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Volume XIII, Issue VII July 2013

The first article in this two­part series on vitamin D defi­ciency reviewed the risk factors, epidemiology, and clinical effects of vitamin D deficiency and was published in the June 2013 edition of FHEA News. Here, steps in detecting and treating this common problem are discussed.

T he preferred test for assessment of vitamin D status is measurement of serum 25‐hydroxyvitamin D (25(OH)D). The results of this test are minimally influenced by recent dietary intake or recent sun exposure, and it is considered the most accurate functional indicator of vita‐min D stores. The serum level of the biologically active form of vitamin D, 1,25‐dihydroxyvitamin D (1,25(OH)2D), is not an accurate indicator of nutritional vitamin D status because levels of 1,25(OH)2D typically are not al‐tered until vitamin D deficiency is well advanced. The

Vitamin D Deficiency: Diagnosis and Treatment

Inside this issue:

Q&A with Dr. Fitzgerald

Information about NPH Insulin Pharmacokinetics

3

Special Offer of the Month: 10% off Pediatric Physical Assessment Cue Cards

3

Important System Update Information 3

New Lung Cancer Screening Guidelines for Older Heavy Smokers

4

FHEA Live­Online Continuing Education Presentations

5

Recently Added Course NP Review in Hawaii

5

Getting Ready For the NP Certification Exam 6

FHEA Exhibit Locations 6

New and Updated Products 7

Report on the Literature: Coverage of NEJM Report on NPs Commentary by Dr. Fitzgerald

8

Congratulations to Two Fitzgerald Health Faculty

10

25th Anniversary Resort Destination

11

Upcoming Live and Online Courses 12

NP Certification Exam Review Courses

Family, Adult and Adult­Gerontology Primary Care Tracks

09/04/2013 Manhattan, NY

09/06/2013 North Andover, MA

09/10/2013 Atlanta, GA

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Acute Care, Adult­Gerontology Acute Care Track

09/20/2013 Philadelphia, PA

Psych/Mental Health Track

11/15/2013 Birmingham, AL

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Continuing Education Programs

Pharmacology Update

09/15/2013 Prague, Czech Rep.

Click Here for More Information by Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC

1 Fitzgerald Health Education Associates, Inc. • NP Certification Exam Preparation & Continuing Education (978) 794-8366 • www.fhea.com

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Continued on page 2

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Vitamin D Deficiency Continued from page 1

cost of testing ranges from $50 to $200.

Opinions differ on what constitutes deficiency. Physi‐ologic deficiency is defined as a level of serum 25(OH)D that is sufficiently low to cause an increase in parathy‐roid hormone (PTH) levels. Production and secretion of PTH increases to correct low calcium levels via increased bone turnover and accelerated bone loss, effects that

clearly occur later in the disease process. Clinical studies have revealed that increased PTH levels occur with 25(OH)D levels of 20 ng/mL (50 nmol/L). As a result, most laboratories report the normal range to be 20 to 100 ng/mL (50 to 250 nmol/L); however, the preferred mini‐mum level is likely 35 to 40 ng/mL (87.5 to 100 nmol/L).

Vitamin D Deficiency: Treatment and Prevention of Recurrence Vitamin D3 is the preferred form of the micronutrient for the treatment of vitamin D deficiency and for mainte‐nance of vitamin D levels. Because vitamin D3 is stored in fat and has a long half‐life, low‐dose (400‐800 IU per day) vitamin D3 supplementation is not sufficient to cor‐rect a deficiency. Approximately 100 IU given daily for 3 months will increase the 25(OH)D level by just 1 ng/mL (2.5 nmol/L); considered in multiples of 100 IU, 400 IU taken for 3 months will increase the level by 4 ng/mL (10 nmol/L).

For treatment of vitamin D deficiency in adults, a dose of 50,000 IU of vitamin D3 by mouth once per week for at least 8 weeks is advised, with extension of this course to 16 weeks if the initial 25(OH)D level was below 30 ng/mL. For long‐term prevention, patients should be given 50,000 IU of vitamin D3 once or twice per month plus 1,000 to 2,000 IU of vitamin D3 daily. Consuming a diet rich in vitamin D–containing foods and exposing the skin to a sensible and safe level of sunlight can aid in prevent‐ing the condition. A confirmation of vitamin D correction should be obtained after the recommended length of high‐dose repletion therapy.

Vitamin D Toxicity: An Uncommon Problem Excessive supplementation, though not excessive sun ex‐posure, can cause vitamin D toxicity, leading to a variety of problems, including calcium deposition into solid or‐gans. This is rarely seen and is usually a consequence of chronic use of ≥10,000 IU/d vitamin D3 . On a personal note, I have treated numerous patients for vitamin D deficiency, with many achieving great health benefits. Maintaining a high index of suspicion for this common clinical problem is the first step in successful diagnosis and treatment.

Resources Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266‐281.

Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003;78:1457‐1459.

Continued on page 7

Vitamin D3 is the preferred form of the

micronutrient for the treatment of vitamin D

deficiency and for maintenance of vitamin

D levels.

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Question and Answer With Dr. Margaret A. Fitzgerald

Question: As I study for my NP certification examina‐tion, I have found that, depending on the source, the time to peak effect for NPH insulin (Humulin N, Novolin N) ranges from 4 to 9 hours after it is given to as much as 6 to 10 hours after the injection. What numbers should I use if there is a question on the test about time to peak effect for NPH insulin? Dr. Fitzgerald: Depending on the brand of insulin and a number of other factors, the time to peak effect for NPH insulin can vary, and this is why the peak ranges listed in various references can be different. These differences can make studying for the test challenging and confus‐ing. At the same time, remember to focus on the clinical

significance of NPH pharmacokinetics. NPH is insulin with an intermediate duration of ac‐tion; onset of action is usually within 2 hours of injec‐tion, and duration of action lasts about 10 to 16 hours. As a result, NPH insulin is given in two injections per day to provide basal insulin needs. Usually, the morning NPH dose provides about two‐thirds of the total basal insulin,

Important System Update Information

Routine maintenance is scheduled for August 17, 2013. FHEA is committed to providing our customers maximum uptime, reliability and security for our Online Testing and

Learning Site, www.fhea.com/npexpert. Regular system maintenance is critical to achieving this goal and is normally performed the third Saturday of each month.

with the remaining one‐third provided in an injection later in the day. Insulin‐induced hypoglycemia is most likely to occur during the drug’s peak concentration, roughly 6 to 9 hours after administration. Hypoglycemia induced by an early morning (7‐8 AM) NPH insulin dose will most likely occur in the afternoon. While I appreciate that the minor differences you have pointed out can be rather off‐putting, remember to think about concepts of care. Consider the overlap of the differing ranges: in both, 6 to 9 hours is included. This will help a great deal as you prepare for the test and in your practice.

Resource

Fitzgerald MA. Endocrine disorders. In: Fitzgerald MA. Nurse Practitioner Certification Examination and Practice Preparation. 3rd ed. Philadelphia: F.A. Davis; 2010.

FHEA Offer of the Month

10% off

Pediatric Physical Assessment Cue Cards,

8th edition

Insulin‐induced hypoglycemia is most likely to

occur during the drug’s peak concentration,

roughly 6 to 9 hours after administration.

Information about NPH Insulin Pharmacokinetics

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N ew guidelines from the American College of Chest Physicians (ACCP) recommend that patients at sig‐nificant risk for lung cancer be offered annual screening with low‐dose computed tomography (LDCT).1 According to the ACCP, patients considered at high risk are current smokers aged 55 to 74 years with a smoking history of at least 30 pack‐years and former smokers of the same age who have quit within the past 15 years but have the same smoking history. Current Guidelines With these updated guidelines, the ACCP joins the Ameri‐can Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) in endorsing consideration of lung cancer screening in certain high‐risk patients. However, the ACCP, ACS, and ASCO differ from the NCCN in terms of which patients should be considered for screening. The NCCN recommends annual CT screening for younger patients (50 or older, versus 55) with a less extensive smoking history (at least 20 pack‐years, versus 30 pack‐years), who have one additional risk factor, such as a his‐tory of cancer or lung disease, family history of lung can‐cer, radon exposure, or occupational exposure. National Lung Screening Trial The ACCP's new recommendation to screen high‐risk in‐dividuals is based on findings from the National Lung Screening Trial (NLST), a randomized clinical trial begun in 2002 that studied more than 53,000 current and for‐mer heavy smokers (defined as a smoking history of ≥30 pack‐years) between the ages of 55 and 74 years.2 Pa‐tients were assigned to receive annual screening for 3 years with either LDCT or standard chest radiography.

The NLST Investigators concluded in 2011 that LDCT scanning reduced deaths from lung cancer in these high‐risk patients by 20% compared with chest radiography. In addition, the NLST found that for every 320 high‐risk smokers screened with LDCT, one death from lung cancer was prevented. In comparison, the number of women who need to be screened with mammograms to prevent one death from breast cancer is 780.

Impact on Survival Rates In the United States, lung cancer accounts for more deaths than any other cancer. Nearly 160,000 deaths are expected to occur because of lung cancer in 2013, more than the expected number of deaths from breast, colon, prostate, and pancreatic cancer combined. Early detection is important, since early‐stage lung cancers

are more likely to respond to treatment, such as sur‐gery. The 5‐year survival rate for localized stage lung cancer is 52% versus 16% for all stages combined. Cur‐rently, however, only 15% of lung cancers are diag‐nosed at the localized stage.3

Although screening certain high‐risk patients offers the potential to reduce lung cancer mortality, as demon‐

New Lung Cancer Screening Guidelines for Older Heavy Smokers

Noelle Proulx‐DeCain, staff writer

The NLST Investigators concluded in 2011

that LDCT scanning reduced deaths from

lung cancer in these high‐risk patients by

20% compared with chest radiography.

Continued on page 7

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July 2013

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Recently Added Course

Nurse Practitioner Certification Exam Review

and Advanced Practice Update

December 9­11, 2013 Waikiki, O’ahu, Hawaii

Presented by Margaret A. Fitzgerald, DNP, FNP­BC, NP­C, FAANP, CSP, FAAN, DCC

More information

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Enter contact hours from any CE provider. Monitor deadlines and CE requirements for multiple

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Print contact hour summaries by category and source to help complete certification and license renewal paperwork.

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NP Certification Tracks

In accordance with the recent implementation of the Consensus Model for APRN Regulation, FHEA is

offering the following NP Certification Exam Review and Advanced Practice Update courses:

Family Adult‐Gerontology Primary Care

Adult‐Gerontology Acute Care

Adult Psychiatric/Mental Health Pediatric Women’s Health

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Date/Time Cost Presenter Title

8/7/2013 8‐10 p.m. EST $18

Margaret A. Fitzgerald,

DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,

DCC

Bacterial Pharyngitis, Conjunctivitis, Acute Otitis

Media: A focus on the latest treat­

ment recommendations

8/13/2013 8‐10 p.m. EST $18

Margaret A. Fitzgerald,

DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,

DCC

Antimicrobial Update: A focus on the treatment

recommendations in sexually

transmitted infection (STI)

8/14/2013 8‐10 p.m. EST $18

Margaret A. Fitzgerald,

DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,

DCC

Probiotic and Prebiotic Use in Clinical Practice: What we know, what we are learning

08/26/2013

8‐10 p.m.

EST

$18

Margaret A. Fitzgerald,

DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,

DCC

Best of the $4 Drugs: Optimizing Your Choice of the Least Costly Gener­

ics

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Come see Fitzgerald Health in person! We will be exhibiting at the following locations:

Date Location

Sept. 13­14, 2013

Fitzgerald Health Education Associ­ates, Inc. Pharmacology Update Prague, Czech Republic

Sept. 19­21, 2013

Illinois Society for Advanced Practice Nursing Midwest Conference East Peoria, IL

Oct . 25, 2013

Mississippi Nurses’ Association Annual Convention Advanced Practice Workshop Expo Biloxi, Mississippi

Getting Ready for the NP Certification Exam

A FREE Live

Online presentation

Available Dates

10/14/2013 8-9:30 p.m. EST

Click Here for More Information or to Register

Join Dr. Margaret A. Fitzgerald for a free, 75-minute live online presentation on certification exam preparation and comparisons between the exams. Learn the best practices

for preparing for certification and what to expect on the exams with this webinar designed for NP students, recent

NP grads and practicing NPs who are not certified.

An $18 value!!

Click here to view the On demand prerecorded presentation.

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Linus Pauling Institute, Micronutrient Information Center. Vita‐min D. Available at: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/. Accessed July 17, 2013.

Moyad MA. Vitamin D: a rapid review. Medscape Today News. Available at: http://www.medscape.com/viewarticle/589256. Accessed July 17, 2013.

Plotnikoff G, Quigley J. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78:1463‐1470.

Tangpricha V, Griffing GT. Vitamin D deficiency and related dis‐orders. Medscape Reference. Available at: http://emedicine.medscape.com/article/128762. Accessed July 17, 2013.

New and Updated Products

Nurse Practitioner Pharmacology Package for Family, Adult­Gerontology, and Gerontology

Primary Care Online and on Audio CD

The online and audio CD versions of our 2013 pharmacology packages for family, adult­gerontology, and gerontology primary care nurse practitioners are now available. Each of these packages is designed to keep you up to date with the latest in pharmacotherapeutics.

For more information or to purchase these products, visit our web store.

strated in the NLST, the decision‐making process concerning whether to offer screening must take into consideration its associated risks. These include high false‐positive rates, radiation exposure from multiple CT scans, patient anxiety, and unnecessary invasive procedures. Clinicians can mitigate these risks by offering screening only to those patients who fall within the parameters outlined in the ACCP guide‐lines, notes NLST investigator Dr. Peter Mazzone.

References 1. Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for lung cancer: Diagnosis and manage‐ment of lung cancer, 3rd ed: American College of Chest Physicians evidence‐based clinical practice guidelines. Chest. 2013;143(5 suppl):e78S–92S.

2. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al. Reduced lung‐cancer mortality with low‐dose computed tomo‐graphic screening. N Engl J Med. 2011;365(5):395–409.

3. American Cancer Society. Cancer Facts and Fig‐ures. 2013. Available at: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc‐036845.pdf. Accessed July 5, 2013.

New Lung Cancer Screening Guidelines Continued Vitamin D Deficiency Continued

COMING SOON

An interactive and redesigned

FHEA News!

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T he 2014 expansion of healthcare coverage man‐dated by the Affordable Care Act (ACA) is expected to cause a marked rise in patient demand for healthcare services and a consequential shortage in primary care physicians available to treat an expected 35 million newly insured patients by 2016. In the May 16 issue of the New England Journal of Medicine, national corre‐spondent John K. Iglehart discusses the important issue of finding common ground among the different groups of primary care providers so that the potentially critical shortage of providers can be addressed and potentially averted. The NEJM Health Policy Report advocates coop‐eration among all primary care providers, with the goal of promoting team‐based care that is focused on fulfill‐ing the expanded need for healthcare. In order to facili‐

tate this recommendation, the Report notes that changes must be made in restrictive scope‐of‐practice laws in many states.

John Iglehart, who is also Founding Editor of Health Affairs, points out that in 2010 the Institute of Medicine (IOM) report in which the organization recommended that APRNs should “practice to the full extent of their education” and that nurses should achieve higher levels

of education, so that they can expand their clinical reach in order to address the increased need for more primary care practitioners.

However, the American Medical Association (AMA) opposes autonomous practice by APRNs and is critical of studies that support the clinical performance of APRNs. The organization points to the greater educa‐tional level of physicians, highlighting the success only of integrated systems that incorporate APRNs into physician‐led teams.

Furthermore, the AMA suggests that a recent law passed in Virginia should serve as a model for other states to consider. The Virginia law states that NPs must be managed by a single physician and expands the number of NPs who can be supervised by a single physician from 4 to 6. Telemedicine is a legal form of supervision under this law. The American Association of Nurse Practitioners believes the Virginia legislation is out of step with national trends.

Another important limitation on NPs’ autonomous practice is promulgated by state scope‐of‐practice laws. These laws vary considerably by state, with a minority of states allowing APRNs to see patients and prescribe medications autonomously, while the major‐ity of states do not allow this practice. John Iglehart notes that the US Federal Trade Commission (FTC) has issued many actions since 2010 to try to combat these state restrictions on NP practice. For example, the FTC recently wrote a letter to the Connecticut House of Representatives stating that physician supervision of APRNs was unnecessary, that these providers are as

Report on the Literature: N Engl J Med* A Health Policy Report on NPs: What are they saying about our role? Kristin Della Volpe With commentary by Dr. Margaret A. Fitzgerald Articles published in The New England Journal of Medicine often garner a lot of attention, so a recent Health Policy Report, “Expanding the role of advanced nurse practitioners—risks and rewards,” caught our eye. Our summary of the report highlights forces working to potentially limit NP scope of practice and the need for NPs to remain vigilant and continue to advocate for legislative initiatives that eliminate restrictions on NP autonomous practice.

We need to move from hierarchical leadership

to situational leadership . . . A physician,

nurse [nurse practitioner], social worker or

other provider may take the lead in a given

situation.”

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July 2013

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capable as physicians in delivering “safe, efficient, and effective” care, and that “decades of research” backed up this claim. The AMA leadership decried the FTC’s actions as “aggressive advocacy” and stated that “physicians have raised concerns that the physician‐led model of care is being undermined.” However, the National Governors Association in 2012 issued what John Iglehart termed a “surprise” recommendation supporting expanded roles for APRNs and recom‐mending that states consider reexamining their scope‐of‐practice laws as one option for increasing the num‐ber of primary care providers.

The Robert Wood Johnson Foundation sponsored meetings with 12 leaders of physician and nursing or‐ganizations to discuss issues that have divided the two groups of healthcare providers. In a report written fol‐lowing the meeting, the foundation noted that “The ‘captain of the ship’ notion . . . needs to be eliminated, focusing on the patient as the driver of care. We need to move from hierarchical leadership to situational leadership . . . A physician, nurse [nurse practitioner], social worker or other provider may take the lead in a given situation.” The Robert Wood Johnson Foundation and many of the NP and physician leaders believed that all meeting attendees supported the document,

but this was not the case. The document was leaked to the AMA before it was approved, and the AMA’s House of Delegates expressed concern with it. Likewise, the AAFP, American Osteopathic Association, and the American Academy of Pediatrics withdrew their support for these meetings. John Iglehart notes, “The collapse of this dialogue offered a snapshot of the unsettled states of discussions between national physician and nursing organizations over defining roles in an emerging model of team‐based care that relies on interprofessional col‐laboration as one of its touchstones.”

A Look to the Future The NEJM Health Policy Report concludes that given the differing opinions among physician and nursing organi‐zations and the partisanship that halts policymaking on both a federal and state level, progress in restructuring delivery systems may come more rapidly at the practice level, where physicians, nurses [nurse practitioners], and other caregivers are freer to innovate and to assign tasks to persons on the basis of the full extent of their training and what makes organizational sense. *Iglehart JK. Expanding the role of advanced nurse practitio‐ners—risks and rewards. N Engl J Med. 2013;368:1935‐1941.

Commentary by Dr. Margaret A. Fitzgerald In this NEJM article, Iglehart begins by defining the major problem to be an upcoming shortage of primary care

physicians—the major impediment to accommodating the increasing number of currently uninsured people who will

be seeking healthcare in the next stage of the ACA enactment. Nurse practitioners and other “nonphysician provid‐

ers” are mentioned as a possible way of filling this implied gap in primary care. The inference is that medical physi‐

cians are the “gold standard” in providing primary care; other providers are therefore a “good enough” fill‐in. This

inaccurate portrayal of primary care practice is often promulgated in comments about the primary care provider

(PCP) shortage in professional and popular literature. NPs and PAs have demonstrated a long and well‐documented

history of providing high‐quality care. We do not “fill in the gap” created by a physician shortage, but rather care for

people who need and benefit from the service we can provide. While it is not surprising to see language such as this

in a medical journal, this school of thought is often found in the NP, PA, and popular press as well. Reflecting on the

NEJM article’s title, there is great risk to the NP and PA professions in allowing a physician shortage to create the

rationale for our professional existence, and there is great reward in continuing to promote ourselves as the

highly qualified healthcare providers we are.

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FHEA News welcomes articles, news, comments, and ideas from

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jasmin@fhea.com with submissions.

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about pricing and circulation, please

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Three Cheers for Two Fitzgerald Health Education

Faculty!

CONGRATULATIONS ON TWO COUNTS TO

Christy M. Yates, MS, FNP‐BC, NP‐C, AE‐C

Fitzgerald Health Education Faculty, Senior Lecturer!

Christy was recognized for receiving the AANP State

Award for Excellence for Kentucky at the 2013 AANP 28th

National Conference in Las Vegas in June.

&

Christy’s article “Assessing Asthma Control: An Evidence‐based Approach

to Improve Skills and Outcomes“ was published in the June 2013 issue of

The Nurse Practitioner.

CONGRATULATIONS

Teresa “Tess” Judge‐Ellis, DNP, FNP‐BC, PMHNP‐BC, FAANP

Fitzgerald Health Education Faculty, Associate Lecturer!

Tess was inducted as a Fellow of the American Association of

Nurse Practitioners on June 20th, 2013 in Las Vegas.

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Following the FHEA Twitter page will provide you with up‐to‐date information on our course offerings and products. You can also use the FHEA Twitter to interact with us at our live courses, start conversa‐tions with your nurse practitioner colleagues, and

discuss the latest in healthcare news.

FHEA is on Twitter!

Click Here for More Information

FHEA 25th Anniversary Resort Destination

Learn about the latest in drug therapy with Dr. Margaret A. Fitzgerald as she

presents the FHEA Pharmacology Update in a desirable resort setting.

Topics Include: Drug Update: New products, new indications, new warnings

Pharmacogenomics: Exploring genetic variations in drug metabolism

Antimicrobial Update: A focus on treatment recommendations in urinary tract infections (UTI)

Prescribing in the Presence of Impaired Renal Function

Depression: A primary care approach to assess‐ment and intervention

As Seen on TV: What's in the OTC and herbal products your patients are taking?

Itinerary Includes Three Sightseeing Tours: Sept. 16th — 3 hour guided walking tour of the Old Town. $24 USD pp. Sept. 17th — 5‐6 hour

guided Karlstejn Castle tour. $50 USD pp. Sept. 18th — 3 hour guided walking tour of Hradcany Town. $40 USD pp.

*In­class time will be held on Sept. 15­16.

At FHEA, we sometimes receive complaints or concerns from customers who have purchased FHEA products or Dr. Fitzgerald’s book, now in its 3rd edition, from other online vendors and second­hand sellers. Of course, that’s what free enterprise is all about but it also means buyer

beware. Often the prices on these offers look good. However, what is being offered is either obsolete (there are newer, up­to­date editions available) or the product is incomplete (these products don’t include NP review workbooks or access to the

online materials and lectures that are an integral part of the product). This can be a problem with all

forms of the product whether they be printed, recorded, or e­book formats.

To be certain you are getting the complete and latest editions of Fitzgerald products, please

shop through our store. When you do, our customer

service personnel will be happy to ensure your satisfaction

Customer Service Notice

Boscolo Prague Hotel Prague, Czech Republic September 15­16,

2013*

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Click here for more information about these and other courses

Fitzgerald Health Education Associates, Inc.

85 Flagship Dr. North Andover, MA

01845‐6154 Phone: (978) 794‐8366 Fax: (978) 794‐2455 Email: cs@fhea.com

Interested in advertising in this newsletter? Email: june@fhea.com Editorial Staff Publisher Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC Managing Editor Marc Comstock Editor Jasmin Pastrana Assistant Editor June Kuznicki Staff Writers Charlene Cashman Noelle Proulx‐DeCain Technical Assistant Bernice Flete Contributors: Carolyn Buppert, NP, JD Open Forum FHEA welcomes articles, news, com‐ments, and ideas from its readers! Please email: jasmin@fhea.com. If you would like to contact customer service please email: cs@fhea.com. We have sent this email newsletter in the hope that you will find it useful. If you prefer not to receive future issues, please email: Unsub‐scribe@fhea.com. Please include "Unsubscribe" as the subject of your email and your full name and the email address where you receive the newsletter in the body. If you received a copy of this newsletter from a friend, you can subscribe by sending an email to: newsletter@fhea.com. Be sure to include your full name, mailing address, and daytime phone number so that we can confirm and authenticate your subscription.

Clinical Pharmacology for NPs and Advanced Practice Clinicians

Presented by: Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC Sally K. Miller, PhD, ACNP‐BC, ANP‐BC, FNP‐BC, GNP‐BC, CNE, FAANP

Earn 45 Contact Hours!

This course addresses the growing need for a thorough course in the principles of pharmacotherapeutics. Be‐cause states’ requirements vary, it is important that you contact your state board of nursing for details regarding educational requirements for prescriptive authority. This course is also available online.

Advanced Pathophysiology for NPs and Advanced Practice Clinicians

Presented by: Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC Sally K. Miller, PhD, ACNP‐BC, ANP‐BC, FNP‐BC, GNP‐BC, CNE, FAANP

Earn 45 Contact Hours!

This course is reviewed and updated bi‐annually to ensure up‐to‐date content. It is presented by highly acclaimed clinician‐educators who currently maintain clinical practice. Fitzgerald Health brings the highest quality pathophysiology program to our customers. We believe our approach provides an advanced pathophysi‐

ology course that will meet your needs whether you are new to the profession or brushing up your pathophysiology. This course is also available online.

This course is scheduled live annually and is always available online. Contact hours are awarded upon successful completion of this course.

This course is scheduled live annually and is always available online. Contact hours are awarded upon successful completion of this course.