the georgia pharmacy journal: december 2008

The Official Publication of the Georgia Pharmacy Association December 2008

VVoolluummee 3300,, NNuummbbeerr 1122 www.gpha.org

The Georgia Pharmacy Journal December 20082

Are your individual or group rates increasing?Is your network of providers shrinking?Are your COBRA benefits ending?

Do you need a quote?OPEN ENROLLMENT CONTINUES

THRU DECEMBR 19, 2008Call or e-mail TODAY to schedule a time to discuss your health insurance needs and see if

The Insurance Trust can bring you back in 2009!

CALLTrevor Miller – Director of Insurance Services404.419.8107 or e-mail at [email protected]

NEW PLANS – BETTER RATES – MORE BENEFITS in 2009


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

18 Pharmacists in the Legislature

22 Pharmacy Schools’ News

24Pharmacy Profile In Leadership

C O L U M N S

4 President’s Message

6 Editorial

For an up-to-date calendarof events, log onto

www.gpha.org.

16Save the Date

February 18, 2009Very Involved Pharmacist Day

May 12, 2009Eggs and Issues Breakfast

Departments10 New Members10 PharmPAC Contribution Form25 Journal CE30 GPhA Board of Directors

Advertisers2 The Insurance Trust2 Meadowbrook® Insurance Group8 Pharmacists Mutual Companies10 Michael T. Tarrant13 Middle Georgia Relief Services24 Toliver & Gainer31 PACE Alliance32 The Insurance Trust

P R E S I D E N T ʼ S M E S S A G E

Our Door to the Future –Gratitude


As we have recently observed Thanksgiving, Ihope that each of us has taken time to expressour gratitude for the many blessings that weenjoy. On November 7 I went on a medicalmission trip to Colon, Panama, with 20 otherindividuals.

Certainly as one would expect, this was anincredible opportunity to witness first-hand theconditions and lifestyles of the people in Colon.I had been on a medical mission trip to Hondurasin 1987 and was aware of the things that I wouldprobably see. During this time, I had theprivilege of supervising the dispensing ofmedication to those who were seen by one of ourphysicians. Those on the pharmacy teamincluded a 69-year-old retired gentleman andtwo high school students. A missionary serving in

Panama and a Panamanian registered nurseserved as translators for us.

During our flight from Atlanta to Panama, oneof our team members had a tooth break off.When we arrived in Colon, the hotel clerk madearrangements for her to go to a dentist’s officethat was only a block away. The patient’shusband, a missionary in Panama, the dentist onour team, and the patient walked to thedentist’s office. Fortunately, the Panamaniandentist wanted our dentist to repair the tooth sothat he could see how the procedure was done inthe United States. When they completed theprocedure, they started to walk back to thehotel. The Panamanian dentist quickly stoppedthem and told them he would have themescorted back to the hotel because it would be

Robert BowlesPresident


unsafe for them to walk back. This was our firstexperience with the extreme safety measuresthat we would need to have in place.

Our clinics were held in two differentlocations in Colon. Our clinics were open from 9 a.m. until 4 p.m. on Monday throughWednesday. On Thursday, the clinic was openfrom 9 a.m. until 1 p.m. The first two days theclinic was held in downtown Colon. On each ofthese days we dispensed approximately 225prescriptions each day. We set the clinic up in achurch building that was clean and neat. Most ofthe patients had exposure to the Department ofHealth Ministry for basic care; therefore, theneeds were not as great as we would experiencein the next area of Colon where we would set upa clinic. Later on, we found out that there weretwo gangs that were operating within a shortdistance of the church. On Wednesday, wemoved the clinic to an area of Colon that wasmuch different. In this area, we witnessed moremalnutrition, the need for more anthelminicsand the usual hypertension, diabetes, andarthritis medications. On the third day of ourclinic, we dispensed 534 prescriptions and onthe 4th day which was only a half day, wedispensed 418 prescriptions.

We were warned that security was even morecritical as we went into the village that wasabout 10 miles from Colon. In fact, the first daythat we were there, someone broke into aschool building and shots were fired. Soon wenoticed two armed guards outside of our clinic.

Our last day, we were able to spend time atthe Panama Canal. It was an incredibleopportunity to witness freighters and cruiseships passing through the Panama Canal. Thisprovides a savings of approximately three weekson delivery of shipments originating in somecountries.

I have spent a lot of time reflecting on mytime in Panama. I have been reminded of howmuch we take for granted in the United States.We, as U.S. citizens, enjoy a healthcare systemthat allows us to receive care that is needed forso many diseases. Most of us do not experiencepoverty, malnutrition and preventable diseaselike some areas of Panama.

We as pharmacists very often becomefrustrated with the delivery of pharmaceuticalsand the endless measures that we often mustattend to in order to take care of our patients.Even with these frustrations, we have beenblessed beyond what we deserve. I hope thateach of us will take time to spend with ourfamilies this holiday season and showappreciation for all of our blessings. Again, Ihope that we will never take lightly theprivileges that we enjoy by living in the UnitedStates. If we have not expressed gratitude for allof this, I would encourage each of us to make agratitude list. It will truly help us put things inthe proper perspective.

Gratitude is an important part of living theAmerican Dream and will play an important roleas we deal with the issues that lie before us.

E X E C U T I V E V I C E P R E S I D E N T ʼ S E D I T O R I A L

Jim BracewellExecutive Vice President / CEO

A Holiday Gift For You!

6The Georgia Pharmacy Journal December 2008

Finding the right gift for a friend or familymember is a major challenge today, so much sothat a whole business and industry of Gift Cardshas come into being. The idea is that the receiverof the gift card can use the money associated withthe card to purchase a gift of their own choosing.

As your Executive Vice President I would liketo give you a gift to express my appreciation forthe opportunity to serve this profession so I wouldlike to give you a gift like a gift card that wouldallow you to choose something that would meanthe most to you.

To select your gift you will need to go towww.gpha.org, the official website of the GeorgiaPharmacy Association.

What are some of the selections atwww.gpha.org ?

1. A direct link to all members of the GPhABoard of Directors and their emails.

2. A direct link to the Georgia Board ofPharmacy and national pharmacy associations.

3. The Georgia Pharmacy Journal Online.Your association’s website is your 411 of

information for the profession of pharmacy inGeorgia and it is a gift of knowledge for you. Ihope you will make it your home page or at leastsave as one of your favorites.

Merry Christmas and Happy New Year and ifyou have read this far go to the GPhA website andcheck out these fours items in this order.


1) Georgia Pharmacy Journal Online Edition 2) Continuing Education Articles3) GPhA Convention Page and4) Pharmacy Legislative Day.On each page there will be a number and on

the next page the next number and these fournumbers in the order in which they are listed willbe the last four digits of a Georgia pharmacist’slicense belonging to a GPhA member. This

pharmacist wins a free registration to the GPhAAnnual Convention and two round trip tickets onDelta Airlines to anywhere in the continentalUnited States. If you are the holder of the Georgiapharmacist’s license listed on the GPhA websiteemail me immediately at [email protected] toredeem your prize.

Look for the winner’s name at the end of thisarticle next month.


AIP Spring MeetingApril 25-26, 2009

Sea Palms Resort, St. Simons Island, GA

Please Fax Registration to 404.237.8435

• CE opportunities • AIP Business Meeting • Social and Cocktails with our PartnersRegistration: (For Planning Purposes Please Fill Out and Return)

Memberʼs Name: __________________________Nickname (for badge): __________________________GA R.Ph. License No:___________ Pharmacy Name: _________________________________________Address: _____________________________________________________________________________Phone:(____)____________ Fax:(____)_____________ E-mail Address: __________________________Please circle the following: Academy Member? Yes No GPhA™ Member? Yes No**If Spouse/Guest is attending please print his/her name: ______________________________________Nickname (for badge): ___________________ Is the above guest a member of GPhA? Yes____ No ____

Georgia Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as aprovider of continuing pharmacy education.

Please call 1.800.841.6268 for reservations(Ask for the AIP room block)

Come relax in the lush oasis that is Sea Palms Resort. Take a walk under ancientlive oaks, where the ocean air mixes with a soft marsh breeze. Bike on the beach,play golf, tennis or just relax on your balcony overlooking the island's natural beauty.Sea Palms Resort offers the perfect setting for our AIP Spring Meeting.

Our spring meeting will offer continuing education, time to meet with our vendors,an AIP Business Session to discuss issues impacting independent pharmacy, time tonetwork with other AIP Pharmacies and catch up with old friends. Plan onattending and bring your family for a weekend to be remembered.

AIP has negotiated a special room rate of $139 (Deluxe) and special pricing on otheraccommodations (accommodation choices include hotel-style deluxe guest rooms,executive studios with kitchenette and fully furnished one to three bedroom suiteswith scenic sun deck or screened porch). To guarantee that you receive this specialrate and to ensure you get a room please make your reservation as soon as possible.

Sea Palms has more amenities than any other property on St. Simons Island and isjust minutes from the beach. With twenty seven holes of golf, three swimmingpools, three rubico clay tennis courts, a fitness center and sauna, sandpit volleyballcourt, bike rentals and horseshoes, the recreational opportunities are boundless.

We are very excited about this year’s AIP Spring Meeting. We will give you moredetails as the time nears. Make your plans now to attend.


Welcome to GPhA!The following is a list of new members

who have joined Georgiaʼs premierprofessional pharmacy association!

Jean B. Cox, DunwoodyMary Beck Griffenhagen, R.Ph.,

Fort ValleyCharles D. Griffin, R.Ph., EatontonSidney Collier Hardy, R.Ph., Dublin

John R. Hunt, AtlantaBrian Johnson, Atlanta

Lindsey Michelle, LovvornKreslyn B. Odum, SandersvilleTikeeya Pelzer, Blythewood, SC

Lauren Riley, AtlantaMichael J. Romanzo, R.Ph.,

Mahwah, NJNatalya A. Rozenberg, Lawrenceville

Kelly Silvers, Adairsville, GASteven R. Stein, Marietta

Financial Planningfor Georgia’s Pharmacists

Michael T. Tarrant

Independent Strategies andCustomized Solutions for

Building Wealth & Security

Financial Network Associates1117 Perimeter Center West, Suite N-307Atlanta, GA 30338 • 770.350.2455

[email protected] www.fnaplanners.com

Securities, certain advisory services and insurance productsare offered through INVEST Fi nanci al Co rpo rati o n(INVEST), member FINRA/SIPC, a federally registeredInvestment Adviser, and affiliated insurance agencies.INVEST is not affiliated with Financial Network Associates,Inc. Other advisory services may be offered through FinancialNetwork Associates, Inc., a registered investment adviser.

50 Lenox Pointe, NEAtlanta, GA 30324


Do you knowa future

leader?

The 2008 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia tospend time together in a retreat setting to develop organizational skills that will enable both personal and professionalgrowth. A select group of 20 practitioners will be chosen to attend the Conference.Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in theConference. Applicants need not be members of GPhA to apply. Participants are selected by GPhAʼs ExecutiveCommittee based on the following criteria:(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations;(3) Community activities; (4) Clarity and vision in response to application questions.I would like to nominate the following individual to attend the 2009 New Practitioner Leadership Conference:Name: ___________________________________________________________ Designation: ________________

(R.Ph., Pharm.D., etc.)Works for: ____________________________________________________________________________________Address: _____________________________________________________________________________________[ ] Home or [ ] Work _____________________________________________________________________________

________________________________________________ State: ______ ZIP: _____________Telephone: (Work) (_____) __________________ (Home) (_____) _____________________

(Fax) (_____) ____________________ E-mail: __________________________________________Nominaed by: _______________________________________________________ Designation: _______________Address: _____________________________________________________________________________________

____________________________________________________________State: _______ Zip: ________Tel. (______) ____________________ E-mail: _______________________________________________________

NOMINATION FORM FOR THE 2009 GPhANEW PRACTITIONER LEADERSHIP CONFERENCE

April 17-19, 2009Sea Palms Golf & Tennis Resort, St. Simons Island, GA

Please return this Nomination Form to: GPhF, New Practitioner Leadership NominationAttention: Regena Banks50 Lenox Pointe, Atlanta, GA 30324

Or, you may FAX this Nomination Form to: 404.237.8435If you have questions, please contact Regena Banks at GPhF:Direct # 404.419.8121 • Email: [email protected] you in advance for your assistance.

PLEASE RETURN BYJANUARY 30, 2009

16thYEAR

U P C O M I N G E V E N T S


U P C O M I N G E V E N T S


G P h A M E M B E R S I N T H E N E W S

Representative-elect Buddy Harden, R.Ph.,

former Executive Vice President of the Georgia

Pharmacy Association, won his bid for State House

in the 147th district. This seat was formerly held

by Johnny Floyd. Harden’s total vote count in the

five counties, portions of which are included in

the district, was 10,083 or 56.6 percent. His

Democratic challenger, Roy Gibbs garnered a total

of 7,732 votes or 43.4 percent.

All of Crisp County is included in the district,and Gibbs was a narrow winner there with 3,592votes to Harden’s 3,469. Gibbs also took amajority of the Dooly County votes, gaining 1,316while Harden polled 1,207.

Harden picked up 3,391 additional votes inHouston County; 1,357 in Pulaski and 659 inWorth. Gibbs’ totals in those counties were 1,597in Houston, 946 in Pulaski and 281 in Worth.

Melody Sheffield, PharmD., Public ServiceAssociate at the University of Georgia, and MerrillNorton, R.Ph., presented the Annual SubstanceAbuse Workshop at the UGA College of Pharmacyin October.

Ten Faculty/Residents JoinCollege of Pharmacy This Fall

Ten new faculty and residents joined theUniversity of Georgia College of Pharmacy duringfall semester—three faculty and four residents inthe Department of Clinical and Administrative

Pharmacy, two faculty in the Department ofPharmaceutical and Biomedical Sciences and onefaculty in the Office of Experience Programs.

New to Clinical and Administrative Pharmacyprogram are Virginia Fleming, a clinical assistantprofessor who earned a Doctor of Pharmacydegree at UGA in 2006, then completed apharmacy practice residency at the MedicalCollege of Georgia and an internal medicinespecialty residency at the University of Texas,Brackenridge Hospital.

Michael Neville, a clinical associateprofessor, had previously been a clinical


Lawyer and Pharmacist Leroy Toliver, Pharm.D., R.Ph., J.D.

• Professional LicensureDisciplinary Proceedings

• Medicaid Recoupment Defense• Challenges in Medicaid Audits• OIG List Problems• SCX or Other Audits

Leroy Toliver has been a Georgia Registered Pharmacistfor 34 years. He has been a practicing attorney for 25years and has represented numerous pharmacists andpharmacies in all types of cases. Collectively, he has

saved his clients millions of dollars.

Toliver and Gainer, LLP942 Green Street, SW

Conyers, GA [email protected]

ScriptPro S/P 200 –Central Server and

1 S/P Station

Installed July 2006 –currently not in use.

Owner financing optionsavailable.

E-mail inquiries: [email protected]

associate professor at the Nell Hodgson WoodruffSchool of Nursing at Emory University and aclinical pharmacist at Emory University Hospital.He graduated in 1992 from UGA and completed ageneral clinical residency at Emory UniversityHospital before joining the Emory faculty. Hemost recently was director of EmoryHealthcare’s Department of PharmaceuticalScience’s PGY-1 Residency Program.

Rahul Jain, earned a Ph.D. in Economics atthe State University of New York at Buffalo in2006 and completed a postdoctoral fellowship atthe University of Maryland School of Pharmacy.His research interests are pharmacoeconomicsand health policy.

The new residents are Courtney Blackwell,who has undertaken a community practiceresidency in Athens, and Weng Man Lam and KacySchulman, whose residencies in pediatrics and inpharmacy practice, respectively, are located atthe Medical College of Georgia.

New faculty in Pharmaceutical andBiomedical Sciences include Rajgopal

Govindarajan, an assistant professor who earneda Ph.D. in biochemistry and molecular biology atthe University of Nebraska Medical Center, andcompleted a postdoctoral fellowship inpharmaceutics at the University of Washington.His special interests are anti-cancer and anti-HIVNucleoside Drugs, pharmacokinetics of drugtransport and toxicology.

Mandi Murph, also an assistant professor,earned a Ph.D. in biology at Georgia Tech in2005, followed by a postdoctoral position at M.D.Anderson Cancer Center in Houston.

Whitney Unterwagner, formerly director ofExperiential Education at Mercer UniversityCollege of Pharmacy and Health Sciences, joinedthe Office of Experience Programs as a publicservice associate. She is regional coordinator forColumbus and Northwest Georgia andcoordinator of first-year introductory pharmacypractice experience. She earned a Doctor ofPharmacy degree from Virginia CommonwealthUniversity in 1999.



David and Donna Ledbetter, owners ofClarkesville Drug located on West Louise Street,recently added Clarkesville Drug CompoundingPharmacy to their business.

The state-of-the-art compounding facility islocated in the newly-remodeled Clarkesville Druglocation that has been described as “homey andpatient friendly.”

“We have upgraded our facility to better serve thecommunity and our patients,” said David Ledbetter.“We are all about helping doctors to help theirpatients and this facility will help us do even better.”

The compounding lab is equipped with the latestequipment to manufacture drugs that are notcommonly available in a manufactured dosage form.

“Commonly available drugs do not meeteveryone’s needs,” said Ledbetter. “We are able tocompound special formulations to help with specialneeds that don’t come in manufactured dosages.Working with the patient’s doctor we are able to helpthe patient better fill their particular needs.”

He said Clarkesville Drug has been in business formore than 19 years and his pharmacists and staffremain committed to providing the highest level ofservice to their patrons, whom the Ledbetters refer toas patients, never customers.

The Ledbetters have a combined 69 years ofexperience in the independent pharmacy business.

“Personalized service is what we do best,” saidLedbetter. “We are about serving our patients and wehave a staff here that loves their jobs and loves whatthey do.”

He said the company’s mission is to serve God andthe community by providing professional services,while dispensing medications at everyday low prices.

In addition to compounding pharmacyClarksville Drug also offers:• Physician-ordered immunizations including

Zostavax, Influenza, Pneumococcal,Tetanus/Diphtheria, Tet/Dipth/Pertusis,Hepatitis A and B, Meningococcal andGardasil

• Hormone replacement therapy• A competitive generic drug program that is

comparable to large discount stores• Specialized medications for specialized

patient needs• A bilingual pharmacy technicians• A drive-through window

The Clarkesville Drug CompoundingPharmacy Opens

Excerpts from an article in The Northeast Georgia by Ricky Shaw

Clarkesville DrugCompounding Pharmacystaff: Casey, Donna, David,Deborah and Diana

G P h A U P D A T ES A V E T H E D A T E

Become a part of GPhA’s grassroots team and support your profession!

February 18, 2009Very Involved Pharmacist Day

Georgia State Capital

–� –May 12, 2009

Eggs and Issues BreakfastWashington, D.C.

Check www.gpha.org and future issues of the Georgia Pharmacy Journal formore information about these and other important upcoming events.


G P h A U P D A T EG P h A ʼ S 2 0 0 9 L E G I S L A T I V E A G E N D A


Editor’s Note: The GeorgiaGeneral Assembly convenes early inJanuary 2009 to begin the 2009legislative session. Pharmacists canrefer to this article as they interactwith legislators.

Pharmacy Benefit Managers,Licensure & Regulation –Stuart Griffin, GPhA’s Director ofGovernmental Affairs, is meetingwith Senator Ralph Hudgens(District 47–R), Senator Jack Murphy(District 27–R), Senator Lee Hawkins(District 49–R) and Senator EdHarbison (District 15–R) regardingthis piece of legislation. Theselegislators are the leaders for PBMlegislation in the Senate. Ourconcern in the Senate is the supportof the Lieutenant Governor. At theend of September, Griffin and CindyShepherd, GPhA’s contract lobbyist,met with the Lt. Governor toexpress our sense of urgency on thisissue and its importance to thepharmacy community and ourpatients.

Griffin has been in contact withSenator Tommie Williams (District19–R), the Senate majority leader,to arrange for PBM expert GerryPurcell to speak to the entirelegislature on the effects of PBMs toour nation’s health care system.This will be taking place at theBiennial Institute in Athens betweenDecember 7 and 9.

Stuart and the GPhA leadershipare confident that we will be ableto answer the Lt. Governor’sreservations about this PBM

legislation, and we will see theSenate voting on this bill in 2009.GPhA is also confident we will gainmuch more Senate support for thisbill after Gerry Purcell speaks at theBiennial Institute.

Immunization Legislation – Nochanges to immunization authoritywill be made until the 2009legislative session. Pharmacistscurrently are able to administerimmunizations with a validprescription order for each vaccineadministered. With the realizationof this, we are able to take acareful approach to the legislationsupported by the MedicalAssociation of Georgia. MAG haspenned draft legislation foraddressing immunization and GPhAfeels as if there is room in thislegislation to ensure thatpharmacists retain the ability toadminister immunizations underprotocol, an aspect of theirprofession for which they arewell trained.

Epilepsy, Restricted Prescrip-tions, – On Friday, August 29,Senator Lee Hawkins led a studycommittee on generic substitution.The meeting went well with allinterested parties agreeing there isno need for new legislation butrather to further emphasize thecurrent mechanism of brandnecessary. Representative SharonCooper (District 41–R) mayreintroduce legislation like HB 127as well as similar genericsubstitution bills covering other NTI drugs. With the currentunderstanding the Senate conveysabout these bills increasing the costof medication, another vehicle toenforce brand necessary may besought.

If you have question aboutspecific pharmacy related issuesand their treatment in the House orthe Senate please contact GPhADirector of Government Affairs,Stuart Griffin by phone at404.419.8118 or by email [email protected].

P H A R M A C I S T S I N T H E L E G I S L A T U R E

The longest servingpharmacist in the legislatureis Representative BobbyEugene Parham, R.Ph., ofMilledgeville. He is a retiredpharmacist and formerowner of Medical ArtsPharmacy in Milledgeville.

He is a 1963 graduate of the University ofGeorgia with a B.S. in Pharmacy. In an effort toserve his community, he ran for Baldwin CountyCommissioner in 1969 and was overwhelminglyelected. In 1975, he ran for and won in Georgia’sHouse of Representatives. He has been serving inthat seat for 33 years and plans to continueserving the citizens of the state of Georgia.

Another elected GPhAmember-pharmacist isRepresentative Larry J.“Butch” Parrish, R.Ph., ofSwainsboro. RepresentativeParrish has been serving thepeople of Georgia since 1985.He graduated from theUniversity of Georgia with a

B.S. in Pharmacy in 1964, and began practicingpharmacy in Swainsboro in 1965. Parrish ran forand was elected to the Swainsboro City Council.He served three three-year terms, and thendecided to run for a seat in the House ofRepresentatives in 1985. He won and has been inpublic service ever since.

Representative RonStephens, R.Ph., of GardenCity, began his career in thelegislature 11 years ago, aftercompleting five years on theGarden City City Council.Representative Stephens is a

1978 Mercer University Southern School ofPharmacy graduate with a B.S. in Pharmacy.Representative Stephens is the owner of QuickRx Drugs, Inc., which operates severalcommunity pharmacies in the Savannah area.

Representative Earl L.“Buddy” Carter, R.Ph., ofPooler, is a 1980 graduateof the University of Georgiawith a B.S. Pharmacy. He isthe owner of Omnicare,Inc., and Carter’sPharmacy, Inc., which arelocated in Pooler and Garden City.Before being elected to the House ofRepresentatives in 2004, Carter was the Mayor ofPooler from 1996 to 2004 and prior to that hewas on the Pooler City Council from 1993-1995.

The latest addition tothe roster of pharmacistsin the state legislature isRepresentat ive-E lectOren H. “Buddy”Harden, Jr., R.Ph.,Harden was decisivelyelected to the House inNovember of 2008, and willbegin serving his term in the January of 2009.Graduating from the University of Georgia in1962 with a B.S. in Pharmacy, he spent manyyears as a community pharmacist. In 1993, heserved as the president of GPhA and then asExecutive Vice President of GPhA from 1996 to2006. Harden is not a newcomer to publicservice, having also served as the Mayor ofSylvester and on the Georgia State Board ofPharmacy.

Bobby Eugene Parham, R.Ph.

Larry J. “Butch” Parrish, R.Ph.

Ron Stephens, R.Ph.

Earl L. “Buddy” Carter, R.Ph.

Oren H. “Buddy” Harden, Jr.



Help Make GPhA the Most Powerful Grassroots Force in Georgia

2008 - 2009 GrassrootsSign-Up Form

Please complete and return via fax to GPhA at 404.237.8435

Your Name: ________________________________________________________________

Preferred Address: ___________________________________________________________

City, State Zip Code: _________________________________________________________

Preferred Phone(s): __________________________________________________________

Email Address: ____________________________________ Fax:______________________

How do you prefer to receive legislative information? (Select One)Email Fax

Which of the following activities are you willing to perform to assist GPhAʼs legislativeefforts?

Write A Letter Phone Call Personal Visit Testify On A Bill

Have you made a financial contribution to the campaign of any legislator in the past 4years? If yes, please complete the form below. For nature of relationship, indicate how you knowthe legislator (business, childhood friend, college, church, civic, family, campaign volunteer, etc.).

Yes No*** Confidential - For GPhA File Only ***

Your Legislators Legislatorʼs Name Amount Nature of RelationshipState Representative: ________________________________________________________________State Senator: ______________________________________________________________________US Representative: __________________________________________________________________US Senator: ________________________________________________________________________


Call for awards nominations...The GPhA Awards Committee is seeking nominations for the following awards which will be presented atthe GPhA 134th Annual Convention in 2009. A brief description and criteria of each award is included.Please select the award for which you would like to nominate someone and indicate their name on the formbelow. Deadline for submitting the completed nomination form is March 9, 2009. Nominations will bereceived by the Awards Committee and an individual will be selected for presentation of the Award atGPhA’s 134th Annual Convention at the Marriott Sawgrass in Ponte Vedra Beach, FL.

Bowl of Hygeia Award (sponsored by Wyeth-Ayerst)Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all statepharmacy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not madeposthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee isnot currently serving nor has served within the immediate past two years as an officer ofGPhA other than ex-officio capacity or its awards committee; 5) The nominee has anoutstanding record of service to the community which reflects will on the profession.Distinguished Young Pharmacist Award(sponsored by Pharmacist Mutual)Created in 1987 to recognize the achievements of young pharmacists in the profession, theAward has quickly become one of GPhAʼs most prestigious awards. The purpose of the Award istwo-fold: 1) The encourage new pharmacists to participate in association and communityactivities, and 2) To annually recognize an individual in each state for involvement in anddedication to the pharmacy profession. Selection Criteria: 1) The nominee must have receivedentry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgiapharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must beactively engaged in pharmacy practice; 5) Nominee must have participated in pharmacyassociation programs or activities and community service projects.Innovative Pharmacy Practice Award (sponsored by NASPA/GPhA)This Award is presented annually to a practicing pharmacist who has demonstrated innovativepharmacy practice which has resulted in improved patient care. Selection Criteria: 1) Thenominee must have demonstrated innovative pharmacy practice which has resulted inimproved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be amember of the GPhA in the year of selection.

2009 Awards2009 Bowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Award

Nomineeʼs Full Name _______________________________________________ Nickname ___________________Home Address _________________________________________ City _______________ State _____ Zip ______Practice Site __________________________________________________________________________________Work Address __________________________________________ City _______________ State _____ Zip ______College/School of Pharmacy _____________________________________________________________________List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:__________________________________________________________________________________________________________________________________________________________________________________________Supporting information: ______________________________________________________________________________________________________________________________________________________________________Submitted by (optional): _________________________________________________________________________Submit this form completed by March 9, 2009 to: GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324. Complete this form online at www.gpha.org.

Call fornominationsGPhA 134th

AnnualConvention

2009

PRESS RELEASEFor Immediate Release

Pamala Marquess Named Mercer University College of Pharmacyand Health Sciences Dean’s Award Winner

In recognition of her exceptional service to the school, PamalaMarquess, Pharm.D., was awarded the Deanʼs Award of MercerUniversity College of Pharmacy and Health Sciences by Dean H.W. “Ted”

Matthews. “Pam Marquess is an incredible pharmacist. Her passion and

innovative methods in the practice of pharmacy make her a leader in our

profession,” said Robert Bowles, president of the Georgia PharmacyAssociation. “Pam has tremendous insights that enable her to be asuccess in whatever she does and she is always willing to share her

knowledge with others.”Marquess is a 1993 graduate of Mercer University Collegeof Pharmacy and Health Sciences with a doctorate ofpharmacy. She and her husband, Jonathan Marquess,Pharm.D., CDM, CDE, jointly own three pharmacies: East

Marietta Drugs of Marietta, Woodstock Pharmacy ofWoodstock, and McKenzie Drugs of Lilburn. Marquess is a

resident of Acworth with her husband and two children, Will and Madison.




G E O R G I A P H A R M A C Y S C H O O L S ʼ N E W S

Georgia Pharmacy Foundation AwardsScholarships to Mercer University Collegeof Pharmacy and Health Sciences’ Students

In October 2008, the Georgia PharmacyFoundation presented the Carlton HendersonScholarship, the Regina Baird Scholarships, andthe Neil L. Pruitt, Sr. Entrepreneurial Scholarshipto four deserving Mercer University College ofPharmacy and Health Sciences’ students.

Hillary Volsteadt of Tucson, Arizona, and TreyRump of Chattanooga, Tennessee, were bothawarded Regina Baird Scholarships based on theirscholarship and faculty recommendation. TheRegina Baird Scholarships were named in honorof Mrs. Regina Baird, who was one of the GeorgiaPharmacy Association’s (GPhA) first full-timestaff members. She served as the ExecutiveSecretary of GPhA for many years, and was aleader not only in GPhA, but also in pharmacyassociations throughout the Southeast. Thisscholarship was established in her memory tohelp student pharmacists in the pursuit of theireducation. Two students from each of thepharmacy schools in Georgia are selected toreceive $1,000 each.

Neelam Patel of Sylvester, Georgia, wasawarded the Carlton Henderson Scholarshipbased on her recommendation by a facultycommittee at Mercer University. The CarltonHenderson Scholarship was named in honor ofMr. Carlton Henderson, who was one of GPhA’slong time staff members. He served in thepharmacy industry until his death and was a

valuable staff member of the association formany years. His love for pharmacy and especiallyfor Mercer University knew no boundaries. Thisscholarship was established in his memory tohelp deserving student pharmacists in theirpursuit of education. One student from eachschool receives $1,000 for the Carlton HendersonScholarship.

Laura Coker of Canton, Georgia, was awardedthe Neil L. Pruitt, Sr. Entrepreneurial Scholarshipbased on the recommendation by facultymembers at Mercer University and Coker’sdemonstration of entrepreneurial abilities. LauraCoker is the daughter of GPhA’s First VicePresident, Dale Coker, R.Ph. The Neil L. Pruitt,Sr. Entrepreneurial Scholarship was named inhonor of Neil L. Pruitt, Sr., R.Ph., who was oneof the association’s most loyal and supportivemembers. He served the pharmacy profession inmany arenas until his death. His innovative ideasand entrepreneurial spirit were knownnationally. This scholarship was established in hismemory to help student pharmacists who havedemonstrated entrepreneurial abilities. Onestudent pharmacist from each of the threeGeorgia schools of pharmacy will be selected toreceive this $1,000 scholarship.


Can You Answer CMS Part D Audit?Medicare Part D requires prescription plans to assure continuous quality improvement and yourparticipation via third party contracts necessitates adherence to these directives.

Are you aware that there is language in most contracts mandating the implementation and useof a verifiable, documented pharmacy quality assurance program?

Part D quality assurance requirements under CMS section 423.153©.The following are examples of language from Pharmacy Network Contracts:

� Caremark: “Pharmacy agrees to implement utilization management and qualityassurance programs dictated by Caremark” (Pharmacy Responsibilities Item 14).

� CIGNA HealthCare (Connecticut General Life Insurance Company): “Pharmacy shallestablish internal medication error identification and reduction systems” (Services,Section 3.b).

� Community Care Rx (CCRx; Member Health): “Pharmacy will abide by, and all serviceswill be provided in accordance with CMS guidelines applicable to Part D” (providerresponsibilities Section 3). “Member Health shall routinely monitor performance of thePharmacy per Member Health audit policies” (Miscellaneous Provisions, Section 4).

� Coventry Advantra Rx (Coventry Health Care, Inc.) Utilization Management:“Pharmacy agrees to comply with Utilization Management programs, credentialVerification Programs, Quality Management programs, Provider Sanction Programs andother similar programs.”

� Express Scripts, Inc.: “Have in place systems to reduce medication errors” (Descriptionof Service Components, Section II.20 (iii)).

� WHI Walgreen’s Health Initiatives: “Pharmacy will institute practices that will ensure thereduction of medication errors” (Quality Assurance, Section 4).

Pharmacy Quality Commitment (PQC)will provide such a program andallow you to answer: Yes, I am in compliance. I do have and usea nationally recognized continuous qualityassurance program!

Make your purchase today!

For more information call 1.866.365.7472or visit www.pqc.net. or Sid Anderson,GPhA Member Service Director at404.419.8115(Evaluation of Medicare Part D PDP contacts provided by Ed Heckman, R.Ph. of PAAS National for South Carolina Pharmacy Association.)


P H A R M A C Y P R O F I L E I N L E A D E R S H I P

Alex Tucker, Pharm.D.GPHA REGION 1 PRESIDENT

What type of pharmacy do you practiceand where?I am an employee at the independent pharmacy of RichmondHill Pharmacy in Richmond Hill, Georgia.

Who is your role model/mentor?Ben Chapman would be my mentor when it comes to patientcare. He opened this pharmacy and people respect him as atrue health care provider. Al Dixon would be my mentor forhis business knowledge. They do not teach you much aboutthe business side of pharmacy in pharmacy school.

What do you enjoy most about your job?The diversification in the practice of pharmacy is the mostappealing part. Dealing with the public can be a challenge, butit is rewarding. It is gratifying to know the public valuespharmacists as health care providers, and as an independentcommunity pharmacist I get to spend more time with patientsthanks to a great support staff.

What is the hardest part of your job?Insurance Companies!

What advice can you offer someonecoming into this profession?Get involved in the association and politics. The associationoffers you the opportunity to network with colleagues andallows you access to valuable information. GPhA is lookingout for the profession of pharmacy and we have to standtogether to have our voices heard. GPhA also affords you theopportunity to become involved in politics, and get to knowyour legislators.

What accomplishment are you mostproud of?Birth of my five-month-old, it took a lot of work getting him here.

What do you think has been the mostsignificant change/advancement inpharmacy?Technology – everything from robotics to e-prescribing.Count, lick and stick has gone away which affords thepatients time with the pharmacists they would not have had inthe past. With a great support staff, the pharmacist can focuson counseling, which becomes the most important part of thepractice of pharmacy.

Professionally, if you could changesomething, what would it be?I would like to have the ability to negotiate contracts.

Middle Georgia PharmacyRelief Services

Pharmacy Staffing for:• Chain & Independent Pharmacy• Clinic & Hospital Pharmacy• Specialty & Long Term Care Pharmacy• Over 30 years Rx Experience

Call 478-552-7220 AL Curry, R.Ph.Email: [email protected]

Tennille, GA 31089 www.middlegeorgiapharmacyreliefservices.com


Goal. The goal of this lesson is toexplain attention-deficit/hyperactivity disorder (ADHD) inchildren and adolescents with focuson its pathogenesis, clinicalcharacteristics and confirmation, andits treatment.

Objectives. At the conclusion ofthis lesson, successful participantsshould be able to:

1. recognize historical events andepidemiologic information relevantto ADHD;

2. identify symptomatology thatcharacterizes ADHD and theprinciples that govern its clinicalconfirmation and management; and

3. select from a list specificnonpharmacologic andpharmacologic measures that arereported to modify signs andsymptoms of ADHD.

Attention-deficit/hyperactivitydisorder (ADHD) affectsapproximately 4 to 12 percent ofchildren and adolescents, andpersists throughout adulthood. It isthe most commonly diagnosedpsychiatric condition of childhoodand adolescence. ADHD persists intoadulthood in up to 60 percent ofdiagnosed cases, with 4 to 5 percent

of adults worldwide affected. It is,thus, a major public health problembecause of associated morbidity anddisability across the lifespan ofaffected persons.

Annual medical costs of affectedindividuals are 50 to 75 percenthigher than expenses for non-affected persons. Overall costs ofillness are estimated to be upwardsof $40 billion annually in the UnitedStates alone.

BackgroundAlthough ADHD was first

described in 1845, it was not until1902 that a description waspublished.

ADHD can lead to serious long-term effects including impairment ofmajor life activities and prematuremorbidity. Persons with ADHD mayexhibit underachievement anddisruptive behavior in school, as wellas antisocial and criminal behavior.They typically have unsafe drivinghabits, and are twice as likely to usetobacco.

Males are reportedly affectedmore often than females (2:1 to 3:1ratio). These numbers can bedeceptive because females withADHD may be diagnosed less

frequently since many of them havethe inattentive (i.e., less disruptive)form. Many girls are not diagnoseduntil middle school or later.

PathogenesisAlthough the precise cause of

ADHD is unknown, a deficiency incentral stores of theneurotransmitters dopamine andnorepinephrine has been implicated.These deficits are associated withboth genetics and environmentalinfluences. Recent imaging studieshave failed to find evidence of grossbrain damage in children with ADHD.

In the 1970s, it was hypothesizedthat the core problem in hyperkineticchildren was one of inattention. Thisled in 1980 to adoption of the newdiagnostic label attention-deficitdisorder.

Since the symptoms of ADHDrespond well to treatment withcentral stimulants, and becausethese drugs enhance the availabilityof dopamine, the dopaminehypothesis has captured theattention of many researchers. Thedopamine hypothesis proposes thatADHD is caused by an inadequatesupply of dopamine in the CNS.Dopamine plays a major role in

Gossel Wuest

Thomas A. Gossel, R.Ph., Ph.D.Professor EmeritusOhio Northern UniversityAda, Ohio

J. Richard Wuest, R.Ph., PharmDProfessor Emeritus

University of CincinnatiCincinnati, Ohio

ADHD and Its Treatment in Children and Adolescents

Volume XXVI, No. 8

Editors Note: Due to a mix-up there was an error in the November 2008 Journal that resulted in a key chart beingleft out of the layout. If you are interested in taking the Journal CE please visit the GPhA website to obtain access tothe November Journal CE in its entirety.


initiating purposeful movement andincreasing motivation and alertness,behaviors that are often noted whena child with ADHD responds positivelyto stimulant therapy. The dopaminehypothesis has thus influenced muchof the recent research into thecause(s) of ADHD.

Genetic Influence. The fact thatADHD runs in families lends strongsupport to the theory that heredity isan important risk factor. Ten to 35percent of children with ADHD have afirst-degree relative with a past orpresent history of ADHD.Approximately one-half of parentswith ADHD have a child with thedisorder. Studies suggest that ADHDis among the most familial (affectingother members of the family) ofpsychiatric disorders.

Research to identify specificabnormal genes has concentrated ontwo: a dopamine-receptor gene onchromosome 11 and the dopamine-transporter gene on chromosome 5.Evidence is mounting that childrenwith ADHD have genetic variations inone of the dopamine-receptor genes.Several studies have found evidencefor abnormalities of the dopamine-transporter gene in children withvery severe forms of ADHD.

While the high heritability ofADHD suggests that it is a “genetic”disorder, it is inaccurate to assertthat any single gene is at fault.Rather, some gene variants boost anindividual’s susceptibility toenvironmental triggers.

Even though many imagingstudies have failed to identifyevidence of gross brain damage inADHD, some have noted thatexposure to toxins such as lead, orepisodes of fetal oxygen deprivation,may adversely affect dopamine-richareas of the brain. These findingssupport the many observations thathyperactivity and inattention ofADHD are more common in childrenwhose mothers smoked or usedalcohol during pregnancy (especiallyduring the first trimester), inchildren with impaired oxygenationleading to fetal distress and low birthweight, in children who have been

exposed to high quantities of lead orcarbon monoxide, and in childrenwith infections of the CNS and thosewith serious head injury. Recentlypublished data have shown thatchildren born to nonsmoking motherswho were exposed to chronicsecondhand smoke during pregnancyface serious problems of ADHD andconduct disorder.

Some studies have reported thatparents of hyperactive children areoften overintrusive and over-controlling, which suggests thatparental behavior is another possiblerisk factor for ADHD.

To date, no single mechanism hasbeen identified as the definitivecause of ADHD. It is believed that itsdevelopment most likely results fromcombined action of multiple geneticand environmental risk factors.

Clinical ConfirmationThere is no laboratory or imaging

test, or battery of psychologicaltests, that reliably confirm thepresence of ADHD. Rather,confirmation is based mainly on thepatient’s behavior history (Table 1)and elimination of other sources forthe troublesome behaviors.

ADHD diagnosis is subject to avariety of influences, particularlybecause it is often first suggested byschool teachers (52 percent) andparents (30 percent) rather thanhealth professionals. A diagnosis isfirst suggested by a primary carephysician, child psychiatrist orpsychologist in only 14 percent ofcases. Regardless of who firstsuggests that a child may have ADHD,physicians and mental healthprofessionals typically depend onsuggestions by parents, teachers andother school personnel in confirminga diagnosis. The DSM IV criteria forADHD are summarized in Table 2.Most clinicians report they arehesitant to confirm a diagnosis priorto six years of age because of thewide variability in levels of activitythat overlap with symptoms of ADHD,and therefore are considered normalin early childhood.

TreatmentGoals of therapy include

controlling symptoms, improvingclassroom attention and learningability, enhancing interpersonalrelationships and enriching transitionto adult life. Pharmacotherapy hasbeen the mainstay of treatment fordecades, with hundreds of well-controlled clinical trials documentingits usefulness in children,adolescents and adults. The mostwidely available option for treatmentof ADHD, an option supported by avast literature, are the centralstimulants.

PharmacotherapyStimulants. First shown to be

beneficial for treatment of abnormalbehavior more than seven decadesago, central stimulants have becomethe first-line treatment option forADHD with benefit attained in 75 to90 percent of recipients. Theirprecise mechanism of action in ADHDis not fully understood, although theyare believed to increase release ofdopamine and/or norepinephrinefrom presynaptic neurons or inhibittheir reuptake. These actions resultin increased adrenergic activity. Thestimulant drugs exert these actionsto various degrees, thus working byslightly different mechanisms ofaction. Therefore, failure of therapywith one agent does not translate toa class failure and alternate agentswithin this class often may beadministered to the patient’sbenefit.

The drugs are rapidly absorbedand typically result in an onset ofaction within 30 minutes. Theiraction extends over three to sixhours. Administration is timed tomeet the individual’s school or workschedule, to enhance the person’sability to pay attention and meet hisor her academic or work demands,and to mitigate side effects. Theirgreatest effects are on symptoms ofhyperactivity, impulsivity, andinattention and the associatedfeatures of defiance, aggression, andoppositionality. They also improveclassroom performance and behavior

Volume XXVI, No. 8


and promote increased interactionwith teachers, parents and peers.

Stimulant drugs include mixedamphetamine salts (Adderall, etc.),dextroamphetamine (Dexedrine,etc.), methylphenidate (Ritalin, etc.)and dexmethylphenidate (Focalin).Lisdexamfetamine (Vyvanse) is aprodrug of dextroamphetamine witha longer duration of action. TheAmerican Academy of Pediatrics(AAP), working through itsCommittee on Quality Improvement –Subcommittee on Attention-Deficit/Hyperactivity Disorder,published its Clinical PracticeGuidelines for treatment of school-aged children with ADHD in 2001.AAP determined that there were noclear differences amongdextroamphetamine, lisdexam-fetamine and methylphenidate.Newer products were not available atthe time of guideline development.Subsequent reports suggest that theuse of methylphenidate and mixedamphetamine salts are first-linetherapy because of ample evidenceof their safety and efficacy.

Clinical trials consistentlydocument that stimulants reduce thecore symptoms of ADHD. Recenttrials tend to focus on use of thenewer agents to assist with dosingconvenience and overall ease ofpatient care. Advances in dosageformulations such as long-actingagents aid treatment adherence,decrease embarrassment for childrenin school who must take multipledaily doses, lessen burdens for schoolstaff to administer these doses anddecrease the potential for drugdiversion and abuse. Long-actingformulations extend the action ofthese drugs over eight to 12 hours toallow once-daily dosing.

Advances in methylphenidateformulations include chewabletablets, oral solution and a patchformulation. The patch (Daytrana)has demonstrated statisticallysignificant reductions in ADHDsymptoms for children ages sixthrough 12 years. The patch is wornfor nine hours daily. In clinical trials,application site reactions, insomnia,

anorexia and nervousness were theadverse effects most commonlyreported leading to discontinuationof therapy.

Adverse effects associated withstimulants used in ADHD includeappetite suppression with initialweight loss, insomnia, headache,jitteriness and stomach pain. Ifinsomnia is a problem, giving thestimulant earlier in the day,discontinuing the afternoon orevening dosage, or giving an adjunctmedication such as a low-dosageantidepressant may help. Otherconcerns include tic development,growth delay and potential forsubstance abuse. Mild adverseeffects may be partially controlled byreducing the dose or altering thetiming of administration. Mostadverse effects are mild, recede overtime and respond to dose changes.Appetite may fluctuate, usually beinglow during the middle of the day andmore normal by suppertime. Parentsmay choose to have their child take a“drug holiday” on weekends andvacations to reduce overall exposure,but the utility of this strategy has notbeen demonstrated. Concerns remainabout inhibition of long-term growth;however, most studies conclude thatsuch effects are minimal and of smallclinical importance. As with allmedication use, risks versus benefitsmust be weighed.

Recent concerns have highlightedthe possibility of cardiovascularevents with stimulants. In April 2008,the American Heart Association(AHA) released a statement callingfor a thorough examination includingfamily history and an electro-cardiogram, and routine cardiacmonitoring for children andadolescents prescribed stimulantmedication for ADHD. The call forcloser cardiac monitoring was givento identify the very small number ofchildren and adolescents who mayhave an undiagnosed cardiacproblem.

Non-stimulants. Atomoxetine(Strattera) is the newest non-stimulant treatment option forADHD. It is a selective norepine-

phrine reuptake inhibitor inpresynaptic neurons with less actionto reduce dopamine reuptake in theprefrontal lobes. The drug has aslower onset of action thanstimulants; thus, effects may not beseen until the end of the first week oftreatment. Atomoxetine seems tohave a longer duration of action afteronce-a-day dosing with suggestions ofsymptom relief during the eveningand early-morning hours.

A meta-analysis evaluatedatomoxetine for safety andtolerability. Following 601 subjectsfor up to two years of study, only 5.2percent discontinued medication usebecause of adverse effects. Therewere no discontinuations due to tics,

Volume XXVI, No. 8

Table 1Presentation of ADHD

Reported by child or adolescent• Does not like school or particularsubjects or teachers

• No close or long-term friends• Conflict with parents• Low self-esteem• Always getting in troubleReported by parents• Aggression and problems with anger• Difficulty completing tasks• Disorganized, messy• Does not follow directions• Impulsive• Difficulties with school• “Always on the go”• Does not make or keep friends• Socially or emotionally immature• Engages in dangerous activities• “Spaced out” or absentminded• Loses possessionsReported by teachers• Hyperactive• Inattentive, easily distracted• Interferes with others, disruptsclass

• Underachiever, school failure• Does not listen• Fidgets, will not stay in seat• Blurts out answers, does notconsider others• Frequent behavior problems

Adapted in part from Culpepper L. JClin Psychiatry. 2006;67[suppl 8]:32-37.


Recommendations are as a second-line option following unsuccessfultrials with stimulant therapy.

Tricyclic antidepressants, oncecommonly used, have lost favor overthe years because of their adverseeffect profile; several deaths in theearly 1990s were associated withdesipramine use. Tricyclics aretypically recommended following apoor response with one or morestimulants or atomoxetine. Baselineand periodic electrocardiogrammonitoring are needed to assesssafety of therapy.

Bupropion (Wellbutrin, etc.) hasshown modest efficacy in ADHD. Itsuse may be considered as an optionfor adjunct therapy in persons whoalso smoke tobacco or possessunderlying depression or bipolardisorder, or those with a history ofsubstance abuse. Because bupropionmay induce seizures, the drugshould not be used in persons with aseizure history.

Non-pharmacologic TherapiesBehavioral Intervention.

Behavioral intervention incombination with medication use isthe optimal approach to treatment ofADHD. The MTA Study has shown that

Volume XXVI, No. 8

seizures, hepatic toxicity or growthconcerns. The most commontreatment-emergent adverse effectsoccurring at 10 percent incidenceincluded cough, decreased appetite,dizziness, fatigue, irritability, upperrespiratory tract infection andvomiting. Most effects occurredwithin three months and tapered offthereafter. Weight and heightincreased as expected, even thoughthere was an initial weight decreaseover the first three months oftreatment. Statistically significantchanges were noted in pulse rate andboth diastolic and systolic bloodpressures, but these were consistentwith age-expected increases.

Atomoxetine labeling contains awarning about the potential forsevere liver injury in rare cases. Itshould be discontinued when there isevidence of jaundice or hepaticinjury. The drug also has a black boxwarning concerning the potential forincreased risk of suicidal ideation inchildren and adolescents beingtreated for ADHD. Patients startingatomoxetine should be monitoredclosely for changes in behavior.Compared with stimulants,atomoxetine has relatively lowpotential for abuse.

patients with combined medicationand behavioral intervention improvedin the core areas of ADHD; moreover,family members consistentlybenefited from this approach. Thecombined approach to treatment alsoresulted in less challenging behaviorsand permitted reduced doses ofmedication to be used.

Dietary Intervention. Somemedical researchers and clinicianshave proposed that dietaryintervention has potential benefit intreatment of ADHD. Parents maytherefore choose to supplement or,in some cases, replace medicationwith dietary intervention. Onecommonly promoted intervention isthe Feingold diet, in which dietarysalicylates, artificial colors, flavorsand preservatives are removed fromthe diet. Other proposed dietaryinterventions include removing allsugars, adding high-dose vitamin/mineral supplementation, andsupplying essential fatty acids to helpalleviate ADHD symptoms. At thispoint, none of these approaches havebeen supported by well-designedclinical trials.

Summary and ConclusionsADHD is a chronic condition with

unknown etiology and potentiallyharmful sequelae if not treated.Central stimulants remain the mostwidely used therapy. Innovativedosage forms and longer actingagents assist with ease of dosing andimprovement of drug adherence, andas a means to discourage abuse anddiversion. Stimulant use is notwithout safety concerns, includingthe recent call from the AHA tomonitor patients for cardiovascularevents. Non-stimulant therapies,including atomoxetine andantidepressants, may be of benefit inpersons who do not respondadequately to stimulant therapy.

The content of this lesson wasdeveloped by the Ohio PharmacistsFoundation, UPN: 129-000-08-008-H01-P. Participants should not seekcredit for duplicate content.

Table 2Summary of DSM-IV* diagnostic criteria for ADHD

Criterion DescriptionA Patients must exhibit 6 to 9 symptoms of inattention or 6 to 9 symptoms

of hyperactivity-impulsivity that have persisted for at least 6 months.B Some hyperactive-impulsive or inattentive symptoms that caused

impairment were present before age 7 years.C Some impairment from the symptoms is present in 2 or more settings

(e.g., at school [or work] and at home).D There must be clear evidence of clinically significant impairment in

social, academic, or occupational functioning.E The symptoms do not occur exclusively during the course of a pervasive

developmental disorder, schizophrenia, or other psychotic disorder andare not better accounted for by another mental disorder (e.g., mooddisorder, anxiety disorder, dissociative disorder, or a personalitydisorder).

*Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC,American Psychiatric Association, 1994.Adapted in part from Findling RL, Arnold LE, Greenhill LL, et al. J Clin Psychiatry.2007;68:1963-1970.


1 . Whi le the preci se cause o f ADHD i s unknown, a defi ci encyi n central s to res o f whi ch o f the fo l l owing s ets o fneurotransmi tters has been impl icated?a. Norepinephrine and serotonin c. Dopamine and norepinephrineb. Acetylcholine and serotonin d. Acetylcholine and dopamine2 . Which o f the fo l lowing plays a major ro le in ini tiatingpurpo s eful mov ement and i ncreas i ng mo ti v ati on andalertness when a chi ld wi th ADHD responds pos i tively tos timulant therapy?a. Acetylcholine c. Norepinephrineb. Dopamine d. Serotonin3 . There hav e been fi ndi ng s that s uppo rt the manyobservations that hyperactiv i ty and inattention o f ADHD aremore common in chi ldren in al l o f the fo l lowing ins tancesexcept those:a. whose mothers have diabetes or hypertension.b. with impaired oxygenation leading to fetal distress.c whose mothers smoked during pregnancy.d. with infections of the CNS.4 . Confirmation o f the presence o f ADHD i s based mainly on:a. laboratory tests. c. psychological tests.b. imaging tests. d. patient behavior history.5 . Whi ch o f the fo l l owing i s a prodrug o fdextroamphetamine?

QuizADHD and Its Treatment

in Children and Adolescents

The Georgia PharmacyAssociation is accredited by theAccreditation Council for

Pharmacy Education as a provider ofcontinuing pharmacy education.ADHD and Its Treatment in Childrenand AdolescentsVolume XXVI, No. 8GPhA Code J08-12Program Number: 142-999-08-008-H01-PCE Hours: 1.5 (0.15 CEUs)Release Date: 12/5/2008Expiration: 08/15/2011

1. Select one correct answer per question and circle theappropriate letter below using blue or black ink (no red inkor pencil).

2. Members submit $4, Non-members must include $10 tocover the cost of grading and issuing statements of credit.Please send check or money order only. Note: GPhAMembers will receive priority in processing CE.Statements of credit for GPhA members will be mailedwithin four weeks of receipt of the course quiz.

1. A B C D 6. A B C D2. A B C D 7. A B C D3. A B C D 8 A B C D4. A B C D 9. A B C D5. A B C D 10. A B

Mail completed quiz to: GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324A passing grade of 70% is required for each examination. A person who fails the exam may resubmit the quiz only once at noadditional charge.

Please check here if you are indicating a change of address ______ Phone # __________________Name ________________________________________ License Number(s) and State(s) ____________Address _____________________________________________________________________________City ____________________________________________________ State __________ Zip __________How long did this program take to complete? ________________________________________________

a. Focalin c. Stratterab. Ritalin d. Vyvanse6 . Advances in long-acting oral dosage forms o f drugs usedto treat ADHD have shown al l o f the fo l lowing benefi tsEXCEPT:a. significantly increased effectiveness.b. fewer burdens on school staff.c. decreased embarrassment for children in school.d. aiding treatment adherence.

7 . Which o f the fo l lowing i s a non-s timulant treatmentoption for ADHD?a. Focalin c. Stratterab. Ritalin d. Vyvanse

8 . Al l o f the fo l lowing are common treatment-emergentadverse effects that occur in pati ents receiv ing the drugreferred to in ques tion # 7 wi th the exception o f:a. fatigue. c. irritability.b. seizures. d. dizziness.

9 . The drug referred to in ques tion # 7 has a black boxwarning for increased potential ri sk o f:a. bulimia. c. jaundice.b. growth concerns. d. suicidal ideation.


The Georgia Pharmacy Journal

Editor: Jim [email protected]

Managing Editor: Kelly [email protected]

The Georgia Pharmacy Journal® (GPJ) is the officialpublication of the Georgia Pharmacy Association, Inc. (GPhA).Copyright © 2008, Georgia Pharmacy Association, Inc. Allrights reserved. No part of this publication may be reproducedor transmitted in any form or by any means, electronic ormechanical including by photocopy, recording or informationstorage retrieval systems, without prior written permissionfrom the publisher and managing editor.

All views expressed in bylined articles are the opinions of theauthor and do not necessarily express the views or policies ofthe editors, officers or members of the Georgia PharmacyAssociation.

ARTICLES AND ARTWORKThose who are interested in writing for this publication areencouraged to request the official GPJ Guidelines for Writers.Artists or photographers wishing to submit artwork for use onthe cover should call, write or e-mail the editorial offices aslisted above.

SUBSCRIPTIONS AND CHANGE OF ADDRESSThe Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) isdistributed as a regular membership service, paid for throughallocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per singlecopy; international rates $65.00 per year and $20.00 singlecopy. Subscriptions are not available for non-GPhA memberpharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) ispublished monthly by the GPhA, 50 Lenox Pointe NE, Atlanta,GA 30324. Periodicals postage paid at Atlanta, GA andadditional offices. POSTMASTER: Send address changes toThe Georgia Pharmacy Journal®, 50 Lenox Pointe, NE,Atlanta, GA 30324.

ADVERTISINGAdvertising copy deadline and rates are available atwww.gpha.org upon request. All advertising and productionorders should be sent to the GPhA headquarters as listedabove.

GPhA HEADQUARTERS50 Lenox Pointe, NEAtlanta, Georgia 30324Office: 404.231.5074Fax: 404.237.8435 http://www.gpha.orgDesign & Print: Landmark Communications, Inc. - 770.813.1000

2008 - 2009 GPhA BOARD OF DIRECTORS

Name PositionSharon Sherrer Chairman of the BoardRobert C. Bowles PresidentEddie Madden President ElectDale Coker First Vice PresidentJack Dunn Second Vice PresidentJim Bracewell Executive Vice President/CEOBurnis Breland State at LargeHugh Chancy State at LargeJudy Gardner State at LargeKeith Herist State at LargeJohn McKinnon State at LargeAndy Rogers State at LargeTommy Whitworth State at LargeAlex Tucker Region One PresidentTony Singletary Region Two PresidentRenee Adamson Region Three PresidentBill McLeer Region Four PresidentShobhna Butler Region Five PresidentBobby Moody Region Six PresidentPam Marquess Region Seven PresidentLarry Batten Region Eight PresidentAlissa Rich Region Nine PresidentChris Thurmond Region Ten PresidentMarshall Frost Region Eleven PresidentKen Eiland Region Twelve PresidentRusty Lee ACP ChairmanLiza Chapman AEP ChairmanDebbie Nowlin AHP ChairmanTim Short AIP ChairmanMichelle Bishop APT ChairmanHillary Volsteadt ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael Farmer Insurance Trust ChairmanPat McPherson Ex Officio - President, GA

Board of PharmacyCynthia Pangburn Ex Officio - Chairman, GSHPGina Ryan EX Officio MercerMeagan Spencer Ex Officio Mercer ASPRusty Fetterman Ex Officio South Rebecca Cubbedge Ex Officio South ASPBrian Buck Ex Officio UGAWalter Williams Ex Officio UGA ASP


Sid Anderson [email protected] Free 1.888.871.5590

Georgia Pharmacy Journal®50 Lenox Pointe, N.E.Atlanta, Georgia 30324

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