I think my leadership style

PlusThe GPhA Goes to Washington

Deal Announces Medical Marijuana Project

Drilling Down on Drug Errors

buddy carter in a runoff

for us congress

page 14

ChallengeChallenge

Editor: Jim Bracewelljbracewell@gpha.org

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

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

Articles And ArtworkThose interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org.

subscriptions And chAnge of AddressThe Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly 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 Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

AdvertisingAdvertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org.

gphA headquarters50 Lenox Pointe, NE

Atlanta, Georgia 30324t 404-231-5074 f 404-237-8435

www.gpha.org

June 2014

1The Georgia Pharmacy Journal

ContentsMessage from Pamala Marquess .................

Message from Jim Bracewell .........................

New GPhA Members ......................................

Member News ..................................................

24

75

PharmPAC Supporters ................................18Continuing Education ...............................20GPhA Board of Directors .........................28

Industry News ...............................................15

Meet Bobby Moody, 2014-15 GPhA President 10................

Editor: Jim Bracewelljbracewell@gpha.org

The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

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

Articles And ArtworkThose interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org.

subscriptions And chAnge of AddressThe Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly 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 Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

AdvertisingAdvertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org.

gphA headquarters50 Lenox Pointe, NE

Atlanta, Georgia 30324t 404-231-5074 f 404-237-8435

www.gpha.org

June 2014

1The Georgia Pharmacy Journal

ContentsMessage from Pamala Marquess .................

Message from Jim Bracewell .........................

New GPhA Members ......................................

Member News ..................................................

24

75

PharmPAC Supporters ................................18Continuing Education ...............................20GPhA Board of Directors .........................28

Industry News ...............................................15

Meet Bobby Moody, 2014-15 GPhA President 10................

This past October, the EC hit the road to see as many members as possible across our state with our Region Meetings. We actually visit more members during region meetings than we host at our annual meeting in June. This fall was no exception. The Region Presidents did an excellent job in planning, communicating, and encouraging attendance at the meetings. October is also the time for the NCPA annual meeting. Your President Elect, Bobby Moody, and I attended this meeting to represent you and the GPhA at this meeting. Our two Past Presidents of GPhA, John Sherrer and Hugh Chancy, are part of the NCPA leadership and we are proud of their national accomplishments and the manner in which they represent Georgia.

After we finished fall region meetings and the holidays, the Board of Directors and Standing committee’s held its annual January meeting. This meeting serves to ensure the association is following the recommenda-tions set forth by the various committees. This year’s meeting was very productive. The transition committee set a timeline for the hiring of a new GPhA Executive Vice President, the legislative agenda was reviewed, and the convention planning was ahead of schedule.

February is a short month but was action packed! I attended the National Association of Chain Drug Stores (NACDS) meeting where the focus was on adherence, pharmacists making a difference, and the changing landscape of our profession. The most important event in February was our VIP day. We had another milestone in GPhA history! We had almost 500 attendees but more importantly, we had more pharmacists in attendance than ever before!! Governor Nathan Deal kicked off the morning by speaking to our group, which was followed by our keynote speaker Tom Menighan, CEO/EVP of APhA. We also had the honor of hearing from Lt. Gover-nor Casey Cagle and many other dignitaries. But most importantly, you were there to make sure your voice was heard by your legislator!

March was a time for Council of President’s meeting and GPhA Award nominee selections. This group is the think tank for the Association and we appreciate their input and wisdom. I have called on many of the Past Presidents to ask for advice and opinions and they have always been honest, forthright, and put GPhA at the fore-front of any discussion. March is also the time for the annual APhA meeting. This meeting is the most demanding of all the conferences as a GPhA President. President receptions, caucuses, House of Delegates, hosting a Georgia reception for all our alumni around the world, and attending sessions to learn new ideas to bring home to our members. I was honored to be asked to lead the Southeastern Caucus at this meeting. We discussed and debated critical issues in the profession. President Elect Bobby Moody and I attended this meet-ing on behalf of the EC.

April and May brought a close to the Legislative session, region meetings and the NCPA Legislative Confer-ence. Although our Legislative session did not bring the results we desired, we will never give up on fighting for patient access. This EC is committed to this outcome. President-Elect Bobby Moody and I, along with several AIP members, traveled to Washington DC and met with our Congressman to discuss issues important to Phar-macist and Patient access. The remainder of May was spent interviewing candidates for GPhA’s EVP position. The timeline was met, confidentiality was maintained and the process was nearly flawless. Again, I want to recognize the GPhA Board of Directors for their insightfulness, wisdom, and leadership. A final selection for an EVP has been decided and will be introduced at this year’s annual convention in June.

I chose to highlight some of the more important events, but your Executive Committee has been involved in countless phone calls with members, meetings with your legislators, political fund raisers, conference calls, and weekend events.

As I near the transition to Chairman of the Board, I am thankful for the hard work and dedication of the GPhA staff, legislative team, and Executive Committee. I would encourage everyone to remain involved with GPhA and to get involved in leadership. It is only two days a month! Yes, it requires time - your most valued treasure, but the rewards will far outweigh the sacrifice!

Thank you for entrusting me to lead this Association. It has been my honor to serve each of you!

Professionally yours,

Pamala S. Marquess

Pamala MarquessGPhA President

The Georgia Pharmacy Journal2

MESSAGE from Pamala Marquess

GPhA has a lot to celebrate! We have had a very exciting and success filled year. We had our share of challenges but were able to overcome these due to our incredible TEAM.

The President’s first responsibility is to lead the Executive Committee(EC) retreat. The President plans the venue, topics, and agenda so as to produce a plan for the upcoming year. So, for inspiration, I chose grounds of higher learning in Athens since 1905. The University of Georgia College of Pharmacy graciously was our host for this two and a half day intensive and strategic meeting. Each of your Executive Committee members; Robert Hatton, Bobby Moody,

Tommy Whitworth, Lance Boles, and Jim Bracewell came as individuals with positive attitudes, ideas, opin-ions, and experiences and left as a unified team with a specific strategy focusing on:

• Provider Status, • MAC pricing, • and expanding immunizations in Georgia. We performed a detailed review of the GPhA Bylaws and Constitution, GPhA Journal, finalized the calen-

dar of events including EC monthly meetings, region meetings, BOD meetings, then discussed the legislative agenda, reviewed the 2014 convention plans and took individualized personality tests to identify strengths for the team.

In July, the President is the representative for GPhA at the Georgia Society of Health System Pharma-cists(GSHP) annual Board of Directors meeting. We had long and meaningful discussions about Provider Status, Legislative, and workplace issues, thus reinforcing our positive relationship with GSHP. My next week-end was equally as stimulating with the Academy of Independent Pharmacy’s (AIP) Board retreat. This board created a lengthy list of goals and objectives to continue their support of independent pharmacy’s growth and strength. Both GSHP and AIP are very important strategic partners with GPhA and of utmost importance to the Georgia Pharmacy Team.

The first weekend of August, the EC attends the Southeastern Pharmacy Officers Conference. This year it was held in Nashville, TN, and to make efficient use of time, we rented a van and held our EC meeting during the drive to the meeting. This forum is a time for officers of the Southeastern states to share professional and legislative successes, network as well as challenge and strategize for the profession. We left this meeting in-spired with the successes our colleagues were having and ideas we knew Georgia needed to address. Within two weeks, we took these ideas and shared them with the GPhA Board of Directors at their yearly Board retreat which happened at Chateau Elan in Braselton, GA last August. This Board took our challenges which included; membership, legislative initiatives, clinical and professional advancements, leadership advancements, and an Executive Vice President Transition policy. We addressed each topic as a Team with a unified voice. This final-ized the direction for the remainder of the year and I appreciate the Board members for their dedication and professionalism during this year.

Within a week, I boarded a plane for the International Pharmacy Federation (FIP) meeting in Dublin, Ireland. I traveled with the American Pharmacists Association President Steve Simenson, President Elect Matt Osterhaus, Trustee Jonathan Marquess, and EVP Tom Menighan. The focus of this meeting was on Integrated Care. This was my second FIP meeting and it always rings true that we live in a small world. I was able to see pharmacists from around the globe focusing on patient care with a similar approach. It is extremely important to learn from not only your own mistakes, but mistakes of others with processes and systems that we do not wish to implement at home. When I returned home, it was September and time for Standing Committee Meet-ings. I am especially proud of our Committee Chairs this year. Each had a long list of goals and objectives. We encouraged them to continue their work into a year round active committee. They took on these new objectives with strategic monthly conference calls with their committees as an effort to stay on track. This was very suc-cessful and meaningful to the members and also to the work of GPhA.

Pam

All In a Year’s Work

3The Georgia Pharmacy Journal

This past October, the EC hit the road to see as many members as possible across our state with our Region Meetings. We actually visit more members during region meetings than we host at our annual meeting in June. This fall was no exception. The Region Presidents did an excellent job in planning, communicating, and encouraging attendance at the meetings. October is also the time for the NCPA annual meeting. Your President Elect, Bobby Moody, and I attended this meeting to represent you and the GPhA at this meeting. Our two Past Presidents of GPhA, John Sherrer and Hugh Chancy, are part of the NCPA leadership and we are proud of their national accomplishments and the manner in which they represent Georgia.

After we finished fall region meetings and the holidays, the Board of Directors and Standing committee’s held its annual January meeting. This meeting serves to ensure the association is following the recommenda-tions set forth by the various committees. This year’s meeting was very productive. The transition committee set a timeline for the hiring of a new GPhA Executive Vice President, the legislative agenda was reviewed, and the convention planning was ahead of schedule.

February is a short month but was action packed! I attended the National Association of Chain Drug Stores (NACDS) meeting where the focus was on adherence, pharmacists making a difference, and the changing landscape of our profession. The most important event in February was our VIP day. We had another milestone in GPhA history! We had almost 500 attendees but more importantly, we had more pharmacists in attendance than ever before!! Governor Nathan Deal kicked off the morning by speaking to our group, which was followed by our keynote speaker Tom Menighan, CEO/EVP of APhA. We also had the honor of hearing from Lt. Gover-nor Casey Cagle and many other dignitaries. But most importantly, you were there to make sure your voice was heard by your legislator!

March was a time for Council of President’s meeting and GPhA Award nominee selections. This group is the think tank for the Association and we appreciate their input and wisdom. I have called on many of the Past Presidents to ask for advice and opinions and they have always been honest, forthright, and put GPhA at the fore-front of any discussion. March is also the time for the annual APhA meeting. This meeting is the most demanding of all the conferences as a GPhA President. President receptions, caucuses, House of Delegates, hosting a Georgia reception for all our alumni around the world, and attending sessions to learn new ideas to bring home to our members. I was honored to be asked to lead the Southeastern Caucus at this meeting. We discussed and debated critical issues in the profession. President Elect Bobby Moody and I attended this meet-ing on behalf of the EC.

April and May brought a close to the Legislative session, region meetings and the NCPA Legislative Confer-ence. Although our Legislative session did not bring the results we desired, we will never give up on fighting for patient access. This EC is committed to this outcome. President-Elect Bobby Moody and I, along with several AIP members, traveled to Washington DC and met with our Congressman to discuss issues important to Phar-macist and Patient access. The remainder of May was spent interviewing candidates for GPhA’s EVP position. The timeline was met, confidentiality was maintained and the process was nearly flawless. Again, I want to recognize the GPhA Board of Directors for their insightfulness, wisdom, and leadership. A final selection for an EVP has been decided and will be introduced at this year’s annual convention in June.

I chose to highlight some of the more important events, but your Executive Committee has been involved in countless phone calls with members, meetings with your legislators, political fund raisers, conference calls, and weekend events.

As I near the transition to Chairman of the Board, I am thankful for the hard work and dedication of the GPhA staff, legislative team, and Executive Committee. I would encourage everyone to remain involved with GPhA and to get involved in leadership. It is only two days a month! Yes, it requires time - your most valued treasure, but the rewards will far outweigh the sacrifice!

Thank you for entrusting me to lead this Association. It has been my honor to serve each of you!

Professionally yours,

Pamala S. Marquess

Pamala MarquessGPhA President

The Georgia Pharmacy Journal2

MESSAGE from Pamala Marquess

GPhA has a lot to celebrate! We have had a very exciting and success filled year. We had our share of challenges but were able to overcome these due to our incredible TEAM.

The President’s first responsibility is to lead the Executive Committee(EC) retreat. The President plans the venue, topics, and agenda so as to produce a plan for the upcoming year. So, for inspiration, I chose grounds of higher learning in Athens since 1905. The University of Georgia College of Pharmacy graciously was our host for this two and a half day intensive and strategic meeting. Each of your Executive Committee members; Robert Hatton, Bobby Moody,

Tommy Whitworth, Lance Boles, and Jim Bracewell came as individuals with positive attitudes, ideas, opin-ions, and experiences and left as a unified team with a specific strategy focusing on:

• Provider Status, • MAC pricing, • and expanding immunizations in Georgia. We performed a detailed review of the GPhA Bylaws and Constitution, GPhA Journal, finalized the calen-

dar of events including EC monthly meetings, region meetings, BOD meetings, then discussed the legislative agenda, reviewed the 2014 convention plans and took individualized personality tests to identify strengths for the team.

In July, the President is the representative for GPhA at the Georgia Society of Health System Pharma-cists(GSHP) annual Board of Directors meeting. We had long and meaningful discussions about Provider Status, Legislative, and workplace issues, thus reinforcing our positive relationship with GSHP. My next week-end was equally as stimulating with the Academy of Independent Pharmacy’s (AIP) Board retreat. This board created a lengthy list of goals and objectives to continue their support of independent pharmacy’s growth and strength. Both GSHP and AIP are very important strategic partners with GPhA and of utmost importance to the Georgia Pharmacy Team.

The first weekend of August, the EC attends the Southeastern Pharmacy Officers Conference. This year it was held in Nashville, TN, and to make efficient use of time, we rented a van and held our EC meeting during the drive to the meeting. This forum is a time for officers of the Southeastern states to share professional and legislative successes, network as well as challenge and strategize for the profession. We left this meeting in-spired with the successes our colleagues were having and ideas we knew Georgia needed to address. Within two weeks, we took these ideas and shared them with the GPhA Board of Directors at their yearly Board retreat which happened at Chateau Elan in Braselton, GA last August. This Board took our challenges which included; membership, legislative initiatives, clinical and professional advancements, leadership advancements, and an Executive Vice President Transition policy. We addressed each topic as a Team with a unified voice. This final-ized the direction for the remainder of the year and I appreciate the Board members for their dedication and professionalism during this year.

Within a week, I boarded a plane for the International Pharmacy Federation (FIP) meeting in Dublin, Ireland. I traveled with the American Pharmacists Association President Steve Simenson, President Elect Matt Osterhaus, Trustee Jonathan Marquess, and EVP Tom Menighan. The focus of this meeting was on Integrated Care. This was my second FIP meeting and it always rings true that we live in a small world. I was able to see pharmacists from around the globe focusing on patient care with a similar approach. It is extremely important to learn from not only your own mistakes, but mistakes of others with processes and systems that we do not wish to implement at home. When I returned home, it was September and time for Standing Committee Meet-ings. I am especially proud of our Committee Chairs this year. Each had a long list of goals and objectives. We encouraged them to continue their work into a year round active committee. They took on these new objectives with strategic monthly conference calls with their committees as an effort to stay on track. This was very suc-cessful and meaningful to the members and also to the work of GPhA.

Pam

All In a Year’s Work

3The Georgia Pharmacy Journal

Registered Representative of INVEST Financial Corporation, member FINRA/SIPC. INVEST and its a� liated insurance agencies o� er securities, advisory services and certain insurance products and are not a� liated with Financial Network Associates, Inc. Other advisory services o� ered through Financial Network Associates, Inc. ad.10040.110749

Real Financial Planning.No Generics.

It means having real strategies for all your � nancial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their

families and their practices. It means working with an independent � rm you can trust.

Michael T. Tarrant, CFP®• Speaker & Author• PharmPAC Supporter• Creating Real Financial

Planning for over 20 Years

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • mike@FNAplanners.com

Jim Bracewell Executive Vice President

The Georgia Pharmacy Journal

I was recently told a story of a man named Bob who lives in a city some distance from his childhood home and was not able to get back home for his mother’s birthday. His mother is widowed and lives alone so Bob invested several hundred dollars to purchase a well-trained talking parrot for his mother to have as company.

Several days after the parrot was delivered, Bob called to see how much she enjoyed the gift. “Mom... did you get the parrot I sent you and how do you like it?” Bob asked. His mother replied, “Yes, I got that beautiful bird and enjoyed it very much. It was delicious.”

Bob was stunned. “Mom! That parrot cost $600 dollars, spoke 200 words and you cooked it?,” Bob asked.

His mom replied, “Well son... if the parrot was so smart he should have said some-thing.”

Last spring, I accompanied a wonderful young pharmacist on her visit to meet her legislator. We had a great meeting and the two really got acquainted.

After this past legislative session, I went to visit that same legislator to find out why he did not support us on a certain issue. The frustrated legislator said he did not know the

issue was important to pharmacy. “I did not hear anything about it from anyone back home in my district,” he stated.

As a pharmacist and a member of the most over-regulated health profession in America you owe it to yourself, to your career, and to your profession to speak up. It is part of your role. It is part of your profession-al responsibility. All too often the silent voice of pharmacy has led to the undervaluing of the profession and the underutilization of your scope of practice. This silence has led the public to think you can only count by five

and run a computer with a phone in your ear. I’m sure that this is not the picture you want for the second most highly educated health profession in America.

The moral of this story is that pharmacy is much like that beautiful, highly trained par-rot. If we do not speak up for pharmacy, our future will be deliciously consumed by others as a result of our silence.

Your voice is of great value. Do not squawk. Just make sure it’s heard. n

Jim

4

“You owe it to yourself, to your

career, and to your profession

to speak up.”

The Value of Your Voice

The Georgia Pharmacy Journal

M E M B E R N E W S

Hundreds of Independent Phar-macists from all over the USA went to DC for NCPA’s annual legislative con-ference including a dozen from Georgia. While there, they learned about issues that Congress is working to address to improve the profession of pharmacy. Some of the issues that were discussed included Preferred Network Fairness, Provider Status for Pharmacists and Ge-neric Drug Pricing Transparency.

The author of the Generic Drug Pric-ing Transparency Act, HR 4437, is no stranger to members of GPhA. It is for-mer State Representative and now cur-rent Congressman from the 9th District of Georgia, Doug Collins. HR 4437 would allow a pharmacy to know how its individual maximum allowable cost (MAC) reimbursement rates for multi-source generic drugs would be deter-mined. It would also require payments to be updated more frequently to keep pace with actual market costs.

In introducing the bill, Collins said: “A pharmacist often must provide cru-cial, very personal reassurance to their customers. A pharmacist can’t provide certainty to a patient if they’re operating with this kind of uncertainty about how much they’ll have to pay for their stock. This is something we can do to create transparency and fairness in how pre-scription drugs reach customers—our constituents.”

Congressman Collins delivered the key note speech at the opening luncheon at the NCPA legislative conference. He shared his own positive experiences with pharmacists in his own district as well as the healthcare delivered to his family members by pharmacists.

When not in workshops, GPhA mem-bers took to Capitol Hill to visit their Congressmen and Senators and ask for their support of important issues for pharmacists being addressed by Federal legislation. n

The GPhA Goes to Washington

Georgia Pharmacists with Georgia Congressman Doug Collins before he delivers his keynote address.

GPhA members Laird Miller, President Pam Marquess and Ira Katz discuss issues they learned at a NCPA workshop.

NCPA’s CEO Doug Hoey welcomes pharmacists to DC.

Registered Representative of INVEST Financial Corporation, member FINRA/SIPC. INVEST and its a� liated insurance agencies o� er securities, advisory services and certain insurance products and are not a� liated with Financial Network Associates, Inc. Other advisory services o� ered through Financial Network Associates, Inc. ad.10040.110749

Real Financial Planning.No Generics.

It means having real strategies for all your � nancial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their

families and their practices. It means working with an independent � rm you can trust.

Michael T. Tarrant, CFP®• Speaker & Author• PharmPAC Supporter• Creating Real Financial

Planning for over 20 Years

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • mike@FNAplanners.com

Jim Bracewell Executive Vice President

The Georgia Pharmacy Journal

I was recently told a story of a man named Bob who lives in a city some distance from his childhood home and was not able to get back home for his mother’s birthday. His mother is widowed and lives alone so Bob invested several hundred dollars to purchase a well-trained talking parrot for his mother to have as company.

Several days after the parrot was delivered, Bob called to see how much she enjoyed the gift. “Mom... did you get the parrot I sent you and how do you like it?” Bob asked. His mother replied, “Yes, I got that beautiful bird and enjoyed it very much. It was delicious.”

Bob was stunned. “Mom! That parrot cost $600 dollars, spoke 200 words and you cooked it?,” Bob asked.

His mom replied, “Well son... if the parrot was so smart he should have said some-thing.”

Last spring, I accompanied a wonderful young pharmacist on her visit to meet her legislator. We had a great meeting and the two really got acquainted.

After this past legislative session, I went to visit that same legislator to find out why he did not support us on a certain issue. The frustrated legislator said he did not know the

issue was important to pharmacy. “I did not hear anything about it from anyone back home in my district,” he stated.

As a pharmacist and a member of the most over-regulated health profession in America you owe it to yourself, to your career, and to your profession to speak up. It is part of your role. It is part of your profession-al responsibility. All too often the silent voice of pharmacy has led to the undervaluing of the profession and the underutilization of your scope of practice. This silence has led the public to think you can only count by five

and run a computer with a phone in your ear. I’m sure that this is not the picture you want for the second most highly educated health profession in America.

The moral of this story is that pharmacy is much like that beautiful, highly trained par-rot. If we do not speak up for pharmacy, our future will be deliciously consumed by others as a result of our silence.

Your voice is of great value. Do not squawk. Just make sure it’s heard. n

Jim

4

“You owe it to yourself, to your

career, and to your profession

to speak up.”

The Value of Your Voice

The Georgia Pharmacy Journal

M E M B E R N E W S

Hundreds of Independent Phar-macists from all over the USA went to DC for NCPA’s annual legislative con-ference including a dozen from Georgia. While there, they learned about issues that Congress is working to address to improve the profession of pharmacy. Some of the issues that were discussed included Preferred Network Fairness, Provider Status for Pharmacists and Ge-neric Drug Pricing Transparency.

The author of the Generic Drug Pric-ing Transparency Act, HR 4437, is no stranger to members of GPhA. It is for-mer State Representative and now cur-rent Congressman from the 9th District of Georgia, Doug Collins. HR 4437 would allow a pharmacy to know how its individual maximum allowable cost (MAC) reimbursement rates for multi-source generic drugs would be deter-mined. It would also require payments to be updated more frequently to keep pace with actual market costs.

In introducing the bill, Collins said: “A pharmacist often must provide cru-cial, very personal reassurance to their customers. A pharmacist can’t provide certainty to a patient if they’re operating with this kind of uncertainty about how much they’ll have to pay for their stock. This is something we can do to create transparency and fairness in how pre-scription drugs reach customers—our constituents.”

Congressman Collins delivered the key note speech at the opening luncheon at the NCPA legislative conference. He shared his own positive experiences with pharmacists in his own district as well as the healthcare delivered to his family members by pharmacists.

When not in workshops, GPhA mem-bers took to Capitol Hill to visit their Congressmen and Senators and ask for their support of important issues for pharmacists being addressed by Federal legislation. n

The GPhA Goes to Washington

Georgia Pharmacists with Georgia Congressman Doug Collins before he delivers his keynote address.

GPhA members Laird Miller, President Pam Marquess and Ira Katz discuss issues they learned at a NCPA workshop.

NCPA’s CEO Doug Hoey welcomes pharmacists to DC.

M E M B E R N E W S

WELCOME New Members

THE GEORGIA PHARMACY ASSOCIATION

Active PharmacistsJulie Feltman – Chatsworth, GA

Ana Cohen – Atlanta, GAAnn Moss – Rome, GA

Sara Dasher – Claxton, GAVickie Andros – Atlanta, GA

Matthew Frazier – Macon, GA

Pharmacy TechTodd Reed, Jr. – Oakwood, GA

Th e Georgia Pharmacy Journal

NCPA First Vice President Hugh Chancy is also a GPhA member.

Georgia Congressman Austin Scott raced back from the airport just to meet with GPhA members in DC.

Independent Pharmacists from across America attended workshops about many issues facing pharmacy today.

NCPA President Mark Riley gets the crowd fi red up.

Congratulations to Chancy Drugs in Valdosta on their Initial Accredi-tation for Non-Sterile Compounding

by the Pharmacy Compounding Accreditation Board.

Member RECOGNITION

www.phmic.com

your single sourcefor insurance protection

Not licensed to sell all product in all states.

we will be there, standing beside you

from one generation to the nextAt Pharmacists Mutual, we are committed to building lasting relationships with our customers, always promising to focus on our members’ best interests. We are proud to be the leading provider of specialty commercial and personal insurance products and risk management services for the pharmacy profession. Give us a call, we look forward to partnering with you.

Find us on Social Media:

Hutton Madden800.247.5930 ext. 7149

404.375.7209

Seth Swanson800.247.5930 ext. 7128

850.688.3675

M E M B E R N E W S

WELCOME New Members

THE GEORGIA PHARMACY ASSOCIATION

Active PharmacistsJulie Feltman – Chatsworth, GA

Ana Cohen – Atlanta, GAAnn Moss – Rome, GA

Sara Dasher – Claxton, GAVickie Andros – Atlanta, GA

Matthew Frazier – Macon, GA

Pharmacy TechTodd Reed, Jr. – Oakwood, GA

Th e Georgia Pharmacy Journal

NCPA First Vice President Hugh Chancy is also a GPhA member.

Georgia Congressman Austin Scott raced back from the airport just to meet with GPhA members in DC.

Independent Pharmacists from across America attended workshops about many issues facing pharmacy today.

NCPA President Mark Riley gets the crowd fi red up.

Congratulations to Chancy Drugs in Valdosta on their Initial Accredi-tation for Non-Sterile Compounding

by the Pharmacy Compounding Accreditation Board.

Member RECOGNITION

www.phmic.com

your single sourcefor insurance protection

Not licensed to sell all product in all states.

we will be there, standing beside you

from one generation to the nextAt Pharmacists Mutual, we are committed to building lasting relationships with our customers, always promising to focus on our members’ best interests. We are proud to be the leading provider of specialty commercial and personal insurance products and risk management services for the pharmacy profession. Give us a call, we look forward to partnering with you.

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M E M B E R N E W S

The Georgia Pharmacy Journal8

M E M B E R N E W S

GPhA Academy of Independent Pharmacy Board members Tim Short, Laird Miller, Jeff Lurey, Ira Katz and Chris Thurmond pose for a quick picture on Capitol Hill.

Andy Freeman, Wes Chapman, Bobby Moody and Anna Plotkina had the opportunity to meet with Georgia Congressman Sanford Bishop.

Congressman Austin Scott welcomes GPhA members to his office.

GPhA-AIP Director Jeff Lurey is proud the Academy sponsored the opening luncheon, featuring Congressman Doug Collins.

Pharmacists learned about pharmacist candidates running for Congress while at the Legislative Conference.

The panelists encouraged a lot of dialogue with participants.

During a recent Congressional re-cess, GPhA members had members of Congress stopped by their pharmacies to talk about issues that are of importance to our profession.

Congressman Lynn Westmoreland stopped by Wynn’s Pharmacy in Griffin Georgia and met with Carson Gleaton, Drew Miller, Kim Potter, Diane Brown, Blake Daniels, Nick Bland and David Clements. Congressman John Bar-row made it a point to go to Chapman Healthcare Pharmacy in Vidalia while he was recently in his District.

Both Congressmen Barrow and Westmoreland are members of the Con-gressional Pharmacy Caucus but want to know firsthand what goes on in the pharmacies “back home.” n

Congressman John Barrow visits with Wes Chapman at his pharmacy in Vidalia.

Congressman Lynn Westmoreland stopped by Wynn’s Pharmacy in Griffin.

Chapman Healthcare Pharmacy and Wynn’s Pharmacy Enjoy Visits from Congressmen

M E M B E R N E W S

The Georgia Pharmacy Journal8

M E M B E R N E W S

GPhA Academy of Independent Pharmacy Board members Tim Short, Laird Miller, Jeff Lurey, Ira Katz and Chris Thurmond pose for a quick picture on Capitol Hill.

Andy Freeman, Wes Chapman, Bobby Moody and Anna Plotkina had the opportunity to meet with Georgia Congressman Sanford Bishop.

Congressman Austin Scott welcomes GPhA members to his office.

GPhA-AIP Director Jeff Lurey is proud the Academy sponsored the opening luncheon, featuring Congressman Doug Collins.

Pharmacists learned about pharmacist candidates running for Congress while at the Legislative Conference.

The panelists encouraged a lot of dialogue with participants.

During a recent Congressional re-cess, GPhA members had members of Congress stopped by their pharmacies to talk about issues that are of importance to our profession.

Congressman Lynn Westmoreland stopped by Wynn’s Pharmacy in Griffin Georgia and met with Carson Gleaton, Drew Miller, Kim Potter, Diane Brown, Blake Daniels, Nick Bland and David Clements. Congressman John Bar-row made it a point to go to Chapman Healthcare Pharmacy in Vidalia while he was recently in his District.

Both Congressmen Barrow and Westmoreland are members of the Con-gressional Pharmacy Caucus but want to know firsthand what goes on in the pharmacies “back home.” n

Congressman John Barrow visits with Wes Chapman at his pharmacy in Vidalia.

Congressman Lynn Westmoreland stopped by Wynn’s Pharmacy in Griffin.

Chapman Healthcare Pharmacy and Wynn’s Pharmacy Enjoy Visits from Congressmen

Th e Georgia Pharmacy Journal10

M E E T B O B B Y M O O D YM E E T B O B B Y M O O D Y

11Th e Georgia Pharmacy Journal

Rising to the

Challenge - Bobby Moody, GPhA President

2014-15“I think my leadership style would be considered very hands-on.”

Bobby Moody did not always want to be a pharmacist. While growing up in Tift on, he wanted to become a doctor. “My grandfather was a doctor and I always wanted to help peo-ple like he did,” said Bobby. “Most of my family was in the healthcare business in some way,” he added.

Bobby’s parents were nursing home admin-istrators and from the age of 15 he worked in the nursing home doing odd jobs and always attended the nursing home association con-ventions with his parents.

While attending Tift County High School he marched in the Blue Devil Brigade and was section leader his sophomore, junior and senior years. He also marched in the Redcoat Band at UGA and was featured on the football game program when the Bull-dogs played Cal State Fullerton.

“One day I talked to a friend from Tif-ton who was also thinking about going to medical school,” Bobby said. “Th e friend also mentioned pharmacy and I though it sounded like a great option.”

While in pharmacy school at UGA, Bobby met his wife Sherri at a GPhA Convention and over the years they have

enjoyed the companionship of many pets including ferrets, cats, and dogs. Th ey currently have 3 dogs (Snickers, Chunky, and Scooter) who travel most everywhere with them. He also enjoys playing golf, boating, salt water fi shing, and as all his friends know... playing poker.

“I intend to focus on past president Eddie Madden’s Strategic Plan of in-creasing membership and Pamela Mar-

quess’s new Leadership Advancement portion of the Strategic Plan,” says Bob-by. “I believe we can increase member-ship by making sure every pharmacist in Georgia realizes that they are im-portant to the profession, and that their involvement in the GPhA is important to their career,” he added.

“I would also like to start a Lead-ership GPhA Program with 6-10 new practitioners to learn leadership skills

that would help them in their profes-sional careers, personal life, and help them develop into future leaders of the GPhA.”

Bobby’s leadership style could best be described as hands-on. He likes to get input from many sides and then decide the best course of action. In addition he looks forward to the day when pharmacists have provider status, when pharmacists can actually bill for

Bobby has served the GPhA in many ways: as a student mem-ber, Region 6 Presi-dent, member of the PharmPAC Board of Directors, GPhA’s 2nd Vice President and now GPhA President for 2014-15.

obby Moody did not always want to be a pharmacist. While growing up in Tift on, he wanted to become a doctor. “My grandfather was a doctor and I always wanted to help peo-ple like he did,” said Bobby. “Most of my family was in the healthcare business in some way,”

Bobby’s parents were nursing home admin-istrators and from the age of 15 he worked in the nursing home doing odd jobs and always attended the nursing home association con-

Th e Georgia Pharmacy Journal10

M E E T B O B B Y M O O D YM E E T B O B B Y M O O D Y

11Th e Georgia Pharmacy Journal

Rising to the

Challenge - Bobby Moody, GPhA President

2014-15“I think my leadership style would be considered very hands-on.”

Bobby Moody did not always want to be a pharmacist. While growing up in Tift on, he wanted to become a doctor. “My grandfather was a doctor and I always wanted to help peo-ple like he did,” said Bobby. “Most of my family was in the healthcare business in some way,” he added.

Bobby’s parents were nursing home admin-istrators and from the age of 15 he worked in the nursing home doing odd jobs and always attended the nursing home association con-ventions with his parents.

While attending Tift County High School he marched in the Blue Devil Brigade and was section leader his sophomore, junior and senior years. He also marched in the Redcoat Band at UGA and was featured on the football game program when the Bull-dogs played Cal State Fullerton.

“One day I talked to a friend from Tif-ton who was also thinking about going to medical school,” Bobby said. “Th e friend also mentioned pharmacy and I though it sounded like a great option.”

While in pharmacy school at UGA, Bobby met his wife Sherri at a GPhA Convention and over the years they have

enjoyed the companionship of many pets including ferrets, cats, and dogs. Th ey currently have 3 dogs (Snickers, Chunky, and Scooter) who travel most everywhere with them. He also enjoys playing golf, boating, salt water fi shing, and as all his friends know... playing poker.

“I intend to focus on past president Eddie Madden’s Strategic Plan of in-creasing membership and Pamela Mar-

quess’s new Leadership Advancement portion of the Strategic Plan,” says Bob-by. “I believe we can increase member-ship by making sure every pharmacist in Georgia realizes that they are im-portant to the profession, and that their involvement in the GPhA is important to their career,” he added.

“I would also like to start a Lead-ership GPhA Program with 6-10 new practitioners to learn leadership skills

that would help them in their profes-sional careers, personal life, and help them develop into future leaders of the GPhA.”

Bobby’s leadership style could best be described as hands-on. He likes to get input from many sides and then decide the best course of action. In addition he looks forward to the day when pharmacists have provider status, when pharmacists can actually bill for

Bobby has served the GPhA in many ways: as a student mem-ber, Region 6 Presi-dent, member of the PharmPAC Board of Directors, GPhA’s 2nd Vice President and now GPhA President for 2014-15.

obby Moody did not always want to be a pharmacist. While growing up in Tift on, he wanted to become a doctor. “My grandfather was a doctor and I always wanted to help peo-ple like he did,” said Bobby. “Most of my family was in the healthcare business in some way,”

Bobby’s parents were nursing home admin-istrators and from the age of 15 he worked in the nursing home doing odd jobs and always attended the nursing home association con-

Th e Georgia Pharmacy Journal12

M E E T B O B B Y M O O D Y

Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to

use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES.

There is not a singlePharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/

With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

SUPPORT BUDDY CARTER R.Ph FOR CONGRESS

PAID FOR BY BUDDY CARTER FOR CONGRESSCARLTON HODGES, TREASURER

Primary Runoff is July 22. Visit with Buddy at the GPhA Convention - Booth #67services provided. “With the PBM’s un-

derpaying for the cost of medications and decreasing fee payments, we need to work toward getting reimbursed for services we now provide for free,” he stated.

Bobby has served the GPhA in many ways: as a student member, Region 6 Pres-ident, member of the PharmPAC Board of Directors, GPhA’s 2nd Vice President and now GPhA President for 2014-15. Bobby also owns Powells Bloomfi eld Pharmacy, Arlington Rexall Drugs, and Coliseum Park Professional Pharmacy.

His dedication and involvement in the GPhA and the pharmacy profession throughout the years have prepared him well to serve the Association as president. Bobby also realizes that to face the many challenges of pharmacy today, he needs your help.

Bobby begins his term as president at the upcoming GPhA Convention and we hope all of you will congratulate him and join with him as we work together to en-hance the profession of pharmacy. n

Did we mention that Bobby is a Georgia Bulldog fan?

Th e Georgia Pharmacy Journal12

M E E T B O B B Y M O O D Y

Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to

use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES.

There is not a singlePharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/

With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

SUPPORT BUDDY CARTER R.Ph FOR CONGRESS

PAID FOR BY BUDDY CARTER FOR CONGRESSCARLTON HODGES, TREASURER

Primary Runoff is July 22. Visit with Buddy at the GPhA Convention - Booth #67services provided. “With the PBM’s un-

derpaying for the cost of medications and decreasing fee payments, we need to work toward getting reimbursed for services we now provide for free,” he stated.

Bobby has served the GPhA in many ways: as a student member, Region 6 Pres-ident, member of the PharmPAC Board of Directors, GPhA’s 2nd Vice President and now GPhA President for 2014-15. Bobby also owns Powells Bloomfi eld Pharmacy, Arlington Rexall Drugs, and Coliseum Park Professional Pharmacy.

His dedication and involvement in the GPhA and the pharmacy profession throughout the years have prepared him well to serve the Association as president. Bobby also realizes that to face the many challenges of pharmacy today, he needs your help.

Bobby begins his term as president at the upcoming GPhA Convention and we hope all of you will congratulate him and join with him as we work together to en-hance the profession of pharmacy. n

Did we mention that Bobby is a Georgia Bulldog fan?

The Georgia Pharmacy Journal14

M E M B E R N E W S I N D U S T R Y N E W S

GPhA Member Buddy Carter Clinches First Place in May 20th Primary

When the Founding Fathers set up Congress, they wanted the House of Representatives to be the “People’s House” and have members from vari-ous walks of life. Today there are former professional athletes, a comedian, two almond orchard owners and a variety of other occupations making up the mem-bership. When it comes to healthcare occupations 17 doctors, an optometrist, five nurses, three psychologists, two dentists, two veterinarians, one ophthal-mologist and one psychiatrist but there are currently no pharmacists in the US House.

As you may remember, when Con-gressman Jack Kingston announced his intention to run for the US Senate for the seat being vacated by the retiring Saxby Chambliss, a pharmacist, Buddy Carter declared his candidacy for the First Con-gressional District in Georgia. Buddy is a member of GPhA and AIP. He is a previ-ous Mayor and State Representative and currently serves as a State Senator when he isn’t serving his patients at one of his three pharmacies.

Buddy Carter received the most votes out of the six candidates on the May 20 Republican Primary ballot but did not

Governor Nathan Deal is follow-ing through on plans he announced last month to launch clinical trials that could lead to the legal use of oil derived from the marijuana plant to treat children with epilepsy.

The state of Georgia, Salisbury, En-gland-based GW Pharmaceuticals and Georgia Regents University – the state’s medical college – have entered into an agreement to study Epidiolex, a non-psy-choactive derivative of marijuana the company is working to develop.

Families of children with epilepsy lobbied heavily during this year’s Gen-eral Assembly session in support of leg-islation legalizing the use of cannabis

Runoff Set for July 22

have the 50% + 1 vote required by Geor-gia law to avoid a runoff election. Buddy ended up with almost twice the number of the votes cast for Dr. Bob Johnson and the two will meet on the ballot on Tues-day, July 22, 2014 for the runoff election.

Pharmacists have been excited about the prospect of having someone in Con-gress that understands how Government reimbursement rates effect their phar-macy and what PBMs are allowed to do when they are unregulated. n

Senator Carter is interview by WASV Channel 3 as it becomes clear he will be the front runner in the primary.

Senator Buddy Carter and supporters intently watch early returns.

Darwin Carte

r

20,000

15,000

10,000

5,000

0

Buddy Carte

r

Jeff Chapman

Bob Johnson

Earl Martin

John McCallum

18,959

2,812

6,903

11,885

1,060

10,710

Buddy Carter 36.23% Bob Johnson 22.71%

Georgia to Team With Pharmaceutical Company On Medical Marijuana ProjectBy Dave Williams: Staff Writer - Atlanta Business Chronicle

oil in Georgia for treatment of children with seizure disorders. Shortly after the bill died on the session’s last day, the gov-ernor announced he would try to find a way to make the safe and legal use of cannabis oil possible without waiting for lawmakers to return to the Capitol next winter.

“I have learned the stories of brave Georgia families desperately seeking treatment for their children’s debilitating condition,” Deal said Tuesday. “As gov-ernor, it is my responsibility to address the needs of and protect our state’s most vulnerable citizens, especially when they are suffering.

“I’m grateful to Georgia Regents Uni-

versity and GW Pharmaceuticals for their leadership on this venture, and I’m confident that this public-private part-nership will deliver relief and improve quality of life for these children and their families.”

The U.S. Food & Drug Administration has already authorized physician-spon-sored Investigational New Drug pro-grams with Epidiolex involving more than 300 children. In parallel, GW is undertaking a company-sponsored for-mal development program for Epidiolex focusing on the treatment of two rare and severe forms of childhood epilepsy: Dravet syndrome and Lennox-Gastaut syndrome. n

The Georgia Pharmacy Journal14

M E M B E R N E W S I N D U S T R Y N E W S

GPhA Member Buddy Carter Clinches First Place in May 20th Primary

When the Founding Fathers set up Congress, they wanted the House of Representatives to be the “People’s House” and have members from vari-ous walks of life. Today there are former professional athletes, a comedian, two almond orchard owners and a variety of other occupations making up the mem-bership. When it comes to healthcare occupations 17 doctors, an optometrist, five nurses, three psychologists, two dentists, two veterinarians, one ophthal-mologist and one psychiatrist but there are currently no pharmacists in the US House.

As you may remember, when Con-gressman Jack Kingston announced his intention to run for the US Senate for the seat being vacated by the retiring Saxby Chambliss, a pharmacist, Buddy Carter declared his candidacy for the First Con-gressional District in Georgia. Buddy is a member of GPhA and AIP. He is a previ-ous Mayor and State Representative and currently serves as a State Senator when he isn’t serving his patients at one of his three pharmacies.

Buddy Carter received the most votes out of the six candidates on the May 20 Republican Primary ballot but did not

Governor Nathan Deal is follow-ing through on plans he announced last month to launch clinical trials that could lead to the legal use of oil derived from the marijuana plant to treat children with epilepsy.

The state of Georgia, Salisbury, En-gland-based GW Pharmaceuticals and Georgia Regents University – the state’s medical college – have entered into an agreement to study Epidiolex, a non-psy-choactive derivative of marijuana the company is working to develop.

Families of children with epilepsy lobbied heavily during this year’s Gen-eral Assembly session in support of leg-islation legalizing the use of cannabis

Runoff Set for July 22

have the 50% + 1 vote required by Geor-gia law to avoid a runoff election. Buddy ended up with almost twice the number of the votes cast for Dr. Bob Johnson and the two will meet on the ballot on Tues-day, July 22, 2014 for the runoff election.

Pharmacists have been excited about the prospect of having someone in Con-gress that understands how Government reimbursement rates effect their phar-macy and what PBMs are allowed to do when they are unregulated. n

Senator Carter is interview by WASV Channel 3 as it becomes clear he will be the front runner in the primary.

Senator Buddy Carter and supporters intently watch early returns.

Darwin Carte

r

20,000

15,000

10,000

5,000

0

Buddy Carte

r

Jeff Chapman

Bob Johnson

Earl Martin

John McCallum

18,959

2,812

6,903

11,885

1,060

10,710

Buddy Carter 36.23% Bob Johnson 22.71%

Georgia to Team With Pharmaceutical Company On Medical Marijuana ProjectBy Dave Williams: Staff Writer - Atlanta Business Chronicle

oil in Georgia for treatment of children with seizure disorders. Shortly after the bill died on the session’s last day, the gov-ernor announced he would try to find a way to make the safe and legal use of cannabis oil possible without waiting for lawmakers to return to the Capitol next winter.

“I have learned the stories of brave Georgia families desperately seeking treatment for their children’s debilitating condition,” Deal said Tuesday. “As gov-ernor, it is my responsibility to address the needs of and protect our state’s most vulnerable citizens, especially when they are suffering.

“I’m grateful to Georgia Regents Uni-

versity and GW Pharmaceuticals for their leadership on this venture, and I’m confident that this public-private part-nership will deliver relief and improve quality of life for these children and their families.”

The U.S. Food & Drug Administration has already authorized physician-spon-sored Investigational New Drug pro-grams with Epidiolex involving more than 300 children. In parallel, GW is undertaking a company-sponsored for-mal development program for Epidiolex focusing on the treatment of two rare and severe forms of childhood epilepsy: Dravet syndrome and Lennox-Gastaut syndrome. n

The Georgia Pharmacy Journal

I N D U S T R Y N E W SI N D U S T R Y N E W S

Drilling Down on Drug Errors

The Georgia Pharmacy Journal

Professional LicensingMedicare and Medicaid

Fraud and ReimbursementCriminal Defense

Administrative LawHealthcare LawLegal Advice for

Licensed Professionals

WWW.FRANCULLEN.COM

(404) 806-6771 • admin@francullen.com

Representing pharmacists and pharmacies before the Georgia Pharmacy Board, GDNA and DEA.

AREAS OF PRACTICE

One of the staples of the Pharma-cists Mutual Claims Study for the last decade or so has been the listing of the top 10 drugs delivered to patients in the Mechanical Error claims. Mechani-cal Errors are defined as providing the wrong drug, the wrong strength of the

right drug, or the wrong directions on the label. Mechanical Errors occur be-cause of how our brains are wired and how we process information. They are not a refections of competence or intel-ligence. These “human errors” are the most common, making up 85% of the

claims in the study. With any good risk management pro-

gram, techniques must be put in place to minimize the potential for error. In this article, we will go deeper into the data to help you better understand the risk potentials. The examples we will use from the top 11 drugs include warfarin, levothyroxine, insulin, oral hypoglyce-mics and prednisone. The inclusion on this list tells you that these drugs are problematic, but that, in and of itself, doesn’t give you much of a clue as to how they are problematic.

Levothyroxine is delivered to pa-tients in 5.7% of the Mechanical Er-rors claims, making it the second most common drug on the list. Simply telling the staff to be careful when dispensing levothyroxine is not very helpful. How-ever, looking further at the data, we find that two-thirds of the time the wrong strength of levothyroxine is dispensed. This is not surprising considering that there are now 12 strengths available. It is also not surprising that only 3.6% of these claims involve the wrong di-rections since the once daily dose is so ubiquitous. While the 29% of patients who received levothyroxine when they should have received something else isn’t insignificant, it is more efficient to tackle the issue of wrong strength first. It focuses on one issue and gives the great-est potential for a reduction of errors. This same logic holds true for warfarin. Warfarin is delivered incorrectly in 7.1% of the claims. Again, most of these are delivering the wrong strengths of the 9 strengths available. This happens about 60% of the time. There is a little more variability in dosing, we see wrong di-rection errors increase to just over 12%. Patients received warfarin instead of their intended drug in 27.5% of claims.

As with levothyroxine, the greatest po-tential reduction in errors will occur by focusing on the strength dispensed.

The data tells us we don’t want to use this approach when we are dealing with insulin and oral hypoglycemics. Deliver-ing the wrong strength of these drugs is not that frequent, 16% and 9.5% respec-tively. Insulin claims account for 3.3% of our Mechanical Errors and oral hypo-glycemics account for 4.5%. This 7.8% total is significant when the effectiveness of these drugs’ actions is linked to them being frequently dispensed incorrectly. For insulin, patients received the wrong drug 71% of the time. For oral hypogly-cemics, the frequency was a whopping 88.6%! The focus of these two groups of drugs should be making sure that the proper drug is being dispensed. Tech-niques that are useful here are “Show & Tell” counseling and the “NDC” Check. Again, focusing on the 1 of the 3 possible errors that gives the biggest return on ef-fort increases the chance for the staff to receive positive feedback.

The last example is one where nei-ther of the above approaches will work best. Prednisone is the drug delivered in 3.2% of our Mechanical Error claims. For prednisone however, the types of errors involved are more scattered. Pa-tients received the wrong drug in just under 36% of claims. Prednisolone,

By Don McGuire, R.Ph., JD, General Council - Pharmacists Mutual Insurance

You work hard and you really care about your future in the pharmacy profession. � at’s why you support � e Georgia Pharmacy Association and attend the GPhA Convention. But you also deserve time to get out,

enjoy one of the fantastic amenities at the convention and support a very worthy cause - � e Georgia Pharmacy Foundation Student Scholarship Program.

Designed by the great Jack Nicklaus himself, this course is one of the best in Northwest Florida. So take a break and join us on the course that Jack built because as they say,

“all work and no play makes Jack a dull boy.”

Friday, June 27, 2014 � e Nicklaus Course at Bay Point Resort | Panama City Beach, FL

CARLTON HENDERSON MEMORIAL GOLF TOURNAMENT

15th A N N U A L

Georgia Pharmacy Foundation

Play the Course

� at Jack Built.

2014 GPhA Conventionmethylprednisolone, dexamethasone, and other steroids contribute to these errors. Patients received the wrong dose almost 42% of the time. Here there are 6 tablet strengths and 2 concentrations of oral liquids that contribute to these errors. Prednisone is not a drug where we have on overwhelming “regular” dose like levothyroxine does. The result is that wrong directions make up 22% of the prednisone errors. Different factors make it so that no one category domi-nates the type of errors committed.

So how do we proceed with pred-nisone? We might be able to tackle all

3 categories at once if it were the only drug, or one of a few drugs, that we were approaching that way. Tackling all drugs that way would be too overwhelming.

We might also start with the wrong strength situations since that makes up 42% of the claims. Another approach is to examine the error history in your practice setting specifically. Perhaps you vary from the broad sample that contributes to the Pharmacists Mutual Claims Study and a more specific prob-lem will identify itself in your pharmacy.

The data in our Claims Study is drawn form a wide variety of pharma-cies. The value in examining it is that it provides a head start to any pharmacy’s risk management program by trying to learn from other’s mistakes. Specialty pharmacies experiences will likely be different. It is also valuable by providing information about where to attack the whole idea of dispensing errors. Tell-ing someone to be more careful is not terribly effective alone. It is too broad. Telling them to make sure that the right strength of levothyroxine is being dis-pensed is more useful and effective. The key is to get started. Little victories in-spire us too achieve greater victories. n

With any good risk management program, techniques must be put in place to minimize the potential for error.

Coumadin®

Levothyroxine

Anti Diabetic

s

Toprol/MetoprololInsulin

Amoxicillin/Augmentin

®

Prednisone

Amitriptyl

ine/Elavin®

Hydrocodone

Oxycodone

Lisinopril

8.0%

7.0%

6.0%

5.0%

4.0%

3.0%

2.0%

1.0%

0.0%

7.1%

5.7%

4.5%

3.5% 3.4% 3.3% 3.3% 3.2% 3.0%2.7% 2.6%

The Georgia Pharmacy Journal

I N D U S T R Y N E W SI N D U S T R Y N E W S

Drilling Down on Drug Errors

The Georgia Pharmacy Journal

Professional LicensingMedicare and Medicaid

Fraud and ReimbursementCriminal Defense

Administrative LawHealthcare LawLegal Advice for

Licensed Professionals

WWW.FRANCULLEN.COM

(404) 806-6771 • admin@francullen.com

Representing pharmacists and pharmacies before the Georgia Pharmacy Board, GDNA and DEA.

AREAS OF PRACTICE

One of the staples of the Pharma-cists Mutual Claims Study for the last decade or so has been the listing of the top 10 drugs delivered to patients in the Mechanical Error claims. Mechani-cal Errors are defined as providing the wrong drug, the wrong strength of the

right drug, or the wrong directions on the label. Mechanical Errors occur be-cause of how our brains are wired and how we process information. They are not a refections of competence or intel-ligence. These “human errors” are the most common, making up 85% of the

claims in the study. With any good risk management pro-

gram, techniques must be put in place to minimize the potential for error. In this article, we will go deeper into the data to help you better understand the risk potentials. The examples we will use from the top 11 drugs include warfarin, levothyroxine, insulin, oral hypoglyce-mics and prednisone. The inclusion on this list tells you that these drugs are problematic, but that, in and of itself, doesn’t give you much of a clue as to how they are problematic.

Levothyroxine is delivered to pa-tients in 5.7% of the Mechanical Er-rors claims, making it the second most common drug on the list. Simply telling the staff to be careful when dispensing levothyroxine is not very helpful. How-ever, looking further at the data, we find that two-thirds of the time the wrong strength of levothyroxine is dispensed. This is not surprising considering that there are now 12 strengths available. It is also not surprising that only 3.6% of these claims involve the wrong di-rections since the once daily dose is so ubiquitous. While the 29% of patients who received levothyroxine when they should have received something else isn’t insignificant, it is more efficient to tackle the issue of wrong strength first. It focuses on one issue and gives the great-est potential for a reduction of errors. This same logic holds true for warfarin. Warfarin is delivered incorrectly in 7.1% of the claims. Again, most of these are delivering the wrong strengths of the 9 strengths available. This happens about 60% of the time. There is a little more variability in dosing, we see wrong di-rection errors increase to just over 12%. Patients received warfarin instead of their intended drug in 27.5% of claims.

As with levothyroxine, the greatest po-tential reduction in errors will occur by focusing on the strength dispensed.

The data tells us we don’t want to use this approach when we are dealing with insulin and oral hypoglycemics. Deliver-ing the wrong strength of these drugs is not that frequent, 16% and 9.5% respec-tively. Insulin claims account for 3.3% of our Mechanical Errors and oral hypo-glycemics account for 4.5%. This 7.8% total is significant when the effectiveness of these drugs’ actions is linked to them being frequently dispensed incorrectly. For insulin, patients received the wrong drug 71% of the time. For oral hypogly-cemics, the frequency was a whopping 88.6%! The focus of these two groups of drugs should be making sure that the proper drug is being dispensed. Tech-niques that are useful here are “Show & Tell” counseling and the “NDC” Check. Again, focusing on the 1 of the 3 possible errors that gives the biggest return on ef-fort increases the chance for the staff to receive positive feedback.

The last example is one where nei-ther of the above approaches will work best. Prednisone is the drug delivered in 3.2% of our Mechanical Error claims. For prednisone however, the types of errors involved are more scattered. Pa-tients received the wrong drug in just under 36% of claims. Prednisolone,

By Don McGuire, R.Ph., JD, General Council - Pharmacists Mutual Insurance

You work hard and you really care about your future in the pharmacy profession. � at’s why you support � e Georgia Pharmacy Association and attend the GPhA Convention. But you also deserve time to get out,

enjoy one of the fantastic amenities at the convention and support a very worthy cause - � e Georgia Pharmacy Foundation Student Scholarship Program.

Designed by the great Jack Nicklaus himself, this course is one of the best in Northwest Florida. So take a break and join us on the course that Jack built because as they say,

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Friday, June 27, 2014 � e Nicklaus Course at Bay Point Resort | Panama City Beach, FL

CARLTON HENDERSON MEMORIAL GOLF TOURNAMENT

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2014 GPhA Conventionmethylprednisolone, dexamethasone, and other steroids contribute to these errors. Patients received the wrong dose almost 42% of the time. Here there are 6 tablet strengths and 2 concentrations of oral liquids that contribute to these errors. Prednisone is not a drug where we have on overwhelming “regular” dose like levothyroxine does. The result is that wrong directions make up 22% of the prednisone errors. Different factors make it so that no one category domi-nates the type of errors committed.

So how do we proceed with pred-nisone? We might be able to tackle all

3 categories at once if it were the only drug, or one of a few drugs, that we were approaching that way. Tackling all drugs that way would be too overwhelming.

We might also start with the wrong strength situations since that makes up 42% of the claims. Another approach is to examine the error history in your practice setting specifically. Perhaps you vary from the broad sample that contributes to the Pharmacists Mutual Claims Study and a more specific prob-lem will identify itself in your pharmacy.

The data in our Claims Study is drawn form a wide variety of pharma-cies. The value in examining it is that it provides a head start to any pharmacy’s risk management program by trying to learn from other’s mistakes. Specialty pharmacies experiences will likely be different. It is also valuable by providing information about where to attack the whole idea of dispensing errors. Tell-ing someone to be more careful is not terribly effective alone. It is too broad. Telling them to make sure that the right strength of levothyroxine is being dis-pensed is more useful and effective. The key is to get started. Little victories in-spire us too achieve greater victories. n

With any good risk management program, techniques must be put in place to minimize the potential for error.

Coumadin®

Levothyroxine

Anti Diabetic

s

Toprol/MetoprololInsulin

Amoxicillin/Augmentin

®

Prednisone

Amitriptyl

ine/Elavin®

Hydrocodone

Oxycodone

Lisinopril

8.0%

7.0%

6.0%

5.0%

4.0%

3.0%

2.0%

1.0%

0.0%

7.1%

5.7%

4.5%

3.5% 3.4% 3.3% 3.3% 3.2% 3.0%2.7% 2.6%

The Georgia Pharmacy Journal18

Thanks to All Our Supporters Highlight denotes new and increased contributors.

*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.

19The Georgia Pharmacy Journal

NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incor-rect. afreeman@gpha.org 404-419-8118

PharmPac Board of Directors Eddie Madden, ChairmanDean Stone, Region 1Keith Dupree, Region 2Judson Mullican, Region 3Bill McLeer, Region 4Mahlon Davidson, Region 5Mike McGee, Region 6Jim McWilliams, Region 7T.M. Bridges, Region 8Mark Parris, Region 9Chris Thurmond, Region 10Stewart Flanagin, Region 11Henry Josey, Region 12Pam Marquess, Ex-OfficioJim Bracewell, Ex-Officio

Diamond Level$4,800 minimum pledge*Scott Meeks, R.Ph. *Fred Sharpe, R.Ph

Titanium Level$2,400 minimum pledge*Ralph Balchin, R.Ph. T. M. Bridges, R.Ph. 12/14*Ben Cravey, R.Ph.*Michael Farmer, R.Ph.*David Graves, R.Ph. *Raymond Hickman, R.Ph.*Robert Ledbetter, R.Ph.*Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph.*Jeff Sikes, R.Ph.*Danny Smith, R.Ph.*Dean Stone, R.Ph.*Tommy Whitworth, R.Ph.

Platinum Level$1,200 minimum pledgeThomas Bryan, Jr. 12/14*Larry Braden, R.Ph.*William Cagle, R.Ph.*Hugh Chancy, R.Ph.*Keith Chapman, R.Ph.*Dale Coker, R.Ph.*Billy Conley, R.Ph.*Al Dixon Jr., R.Ph.*Ashley Dukes, R.Ph. Patrick Dunham, R.Ph. 3/15*Jack Dunn Jr., R.Ph. *Neal Florence, R.Ph.*Andy Freeman

*Robert Hatton, Pharm.D.Ted Hunt, R.Ph.12/14*Ira Katz, R.Ph.J. Thomas Lindsey, R.Ph. 4/15 Jeff Lurey, R.Ph. 12/14*Eddie Madden, R.Ph.*Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D.*Kenneth McCarthy, R.Ph.*Ivey McCurdy, Pharm. D*Drew Miller, R.Ph.*Laird Miller, R.Ph.*Jay Mosley, R.Ph.*Sujal Patel, Pharm D*Mark Parris, Pharm.D.*Allen Partridge, R.Ph.*Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14*Benjamin Stanley, Pharm.D.*Danny Toth, R.Ph.*Christopher Thurmond, Pharm.D.*Alex Tucker, Pharm.D.Lindsay Walker, R.Ph. 6/14Henry Wilson, Pharm.D. 11/14

Gold Level$600 minimum pledgeJames Bartling, Pharm.D. 6/14*William Brewster, R.Ph.*Liza Chapman, Pharm.D. Carter Clements. Pharm.D. 5/15 *Mahlon Davidson, R.Ph.*Angela DeLay, R.Ph.*Keith Dupree, R.Ph*Stewart Flanagin, R.Ph.*Kevin Florence, Pharm.D.

*Kerry Griffin, R.Ph.*Michael Iteogu, R.Ph.*Joshua Kinsey, Pharm.D.*Dan Kiser, R.Ph.*Allison Layne, C.Ph.TLance LoRusso 6/14 Michael McGee, R.Ph. 4/15*Sheila Miller, Pharm.D.*Robert Moody, R.Ph.*Sherri Moody, Pharm.D.*William Moye, R.Ph.*Anthony Ray, R.Ph.*Jeffrey Richardson, R.Ph.*Andy Rogers, R.Ph. Daniel Royal, R.Ph. 5/15*Michael Tarrant*James Thomas, R.Ph.Zach Tomberlin, Pharm.D. 4/15*Mark White, R.Ph.*Charles Wilson Jr., R.Ph.

Silver Level$300 minimum pledge*Renee Adamson, Pharm.D.Larry Batten, R. Ph. 11/14Lance Boles, R.Ph. 8/14 Robert Cecil, R.Ph. 3/15Laura Coker, Pharm D 6/14*Ed Dozier, R.Ph.*Greg Drake, R. Ph.*Terry Dunn, R.Ph.*Marshall Frost, Pharm.D.*Amanda Gaddy, R. Ph.*Johnathan Hamrick, Pharm.D.*Willie Latch, R.Ph*Hilary Mbadugha, Pharm.D.

*Kalen Manasco, Pharm.D. Max Mason, R.Ph. 3/15*William McLeer, R.Ph.*Sheri Mills, C.Ph.T.*Richard Noell, R.Ph. *Darby Norman, R.Ph.*Cynthia Piela, R.Ph.*Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14*Kristy Pucylowski, Pharm.D.*Edward Reynolds, R.Ph.*Ashley Rickard, Pharm D.*Brian Rickard, Pharm D. Brian Scott, R.Ph. 5/15 Richard Smith, R.Ph. 5/15Flynn Warren, R.Ph. 6/14Steve Wilson, Pharm.D. 7/14*William Wolfe, R.Ph.*Sharon Zerillo, R.Ph.

Bronze Level$150 minimum pledgeMonica Ali-Warren, R.Ph. 6/14*Shane Bentley, Student *Robert Bowles *Mike Crooks, Pharm.D.*Rabun Dekle, R. Ph.Becky Hamilton, Pharm.D. 4/15*Larry Harkleroad, R.Ph.Winton Harris Jr., R.Ph. 6/14 *Hannah Head, Pharm.D.*Amy Grimsley, Pharm.D.*Thomas Jeter, R.Ph. *Henry Josey, Pharm.D.*Brenton Lake, R.Ph.*Tracie Lunde, Pharm.D.

*Michael Lewis, Pharm.D.*Susan McLeer, R.Ph.Judson Mullican, R.Ph. 11/14*Natalie Nielsen, R.Ph.*Mark Niday, R. Ph.*Don Richie, R.Ph. *Amanda Paisley, Pharm.D. Rose Pinkstaff, R.Ph. 1/15*Alex Pinkston IV, R.PhDon Richie, R.Ph. 11/14*Corey Rieck Carlos Rodriguez-Feo, R.Ph. 12/14*Laurence Ryan, Pharm.D.*Olivia Santoso, Pharm. D. Wade Scott, R.Ph. 5/15James Stowe, R.Ph. 12/14*Dana Strickland, R.Ph.G.H. Thurmond, R.Ph. 11/14*Tommy Tolbert, R. Ph.*Austin Tull, Pharm.D.

MembersNo minimum pledgeClaude Bates, R.Ph 6/14Winston Brock, R.Ph. 6/14David Carver, R.Ph. 6/14Marshall Curtis, R.Ph. 6/14Donley Dawson, Pharm.D. 12/14John Drew, R.Ph. 6/14James England, R.Ph. 6/14Martin Grizzard, R.Ph. 12/14Christopher Gurley, R. Ph. 6/14 Lise Hennick, R.Ph. 2/15Marsha Kapiloff, R.Ph. 6/14Charles Kovarik, R. Ph. 6/14Ralph Marett, R.Ph. 6/14

Kenneth McCarthy, R.Ph. 6/14Whitney Pickett, R.Ph. 11/14Michael Reagan, R. Ph 6/14Ola Reffell, R.Ph. 6/14Leonard Reynolds, R.Ph. 6/14Victor Serafy, R.Ph. 6/14Harry Shurley, R.Ph 6/14 Jeff Smith, Pharm.D. 5/15Amanda Stankiewicz, Student 6/14Benjamin Stanley, R.Ph 6/14Krista Stone, R.Ph 6/14John Thomas, R.Ph. 11/14William Thompson, R.Ph. 6/14Carey Vaughan, Pharm.D. 6/14Jonathon Williams R.Ph 8/14*denotes sustaining members

The Georgia Pharmacy Journal18

Thanks to All Our Supporters Highlight denotes new and increased contributors.

*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.

19The Georgia Pharmacy Journal

NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your support or if any information is incor-rect. afreeman@gpha.org 404-419-8118

PharmPac Board of Directors Eddie Madden, ChairmanDean Stone, Region 1Keith Dupree, Region 2Judson Mullican, Region 3Bill McLeer, Region 4Mahlon Davidson, Region 5Mike McGee, Region 6Jim McWilliams, Region 7T.M. Bridges, Region 8Mark Parris, Region 9Chris Thurmond, Region 10Stewart Flanagin, Region 11Henry Josey, Region 12Pam Marquess, Ex-OfficioJim Bracewell, Ex-Officio

Diamond Level$4,800 minimum pledge*Scott Meeks, R.Ph. *Fred Sharpe, R.Ph

Titanium Level$2,400 minimum pledge*Ralph Balchin, R.Ph. T. M. Bridges, R.Ph. 12/14*Ben Cravey, R.Ph.*Michael Farmer, R.Ph.*David Graves, R.Ph. *Raymond Hickman, R.Ph.*Robert Ledbetter, R.Ph.*Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph.*Jeff Sikes, R.Ph.*Danny Smith, R.Ph.*Dean Stone, R.Ph.*Tommy Whitworth, R.Ph.

Platinum Level$1,200 minimum pledgeThomas Bryan, Jr. 12/14*Larry Braden, R.Ph.*William Cagle, R.Ph.*Hugh Chancy, R.Ph.*Keith Chapman, R.Ph.*Dale Coker, R.Ph.*Billy Conley, R.Ph.*Al Dixon Jr., R.Ph.*Ashley Dukes, R.Ph. Patrick Dunham, R.Ph. 3/15*Jack Dunn Jr., R.Ph. *Neal Florence, R.Ph.*Andy Freeman

*Robert Hatton, Pharm.D.Ted Hunt, R.Ph.12/14*Ira Katz, R.Ph.J. Thomas Lindsey, R.Ph. 4/15 Jeff Lurey, R.Ph. 12/14*Eddie Madden, R.Ph.*Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D.*Kenneth McCarthy, R.Ph.*Ivey McCurdy, Pharm. D*Drew Miller, R.Ph.*Laird Miller, R.Ph.*Jay Mosley, R.Ph.*Sujal Patel, Pharm D*Mark Parris, Pharm.D.*Allen Partridge, R.Ph.*Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14*Benjamin Stanley, Pharm.D.*Danny Toth, R.Ph.*Christopher Thurmond, Pharm.D.*Alex Tucker, Pharm.D.Lindsay Walker, R.Ph. 6/14Henry Wilson, Pharm.D. 11/14

Gold Level$600 minimum pledgeJames Bartling, Pharm.D. 6/14*William Brewster, R.Ph.*Liza Chapman, Pharm.D. Carter Clements. Pharm.D. 5/15 *Mahlon Davidson, R.Ph.*Angela DeLay, R.Ph.*Keith Dupree, R.Ph*Stewart Flanagin, R.Ph.*Kevin Florence, Pharm.D.

*Kerry Griffin, R.Ph.*Michael Iteogu, R.Ph.*Joshua Kinsey, Pharm.D.*Dan Kiser, R.Ph.*Allison Layne, C.Ph.TLance LoRusso 6/14 Michael McGee, R.Ph. 4/15*Sheila Miller, Pharm.D.*Robert Moody, R.Ph.*Sherri Moody, Pharm.D.*William Moye, R.Ph.*Anthony Ray, R.Ph.*Jeffrey Richardson, R.Ph.*Andy Rogers, R.Ph. Daniel Royal, R.Ph. 5/15*Michael Tarrant*James Thomas, R.Ph.Zach Tomberlin, Pharm.D. 4/15*Mark White, R.Ph.*Charles Wilson Jr., R.Ph.

Silver Level$300 minimum pledge*Renee Adamson, Pharm.D.Larry Batten, R. Ph. 11/14Lance Boles, R.Ph. 8/14 Robert Cecil, R.Ph. 3/15Laura Coker, Pharm D 6/14*Ed Dozier, R.Ph.*Greg Drake, R. Ph.*Terry Dunn, R.Ph.*Marshall Frost, Pharm.D.*Amanda Gaddy, R. Ph.*Johnathan Hamrick, Pharm.D.*Willie Latch, R.Ph*Hilary Mbadugha, Pharm.D.

*Kalen Manasco, Pharm.D. Max Mason, R.Ph. 3/15*William McLeer, R.Ph.*Sheri Mills, C.Ph.T.*Richard Noell, R.Ph. *Darby Norman, R.Ph.*Cynthia Piela, R.Ph.*Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14*Kristy Pucylowski, Pharm.D.*Edward Reynolds, R.Ph.*Ashley Rickard, Pharm D.*Brian Rickard, Pharm D. Brian Scott, R.Ph. 5/15 Richard Smith, R.Ph. 5/15Flynn Warren, R.Ph. 6/14Steve Wilson, Pharm.D. 7/14*William Wolfe, R.Ph.*Sharon Zerillo, R.Ph.

Bronze Level$150 minimum pledgeMonica Ali-Warren, R.Ph. 6/14*Shane Bentley, Student *Robert Bowles *Mike Crooks, Pharm.D.*Rabun Dekle, R. Ph.Becky Hamilton, Pharm.D. 4/15*Larry Harkleroad, R.Ph.Winton Harris Jr., R.Ph. 6/14 *Hannah Head, Pharm.D.*Amy Grimsley, Pharm.D.*Thomas Jeter, R.Ph. *Henry Josey, Pharm.D.*Brenton Lake, R.Ph.*Tracie Lunde, Pharm.D.

*Michael Lewis, Pharm.D.*Susan McLeer, R.Ph.Judson Mullican, R.Ph. 11/14*Natalie Nielsen, R.Ph.*Mark Niday, R. Ph.*Don Richie, R.Ph. *Amanda Paisley, Pharm.D. Rose Pinkstaff, R.Ph. 1/15*Alex Pinkston IV, R.PhDon Richie, R.Ph. 11/14*Corey Rieck Carlos Rodriguez-Feo, R.Ph. 12/14*Laurence Ryan, Pharm.D.*Olivia Santoso, Pharm. D. Wade Scott, R.Ph. 5/15James Stowe, R.Ph. 12/14*Dana Strickland, R.Ph.G.H. Thurmond, R.Ph. 11/14*Tommy Tolbert, R. Ph.*Austin Tull, Pharm.D.

MembersNo minimum pledgeClaude Bates, R.Ph 6/14Winston Brock, R.Ph. 6/14David Carver, R.Ph. 6/14Marshall Curtis, R.Ph. 6/14Donley Dawson, Pharm.D. 12/14John Drew, R.Ph. 6/14James England, R.Ph. 6/14Martin Grizzard, R.Ph. 12/14Christopher Gurley, R. Ph. 6/14 Lise Hennick, R.Ph. 2/15Marsha Kapiloff, R.Ph. 6/14Charles Kovarik, R. Ph. 6/14Ralph Marett, R.Ph. 6/14

Kenneth McCarthy, R.Ph. 6/14Whitney Pickett, R.Ph. 11/14Michael Reagan, R. Ph 6/14Ola Reffell, R.Ph. 6/14Leonard Reynolds, R.Ph. 6/14Victor Serafy, R.Ph. 6/14Harry Shurley, R.Ph 6/14 Jeff Smith, Pharm.D. 5/15Amanda Stankiewicz, Student 6/14Benjamin Stanley, R.Ph 6/14Krista Stone, R.Ph 6/14John Thomas, R.Ph. 11/14William Thompson, R.Ph. 6/14Carey Vaughan, Pharm.D. 6/14Jonathon Williams R.Ph 8/14*denotes sustaining members

21The Georgia Pharmacy JournalThe Georgia Pharmacy Journal20

Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio

continuing educat ion for pharmacists

Advances in the Treatment of Pulmonary Hypertension: Focus on Adempas and Opsumit

Volume XXXII, No. 4

Dr. Thomas A. Gossel has no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on pulmonary hypertension and its therapy, with emphasis on two recently approved drugs, macitentan (Opsumit®) and riociguat (Adempas®).

Objectives. At the completion of this activity, the participant will be able to:

1. recognize signs and symp-toms, and key features of pul-monary hypertension including information on its prevalence;

2. identify the drugs by generic name, trade name, and chemical name when relevant;

3. recognize the indication(s), pharmacologic action(s), clinical application(s), and route of admin-istration for each drug;

4. demonstrate an understand-ing of adverse effects and toxicity, warnings, precautions, contraindi-cations, and significant drug-drug interactions; and

5. list important information to convey to patients and/or their caregivers.

Pulmonary hypertension (PH) is a hemodynamic and pathophysi-ologic condition. Both progressive and debilitating, with a median survival of only 2.8 years following diagnosis if left untreated, PH is defined as mean pulmonary artery pressure (mPAP) of 25 mmHg or greater at rest. The normal mPAP is 12 to 16 mmHg. Patients with PH have a sustained increase in

pulmonary arterial pressure that results from excessive vasoconstric-tion of the pulmonary arteries. The workload of the heart’s right ven-tricle is therefore increased, lead-ing to its failure and, eventually, death. Treatment of PH is largely palliative, and disease progres-sion continues despite availability of drugs that are specific for the disorder.

This lesson reviews PH and provides a brief introduction to

the drugs used in its treatment with focus on two newly approved therapies. The lesson is not meant to extend beyond an overview of the topic. The reader is, therefore, urged to consult the products’ full Prescribing Information leaflet (package insert), Medication Guide, and other published reference sources for detailed descriptions.

Background The World Health Organiza-

Table 1WHO categories of pulmonary hypertension

Group 1 pulmonary arterial hypertension includes: •PAH that has no known cause (idiopathic) •PAH that is inherited (genetic) •PAH caused by drugs or toxins, such as street drugs and certain diet medications •PAH caused by conditions such as connective tissue diseases, HIV infection, liver infec-tion, chronic hemolytic anemia, sickle cell disease, schistosomiasis (one of the most common causes of PAH in many parts of the world) •PAH caused by conditions that affect the pulmonary vasculature

Group 2 pulmonary hypertension includes: •PH due to left heart disease. Conditions that affect the left side of the heart, such as mi-tral valve disease or long-term hypertension, can cause left heart disease and PH. Left heart disease is likely the most common cause of PH.

Group 3 pulmonary hypertension includes: •PH associated with lung disease and/or hypoxia, such as COPD* and interstitial lung diseases. Interstitial lung diseases cause scarring of lung tissue. Group 3 also includes PH associated with sleep-disordered breathing, chronic exposure to high altitude, and develop-mental abnormalities.

Group 4 pulmonary hypertension includes: •PH caused by chronic thromboembolic disease characterized by obstruction of the pulmo-nary vasculature by residual organized thrombi, leading to increased pulmonary vascular resistance, progressive PH, and right ventricular failure

Group 5 pulmonary hypertension includes: •PH caused by various other diseases or conditions. Examples include blood diseases such as polycythemia vera, thrombocythemia; systemic disorders such as sarcoidosis, vasculitis; and metabolic disorders such as thyroid disease and glycogen storage disease •PH caused by other conditions such as tumors that press on the pulmonary arteries and kidney disease

*COPD – chronic obstructive pulmonary disease

tion (WHO) recognizes a number of etiologies that cause PH and divides them into five categories of disease (Table 1). These groups are organized based on the cause of PH and treatment options. Note that Group 1 is referred to as pulmo-nary arterial hypertension (PAH) and Groups 2 through 5 are called pulmonary hypertension. However, together, all Groups are collectively called pulmonary hypertension.

In addition to the etiological classification of PH, patients can also be classified according to their functional abilities and symptom severity (Table 2). The WHO clas-sification of functional capacity is modeled after the New York Heart Association’s classification system for heart failure and is commonly used in both daily practice and clinical trials to describe patients. The WHO functional class is de-termined from the patient’s own

subjective impression of physi-cal ability and symptom severity. The indications for FDA-approved treatments of PH specify the WHO classification.

The terms “primary” and “sec-ondary” PH are historical and even though they are still mentioned informally in association with the various forms of the disease, their use is now discouraged. The terms suggest clinically inappropriate groupings of the disorders and may thus promote inadequate therapeu-tic decision making.

Pathogenesis. Left heart disease is the most common cause of PH. There is, however, a rela-tive lack of data on the frequency of pathologic pulmonary vascular changes in this heterogeneous group of patients. WHO Group 1 PAH is predominantly a disease of the distal pulmonary arteries (i.e., pulmonary artery vasculopathy). Associated pathology includes pulmonary arterial vasoconstric-tion, medial hypertrophy, intimal proliferation and fibrosis, complex plexiform lesions, and thrombotic lesions. Pathologic changes in PAH typically onset as a compensated phase characterized by abnormal pulmonary artery endothelium, pulmonary arterial vasoconstric-tion and stiffening, loss of micro-vessels, and right ventricle hyper-trophy. As PAH progresses, pulmo-nary vascular intimal proliferation, obliterative pulmonary artery remodeling, and pulmonary vas-cular fibrosis occur and eventually progress to right ventricle dilation and failure.

Symptoms. Progressive dys-pnea is the most common symptom of PH, being the initial symptom in greater than half of patients with PH. It ultimately appears in approximately 85 percent of patients. Since exertional dyspnea is a common symptom of multiple cardiopulmonary pathologies, and PH is relatively uncommon with many primary care physicians never encountering a case, clini-cians need a high index of suspi-cion to correctly identify patients with the condition, especially those

who present at a younger age and patients diagnosed with concurrent asthma. Even as awareness of the disease has increased over the past two decades, delay from symptom onset to diagnosis is still consider-able, with 20 percent of patients experiencing symptoms for longer than two years before a diagnosis of PH is made and treatment is initiated.

Other symptoms include fa-tigue (26 percent), chest pain (22 percent), lower-extremity edema (20 percent), presyncope/syncope (17 percent), and palpitations (12 percent). As PH worsens, patients may find it difficult to undertake any physical activity. A rare symp-tom known as the Ortner syndrome is characterized by onset of hoarse-ness from compression of the left laryngeal nerve by an enlarged pulmonary artery.

Prognosis. PH is considered a negative prognostic sign in many pathologic conditions, including the most commonly associated ones, such as heart failure and chronic obstructive pulmonary disease (COPD). For heart failure, elevated pulmonary arterial pressure on right heart catheterization is a powerful predictor of premature mortality, particularly in the set-ting of myocarditis or decreased right ventricular ejection fraction. Likewise, patients with COPD and more severe PH have a poorer prognosis. Treatment directed at PH has not been linked to im-proved outcomes in either of these pathologic conditions.

As noted earlier, the prognosis of untreated PH is poor, with a median survival of 2.8 years, and an estimated one-year survival of only 68 percent. Treatment with approved therapies has improved survival and quality of life, if initiated early in the course of the disease. But PH continues to be a life threatening condition.

Treatment of Pulmonary Hypertension Appropriate treatment for PH relies on identification of its cause. For persons with chronic cardiac

Table 2WHO functional

classification for patients with pulmonary

hypertensionClass Description I Patients with PH but with- out resulting limitations of physical activity; ordinary physical activity does not cause undue dyspnea or fa- tigue, chest pain, or near syncope

II Patients with PH resulting in slight limitation of physical activity; they are comfortable at rest; ordinary physical activity causes undue dys-pnea or fatigue, chest pain, or near syncope

III Patients with PH resulting in marked limitation of physical activity; they are comfortable at rest; less-than-ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near syncope

IV Patients with PH with an inability to carry out any physical activity without symptoms; these patients manifest signs of right heart failure; dyspnea and/or fatigue can even be present at rest; discomfort is increased by any physical activity

21The Georgia Pharmacy JournalThe Georgia Pharmacy Journal20

Thomas A. Gossel, R.Ph., Ph.D., Professor Emeritus, Ohio Northern University, Ada, Ohio

continuing educat ion for pharmacists

Advances in the Treatment of Pulmonary Hypertension: Focus on Adempas and Opsumit

Volume XXXII, No. 4

Dr. Thomas A. Gossel has no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on pulmonary hypertension and its therapy, with emphasis on two recently approved drugs, macitentan (Opsumit®) and riociguat (Adempas®).

Objectives. At the completion of this activity, the participant will be able to:

1. recognize signs and symp-toms, and key features of pul-monary hypertension including information on its prevalence;

2. identify the drugs by generic name, trade name, and chemical name when relevant;

3. recognize the indication(s), pharmacologic action(s), clinical application(s), and route of admin-istration for each drug;

4. demonstrate an understand-ing of adverse effects and toxicity, warnings, precautions, contraindi-cations, and significant drug-drug interactions; and

5. list important information to convey to patients and/or their caregivers.

Pulmonary hypertension (PH) is a hemodynamic and pathophysi-ologic condition. Both progressive and debilitating, with a median survival of only 2.8 years following diagnosis if left untreated, PH is defined as mean pulmonary artery pressure (mPAP) of 25 mmHg or greater at rest. The normal mPAP is 12 to 16 mmHg. Patients with PH have a sustained increase in

pulmonary arterial pressure that results from excessive vasoconstric-tion of the pulmonary arteries. The workload of the heart’s right ven-tricle is therefore increased, lead-ing to its failure and, eventually, death. Treatment of PH is largely palliative, and disease progres-sion continues despite availability of drugs that are specific for the disorder.

This lesson reviews PH and provides a brief introduction to

the drugs used in its treatment with focus on two newly approved therapies. The lesson is not meant to extend beyond an overview of the topic. The reader is, therefore, urged to consult the products’ full Prescribing Information leaflet (package insert), Medication Guide, and other published reference sources for detailed descriptions.

Background The World Health Organiza-

Table 1WHO categories of pulmonary hypertension

Group 1 pulmonary arterial hypertension includes: •PAH that has no known cause (idiopathic) •PAH that is inherited (genetic) •PAH caused by drugs or toxins, such as street drugs and certain diet medications •PAH caused by conditions such as connective tissue diseases, HIV infection, liver infec-tion, chronic hemolytic anemia, sickle cell disease, schistosomiasis (one of the most common causes of PAH in many parts of the world) •PAH caused by conditions that affect the pulmonary vasculature

Group 2 pulmonary hypertension includes: •PH due to left heart disease. Conditions that affect the left side of the heart, such as mi-tral valve disease or long-term hypertension, can cause left heart disease and PH. Left heart disease is likely the most common cause of PH.

Group 3 pulmonary hypertension includes: •PH associated with lung disease and/or hypoxia, such as COPD* and interstitial lung diseases. Interstitial lung diseases cause scarring of lung tissue. Group 3 also includes PH associated with sleep-disordered breathing, chronic exposure to high altitude, and develop-mental abnormalities.

Group 4 pulmonary hypertension includes: •PH caused by chronic thromboembolic disease characterized by obstruction of the pulmo-nary vasculature by residual organized thrombi, leading to increased pulmonary vascular resistance, progressive PH, and right ventricular failure

Group 5 pulmonary hypertension includes: •PH caused by various other diseases or conditions. Examples include blood diseases such as polycythemia vera, thrombocythemia; systemic disorders such as sarcoidosis, vasculitis; and metabolic disorders such as thyroid disease and glycogen storage disease •PH caused by other conditions such as tumors that press on the pulmonary arteries and kidney disease

*COPD – chronic obstructive pulmonary disease

tion (WHO) recognizes a number of etiologies that cause PH and divides them into five categories of disease (Table 1). These groups are organized based on the cause of PH and treatment options. Note that Group 1 is referred to as pulmo-nary arterial hypertension (PAH) and Groups 2 through 5 are called pulmonary hypertension. However, together, all Groups are collectively called pulmonary hypertension.

In addition to the etiological classification of PH, patients can also be classified according to their functional abilities and symptom severity (Table 2). The WHO clas-sification of functional capacity is modeled after the New York Heart Association’s classification system for heart failure and is commonly used in both daily practice and clinical trials to describe patients. The WHO functional class is de-termined from the patient’s own

subjective impression of physi-cal ability and symptom severity. The indications for FDA-approved treatments of PH specify the WHO classification.

The terms “primary” and “sec-ondary” PH are historical and even though they are still mentioned informally in association with the various forms of the disease, their use is now discouraged. The terms suggest clinically inappropriate groupings of the disorders and may thus promote inadequate therapeu-tic decision making.

Pathogenesis. Left heart disease is the most common cause of PH. There is, however, a rela-tive lack of data on the frequency of pathologic pulmonary vascular changes in this heterogeneous group of patients. WHO Group 1 PAH is predominantly a disease of the distal pulmonary arteries (i.e., pulmonary artery vasculopathy). Associated pathology includes pulmonary arterial vasoconstric-tion, medial hypertrophy, intimal proliferation and fibrosis, complex plexiform lesions, and thrombotic lesions. Pathologic changes in PAH typically onset as a compensated phase characterized by abnormal pulmonary artery endothelium, pulmonary arterial vasoconstric-tion and stiffening, loss of micro-vessels, and right ventricle hyper-trophy. As PAH progresses, pulmo-nary vascular intimal proliferation, obliterative pulmonary artery remodeling, and pulmonary vas-cular fibrosis occur and eventually progress to right ventricle dilation and failure.

Symptoms. Progressive dys-pnea is the most common symptom of PH, being the initial symptom in greater than half of patients with PH. It ultimately appears in approximately 85 percent of patients. Since exertional dyspnea is a common symptom of multiple cardiopulmonary pathologies, and PH is relatively uncommon with many primary care physicians never encountering a case, clini-cians need a high index of suspi-cion to correctly identify patients with the condition, especially those

who present at a younger age and patients diagnosed with concurrent asthma. Even as awareness of the disease has increased over the past two decades, delay from symptom onset to diagnosis is still consider-able, with 20 percent of patients experiencing symptoms for longer than two years before a diagnosis of PH is made and treatment is initiated.

Other symptoms include fa-tigue (26 percent), chest pain (22 percent), lower-extremity edema (20 percent), presyncope/syncope (17 percent), and palpitations (12 percent). As PH worsens, patients may find it difficult to undertake any physical activity. A rare symp-tom known as the Ortner syndrome is characterized by onset of hoarse-ness from compression of the left laryngeal nerve by an enlarged pulmonary artery.

Prognosis. PH is considered a negative prognostic sign in many pathologic conditions, including the most commonly associated ones, such as heart failure and chronic obstructive pulmonary disease (COPD). For heart failure, elevated pulmonary arterial pressure on right heart catheterization is a powerful predictor of premature mortality, particularly in the set-ting of myocarditis or decreased right ventricular ejection fraction. Likewise, patients with COPD and more severe PH have a poorer prognosis. Treatment directed at PH has not been linked to im-proved outcomes in either of these pathologic conditions.

As noted earlier, the prognosis of untreated PH is poor, with a median survival of 2.8 years, and an estimated one-year survival of only 68 percent. Treatment with approved therapies has improved survival and quality of life, if initiated early in the course of the disease. But PH continues to be a life threatening condition.

Treatment of Pulmonary Hypertension Appropriate treatment for PH relies on identification of its cause. For persons with chronic cardiac

Table 2WHO functional

classification for patients with pulmonary

hypertensionClass Description I Patients with PH but with- out resulting limitations of physical activity; ordinary physical activity does not cause undue dyspnea or fa- tigue, chest pain, or near syncope

II Patients with PH resulting in slight limitation of physical activity; they are comfortable at rest; ordinary physical activity causes undue dys-pnea or fatigue, chest pain, or near syncope

III Patients with PH resulting in marked limitation of physical activity; they are comfortable at rest; less-than-ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near syncope

IV Patients with PH with an inability to carry out any physical activity without symptoms; these patients manifest signs of right heart failure; dyspnea and/or fatigue can even be present at rest; discomfort is increased by any physical activity

The Georgia Pharmacy Journal22 23The Georgia Pharmacy Journal

or pulmonary disease, therapy is largely focused on treating the underlying condition.

To date, the majority of drug development in PH has been fo-cused on patients with WHO Group 1 PAH. Approved therapies fall into one of three classes of pulmo-nary vasodilators: (1) prostacyclin analogues, (2) endothelin receptor antagonists (ERAs), and (3) phos-phodiesterase-5 inhibitors. These are collectively termed “advanced therapies” (Table 3), and are avail-able for oral, inhaled, subcutane-ous, and intravenous administra-tion. Each therapy targets a differ-ent cellular pathway implicated in the pathogenesis of PAH.

Prostacyclin Analogues. Prostacyclin is also referred to as prostaglandin I2 (PGI2). Prostacy-clins were the first available tar-geted treatment for PAH and are at present considered the corner-stone of therapy. They have potent vasodilatory, antiplatelet, and antiproliferative properties on the pulmonary vasculature and their synthesis is reduced in patients with PAH. Synthetic prostacyclin derivatives augment decreased prostacyclin levels.

Endothelin Receptor An-tagonists. Endothelin is a potent vasoconstrictor and stimulator of smooth muscle cell proliferation. It contributes to the regulation of

vascular tone by binding to ETA and ETB receptor subtypes in the pulmonary vasculature. Activation of ETA receptors results in vasocon-striction and cellular proliferation. Pharmacotherapeutic influence in these reactions, therefore, is a primary target of ERAs. ETB is thought to have a regulatory effect on endothelin; however, the clinical relevance of blocking this recep-tor is unknown. Endothelin may be overexpressed in patients with PAH and, hence, is an important drug target.

Risks related to treatment with ERAs are well known, and include elevations in liver aminotransfer-ases and edema. Their effect on the liver is possibly a class effect and necessitates monitoring of liver function in patients treated with these compounds. The voluntary withdrawal from the world market of the ERA, sitaxsentan, with ces-sation of all ongoing clinical trials because of cases of unpredictable serious liver injury, illustrates the need for new compounds that have reduced hepatic liability. The drug was never approved in the United States.

Similarly, a reduced risk of edema would constitute a major ad-vance and would allow for the ap-plication of ERAs in other diseases. This is demonstrated by recent findings with the experimental

ERA, darusentan, in patients with treatment-resistant hypertension. While darusentan provided addi-tional reduction in blood pressure in patients in whom hypertension could not be controlled adequately with available drugs, edema oc-curred in 27 percent of patients compared with 14 percent in patients treated with placebo. The drug’s future for approval in the United States remains in question at present.

The mechanism by which ERAs induce liver aminotransferases is unknown. It has been hypothesized that inhibition of the bile salt export pump, a transporter protein involved in mediating secretion of bile salts across the canalicular plasma membrane of hepatocytes, results in intracellular accumula-tion of bile salts with subsequent hepatic injury. The occurrence of edema is possibly caused by circu-lating endothelin-1 via activation of the ETB receptor, suggesting that ERAs that block both ETA and ETB receptors are less prone to causing edema.

Phosphodiesterase Type-5 Inhibitors. Phosphodiesterase type-5 (PDE-5) inhibitors work via the nitric oxide (NO) pathway. They are responsible for the deg-radation of cyclic guanosine mo-nophosphate (cGMP), which plays an important role in regulating processes that influence vascular tone, proliferation, fibrosis, and in-flammation. PH is associated with impaired NO release and reduc-tion of cGMP concentration in the pulmonary tissue. PDE-5s increase cGMP concentration resulting in relaxation of the smooth muscle cells leading to vasodilation of the pulmonary vessels. Intracellular cGMP plays an important role in regulating processes that influ-ence vascular tone, proliferation, fibrosis, and inflammation. PH is associated with endothelial dys-function, impaired synthesis of NO, and insufficient stimulation of the NO-sGC-cGMP pathway.

Combination Therapy. The current status of PH treatment is based on sequential addition of

Table 3Advanced therapies for pulmonary hypertension

Drug Class Mechanism of Action Prostacyclin analogues Stimulates intracellular production of Epoprostenol (Flolan, Veletri) cAMP±

Iloprost (Ventavis) Treprostinil (Remodulin, Tyvaso) Endothelin-receptor antagonists Blocks endothelin-1 receptors on vascular Ambrisentan (Letairis) smooth muscle Bosentan (Tracleer) Phosphodiesterase-5 inhibitors Inhibits breakdown of cGMP§ in vascular Sildenafil (Revatio, Viagra*) smooth muscle Tadalafil (Adcirca, Cialis*)

±cAMP – cyclic adenosine monophosphate§cGMP – cyclic guanosine monophosphate*Cialis and Viagra are not indicated for treatment of PH

advanced therapies. Therapy is chosen initially by assessing illness severity and patient functional class, along with integrating pa-tient preferences and adverse effect profiles of the medications being considered. If PH worsens despite optimum dosing of a single agent, additional therapies from different pharmacologic groups are usually added until treatment goals are reached.

Extending Survival and Quality of LifeA significant number of patients with PH experience little or no improvement despite available therapies, and mortality remains high despite treatment. There is, therefore, an unmet need for drugs that extend survival and improve quality of life in PH patients, while also having a favorable safety profile and a convenient mode of administration.

New drugs with novel mecha-nisms of action are at various levels of development. At present, clinicians are challenged not by having too few therapeutic options, but by having to choose among the various treatments available, monitoring patients for stability, and recognizing when to escalate pharmacotherapy or consider surgi-cal options (lung transplantation or atrial septostomy). Atrial septo-stomy is a surgical procedure in which a small hole is created between the heart’s two atria. This relieves some of the pressure with-in the pulmonary vasculature, but at the expense of reduced oxygen levels in the heart (hypoxia).

Goals of Therapy. The goals of therapy are to prevent advance-ment of the disease; decrease hospi-tal admissions; and improve qual-ity of life (decreased symptoms), WHO functional class (increased activity levels), hemodynamics, 6-minute walk results, and overall survival. Specific PH therapy is usually started for symptomatic patients in WHO functional classes II, III, or IV if they fail to show no acute vasoreactivity or if they did not maintain an acceptable sus-

tained response to calcium chan-nel blockers. General supportive measures are listed in Table 4.

Recently Approved DrugsTwo new drugs for PH were ap-proved in October 2013 (Table 5). The two drugs differ in their basic pharmacology, but both share one troublesome toxicologic effect – they both may cause fetal harm when administered to pregnant females.

Because of this potential toxic-ity, female patients can receive the new drugs only through the manufacturers’ Risk Evaluation and Mitigation Strategy (REMS) program. All female patients must be enrolled in the program, comply with pregnancy testing require-ments and be counseled regarding the need for effective contraception. The REMS restricted distribution program requires prescribers to be certified by enrolling in the pro-gram. Also, pharmacies must be certified and can dispense the new drugs only to patients who are eli-gible to receive it. Males need not be enrolled in the program.

Riociguat (Adempas)Indications and Use. Adempas (a-dem-pahs) was the first drug of any class to be shown to be ef-fective for patients with chronic thromboembolic PH (CTEPH). It is indicated for treatment of adults with persistent/recurrent CTEPH (WHO Group 4) following surgical treatment or inoperable CTEPH, to improve exercise capacity and WHO functional class. It is also in-dicated to treat PAH (WHO Group 1), to improve exercise capacity, improve WHO functional class, and to delay clinical worsening.

Mechanism of Action. Rio-ciguat has a dual mode of action. It sensitizes sGC to endogenous NO by stabilizing the NO-sGC binding. The drug also directly stimulates sGC via a different binding site, in-dependently of NO. The drug stim-ulates the NO-sGC-cGMP pathway and leads to increased generation of cGMP with subsequent vasodi-lation. The active metabolite of

riociguat is 1/3 to 1/10 as potent as the parent drug in vitro.

Efficacy and Safety. Safety and effectiveness of Adempas to treat CTEPH were established in a clinical trial with 261 participants randomized to take Adempas with the dose gradually increased up to 2.5 mg three times daily, or to receive a placebo three times daily. The study was designed to measure the change in distance a patient could walk in six minutes. After 16 weeks of treatment, the average improvement in a six-minute walk distance in participants treated with Adempas was 46 meters (about 150 feet) more than in those treated with placebo.

The clinical trial evaluating the safety and effectiveness of Adem-pas to treat PAH included 443 participants randomly assigned to

Table 4General supportive

measures for patients with pulmonary hypertensionGeneral recommendations •Symptom-limited exercise•Avoid hypobaric environments, including high-altitude travel •Avoid medications with vasocon-strictive properties (e.g., pseudo-ephedrine)•Discourage pregnancy due to high maternal mortality•Avoid oral contraceptives with pro-thrombotic properties

Medical therapy •Anticoagulation to a target INR of 1.5 to 2.5; recommended for most patients•Oxygen supplementation for hypox-emia•Diuretics for management of edema or fluid retention, especially in the setting of right ventricular failure•Consider digoxin, particularly for patients with a high sympathetic activation or with concomitant atrial fibrillation or biventricular failure•Long-term calcium channel block-ers for patients who have a genuine acute vasoreactivity test and calcium channel blocker challenge without significant side effect, (fewer than 7 percent of patients are in this sub-group)

The Georgia Pharmacy Journal22 23The Georgia Pharmacy Journal

or pulmonary disease, therapy is largely focused on treating the underlying condition.

To date, the majority of drug development in PH has been fo-cused on patients with WHO Group 1 PAH. Approved therapies fall into one of three classes of pulmo-nary vasodilators: (1) prostacyclin analogues, (2) endothelin receptor antagonists (ERAs), and (3) phos-phodiesterase-5 inhibitors. These are collectively termed “advanced therapies” (Table 3), and are avail-able for oral, inhaled, subcutane-ous, and intravenous administra-tion. Each therapy targets a differ-ent cellular pathway implicated in the pathogenesis of PAH.

Prostacyclin Analogues. Prostacyclin is also referred to as prostaglandin I2 (PGI2). Prostacy-clins were the first available tar-geted treatment for PAH and are at present considered the corner-stone of therapy. They have potent vasodilatory, antiplatelet, and antiproliferative properties on the pulmonary vasculature and their synthesis is reduced in patients with PAH. Synthetic prostacyclin derivatives augment decreased prostacyclin levels.

Endothelin Receptor An-tagonists. Endothelin is a potent vasoconstrictor and stimulator of smooth muscle cell proliferation. It contributes to the regulation of

vascular tone by binding to ETA and ETB receptor subtypes in the pulmonary vasculature. Activation of ETA receptors results in vasocon-striction and cellular proliferation. Pharmacotherapeutic influence in these reactions, therefore, is a primary target of ERAs. ETB is thought to have a regulatory effect on endothelin; however, the clinical relevance of blocking this recep-tor is unknown. Endothelin may be overexpressed in patients with PAH and, hence, is an important drug target.

Risks related to treatment with ERAs are well known, and include elevations in liver aminotransfer-ases and edema. Their effect on the liver is possibly a class effect and necessitates monitoring of liver function in patients treated with these compounds. The voluntary withdrawal from the world market of the ERA, sitaxsentan, with ces-sation of all ongoing clinical trials because of cases of unpredictable serious liver injury, illustrates the need for new compounds that have reduced hepatic liability. The drug was never approved in the United States.

Similarly, a reduced risk of edema would constitute a major ad-vance and would allow for the ap-plication of ERAs in other diseases. This is demonstrated by recent findings with the experimental

ERA, darusentan, in patients with treatment-resistant hypertension. While darusentan provided addi-tional reduction in blood pressure in patients in whom hypertension could not be controlled adequately with available drugs, edema oc-curred in 27 percent of patients compared with 14 percent in patients treated with placebo. The drug’s future for approval in the United States remains in question at present.

The mechanism by which ERAs induce liver aminotransferases is unknown. It has been hypothesized that inhibition of the bile salt export pump, a transporter protein involved in mediating secretion of bile salts across the canalicular plasma membrane of hepatocytes, results in intracellular accumula-tion of bile salts with subsequent hepatic injury. The occurrence of edema is possibly caused by circu-lating endothelin-1 via activation of the ETB receptor, suggesting that ERAs that block both ETA and ETB receptors are less prone to causing edema.

Phosphodiesterase Type-5 Inhibitors. Phosphodiesterase type-5 (PDE-5) inhibitors work via the nitric oxide (NO) pathway. They are responsible for the deg-radation of cyclic guanosine mo-nophosphate (cGMP), which plays an important role in regulating processes that influence vascular tone, proliferation, fibrosis, and in-flammation. PH is associated with impaired NO release and reduc-tion of cGMP concentration in the pulmonary tissue. PDE-5s increase cGMP concentration resulting in relaxation of the smooth muscle cells leading to vasodilation of the pulmonary vessels. Intracellular cGMP plays an important role in regulating processes that influ-ence vascular tone, proliferation, fibrosis, and inflammation. PH is associated with endothelial dys-function, impaired synthesis of NO, and insufficient stimulation of the NO-sGC-cGMP pathway.

Combination Therapy. The current status of PH treatment is based on sequential addition of

Table 3Advanced therapies for pulmonary hypertension

Drug Class Mechanism of Action Prostacyclin analogues Stimulates intracellular production of Epoprostenol (Flolan, Veletri) cAMP±

Iloprost (Ventavis) Treprostinil (Remodulin, Tyvaso) Endothelin-receptor antagonists Blocks endothelin-1 receptors on vascular Ambrisentan (Letairis) smooth muscle Bosentan (Tracleer) Phosphodiesterase-5 inhibitors Inhibits breakdown of cGMP§ in vascular Sildenafil (Revatio, Viagra*) smooth muscle Tadalafil (Adcirca, Cialis*)

±cAMP – cyclic adenosine monophosphate§cGMP – cyclic guanosine monophosphate*Cialis and Viagra are not indicated for treatment of PH

advanced therapies. Therapy is chosen initially by assessing illness severity and patient functional class, along with integrating pa-tient preferences and adverse effect profiles of the medications being considered. If PH worsens despite optimum dosing of a single agent, additional therapies from different pharmacologic groups are usually added until treatment goals are reached.

Extending Survival and Quality of LifeA significant number of patients with PH experience little or no improvement despite available therapies, and mortality remains high despite treatment. There is, therefore, an unmet need for drugs that extend survival and improve quality of life in PH patients, while also having a favorable safety profile and a convenient mode of administration.

New drugs with novel mecha-nisms of action are at various levels of development. At present, clinicians are challenged not by having too few therapeutic options, but by having to choose among the various treatments available, monitoring patients for stability, and recognizing when to escalate pharmacotherapy or consider surgi-cal options (lung transplantation or atrial septostomy). Atrial septo-stomy is a surgical procedure in which a small hole is created between the heart’s two atria. This relieves some of the pressure with-in the pulmonary vasculature, but at the expense of reduced oxygen levels in the heart (hypoxia).

Goals of Therapy. The goals of therapy are to prevent advance-ment of the disease; decrease hospi-tal admissions; and improve qual-ity of life (decreased symptoms), WHO functional class (increased activity levels), hemodynamics, 6-minute walk results, and overall survival. Specific PH therapy is usually started for symptomatic patients in WHO functional classes II, III, or IV if they fail to show no acute vasoreactivity or if they did not maintain an acceptable sus-

tained response to calcium chan-nel blockers. General supportive measures are listed in Table 4.

Recently Approved DrugsTwo new drugs for PH were ap-proved in October 2013 (Table 5). The two drugs differ in their basic pharmacology, but both share one troublesome toxicologic effect – they both may cause fetal harm when administered to pregnant females.

Because of this potential toxic-ity, female patients can receive the new drugs only through the manufacturers’ Risk Evaluation and Mitigation Strategy (REMS) program. All female patients must be enrolled in the program, comply with pregnancy testing require-ments and be counseled regarding the need for effective contraception. The REMS restricted distribution program requires prescribers to be certified by enrolling in the pro-gram. Also, pharmacies must be certified and can dispense the new drugs only to patients who are eli-gible to receive it. Males need not be enrolled in the program.

Riociguat (Adempas)Indications and Use. Adempas (a-dem-pahs) was the first drug of any class to be shown to be ef-fective for patients with chronic thromboembolic PH (CTEPH). It is indicated for treatment of adults with persistent/recurrent CTEPH (WHO Group 4) following surgical treatment or inoperable CTEPH, to improve exercise capacity and WHO functional class. It is also in-dicated to treat PAH (WHO Group 1), to improve exercise capacity, improve WHO functional class, and to delay clinical worsening.

Mechanism of Action. Rio-ciguat has a dual mode of action. It sensitizes sGC to endogenous NO by stabilizing the NO-sGC binding. The drug also directly stimulates sGC via a different binding site, in-dependently of NO. The drug stim-ulates the NO-sGC-cGMP pathway and leads to increased generation of cGMP with subsequent vasodi-lation. The active metabolite of

riociguat is 1/3 to 1/10 as potent as the parent drug in vitro.

Efficacy and Safety. Safety and effectiveness of Adempas to treat CTEPH were established in a clinical trial with 261 participants randomized to take Adempas with the dose gradually increased up to 2.5 mg three times daily, or to receive a placebo three times daily. The study was designed to measure the change in distance a patient could walk in six minutes. After 16 weeks of treatment, the average improvement in a six-minute walk distance in participants treated with Adempas was 46 meters (about 150 feet) more than in those treated with placebo.

The clinical trial evaluating the safety and effectiveness of Adem-pas to treat PAH included 443 participants randomly assigned to

Table 4General supportive

measures for patients with pulmonary hypertensionGeneral recommendations •Symptom-limited exercise•Avoid hypobaric environments, including high-altitude travel •Avoid medications with vasocon-strictive properties (e.g., pseudo-ephedrine)•Discourage pregnancy due to high maternal mortality•Avoid oral contraceptives with pro-thrombotic properties

Medical therapy •Anticoagulation to a target INR of 1.5 to 2.5; recommended for most patients•Oxygen supplementation for hypox-emia•Diuretics for management of edema or fluid retention, especially in the setting of right ventricular failure•Consider digoxin, particularly for patients with a high sympathetic activation or with concomitant atrial fibrillation or biventricular failure•Long-term calcium channel block-ers for patients who have a genuine acute vasoreactivity test and calcium channel blocker challenge without significant side effect, (fewer than 7 percent of patients are in this sub-group)

The Georgia Pharmacy Journal24 25The Georgia Pharmacy Journal

take the drug at a dose of 1.5 mg or 2.5 mg, or placebo, three times dai-ly. After 12 weeks of treatment, the 6-minute walk distance in patients treated with Adempas improved by an average of 36 meters (about 118 feet) more than in patients treated with placebo.

Common adverse effects observed in patients treated with Adempas included headache, dizzi-ness, indigestion, tissue swelling, nausea, diarrhea, and vomiting.

Warnings, Precautions and Contraindications. The follow-ing warnings and precautions are listed.

•Symptomatic hypotension: Adempas reduces blood pressure. Consider dose reductions if the patient develops signs or symptoms of hypotension.

•Bleeding: Serious hemorrhag-ic events can occur. Monitor patient for signs and symptoms.

•Pulmonary edema in patients with pulmonary veno-occlusive disease: Discontinue treatment if confirmed.

•A boxed warning advises that the drug should not be used dur-ing pregnancy, and that the drug is available only through a restricted distribution program.

Three contraindications are listed: pregnancy, use with nitrates or NO donors in any form (e.g., amyl nitrite), and use with phosphodiesterase inhibitors (e.g.,

dipyridamole, theophylline, silde-nafil, tadalafil, vardenafil).

Drug Interactions. Noted specifically are strong CYP and P-glycoprotein/breast cancer resis-tance protein (P-gp/BCRP) inhibi-tors. For patients receiving strong CYP and P-gp/BCRP inhibitors (e.g., ketoconazole, itraconazole, ritonavir), consider a starting dose of 0.5 mg three times a day. Monitor for hypotension. Antacids such as aluminum- or magnesium hydroxide decrease riociguat ab-sorption, so doses of antacids and riociguat should be separated by at least one hour.

Administration, Dosing, and Counseling. Initiate treatment at 1 mg three times a day. For pa-tients who may not tolerate the hy-potensive effect, consider a starting dose of 0.5 mg three times a day. Dosage may be increased by 0.5 mg intervals of no sooner than two weeks as tolerated, to a maximum dose of 2.5 mg three times a day. If a dose is missed, continue with the next regularly scheduled dose. In the event that Adempas dosing is interrupted for three or more days, re-titrate the drug.

Plasma concentrations are reduced 50 to 60 percent in smok-ers. Consider titrating to dosages higher than 2.5 mg three times a day if tolerated in patients who smoke to match exposure seen in non-smokers. A decrease in dosage

may be required in patients who stop smoking.

Adempas is available in tab-lets containing 0.5 mg, 1 mg, 1.5 mg, 2 mg, and 2.5 mg of riociguat. Specific points for counseling are summarized in Table 6.

Macitentan (Opsumit)Opsumit (OP-sum-it) is the second new drug approved during October, 2013 for treatment of PH.

Table 5New drugs for treatment of pulmonary hypertension

Generic Distributor Indication Dose Dosage Medication Name Form Guide

Macitentan Actelion PAH* (WHO 10 mg 10 mg Yes (Opsumit) Pharmaceu- Group 1) once tablets ticals US, Inc. daily Riociguat Bayer Health- PAH* (WHO 1 mg 0.5 mg, 1 mg, Yes (Adempas) Care Pharma- Group 1); three 1.5 mg, 2 mg, ceuticals Inc. CTEPH± times and 2.5 mg (WHO daily Group 4) (range: 0.5 mg to 2.5 mg three times daily)

*PAH – Pulmonary Arterial Hypertension±CTEPH – Chronic Thromboembolic Pulmonary Hypertension

Table 6Patient information for

riociguat (Adempas)* Patients:•should read the Medication Guide carefully and talk with their pharma-cist or physician if they have ques-tions.•(females) should use emergency con-traception in the event of unprotected sex or contraceptive failure. Females must sign an enrollment form to reg-ister in the Adempas REMS Program; males are not required to do so.•(pre-pubertal females) should report any changes in her reproductive sta-tus immediately to her prescriber.•should be aware of the potential risks/signs of coughing up blood caused by the drug, and must contact their physician right away if signs/symptoms appear.•should be aware it is important to stick closely to the dosing, titra-tion, and maintenance of Adempas. If a dose is missed, patients should continue with the next regularly scheduled dose. In event the drug is interrupted for three or more days, the dose should be re-titrated.•should report all current medicines and new medicines to their physician.•should not take antacids within one hour of taking Adempas.•should be aware Adempas can cause dizziness, which can affect the ability to drive and use machines. •should be aware they should not use Adempas for a condition other than for what it was prescribed, or give it to other people, even if their symp-toms are the same.•should be aware that Adempas should be stored at room temperature between 59oF to 86oF (15oC to 30oC). *Summarized from the FDA-approved Medication Guide

Indications and Use. The new drug is an ERA indicated for treatment of PAH (WHO Group 1) to delay disease progression. Dur-ing clinical trials, disease progres-sion included: death, initiation of intravenous or subcutaneous prostanoids, or clinical worsening of PAH (decreased six-minute walk distance, worsened PAH symptoms and need for additional PAH treat-ment). The new drug also reduced hospitalizations for PAH.

Mechanism of Action. En-dothelin (ET)-1 and its receptors (ETA and ETB) mediate a variety of deleterious effects, such as vaso-constriction, fibrosis, proliferation, hypertrophy, and inflammation. In

disease conditions such as PAH, the local ET system is upregulated and is involved in vascular hy-pertrophy and in organ damage. Macitentan is an ERA with high lipophilicity that prevents the bind-ing of ET-1 to both ETA and ETB receptors. The dual ERA was de-veloped by modifying the structure of bosentan (Tracleer) to increase efficacy and safety. The new drug is characterized by sustained receptor binding and enhanced tissue pen-etration. Macitentan displays high affinity and sustained occupancy of the ET receptors in human pulmo-nary arterial smooth muscle cells. One of the metabolites of maciten-tan is also pharmacologically active at the ET receptors and is estimat-ed to be about 20 percent as potent as the parent drug in vitro.

Efficacy and Safety. Safety and effectiveness were established primarily in one long-term clinical trial where 742 participants were randomly assigned to take Opsumit or placebo. The average treatment duration was about two years. In the study, Opsumit was effective in delaying disease progression, which includes a decline in exercise ability, worsening symptoms of PAH, or need for additional PAH medication.

Common side effects observed in persons treated with Opsumit included low red blood cell count, common cold-like symptoms (naso-pharyngitis), sore throat, bronchi-tis, headache, flu and urinary tract infection.

Warnings, Precautions and Contraindications. The following warnings and precautions are listed.

•Other ERAs cause hepatotoxic-ity and liver failure. Obtain base-line liver enzyme levels and moni-tor as clinically indicated.

•Decreases in hemoglobin: Decreases in hemoglobin concen-tration and hematocrit have been reported. Measure the hemoglobin prior to initiation of treatment and repeat during treatment as clini-cally indicated.

•Pulmonary edema in patients with pulmonary veno-occlusive

disease: If confirmed, discontinue treatment.

•Decreased sperm count: Other ERAs have caused adverse effects on spermatogenesis.

•A boxed warning advises that the drug should not be used dur-ing pregnancy, and that the drug is available only through the Opsumit REMS Program.

The sole contraindication listed is pregnancy.

Drug Interactions. Strong inducers of CYP3A4 (e.g., rifampin) significantly reduce macitentan exposure, thus concomitant use should be avoided. Concomitant use of strong CYP3A4 inhibitors (e.g., ketoconazole) approximately doubles macitentan exposure. Many HIV drugs such as ritonavir are strong inhibitors of CYP3A4. Avoid concomitant use of Opsumit with strong CYP3A4 inhibitors.

Administration, Dosing, and Counseling. The recommended dosage is 10 mg once daily orally. Doses higher than 10 mg once daily have not been studied in patients with PAH and are not recom-mended.

Opsumit tablets contain 10 mg of macitentan. Specific points for counseling are summa-rized in Table 7.

Patient EducationIn general, patients should be counseled that PH is a complex dis-ease and markedly different than systemic hypertension. Regardless of its cause, serious PH almost al-ways indicates significant systemic disease that requires ongoing, closely coordinated medical care, and close attention to salt intake, fluid balance, and home weight monitoring. Patients with PH may need to self-administer medications that have complex instructions, self-monitor for adverse effects or progression of disease, and help ensure that concomitant health care issues do not compromise or adversely interact with their PH regimen. Patients should also be informed of available information and peer support opportunities. Of tremendous assistance to both

Table 7Patient information for macitentan (Opsumit)*

Patients:•should read the Medication Guide carefully and talk with their pharma-cist or physician if they have ques-tions.•(females) may experience fetal harm when Opsumit is used during pregnancy. Instruct females to use effective contraception and to contact her physician if she suspects she may be pregnant. Females must sign an enrollment form to register in the Opsumit REMS Program; males are not required to do so.•(pre-pubertal females) should report any changes in her reproductive sta-tus immediately to her prescriber.•should get hemoglobin levels tested as the physician recommends.•should be aware the drug may inter-fere with spermatogenesis.•should be aware of signs of hepa-totoxicity, and contact their doctor if they have unexplained nausea, vomiting, right upper quadrant pain, fatigue, anorexia, jaundice, dark urine, fever, or itching. •should not split, crush, or chew Opsumit tablets.•should store Opsumit tablets at 20oC to 25oC (68oF to 77oF), with ex-cursions permitted between 15oC and 30oC (59oF and 86oF)

*Summarized from the FDA-approved Medication Guide.

The Georgia Pharmacy Journal24 25The Georgia Pharmacy Journal

take the drug at a dose of 1.5 mg or 2.5 mg, or placebo, three times dai-ly. After 12 weeks of treatment, the 6-minute walk distance in patients treated with Adempas improved by an average of 36 meters (about 118 feet) more than in patients treated with placebo.

Common adverse effects observed in patients treated with Adempas included headache, dizzi-ness, indigestion, tissue swelling, nausea, diarrhea, and vomiting.

Warnings, Precautions and Contraindications. The follow-ing warnings and precautions are listed.

•Symptomatic hypotension: Adempas reduces blood pressure. Consider dose reductions if the patient develops signs or symptoms of hypotension.

•Bleeding: Serious hemorrhag-ic events can occur. Monitor patient for signs and symptoms.

•Pulmonary edema in patients with pulmonary veno-occlusive disease: Discontinue treatment if confirmed.

•A boxed warning advises that the drug should not be used dur-ing pregnancy, and that the drug is available only through a restricted distribution program.

Three contraindications are listed: pregnancy, use with nitrates or NO donors in any form (e.g., amyl nitrite), and use with phosphodiesterase inhibitors (e.g.,

dipyridamole, theophylline, silde-nafil, tadalafil, vardenafil).

Drug Interactions. Noted specifically are strong CYP and P-glycoprotein/breast cancer resis-tance protein (P-gp/BCRP) inhibi-tors. For patients receiving strong CYP and P-gp/BCRP inhibitors (e.g., ketoconazole, itraconazole, ritonavir), consider a starting dose of 0.5 mg three times a day. Monitor for hypotension. Antacids such as aluminum- or magnesium hydroxide decrease riociguat ab-sorption, so doses of antacids and riociguat should be separated by at least one hour.

Administration, Dosing, and Counseling. Initiate treatment at 1 mg three times a day. For pa-tients who may not tolerate the hy-potensive effect, consider a starting dose of 0.5 mg three times a day. Dosage may be increased by 0.5 mg intervals of no sooner than two weeks as tolerated, to a maximum dose of 2.5 mg three times a day. If a dose is missed, continue with the next regularly scheduled dose. In the event that Adempas dosing is interrupted for three or more days, re-titrate the drug.

Plasma concentrations are reduced 50 to 60 percent in smok-ers. Consider titrating to dosages higher than 2.5 mg three times a day if tolerated in patients who smoke to match exposure seen in non-smokers. A decrease in dosage

may be required in patients who stop smoking.

Adempas is available in tab-lets containing 0.5 mg, 1 mg, 1.5 mg, 2 mg, and 2.5 mg of riociguat. Specific points for counseling are summarized in Table 6.

Macitentan (Opsumit)Opsumit (OP-sum-it) is the second new drug approved during October, 2013 for treatment of PH.

Table 5New drugs for treatment of pulmonary hypertension

Generic Distributor Indication Dose Dosage Medication Name Form Guide

Macitentan Actelion PAH* (WHO 10 mg 10 mg Yes (Opsumit) Pharmaceu- Group 1) once tablets ticals US, Inc. daily Riociguat Bayer Health- PAH* (WHO 1 mg 0.5 mg, 1 mg, Yes (Adempas) Care Pharma- Group 1); three 1.5 mg, 2 mg, ceuticals Inc. CTEPH± times and 2.5 mg (WHO daily Group 4) (range: 0.5 mg to 2.5 mg three times daily)

*PAH – Pulmonary Arterial Hypertension±CTEPH – Chronic Thromboembolic Pulmonary Hypertension

Table 6Patient information for

riociguat (Adempas)* Patients:•should read the Medication Guide carefully and talk with their pharma-cist or physician if they have ques-tions.•(females) should use emergency con-traception in the event of unprotected sex or contraceptive failure. Females must sign an enrollment form to reg-ister in the Adempas REMS Program; males are not required to do so.•(pre-pubertal females) should report any changes in her reproductive sta-tus immediately to her prescriber.•should be aware of the potential risks/signs of coughing up blood caused by the drug, and must contact their physician right away if signs/symptoms appear.•should be aware it is important to stick closely to the dosing, titra-tion, and maintenance of Adempas. If a dose is missed, patients should continue with the next regularly scheduled dose. In event the drug is interrupted for three or more days, the dose should be re-titrated.•should report all current medicines and new medicines to their physician.•should not take antacids within one hour of taking Adempas.•should be aware Adempas can cause dizziness, which can affect the ability to drive and use machines. •should be aware they should not use Adempas for a condition other than for what it was prescribed, or give it to other people, even if their symp-toms are the same.•should be aware that Adempas should be stored at room temperature between 59oF to 86oF (15oC to 30oC). *Summarized from the FDA-approved Medication Guide

Indications and Use. The new drug is an ERA indicated for treatment of PAH (WHO Group 1) to delay disease progression. Dur-ing clinical trials, disease progres-sion included: death, initiation of intravenous or subcutaneous prostanoids, or clinical worsening of PAH (decreased six-minute walk distance, worsened PAH symptoms and need for additional PAH treat-ment). The new drug also reduced hospitalizations for PAH.

Mechanism of Action. En-dothelin (ET)-1 and its receptors (ETA and ETB) mediate a variety of deleterious effects, such as vaso-constriction, fibrosis, proliferation, hypertrophy, and inflammation. In

disease conditions such as PAH, the local ET system is upregulated and is involved in vascular hy-pertrophy and in organ damage. Macitentan is an ERA with high lipophilicity that prevents the bind-ing of ET-1 to both ETA and ETB receptors. The dual ERA was de-veloped by modifying the structure of bosentan (Tracleer) to increase efficacy and safety. The new drug is characterized by sustained receptor binding and enhanced tissue pen-etration. Macitentan displays high affinity and sustained occupancy of the ET receptors in human pulmo-nary arterial smooth muscle cells. One of the metabolites of maciten-tan is also pharmacologically active at the ET receptors and is estimat-ed to be about 20 percent as potent as the parent drug in vitro.

Efficacy and Safety. Safety and effectiveness were established primarily in one long-term clinical trial where 742 participants were randomly assigned to take Opsumit or placebo. The average treatment duration was about two years. In the study, Opsumit was effective in delaying disease progression, which includes a decline in exercise ability, worsening symptoms of PAH, or need for additional PAH medication.

Common side effects observed in persons treated with Opsumit included low red blood cell count, common cold-like symptoms (naso-pharyngitis), sore throat, bronchi-tis, headache, flu and urinary tract infection.

Warnings, Precautions and Contraindications. The following warnings and precautions are listed.

•Other ERAs cause hepatotoxic-ity and liver failure. Obtain base-line liver enzyme levels and moni-tor as clinically indicated.

•Decreases in hemoglobin: Decreases in hemoglobin concen-tration and hematocrit have been reported. Measure the hemoglobin prior to initiation of treatment and repeat during treatment as clini-cally indicated.

•Pulmonary edema in patients with pulmonary veno-occlusive

disease: If confirmed, discontinue treatment.

•Decreased sperm count: Other ERAs have caused adverse effects on spermatogenesis.

•A boxed warning advises that the drug should not be used dur-ing pregnancy, and that the drug is available only through the Opsumit REMS Program.

The sole contraindication listed is pregnancy.

Drug Interactions. Strong inducers of CYP3A4 (e.g., rifampin) significantly reduce macitentan exposure, thus concomitant use should be avoided. Concomitant use of strong CYP3A4 inhibitors (e.g., ketoconazole) approximately doubles macitentan exposure. Many HIV drugs such as ritonavir are strong inhibitors of CYP3A4. Avoid concomitant use of Opsumit with strong CYP3A4 inhibitors.

Administration, Dosing, and Counseling. The recommended dosage is 10 mg once daily orally. Doses higher than 10 mg once daily have not been studied in patients with PAH and are not recom-mended.

Opsumit tablets contain 10 mg of macitentan. Specific points for counseling are summa-rized in Table 7.

Patient EducationIn general, patients should be counseled that PH is a complex dis-ease and markedly different than systemic hypertension. Regardless of its cause, serious PH almost al-ways indicates significant systemic disease that requires ongoing, closely coordinated medical care, and close attention to salt intake, fluid balance, and home weight monitoring. Patients with PH may need to self-administer medications that have complex instructions, self-monitor for adverse effects or progression of disease, and help ensure that concomitant health care issues do not compromise or adversely interact with their PH regimen. Patients should also be informed of available information and peer support opportunities. Of tremendous assistance to both

Table 7Patient information for macitentan (Opsumit)*

Patients:•should read the Medication Guide carefully and talk with their pharma-cist or physician if they have ques-tions.•(females) may experience fetal harm when Opsumit is used during pregnancy. Instruct females to use effective contraception and to contact her physician if she suspects she may be pregnant. Females must sign an enrollment form to register in the Opsumit REMS Program; males are not required to do so.•(pre-pubertal females) should report any changes in her reproductive sta-tus immediately to her prescriber.•should get hemoglobin levels tested as the physician recommends.•should be aware the drug may inter-fere with spermatogenesis.•should be aware of signs of hepa-totoxicity, and contact their doctor if they have unexplained nausea, vomiting, right upper quadrant pain, fatigue, anorexia, jaundice, dark urine, fever, or itching. •should not split, crush, or chew Opsumit tablets.•should store Opsumit tablets at 20oC to 25oC (68oF to 77oF), with ex-cursions permitted between 15oC and 30oC (59oF and 86oF)

*Summarized from the FDA-approved Medication Guide.

27The Georgia Pharmacy Journal The Georgia Pharmacy Journal26

Please turn to CorrespondenceCourse Quiz on page 23.

Program 0129-0000-14-004-H01-PRelease date: 4-15-14

Expiration date: 4-15-17CE Hours: 1.5 (0.15 CEU)

The author, the Ohio Pharmacists Foundation and the Ohio Phar-macists Association disclaim any liability to you or your patients resulting from reliance solely upon the information contained herein. Bibliography for additional read-ing and inquiry is available upon request.

This lesson is a knowledge-based CE activity and is targeted to phar-macists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

patients and pharmacists is infor-mation provided by the Pulmonary Hypertension Association (www.phassociation.org). This site also includes advice for newly diagnosed patients.

Overview and Summary PH is a relatively rare disease even though its etiological consid-erations are common. The disease is caused by a variety of etiolo-gies characterized by pulmonary vasculopathy with endothelial dysfunction, cellular proliferation, and elevated pulmonary vascular resistance. Over the previous two decades there have been profound advancements in PH targeted treatments, resulting in symptom improvement, slowed disease pro-gression, and improved survival. Two recently approved drugs have been added to the treatment arma-mentarium. Overall, further ad-vancements are needed to prolong life expectancy and improve quality of life in these patients.

continuing educat ion quiz Advances in the Treatment of PulmonaryHypertension: Focus on Adempas and Opsumit

Program 0129-0000-14-004-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

NABP e-Profile ID____________Birthdate_________ (MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

Completely fill in the lettered box corresponding to 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] [d] 12. [a] [b] [c] [d] 3. [a] [b] [c] [d] 8. [a] [b] [c] [d] 13. [a] [b] [c] [d] 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.

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)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. Median survival time following diagnosis in persons with untreated pulmonary hypertension is: a. 1.5 years. c. 2.8 years. b. 2.0 years. d. 3.2 years. 2. The World Health Organization (WHO) recognizes how many categories of pulmonary hypertension? a. 1 c. 5 b. 3 d. 7

3. The majority of drug development in pulmonary hyper-tension has been focused on patients in which of the follow-ing WHO groups? a. 1 c. 5 b. 3 d. 7 4. Prostacyclin is also known as prostaglandin: a. E1. c. I1. b. E2. d. I2.

5. A drug from the pharmacologic class of compounds considered to be the cornerstone of therapy for pulmonary hypertension is: a. bosetan. c. tadalafil. b. epoprostenol. d. ambrisentan.

6. Which of the following drugs is responsible for the degradation of cyclic guanosine monophosphate (cGMP) in treating pulmonary hypertension? a. Ventavis c. Tracleer b. Remodulin d. Revatio 7. All of the following are goals of therapy in treating pul-monary hypertension EXCEPT to: a. prevent advancement of the disease. b. decrease activity levels. c. improve quality of life. d. decrease hospital admissions.

8. The product approved for treating patients with chronic thromboembolic pulmonary hypertension is: a. Adempas. c. Opsumit. b. Adcirca. d. Flolan.

9. All of the following are contraindications to use of rio-ciguat EXCEPT: a. pregnancy. b. decreased hemoglobin. c. use with nitrates. d. use with phosphodiesterase inhibitors.

10. Patients taking Adempas should be advised to avoid taking which of the following drugs within one hour of Adempas? a. Decongestants c. Antihistamines b. Cathartics d. Antacids

11. Plasma concentrations of riociguat may be reduced by how much in smokers? a. 20 to 30 percent c. 40 to 50 percent b. 30 to 40 percent d. 50 to 60 percent

12. Opsumit is classified as a/an: a. endothelin receptor antagonist. b. prostacyclin derivative. c. phosphodiesterase-5 inhibitor. d. janus kinase inhibitor.

13. Macitentan was developed by modifying the chemical structure of: a. bosentan. c. treprostinil. b. ambrisentan. d. tadalafil.

14. All of the following are precautions/warnings for use of macitentan EXCEPT: a. decreased hemoglobin. c. symptomatic hypotension. b. pulmonary edema. d. decreased sperm count.

15. Advice for persons taking Opsumit includes: a. avoid driving or operating heavy machinery. b. keep unopened bottles of Opsumit refrigerated. c. do not crush or chew tablets. d. avoid sunlight or exposure to UV bulbs.

To receive CE credit, your quiz must be received no later than April 15, 2017. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to opa@ohiopharmacists.org.

apri l 2014

27The Georgia Pharmacy Journal The Georgia Pharmacy Journal26

Please turn to CorrespondenceCourse Quiz on page 23.

Program 0129-0000-14-004-H01-PRelease date: 4-15-14

Expiration date: 4-15-17CE Hours: 1.5 (0.15 CEU)

The author, the Ohio Pharmacists Foundation and the Ohio Phar-macists Association disclaim any liability to you or your patients resulting from reliance solely upon the information contained herein. Bibliography for additional read-ing and inquiry is available upon request.

This lesson is a knowledge-based CE activity and is targeted to phar-macists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

patients and pharmacists is infor-mation provided by the Pulmonary Hypertension Association (www.phassociation.org). This site also includes advice for newly diagnosed patients.

Overview and Summary PH is a relatively rare disease even though its etiological consid-erations are common. The disease is caused by a variety of etiolo-gies characterized by pulmonary vasculopathy with endothelial dysfunction, cellular proliferation, and elevated pulmonary vascular resistance. Over the previous two decades there have been profound advancements in PH targeted treatments, resulting in symptom improvement, slowed disease pro-gression, and improved survival. Two recently approved drugs have been added to the treatment arma-mentarium. Overall, further ad-vancements are needed to prolong life expectancy and improve quality of life in these patients.

continuing educat ion quiz Advances in the Treatment of PulmonaryHypertension: Focus on Adempas and Opsumit

Program 0129-0000-14-004-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

NABP e-Profile ID____________Birthdate_________ (MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

Completely fill in the lettered box corresponding to 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] [d] 12. [a] [b] [c] [d] 3. [a] [b] [c] [d] 8. [a] [b] [c] [d] 13. [a] [b] [c] [d] 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.

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)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. Median survival time following diagnosis in persons with untreated pulmonary hypertension is: a. 1.5 years. c. 2.8 years. b. 2.0 years. d. 3.2 years. 2. The World Health Organization (WHO) recognizes how many categories of pulmonary hypertension? a. 1 c. 5 b. 3 d. 7

3. The majority of drug development in pulmonary hyper-tension has been focused on patients in which of the follow-ing WHO groups? a. 1 c. 5 b. 3 d. 7 4. Prostacyclin is also known as prostaglandin: a. E1. c. I1. b. E2. d. I2.

5. A drug from the pharmacologic class of compounds considered to be the cornerstone of therapy for pulmonary hypertension is: a. bosetan. c. tadalafil. b. epoprostenol. d. ambrisentan.

6. Which of the following drugs is responsible for the degradation of cyclic guanosine monophosphate (cGMP) in treating pulmonary hypertension? a. Ventavis c. Tracleer b. Remodulin d. Revatio 7. All of the following are goals of therapy in treating pul-monary hypertension EXCEPT to: a. prevent advancement of the disease. b. decrease activity levels. c. improve quality of life. d. decrease hospital admissions.

8. The product approved for treating patients with chronic thromboembolic pulmonary hypertension is: a. Adempas. c. Opsumit. b. Adcirca. d. Flolan.

9. All of the following are contraindications to use of rio-ciguat EXCEPT: a. pregnancy. b. decreased hemoglobin. c. use with nitrates. d. use with phosphodiesterase inhibitors.

10. Patients taking Adempas should be advised to avoid taking which of the following drugs within one hour of Adempas? a. Decongestants c. Antihistamines b. Cathartics d. Antacids

11. Plasma concentrations of riociguat may be reduced by how much in smokers? a. 20 to 30 percent c. 40 to 50 percent b. 30 to 40 percent d. 50 to 60 percent

12. Opsumit is classified as a/an: a. endothelin receptor antagonist. b. prostacyclin derivative. c. phosphodiesterase-5 inhibitor. d. janus kinase inhibitor.

13. Macitentan was developed by modifying the chemical structure of: a. bosentan. c. treprostinil. b. ambrisentan. d. tadalafil.

14. All of the following are precautions/warnings for use of macitentan EXCEPT: a. decreased hemoglobin. c. symptomatic hypotension. b. pulmonary edema. d. decreased sperm count.

15. Advice for persons taking Opsumit includes: a. avoid driving or operating heavy machinery. b. keep unopened bottles of Opsumit refrigerated. c. do not crush or chew tablets. d. avoid sunlight or exposure to UV bulbs.

To receive CE credit, your quiz must be received no later than April 15, 2017. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to opa@ohiopharmacists.org.

apri l 2014

Name PositionRobert M. Hatton Chair of the BoardPamala S. Marquess PresidentRobert B. Moody President-ElectThomas H. Whitworth First Vice PresidentLance P. Boles Second Vice PresidentLiza Chapman State At LargeTerry Forshee State At LargeDavid Graves State At LargeJoshua D. Kinsey State At LargeEddie Madden State At LargeLaird Miller State At LargeChris Thurmond State At Large Krista Stone 1st Region PresidentEd S. Dozier 2nd Region PresidentRenee D. Adamson 3rd Region PresidentNicholas O. Bland 4th Region PresidentShelby Biagi 5th Region PresidentSherri S. Moody 6th Region PresidentTyler Mayotte 7th Region PresidentMichael Lewis 8th Region PresidentAmanda Westbrooks 9th Region President Flynn Warren 10th Region PresidentKalen Manasco 11th Region President Ken Von Eiland 12th Region PresidentTed Hunt ACP ChairSharon B. Zerillo AEP ChairJohn Drew AHP ChairDrew Miller AIP ChairMichelle Hunt APT ChairLeah Stowers ASA ChairJohn T. Sherrer Foundation ChairAl McConnell Board of Pharmacy ChairMegan Freeman GSHP PresidentAmy C. Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeLindsey Welch UGA Faculty RepresentativeTyler Bryant ASP, Mercer University Tiffany Galloway ASP, South University Jessica Kupstas ASP, UGA Jim Bracewell Executive Vice President

2013-2014 Board of Directors

THE GEORGIA PHARMACY ASSOCIATION

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The Georgia Pharmacy Journal

AIP Mission Statement: To advance the concept of pharmacy care. To ensure the economic viability and security of Independent Pharmacy; To provide a fo-rum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; To address the unique business and professional issues of independent pharmacies; To develop and implement marketing opportuni-ties for members of the Academy with emphasis on the third party prescription drug program/benefit market; To provide educational programs designed to en-hance the managerial skills of Independent Pharmacy Owners and Managers; and, To establish and implement programs and services designed to assist In-dependent Pharmacy Owners and Managers.

50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.orgTHE GEORGIA PHARMACY ASSOCIATION

...to the many members who support the Georgia Pharmacy Association’s Academy

of Independent Pharmacy.

We pledge to continue to defend and protect the profession to the best of our

ability and we pledge to continue to fight for the economic viability

of Independent Pharmacy.

Thanks ...

Need to update Board of Directors?

Name PositionRobert M. Hatton Chair of the BoardPamala S. Marquess PresidentRobert B. Moody President-ElectThomas H. Whitworth First Vice PresidentLance P. Boles Second Vice PresidentLiza Chapman State At LargeTerry Forshee State At LargeDavid Graves State At LargeJoshua D. Kinsey State At LargeEddie Madden State At LargeLaird Miller State At LargeChris Thurmond State At Large Krista Stone 1st Region PresidentEd S. Dozier 2nd Region PresidentRenee D. Adamson 3rd Region PresidentNicholas O. Bland 4th Region PresidentShelby Biagi 5th Region PresidentSherri S. Moody 6th Region PresidentTyler Mayotte 7th Region PresidentMichael Lewis 8th Region PresidentAmanda Westbrooks 9th Region President Flynn Warren 10th Region PresidentKalen Manasco 11th Region President Ken Von Eiland 12th Region PresidentTed Hunt ACP ChairSharon B. Zerillo AEP ChairJohn Drew AHP ChairDrew Miller AIP ChairMichelle Hunt APT ChairLeah Stowers ASA ChairJohn T. Sherrer Foundation ChairAl McConnell Board of Pharmacy ChairMegan Freeman GSHP PresidentAmy C. Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeLindsey Welch UGA Faculty RepresentativeTyler Bryant ASP, Mercer University Tiffany Galloway ASP, South University Jessica Kupstas ASP, UGA Jim Bracewell Executive Vice President

2013-2014 Board of Directors

THE GEORGIA PHARMACY ASSOCIATION

The GPhA Mobile App.

G ET TH E A PP!

I T ’ S F R E E !

Contact Association

Staff.

Share this App with a friend.

Association and Industry

News.

Check out Association events and

register.

Renew your membership

- join the Association.

Receive Association

reminders and updates.

Connect with the GPhA on

facebook.

Learn about GPhA

services.

Connect with friends and associates.

Important Advocacy

links.

We’re going mobile, leveraging mobile technology to meet member’s com-munication, educa-tion, advocacy, and engagement needs. Available anywhere and anytime you need it.

Android

Apple

Search gpha using the App Store or Google Play. Download and You’ve Got the App!

The Georgia Pharmacy Journal

AIP Mission Statement: To advance the concept of pharmacy care. To ensure the economic viability and security of Independent Pharmacy; To provide a fo-rum for Independent Pharmacy to exchange information and develop strategies, goals and objectives; To address the unique business and professional issues of independent pharmacies; To develop and implement marketing opportuni-ties for members of the Academy with emphasis on the third party prescription drug program/benefit market; To provide educational programs designed to en-hance the managerial skills of Independent Pharmacy Owners and Managers; and, To establish and implement programs and services designed to assist In-dependent Pharmacy Owners and Managers.

50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.orgTHE GEORGIA PHARMACY ASSOCIATION

...to the many members who support the Georgia Pharmacy Association’s Academy

of Independent Pharmacy.

We pledge to continue to defend and protect the profession to the best of our

ability and we pledge to continue to fight for the economic viability

of Independent Pharmacy.

Thanks ...

Need to update Board of Directors?

50 Lenox Pointe, NE Atlanta, GA 30324

THE GEORGIA PHARMACY ASSOCIATION

139 th gph A con ventionJu ne 26-29, 2014

Wy ndham Bay Point R esort - Panama City Beach, FL

As healthcare changes, so do job responsibilities and career tracks. Th e Georgia Pharmacy Association is your development partner as you

address your future in pharmacy. Professional

networking, skills training and continuing

education are key benefi ts of your GPhA membership.

Plan to attend this year’s Convention and take advantage of all the educational and networking opportunities available. Whether you’re a seasoned professional or a fi rst year student, there’s something for you at the GPhA Convention.

We’re looking forward to seeing you there.

50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.orgTHE GEORGIA PHARMACY ASSOCIATION

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