The Georgia Pharmacy Journal: May 2011

GPhA 2011 ConventionJune 18-22, 2011

Register Now!

The Georgia Pharmacy Journal May 20112

Let us be Your Insurance Resource

Join us in celebrating 30 years of serving the membersof the Georgia Pharmacy Association.

To learn more visit www.gpha.org.

Call TODAY to schedule a time to discuss your health insurance needs.

404.237.8435

Celebrating 30 years of service to the Pharmacists of Georgia!

Georgia Pharmacy Association Members Take Advantage ofPremium Discounts Up to 30% on Individual Disability

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Have you protected your most valuable asset?Many people realize the need to insure personal belongings like carsand homes, but often they neglect to insure what provides their lifestyle and financial well-being - their income!

The risk of disability exists and the financial impact of a long-term disability (90 days or more) can have adevastating impact on individuals, families and businesses.During the course of your career, you are 3½ timesmore likely to be injured and need disability coverage than you are to die. (Health Insurance Association of America,2000)

As a member of the Georgia Pharmacy Association, you can help protect your most valuable asset and receivepremium discounts up to 30% on high-quality Individual Disability Income Insurance from Principal Life InsuranceCompany.

For more information visit www.gpha.org.

* Association Program subject to state approval. Policy forms HH 750, HH 702, HH 703. This is a general summary only. Additional guidelines apply. Disability insurance has limitations and exclusions. Forcosts and details of coverage, contact your Principal Life financial representative.


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

5 GPhA Moves to Online Voting

6 Legislative Wrap-up 2011

15 Convention CPE Line-up

18 Toye Moye Appointed to Georgia Board of Pharmacy

21 Mr. Burcher Goes to Washington

23 Continuing Education for Pharmacists: Understanding Asthma in Children and Adults: A Primer for Pharmacists

C O L U M N S

4 President’s Message

7 Editorial

13GPhA 2011 Convention

Register NOW!

Departments8 Pharm PAC 2010-201111 APhA Programs Information12 GPhA New Members14 Alumni Dinner Registration20 12th Annual Georgia Pharmacy

Foundation Golf Tournament31 GPhA Board of Directors

Advertisers2 The Insurance Trust2 Principal Financial Group9 Logix, Inc.9 Melvin Goldstein, P.C.10 Pharmacists Mutual Companies16 GPhA Workers Compensation17 AIP19 Bill McLeer for GPhA 2nd VP22 PQC22 University of Florida 32 The Insurance Trust

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

P R E S I D E N T ’ S M E S S A G E


Arecent trip to Seattle, Washington, for the APhA annualconvention will be long remembered on several counts,especially for one insightful presentation and a very

memorable personal experience. The keynote speaker, Dr.Clayton Christensen, gave a brilliant presentation based on abook he had written entitled “The Innovator’s Prescription.” Dr.Christensen is a Harvard business professor who wrote the bookin an effort to provide a solution to the seemingly unmanageablehealth care web that has been weaved in our country. He spokeabout the need for disruptive innovation in our health caresystem. This is the type of innovation that can change an entireindustry, or that can change the way an entire nation, or eventhe world, does business.

Christensen used the example of the personal computer toexplain what he means by disruptive innovation. Once personalcomputing made its way into businesses and homes, therebecame very limited use in the market for main framecomputers. Those companies manufacturing main framecomputers who did not recognize the changing market andrefused, or waited too late to adjust to the market, soon foundthemselves out of business. I’m going to date myself, but Iremember those first days of computers in pharmacies. In myfirst two years of practicing pharmacy, we were still usingtypewriters to produce prescription labels. Then in 1980, Iworked for an independent pharmacy in Hiram, Georgia. Theowner purchased a computer for around $20,000. I stillremember that 200 pound monstrosity sitting in the corner ofthe pharmacy, purring like an air conditioning compressor.Then, as we all know, the affordable personal computers camealong the next couple of years and made their way into everypharmacy in the country.

The innovation brought about by the personal computerchanged the landscape forever for information technology. Buthow, you might ask, does this relate to health care? He explainedby making an analogy between the main frame computer andthe centralization of health care. In his particular example, heexplained how the hospital system in this country attempts to beeverything to everybody, an attempt, he says, that can never bepossible. The solution to the health care crisis, according to

Christensen, is todecentralize, just as thepersonal computer hadcaused in relation to the mainframe computer. Hesuggested breaking healthcare into specialty units, so that instead of trying to beeverything to everybody, the emphasis is on being the best inthe chosen area of specialty. Although he didn’t mentionpharmacy in particular in this example, the implications areclear. Specialties in MTM, diabetes education, consultativeservices, and compounding are all examples of areas in whichinnovative pharmacists are already reaping professional as wellas financial success in Georgia as well as across the country.

As I was listening to the speaker, I couldn’t help but think of thepast two recipients of the GPhA Innovative Pharmacist awards,David Pope from Barney’s Pharmacy in Augusta, and the teamof Jonathan and Pamala Marquess, who own severalindependent pharmacies in the North Atlanta area. David’sinnovative approach to diabetes education and management hasearned him national recognition. The education component ofthe Marquess’ practice makes them stand out in the crowd.Additionally, being sworn in as the first APhA Trustee fromGeorgia also speaks to Jonathan’s national recognition.

In addition to learning about disruptive innovation while inSeattle, I experienced quite a different kind of disruption, whichis what I referred to in the title of this article- Seattle Stoned,kidney stoned, that is.

Thank goodness for pharmacist friends on the same flight whohappened to have enough meclizine to knock me out so I couldsurvive the flight back to Atlanta. As they say, all is well thatends well, as the boulder sized 9mm stone was passed a fewagonizing days later. My urologist has prescribed a beer a nightto solve my kidney stone problems. So this one’s for pharmacyinnovation and no more stones!

Dale M. Coker, R.Ph., FIACPGPhA President

Disruptive Innovation/Seattle

Stoned

5The Georgia Pharmacy Journal May 2011

February 15, 2011The Georgia Pharmacy Association Nominating Committeemade up of the twelve Region Presidents and the GPhAPresident will meet to consider nominations from themembership.

March 20, 2011The Georgia Pharmacy Association Nominating Committeewill submit their selections for candidates for GPhA First VicePresident and Second Vice President to the GPhAmembership. Any GPhA member who would like to be acandidate for First or Second Vice President and is not amongthose presented by the GPhA Nominating Committee maypetition to have their name included on the ballot or theseoffices. The petition requires the signature of at least twentyactive members of the Georgia Pharmacy Association for thecandidate to be certified by the GPhA Executive Vice Presidentas a candidate via petition, and will allow candidates time toreach out to the membership during the Spring RegionMeetings.

April 19, 2011Noon on this date is the last time in which a candidate notpresented by the GPhA Nominating Committee, can petitionGPhA to be on the ballot as a candidate for office. Anymember of GPhA not wishing to vote via the internet mayrequest from GPhA via phone, mail or email a paper ballotfor voting by April 19, 2011.

May 4, 2011On this day voting via the internet will open. All paper ballotsmust be returned to the special GPhA post office box and be

post-marked no laterthan midnight June10, 2011, in order toallow for pick up,ballot security andcounting.

June 21, 2011At noon on this datethe electronic ballotvia the internet will beclosed and no other votes accepted. This will allow thecandidates several days at the annual meeting to reach out tomembers who will be allowed to vote via the internet at theconvention. An electronic tally will be provided to the Teller’sCommittee at 3:00 p.m. on this day, and the results announcedto the GPhA Board of Directors.

The newly elected officers of GPhA will installed at thePresident’s Inaugural Banquet.

We will be sending ballots via the email address we have on fileat the GPhA office. If you do not wish to receive a digitalballot please call Tei Muhammad at 404-419-8115, andprovide her with the mailing address at which you wish toreceive your paper ballot. For those without emailaddresses on file with GPhA you will receive a paper ballot.

If you have any questions about the election process pleasecontact Maggie Patterson at [email protected] or 404-419-8120.

GPhA Changes its Election Process:

Important Date Changes for 2011

Election

G P H A N E W S

GPhA Needs You and Your Pharmacy KnowledgeWe are looking for a few good writers to write CPE Articlesfor the GPhA Journal. If you are interested in building yourresume and helping GPhA create the premier CPE programin the state of Georgia please contact us at 404-231-5074.

The Georgia Pharmacy Journal July 20106

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

Legislative Wrap-up 2011

Just a few weeks ago, the 2011 Session of the GeorgiaGeneral Assembly ended. In the 40 day session, over2500 bills and resolutions were introduced, of which

around 80 contained some language in either the codesection of Georgia law for controlled substances or thecode section for pharmacies and pharmacists.

With help from members like you, GPhA was successful inpassing our legislative agenda and defeating legislationthat would be harmful to you, including beating backseveral attempts to add sales taxes to prescription drugpurchases and repeated attempts by HCA hospital chainstrying to attach language to different bills to allowautomated pill dispensers without any involvement of apharmacist in a hospital.

One of our legislative victories was the passage of SB 36,the Prescription Drug Monitoring Bill. For four longlegislative sessions, GPhA led the legislative fight to passthis legislation and the final version is something that wecan be proud of. Despite attempts by some to severelylimit what drugs would be monitored, SB 36covers Schedules II through Schedule Vnarcotics.

Georgia was the last state in the Southeast topass this legislation, which led to us being ahaven for prescription drug abusers. Even withthe pill mills that have been popping up all overthe state, it was still a battle to pass SB 36because of some legislators’ concerns overprivacy issues. The compromise we reachedallows pharmacists and doctors to access thedatabase but law enforcement will require asubpoena to view its information.

GPhA also passed SB 93, the Annual DrugUpdate Bill, which included designatingpseudoephedrine as a Schedule V ExemptNarcotic. This had been a legislative priority for

GPhA for six years. Pseudoephedrine is the mainingredient used to manufacture methamphetamine and bymaking it only available in pharmacies behind the counter,it should reduce the amount of meth that is manufacturedin Georgia.

On the last day of the session, we introduced SB 288 toallow pharmacists to give any immunization that isrecognized by the CDC to patients while working within aprotocol agreement with a physician, much likepharmacies can do with influenza vaccines now.Legislative hearings are already in the planning stagesaround this legislation for this summer and fall.

The success GPhA had this session is directlyproportionate to the work our members are doing by theirinvolvement in PharmPac and their direct contact withtheir individual legislators. Next year is going to beanother great year because of this continued involvementof members like you.

by Andy FreemanDirector of Government Affairs

What is the power and clout of Pharm PAC?

It is our unity of purpose in the support of legislative officeholders and candidates. “You have more clout andinfluence than you think you do,” said PAC Chairman,former state Senator Eddie Madden. When you reflect onthe turn out for our February 23, 2011, VIP Day at thestate capitol, you have to be amazed at the results of ourunified effort.

Mike Smith, the head football coach of the AtlantaFalcons, was on the coaching staff of the Baltimore Ravenswhen they won the Super Bowl in 2001, and he hascoached with several other teams. I believe Coach MikeSmith has a unique perspective on what makes a footballteam a great football team. A great team is one that winsthe Super Bowl while an average team doesn’t. CoachSmith has a simple one word answer and that wordis–Unity.

Unity is the key. Whether you are talking about a sportsteam, work team, school team, or a health care team, it isessential that we get everyone on the bus and moving inthe right direction with a shared vision, focus, purpose,and direction. When a team comes together, they are ableto succeed together and succeed we did on VIP Dayaccording to Madden.

The speakers on the podium were Governor Nathan Deal,Insurance Commissioner Ralph Hudgins, AttorneyGeneral Sam Olens, Speaker of the House David Ralston,and Commissioner of the Department of Health andHuman Services David Cook. No other organization inthe state has had that level of participation from the

leadership of our state.

Over fifty legislators also arrived between 7 a.m. and 8:30a.m. to meet with pharmacy constituents from across thestate.

Unity of purpose is the backbone of Pharm PAC. All thecontributions that were given last fall to legislators andcandidates who support pharmacy could have been givenby all the individual pharmacists who support Pharm PACbut the power and clout of the unified contributions frompharmacy would have been lost among the countlessindividual ones that an office holder must solicit. A checkfrom Pharm PAC was larger and clearly said this supportis on behalf of the profession of pharmacy and represents aunity of purpose.

Advocacy is a team sport. One person, one pharmacistalone does not have the power or the clout of a team ofpharmacists united in purpose, speaking with one clearvoice.

The list of Pharm PAC contributors now runs onto twopages of this journal. Is your name there? Are you on theteam that passed significant legislation to improve thepractice of pharmacy this legislative session? Are you onthe team that will expand the scope of the practice ofpharmacy in the delivery of immunizations next year? Ifnot, it is time you stepped up and joined the Pharm PACteam and celebrate with us at the Pharm PAC event at theGPhA Convention at Amelia Island.

UNITY – the power of Pharm PAC.

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

Jim BracewellExecutive Vice President / CEO


Unity: the Power of Pharm PAC


Titanium Level($2400 minimum pledge)Michael E. Farmer, R.Ph.David Graves, R.Ph.Jeffrey L. Lurey, R.Ph.Robert A. Ledbetter, R.Ph.Marvin O. McCord, III, R.Ph.Judson L. Mullican, R.Ph.W.A. (Bill) Murray, R.Ph.Mark L. Parris, Pharm.D.Fred F. Sharpe, R.Ph.Jeff Sikes, R.Ph.

Platinum Level($1200 minimum pledge)Robert Bowles, Jr., R.Ph., CDM, CftsJim BracewellT.M. Bridges, R.Ph.Bruce L. Broadrick, Sr., R.Ph.Thomas E. Bryan, Jr., B.S.William G. Cagle, Jr., R.Ph.Keith Chapman, R.Ph.Hugh M. Chancy, R.Ph.Dale M. Coker, R.Ph., FIACPJ. Ashley Dukes, R.Ph.Jack Dunn, R.Ph.Stewart Flanagin, Jr., R.Ph.Andy FreemanAnn Hansford, R.Ph.Robert M. Hatton, Pharm.D.Alan M. Jones, R.Ph.Ira Katz, R.Ph.Harold M. Kemp, Pharm.D.J.Thomas Lindsey, R.Ph.Brandall S. Lovvorn, Pharm.D.Eddie M. Madden, R.Ph.Jonathan Marquess, Pharm.D., CDE, CPTPam S. Marquess, Pharm.D.Kenneth A McCarthy, R.Ph.

Scott Meeks, R.Ph.Drew Miller, R.Ph., CDMLaird Miller, R.Ph.Jay Mosley, R.Ph.Allen Partridge, Jr., R.Rh.Tim Short, R.Ph.Dean Stone, R.Ph., CDMChris Thurmond, Pharm.D.

Gold Level($600 minimum pledge)Larry Batten, R.Ph.James Bartling, Pharm.D., ADA, CAC IILiza G. Chapman, Pharm.D.Patrick M. Cook, Pharm.D.Mahlon Davidson, R.Ph., CDMJim Elrod, R.Ph.H. Neal Florence, R.Ph.Kevein Florence, R.Ph.Ted Hunt, R.Ph.Robert B. Moody, III, R.Ph.Sherri S. Moody, Pharm.D.Sharon M. Sherrer, Pharm.D.Michael T. TarrantJeffrey Richardson, R.Ph.Houston L. Rogers, Jr., Pharm.D., CDMRobert Anderson Rogers, R.Ph.Daniel C. Royal, R.Ph.Dean Stone, R.Ph., CDMThomas H. Whitworth, R.Ph., CDM

Silver Level($300 minimum pledge)Renee D. Adamson, Pharm.D.John L. Colvard, J. R.Ph.Chandler Conner, R.Ph.F. Al Dixon, R.Ph.Marshall L. Frost, Pharm.D.

James Jordan, R.Ph.Michael O. Iteogu, Pharm.D.John KalvelageWillie O. Latch, R.Ph.W. Lon Lewis, R.Ph.Michael McGee, R.Ph.William J. McLeer, Sr., R.Ph.Albert Nichols, R.Ph.Kalen Beauchamp Porter, Pharm.D.Bill Prather, R.Ph.Sara Mandy Reece, Pharm.D.Edward Franklin Reynolds, R.Ph.David Jack Simpson, R.Ph.James Thomas, R.Ph.Alex S. Tucker, R.Ph.Brandon UllrichAlan M. Voges, Sr., R.Ph.Flynn W. Warren, M.S., R.Ph.Oliver C. Whipple, R.Ph.Walter Alan White, R.Ph.

Bronze Level($150 minimum pledge)Monica M. Ali-Warren, R.Ph.John Bowen, R.Ph.James R. Brown, R.Ph.Mark C. Cooper, R.Ph.Michael A. Crooks, Pharm.D.Charles Alan Earnest, R.Ph.Amanda R. Gaddy, R.Ph.Amy S. Galloway, R.Ph.Johnathan Hamrick, R.Ph.EdKalvelageSteven KalvelageMarsha Kapiloff, R.Ph.William E. Lee, R.Ph.Earl Marbut, R.Ph.Leslie Ponder, R.Ph.Richard Brian Smith, R.Ph.

Pharm PAC Enrollment

Pledge Year 2010-2011

If you made a gift or pledge to Pharm PAC and your name does not appear above please, contact Kelly J. McLendon [email protected] or 404-419-8116. Donations made Pharm PAC are not considered charitable donations and arenot tax deductible.


Pharm PAC Contributors’ List ContinuedMarion Wainright, R.Ph.Steven Wilson, R.Ph.Sharon B. Zerillo, R.Ph.Jackie WhiteJohn KalvelageCarey B. Jones, R.Ph.Fred W. Barber, R.Ph.Jeffrey Richardson, Jr., R.Ph.

Members(no minimum pledge)Jill AugustineClaude W. Bates, B.S.Chad J. Brown, R.Ph.Max C. Brown, R.Ph.Lucinda F. Burroughs, R.Ph.Shobhna D. Butler Pharm.D.Waymon M. Cannon, R.Ph.Walter A. Clark, Jr., R.Ph.Jean N. Courson, R.Ph.Carleton C. Crabill, R.Ph.Charles Gass, R.Ph.Alton D. Greenway, R.Ph.J. Clarence Jackson, Jr., R.Ph.Gina R. Johnson, Pharm.D., BCPS, CDEJoshua Kinsey, Pharm.D.Ashley S. LondonCharles Lott, R.Ph.Tracie D. Lunde, Pharm.D.Randall Marett, R.Ph.Ralph K. Marett, M.S.Roy McClendon, R.Ph.Steve Perry, R.Ph.Whitney B. Pickett, Pharm.D.Donald Piela, R.Ph.Rose Ann Pinkstaff, R.Ph.Michael Reagan, R.Ph.Leonard Franklin Reynolds, III, R.Ph.James Riggs, R.Ph.Victor Serafy, R.Ph.Harry A. Shurley, Jr., R.Ph.James Strickland, R.Ph.Leonard Templeton, R.Ph.Heatwole Thomas, R.Ph.James. E. Stowe, Jr., R.Ph.Erica Veasley, R.Ph.William D. Whitaker, R.Ph.Jonathon A. Williams, Pharm.D.Michael R. Williams, R.Ph.

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APhA Certification Course in

Pharmaceutical Care for Patients

With DiabetesFriday, June 17, 2011 (12:30 - 6:30 PM)For more details and to register online today visit www.gpha.org or call 404-231-5074.

If you plan to attend the GPhA Convention you must register for that eventseparately.

Cost:Member: $350Potential Member: $450Student: $175

The American Pharmacists Association and the Georgia Pharmacy Association are accredited by theAccreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

If you have any questions about these events please call 404-231-5074.

Basic Life Support for Health Care Providers CourseMonday, June 20, 2011 (1:00 PM - 5:00 PM)

Amelia Island Plantation6800 First Coast HighwayAmelia Island, FL 32034 For more details and to register online today visit www.gpha.org or call 404-231-5074.

Cost:Member: $75Potential Member: $100

Cancelation Policy: No refunds will be issued; however, timely notification of cancelation may allow anotherpharmacist to participate in this program.

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


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

Pharmacy School Student MembersEmilee Ann McDonald, Athens

Todd Thomas, AthensZachary Germann, SuwaneeJohn Dow Hyerm, Rincon

Fei Wang, AtlantaDorris Ottens, Athens

Bonnie Angel Rhodes, BufordTravis Ray Harrison, Jesup

Judith I. Onwubiko, LithoniaAmanda Yassin, Savannah

Thuy-Linh Thi Vo, Silver Spring, MDAfeez Salako, Lawrenceville

Mebanga Ojong, LawrencevillePriyank Devta, SnellvilleMelissa S. Denno, Atlanta

Pharmacist Technician MembersBrandy Nicole Medlin, Villa Rica

Kay Goodman, TiftonJosh A. Clark, C.Ph.T., Alamo

Audrey Pietersen, C.Ph.T., AcworthCarol Coston, C.Ph.T., Kennesaw

Cindy Cargill, C.Ph.T., DallasPat VanLinden, Acworth

Robbie LaShawn Howard, LithoniaStephen Andrew Farr, C.Ph.T., Martinez

Lydia J. Daniel, DallasAurie L. Harden, East Dublin

Associate MembersDavid W. Newman, Blue Ridge

New Graduate Pharmacist MembersCecilia J. Inhulsen, Pharm.D., Montezuma

Jason Montegna, Pharm.D., ScottdaleThomas Henry Teasley, Pharm.D., Elberton

Individual Pharmacist MembersKaren Michele Long, R.Ph., Tunnel Hill

Mindy Kim, Pharm.D., MariettaMichael J. Deming, Ph.D., SuwaneeMitra Salehi, Pharm.D., SuwaneeApril L. Scott, R.Ph., Abbeville, SC

Uko Ukoh, R.Ph., DallasKareema D. Abdul-barr, R.Ph., McDonough

Hannah Couch, R.Ph., WatkinsvilleBetsy B Muia, Pharm.D., Atlanta

Richard Kyle Lott, Pharm.D., West GreenWendy Dawson, Pharm.D. Brunswick

Sara J. Lamb, R.Ph., ValdostaJessica Taylor, Pharm.D., Woodstock

Cimone Carter Forbes, Pharm.D., GrovetownCharles Nolan Dooley, R.Ph., Jefferson

Travis Stream, R.Ph., WaycrossGinger Mendoza, R.Ph., Columbus

Audrey M. Eckles, Pharm.D., McDonoughBehzad Khazami, R.Ph., Atlanta

Brandon Robert Selph, Pharm.D., StatesboroJames “Jim” W. White, R.Ph., KennesawRobert M. Woodall, R.Ph., Villa RicaLorri S. Cartin, R.Ph., Powder Springs

Marian E. VanAmore’, R.Ph., WoodstockNnenna K. Makanjuola, Pharm.D., Mabelton

Adeyemi O. Takon, R.Ph., SuwaneeJonathan W. Taylor, Pharm.D., Stockbridge

Alicia Todd Valdez, Pharm.D., AtlantaKetan Patel, Pharm.D., Alpharetta

Anna Marie Faulk, R.Ph., Jeffersonville

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

professional pharmacy association!

The Georgia Pharmacy Journal Rivers,13

June 18-22, 2011: GPhA Convention, Amelia Island

Plantation, Amelia Island, FloridaJoin us on the beaches of Amelia Island to learn aboutnew trends in our ever-changing world of pharmacy.Lock in the lowest rates when you register today!

The Plantation highlights include:• 249 luxurious oceanfront rooms with patios &

balconies overlooking the Atlantic ocean • Indoor and outdoor pools and fully equipped fitness

center • Luxurious full-service spa and salon on site • Golf & tennis shops on site and numerous activities

available • Several fine and casual dining options • More than 49,000 square feet of state-of-the-art

meeting space

Registration Form:GPhA Registration Types (Circle the rate below that applies): 5/2 - 6/1 6/1 - 6/17 On site GPhA Member $320 $345 $400 GPhA Potential Member $495 $520 $570 GPhA Student Member $150 $175 $175

Registration Options (Circle all below that apply):Spouse and Guest Registration (Does not include CPE) $265 Name of Guest or Spouse: ___________________Student Sponsorship $100Tennis Tournament Registration $25Convention T-shirt $20

Name: ____________________________________________________ License Number: ___________Billing Address for Credit Card: ___________________________________________________________City: ________________________________ State: _____________ Zip Code: ___________________Email Address:______________________________________________________________________Credit Card Number: __________________________________ CID#: __________________________Expiration Date: ___________ Total to be billed from above: _________Fax thiscompleted form to Kelly McLendon at 404-237-8435.

How to reserve a hotel room: For information regarding hotel reservationsvisit www.gpha.org or call 904-261-6161. Cancelation Policy: All registration cancelations must be in writing and emailed [email protected]. Cancelations received before June 1, 2011, will be refunded less a $50

cancelation fee. After June 1, 2011, all registration fees will be non-refundable.

The Georgia Pharmacy Association is accredited by the Accreditation Council forPharmacy Education as a provider of continuing pharmacy education.


University of Georgia College of Pharmacy Alumni Dinner

Monday, June 20, 2011, at Slider’s Seaside Grill1998 S. Fletcher Ave., Fernandina Beach, FL

7:30 p.m.

I will attend the Alumni Dinner for alumni spouses and friends of University of Georgia College of Pharmacy.

Please make ______ reservations at $35.00 per person.

_______ Yes, I would like to sponsor ______ student(s) for the alumni dinner at $35.00 each.

Name: ______________________________________________ Class/Year: ________________

Name of spouse and/or guest(s): _____________________________________________________

Address: ______________________________________________________________________

City: _____________________ State: ___________ Zip code: _____________________

Work Phone: _________________________ Home Phone: __________________________Mail registration form with check, payable to UGA Foundation, by June 17, 2011, to Sheila Roberson, College ofPharmacy Alumni Director, University of Georgia, College of Pharmacy, Athens, GA 30602. For more informationplease call 706.542.5303.

Mercer UniversityCollege of Pharmacy and Health Sciences

Alumni DinnerMonday, June 20, 2011, at 7:30 p.m.

Sandy Bottoms Beach Bar & Grill, 2910 Atlantic Ave., Main Beach, Fernandina Beach, FL

Please make ______ reservations at $35.00 per person.

_______ I would like to sponsor ______ student(s) for the alumni dinner at $35.00 each.

Name (on Credit Card): _______________________________________________________________

Name of spouse and/or guest(s): _________________________________________________________

Billing Address: _____________________________________________________________________

City: _______________________________ ST: ___________ Zip Code: ______________________

Cell: ____________________________ Work: ___________________________________________

E-mail: ___________________________________________________________________________

Circle One: Check Visa Master Card Amex

Card Number: __________________________________ CVS#: __________ Exp.Date: ____________Mail registration form to Sharon Lim Harle, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341.Make check payable to Mercer University. For more information call (678) 547-6420 or e-mail to [email protected].


Audit Preparation and Reduction TipsMarlana Smith6/21, 8:00 - 9:00 amCPE Hours: 1

Addiction in pharmacy - treating patientsOR pharmacists addictionsJim Bartling 6/18, 9:00 - 10:00 amCPE Hours: 1

HIV / AIDS: The CommunityPharmacist's PerspectiveKeith Herist6/21, 1:00 - 3:00 pmCPE Hours: 2

Brown BagSharon Zerillo - coordinator6/18, 1:30 - 2:30 pmCPE Hours: 1

Diabetes 1 - Guidelines and TreatmentMandy Reece6/18, 9:00 - 10:00 amCPE Hours: 1

Diabetes 2 - Blood Glucose Monitoring:An Overlooked Treatment for DiabetesJonathan Marquess6/18, 10:30 - noonCPE Hours: 1.5

Diabetes 3 - Insulin 101: A Case-BasedApproach to Understanding InsulinAdjustmentGina Ryan Johnson6/19, 8:00 - 9:00 amCPE Hours: 1

Emergency Preparedness: WorkingUnder ProtocolCatherine White6/21, 1:00 - 2:00 pmCPE Hours: 1

General Session - Current Legislative /Healthcare Reform?Andy Freeman, Bob GreenwoodCPE Hours: 2.5

General Session - State of the Profession?Tom Mennighan, APhACPE Hours: 1

Geriatric PharmacyArmon Neel6/20, 8:00 - 9:00 amCPE Hours: 1

Immunization Update 2011Liza Chapman6/19, 8:00 - 9:30 amCPE Hours: 1.5

Pharmacy Law ReviewFlynn Warren6/18, 1:30 - 3:30 pmCPE Hours: 2

Current Concepts In Lipid TherapyManagementCharles McDuffie, Lindsey Welch6/20, 8:00 - 9:00 amCPE Hours: 1

Men's Health: Hypogonadism andCommercially available TestosteroneReplacement TherapyDee Fanning6/18, 11:00 - noonCPE Hours: 1

MTM - Geriatric PharmacyArmon Neel6/20, 1:00 - 2:00 pmCPE Hours: 1

New Drug Update: A FormularyApproachRusty May6/18, 9:00 - 10:00 amCPE Hours: 1

Novel Routes of Drug AdministrationKevin Henning6/19, 8:00 - 9:00 amCPE Hours: 1

A Pharmacist's Role in ObesityTreatmentTerry Forshee6/21, 1:00 - 2:00 pmCPE Hours: 1

OSHA UpdateLiza Chapman6/21, 8:00 - 9:00 amCPE Hours: 1

Pharmacogenomics for the PharmacistThomas C. Kupiec (Contact - AmyDean)6/20, 8:00 - 9:00 amCPE Hours: 1

Pharmacists PheudJosh Kinsey - coordinator, Dee DeeMcEwen6/19, 1:15 - 4:00 pm (general session)CPE Hours: 1.5

Poster Presentation6/18, 11:00 - noonCPE Hours: 1

Self-care / OTC UpdateSukh Sarao6/20, 1:00 - 2:00 pmCPE Hours: 1

2011 Women's Health UpdateHeather DeBellis, Lauren Garton6/21, 8:00 - 9:00 amCPE Hours: 1

Revitalize Your Store from the OutsideInGabe Trahan6/19, 10:00 - 11:30 amCPE Hours: 1.5

GPhA 2011 Convention CPE Line-up: Schedule is Tentative

Do you want to work for anIndependent Pharmacy?

Do you want to own your ownpharmacy?

Call Jeff Lurey,R.Ph.

AIP Director404 419 8103

[email protected]



GPhA Member Appointed to the

Georgia Board of Pharmacy

As Governor Perdue’s last appointee to the GeorgiaState Board of Pharmacy, Tony Moye is excited toserve the pharmacists and citizens of the state. “It has

been one of my dreams to be able to serve on this board,”Tony said. “I thank Governor Perdue for believing in me andtrusting that I will be an asset to this great board. Manywonderful men and women have served well and brought usforward in Georgia. I hope and pray that my appointment willdo the same.”

Tony has been serving his community as a pharmacist foralmost forty years. A graduate of the University of WestGeorgia in 1970, Tony went on to complete his education atMercer University, earning a B.S. in pharmacy in 1973. Hehas been a member of the Georgia Pharmacy Associationsince his graduation from pharmacy school.

For the first few years after graduation, Tony worked in acouple of different locations, learning the ropes of owningand running a pharmacy business until he felt he was ready tostrike out on his own. The first Moye’s Pharmacy wasestablished in McDonough in 1977, and has grown to sixlocations, including Moye’s Long Term Care and MobilityWarehouse. In 2007, the hard work and dedication of Moye’sPharmacy was recognized by McKesson as a nationalpharmacy of the year.

Tony and his wife, Nancy, live in McDonough and enjoyspending time with their son Michael and his family – wife,Lisa, and daughters, Abby and Lilly. The Moyes have alwaysbeen involved in their community and Tony has beenrecognized and awarded by various community organizationsfor his service. In 2008, he was named Henry County Citizenof the Year, and he is also a previous recipient of the HermanTalmadge Visionary award in Henry County. The Universityof West Georgia awarded Tony its Alumni Achievement

award, and Mercer University awarded him its Young Alumniaward. An Eagle Scout himself, Tony has also been veryinvolved in the Boy Scouts of America and received theGolden Eagle award from the Flint River Council BSA as wellas the God and Country award.

In a recent interview, we asked Tony about the biggestinfluence in his life that led him to success. “My parentstaught me that I could be and do anything if I set out toachieve that goal,” Tony said. “I followed their advice andtried to live up to their expectations, as well as those of Dr.Vince Lopez, who taught me and gave me great support andadvice during school.”

Asked about the changes in pharmacy since he beganworking, Tony said, “Change is a part of our life, which isvery evident in the pharmacy world. When I graduated, theaverage pharmacist filled 75 prescriptions a day. Most of thedrugs that we studied in pharmacy school are not even in useanymore.

In the beginning of my practice, we had much more time tospend with the patients. Now managed care controls much ofour life and there are more rules and regulations and fewernew drugs coming out of the pipeline. But I also believe thereare many more areas of opportunity for pharmacists to exceland expand their profession.”

We asked Tony what he would like to see in the future for thepharmacy profession, a wish list of sorts: “My wish list forpharmacy is to enjoy the profession, look forward every dayto a new adventure and have a more level playing field inmanaged care. And smile a lot and enjoy your family.”

GPhA is proud of Tony and looks forward to working withhim in his appointed position.

by Rebecca Brewer


GPhA member since 1973

Education:B.A. Biology, 1970, University of West GeorgiaB.S. Pharmacy, 1973, Mercer University Southern School ofPharmacy

Employment:Standard Rexall, McDonoughOglethorpe Pharmacy, AtlantaOpened Moye’s Pharmacy in McDonough, 1977

Awards:Henry County Citizen of Year, 2008Herman Talmadge Visionary award, Henry CountyGolden Eagle award winner, Flint River Council BSAEagle Scout and God and Country award with the BoyScoutsUniversity of West Georgia Alumni Achievement awardYoung Alumni award, Mercer University

Community Involvement:Former trustee of University of West Georgia FoundationTwo terms as trustee of Mercer UniversityPast chair of Henry County Chamber of CommercePast president of Kiwanis Club, McDonoughDirector of United Community Bank, Henry CountyGeorgia Sports Hall of Fame Authority memberAdjunct professor, Mercer School of Pharmacy and HealthSciencesPast chair of McKesson’s national advisory boardServed as member of Independent Pharmacy Co-op board ofdirectorsPast member of board of governors of Eagles LandingCounty ClubPast president of Alumni Association for Mercer’s PharmacySchool

Personal: Married to NancyOne son, Michael, and his wife, LisaTwo wonderful granddaughters, Abby and Lilly

Tony Moye’s Biography

Elect BBIILLLL MMCCLLEEEERR FFoorr 22NNDD VViiccee PPrreessiiddeenntt ooff GGPPHHAA

The Right Prescription for the Georgia Pharmacy Association

TRUSTED •INVOLVED • COMMITTED To serve Georgia Pharmacists in all Practice Settings

•BILL BACKS PHARM PAC•2008 Recipent of the GPHA ‘s Mal T. AndersonOutstanding Region President Award• Region President 4 years• AEP Chairman 2 years• AEP Board of Directors 6 years• GPHA Board of Directors 6 years• A long standing member of GPHA• Member of APhA• Previous Independent Pharmacy owner 6 years• Currently employed Fred’s Pharmacy, Zebulon

Bill is ready to continue giving back to the profession whichhas afforded him 38 years of pharmacy practice. As acandidate for 2nd Vice President, Bill is ready to serve GPHAby continuing to promote and enhance the pharmacyprofession as it serves Georgians.

This is a paid advertiment, and should not be construed as an endorsement.

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Mr. Burcher Goes to

Washingtonby Kyle Burcher

Ijust returned from the RxImpact “U” Academy inWashington, D.C., organized by the NationalAssociation of Chain Drug Stores (NACDS). The

academy is designed to develop and hone advocacy skills forstudent pharmacists. Not only did the Academy prepare mefor a lifetime of advocacy and leadership, I was able toimmediately put my new found skills to good use as I metwith many Georgia legislators the following day as part ofNACDS RxImpact Day on Capitol Hill. I was among mypeers at the meeting as nearly 100 student pharmacistsattended the academy from 32 schools or colleges ofpharmacy.

Alex Adams, the event coordinator and Director ofPharmacy Programs for NACDS, explained that “Theoverarching goal (of the advocacy academy) was to create aprogram that helps train and develop the next generation ofadvocates for the profession, and to encourage students tothink broadly about the relationship between public policyand pharmacy.”

The speakers and leaders at the event had a variety ofbackgrounds, ranging from academia to government.Although, each speaker brought their own unique insights tothe advocacy process, they were all united in their message.The leaders impressed upon us the need for students toteach members of the Senate and House of Representativesabout the integral role that pharmacy plays in the healthcareteam. We learned that one of the biggest ideas we couldcommunicate to our legislators was the benefit thatpharmacists can provide by directly improving patient care.

I was further instilled with passion for advocacy by apresentation by Dr. John Michael O’Brien, policycoordinator for the Center for Medicare and MedicaidServices. O’Brien painted a clear portrait of studentpharmacist’s potential to influence the policy process anddrive change. As large an endeavor as that may seem, afterattending the Academy I realized that it was very possible.Through these presentations the students learned how tobecome effective promoters for the profession.

Walking into congressional offices the next day to speak withlegislators may have intimidated me before, but after theAcademy I was strengthened and confident in my pro-pharmacy message. My fellow Georgia students and I spokewith three congressman and many legislative aides regardingH.R. 891: Medication Therapy Management Benefits Act of2011 and how it would benefit both patients andpharmacists alike.

I encourage all members of the profession to get involved.Whether you’re a working pharmacist, or a studentpharmacist it’s never too late to get started with advocacy.We all have the ability to impact the political process.Through NACDS RxImpact it is simple to find out whatlegislation is affecting pharmacy at the national level. Justaccess: capwiz.com/nacds. To see what is affecting ourprofession here in Georgia, please visit the GeorgiaPharmacy Association website for more information atgpha.org. I’m already looking forward to attending nextyear’s RxImpact. I hope to see you there.

A Primer for Pharmacists

V


Online Master of Science inPharmaceutical Outcomes & Policy

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

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

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

PQC is brought to you by your state pharmacy association.

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

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


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

continuing educat ion for pharmacists

Understanding Asthma in Children and Adults : A Primer for Pharmacists

Volume XXIX, No. 1

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

ships to disclose.

Goal. The goal of this lesson is to review the characteristics of asth-ma with emphasis on its causes and triggers for inciting symptoms, epidemiology, prevalence, patho-genesis and clinical impressions, and differentiate between pediatric and adult forms of the disease.

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

1. demonstrate knowledge of asthma including its causes and triggers, epidemiology and preva-lence, pathogenesis, and clinical impressions;

2. differentiate between asthma pathology in children and adults;

3. identify criteria that differ-entiate adult-onset from pediatric asthma; and

4. exhibit knowledge of in-formation relative to asthma to convey to patients and their care-givers.

Background Asthma is one of the most common

the airways, affecting almost 300 million people worldwide. Approx-imately 15.7 million adults and 6.7 million children in the United States have it. The burden of asth-ma affects patients, their families and society in terms of lost school

days and work, decreased quality of life, and unavoidable emergency department visits, hospitalizations and deaths. Asthma accounts for about one out of every 250 deaths worldwide; in 2007, approximately 3,780 patients in the United States died from asthma and its compli-cations. Direct and indirect costs associated with asthma in this country now total about $16 bil-lion annually, with most expenses attributed to prescription drugs, emergency department care and hospitalizations. Asthma is the most common cause of hospitaliza-tion among children, and its mor-tality rate in older adults continues to rise.

Despite current guidelines for its control and effective treatments, asthma remains less than optimal-ly controlled in many patients. At the same time, approximately 60 percent of people with moderately persistent asthma and 30 percent of people with severely persistent asthma consider their illness to be well controlled or completely controlled. This has led many medical researchers to postulate

that a great number of patients overestimate their personal level of asthma control. Moreover, studies

tend to overestimate a patient’s level of education on asthma and its control.

Epidemiology and Prevalence Asthma occurs at all ages, with symptoms appearing most often in infancy. Its prevalence spikes in

years. It increases during adult-hood in females (50 percent higher than in males), and in African Americans (28 percent higher than in Caucasians).

Childhood asthma affects minority populations disproportion-ately with differences in prevalence and severity, emergency depart-ment- and outpatient visits, and hospitalizations. Inequities involv-ing socioeconomic status, housing quality, population density, stress-es related to living in an urban area, lack of family and community support, environmental tobacco smoke exposure, and rodent- and cockroach-infested living areas are contributing factors. There are also disparities in minority populations regarding their level of personal knowledge about asthma, access to medical care and use of health-care services, accurate asthma diagnosis, inadequate medication prescriptions from clinicians, and patient and parental adherence to prescribed treatment protocols.

A

P Bronchopulmonary dysplasia

Aspirated foreign body

Vascular ring

Foreign bodyC Congenital heart disease


Pathogenesis Atopy (the genetic tendency to develop classic allergic disease) is the single largest risk factor for the development of asthma. Atopy involves a capacity to produce ex-cessive amounts of immunoglobulin E (IgE) to environmental allergens such as grass or pollen. Allergic asthma is associated with a person-al and/or familial history of allergic disease such as rhinitis, urticaria and eczema. Sufferers experience

-tions to intradermal injection of extracts of airborne antigens with increased serum levels of IgE, and/or a positive response to provo-cation tests involving inhalation of

At the same time, there is a

asthma who do not have a personal or family history of allergy. They have negative skin tests and nor-mal serum levels of IgE; therefore,

on the basis of immunologic mecha-nisms. These patients have idiosyn-cratic (abnormal susceptibility to a substance that is peculiar to the individual) or nonatopic asthma. Other patients have asthma that

these categories, but rather falls within a mixed group with features of each. For the most part, asthma that appears in younger individu-als tends to have a strong allergic component, compared with asthma that develops in patients later in

life, which tends to be nonallergic or to have mixed etiology.

Asthma results from persistent

-ways that results in their reduced diameter brought about by contrac-tion of smooth muscle, vascular congestion, edema of the bronchial wall, and thick, tenacious secre-tions. The net result is that airway resistance is increased, forced

are decreased, the lungs and tho--

ing requires more energy, elastic recoil is changed, both ventilation

abnormal with mismatched ratios, and arterial blood gas concentra-tions are altered. Thus, although asthma is primarily a disease of the airways, virtually all aspects of pulmonary function are com-promised during an acute attack. Furthermore, in very symptomatic patients there is often electrocar-diographic evidence of right ven-tricular hypertrophy with pulmo-nary hypertension. At the time of therapy, the patient’s FEV1 or peak

percent of predicted. In keeping with the alterations in mechanics, the associated air trapping is sub-stantial, frequently approaching 400 percent of normal, while func-tional residual capacity doubles.

Most individuals with asthma

carbon dioxide in the blood) and respiratory alkalosis. Hypoxia

-tions. The appearance of metabolic

severe obstruction. Cyanosis is a late sign.

Interaction among the resident

in the airway surface epithelium,

kines (endogenous proteins re-leased by cells that have a spe-

cells or on their behavior) bring about the physiologic and clini-cal features of the disease. Cells that contribute in great part to

mast cells, eosinophils, lympho-cytes, and airway epithelial cells. Each can contribute mediators and cytokines to initiate and amplify

pathologic changes. The airway epithelium, therefore, serves both as a target of, and a contributor

exacerbates bronchoconstriction and promotes vasodilation through

by those listed in Table 1.Eosinophils play an important

Interleukin (IL)-5 stimulates their release into the circulation, which extends their survival. When activated, these cells become a rich source of leukotrienes, and the granular proteins (major basic protein and eosinophilic cationic protein) released and oxygen-derived free radicals are capable of destroying the airway epithe-lium that is then sloughed into the bronchial lumen. In addition to resulting in a loss of barrier and secretory function, such damage elicits production of chemotactic cytokines (chemokines; a group of low molecular weight secreted proteins that function in the activa-tion and migration of leukocytes, although some of them also pos-sess other functions) that lead to

can also expose sensory nerve end-ings, thus initiating neutrogenic

turn, could convert a primary local event into a generalized reaction

-tion, the role that eosinophils play in establishing and maintaining airway hyperresponsiveness – the basis for asthma – is undergoing reevaluation.

T lymphocytes are also impor--

tory response. Activated TH2 cells are present in increased numbers in asthmatic airways and produce cytokines such as IL-4 that initiate humoral (the aspect of immunity that is mediated by secreted anti-bodies, as opposed to cell-mediated

Table 1Inflammatory mediators

of asthmaHistamineLeukotrienesProstaglandinsThromboxanePlatelet-activating factorBradykininTachykininsReactive oxygen speciesAdenosineAnaphylatoxinsEndothelinsNitric oxideGrowth factors


immunity, which involves T lym-phocytes) responses. They also elaborate IL-5 with their effect on eosinophils as stated above. Data are accumulating that asthma may be related to an imbalance between TH1 and TH2 immune responses,

drawn at this time.

Clinical Impressions Asthma is an episodic disease that proceeds with acute exacerbations interspersed with symptom-free pe-riods. Most attacks are short-lived, lasting minutes to hours. The pa-tient appears to recover completely after an attack; however, there can be a phase in which the patient experiences some degree of airway obstruction daily. This phase can be mild, with or without superim-posed severe episodes. Conversely, it may be much more serious, with severe obstruction persisting for days or weeks. This latter condition is known as status asthmaticus. In unusual circumstances, acute episodes can cause death.

Symptoms. Asthma symp-toms consist of recurrent episodes

breathing), coughing and wheezing. Recurrent symptomatic periods of wheezing, coughing and breathless-ness in infants may be character-istic of the natural history of the disease, serving as early indicators of developing asthma. Wheezing is regarded as an absolute determi-nant in asthma, although all three symptoms usually coexist. Such wheezing in very young children is

pathologic condition of asthma. At the same time, not all children who wheeze subsequently develop asthma. Moreover, in early child-hood, asthma is often underdiag-nosed because its symptoms can vary widely and are similar to other common childhood maladies including bronchitis, viral lower respiratory infection, and recurrent upper respiratory tract infections. Clinical signs and symptoms of epi-sodic or chronic wheezing, coughing or breathlessness that may indicate a condition other than asthma are listed in Table 2.

As an attack begins, patients note a sense of constriction in the chest, often with a nonproductive cough. Respiration becomes more

-ing both inspiration and expiration. Expiration becomes prolonged and patients frequently experience tachypnea (extremely rapid res-piration), tachycardia and mild systolic hypertension. The lungs

An episode is often marked with a cough along with produc-tion of thick, stringy mucus. In extreme situations, coughing may be ineffective to remove respiratory irritants and the patient may begin a gasping type of respiratory pat-tern. This implies extensive mucus plugging with impending suffoca-tion. Ventilatory assistance by me-chanical means may be required. Atelectasis (collapsed lung tissue) to inspissated (thickened, dried or

occurs during asthmatic attacks. Spontaneous pneumothorax (accu-mulation of air or gas in the pleural cavity) and/or pneumomediasti-num (presence of air or gas in the mediastinum [tissue and organs that separate the two lungs that contains the heart and its vessels, the trachea, esophagus, thymus, lymph nodes and other structures]) are rare.

Less often, asthmatic patients may complain of intermittent episodes of nonproductive cough or exertional dyspnea (shortness of breath during physical activity). Unlike more traditional asthma patients, when these individuals are examined during symptomatic periods, they usually have normal breath sounds but they wheeze fol-lowing repeated forced exhalations and/or may exhibit shortness of breath when tested in the labora-tory.

A very common feature of asthma is awakening during the night with dyspnea and wheezing. In fact, the absence of this phenom-enon questions the diagnosis. Diag-nosis rests on history (Table 3) and characteristic pulmonary function testing, with the demonstration of reversible airway obstruction.

Exacerbations. Exacerbations in children and young adults in northern climates peak in Sep-tember with return to school. In a study of children during a peak pe-riod, 62 percent of cases versus 41 percent of controls showed evidence of viral infection, predominantly rhinovirus (84 percent), highlight-ing viral etiology as an important trigger. Although a number of exacerbations are associated with viral infections, there is increasing evidence that atypical bacterial infections such as Chlamydia pneu-moniae may also be contributory. There is a relationship between C. pneumoniae IgA and exacerba-tion frequency, and in one study, 38 percent of adults presenting with an asthma exacerbation in an emergency department had an increase in C. pneumoniae antibody levels.

Table 2Clinical signs and symptoms indicating a diagnosis

other than asthma

Sign or Symptom Probable Diagnosis Neonatal symptoms/ventilation Bronchopulmonary dysplasia

Sudden onset of cough/choking Aspirated foreign body

Stridor Vascular ring

Unilateral signs Foreign bodyCardiac murmur Congenital heart disease


Table 3Key elements in a medical history that support

a diagnosis of asthma*

-dren. A lack of wheezing and a normal chest examination do not exclude asthma.

Cough (worse particularly at night) Recurrent wheeze

Recurrent chest tightness

Exercise Viral infection Inhalant allergens (e.g., animals with fur or hair, house dust mites, mold, pollen) Irritants (tobacco or wood smoke, airborne chemicals) Changes in weather Strong emotional expression (laughing or crying hard) Stress

*The presence of multiple key indicators increases the probability of asthma, but objective measures (i.e., spirometry) are needed to establish a diagnosis.

Triggers That Incite Asthma Allergens. Allergic asthma has a genetic component, but the genetics involved remain complex. As stated above, allergic asthma is depen-dent on an IgE response controlled by T and B lymphocytes and acti-vated by the interaction of antigen with mast cell-bound IgE mole-cules. IgE circulates in the blood, and binds with receptors on mast cells and basophils. Most allergens that provoke asthma are airborne. Once sensitization has occurred, minute amounts of the offending

-acerbations of the disease. Immune mechanisms are believed to be the cause of development of asthma in up to one-third of all cases and are contributory in another third.

Allergic asthma is often season-al and most often noted in children and young adults. A perennial (nonseasonal) form may result from allergy to animal dander, dust mites, feathers, mold and other environmental airborne allergens that are present year around. Ex-posure to antigens usually results in an immediate response that leads to airway obstruction within minutes and then resolves. A sec-

ond wave of bronchoconstriction, the so-called late reaction, develops six to 10 hours later in 30 to 50 percent of patients.

Pharmacologic Agents. Aspirin, beta-adrenergic an-tagonists, coloring agents such as tartrazine, and sulfating agents are agents commonly associated with the induction of acute episodes of asthma. Drug-induced bronchial narrowing is often associated with high morbidity. The typical aspirin-sensitive respiratory syndrome affects adults primarily, although the condition may occur in child-hood. This problem typically begins with perennial vasomotor rhinitis that is followed by a hyperplastic

mucous membranes of the nose and sinuses) with nasal polyps, with asthma then appearing. Affected individuals typically develop ocular and nasal congestion and acute, often severe episodes of airways obstruction with even small quan-tities of aspirin. There is a great amount of cross-reactivity between aspirin and other nonsteroidal

that inhibit cyclooxygenase type 1. Indomethacin, fenoprofen, naprox-en, ibuprofen and mefenamic acid

this regard. The mechanism by which aspirin and NSAIDs pro-duce bronchospasm appears to be a chronic overexcretion of leuko-trienes, which activate mast cells. Adverse reactions to aspirin can be inhibited with use of leukotriene synthesis blockers or receptor an-tagonists.

Beta-adrenergic antago-nists can obstruct the airways in asthmatic patients as well as in others with heightened airways reactivity and should be avoided by such individuals. The selective

this, particularly at higher doses. In fact, the use of intraocular

glaucoma has been associated with worsening asthma.

-sium and sodium bisulfate, sodium

and sulfur dioxide that are used in the food and pharmaceutical industries as sanitizing and pre-serving agents can produce acute airway obstruction in sensitive individuals. Exposure typically fol-lows ingestion of food or beverages containing these compounds, e.g.,

wine. Exacerbation of asthma has been reported following the use of

-mic solutions, intravenous corti-costeroids and some inhalational bronchodilator solutions.

Environmental Factors. Acute and chronic airway obstruc-tion has been reported following exposure to selective substances used in a wide array of industrial processes. The agents can generally

weight compounds, which are believed to induce asthma through immunologic mechanisms, and low-molecular-weight agents, which serve as haptenes (the portion of an antigenic molecule that determines

can release bronchoconstrictor substances. High-molecular-weight compounds of importance are wood and vegetable dusts (e.g., those


and tragacanth), pharmaceutical agents (e.g., antibiotics, pipera-zine and cimetidine), animal and insect dusts, serums and secretions (e.g., laboratory animals, chickens,

and moths), biologic enzymes (e.g., laundry detergents, pancreatic enzymes, and Bacillus subtilis). Problematic low-molecular-weight compounds include some metal salts (e.g., chromium, platinum, nickel and vanadium) and indus-trial chemicals and plastics (e.g., ethylenediamine, toluene diiso-cyanate, phthalic acid anhydride, persulfates, p-phenylenediamine, western red cedar and various dyes). Formaldehyde and urea formaldehyde are also included in this group, as is exposure to sensitizing chemicals, particularly those used in paints, solvents and plastics.

Infections. The most common stimuli that evoke acute exacerba-tions of asthma are respiratory infections by pathogens other than bacteria. The most important infec-tious agents in young children are respiratory syncytial virus and rhinovirus. In older children and

virus are the predominant patho-gens. Simple colonization within the tracheobronchial tree will usu-

episodes of bronchospasm, and asthmatic attacks occur only when symptoms of an ongoing respira-tory tract infections are, or recently have been, present. Viral infections are perhaps the only stimuli that can produce constant symptoms for weeks.

Exercise. Exercise is a com-mon stimulant of acute asthma attacks. Exercise differs from other naturally occurring provocations, such as antigens, viral infections and air pollutants, in that it nei-ther evokes long-term sequelae, nor increases airway reactivity. At-tacks that follow exertion typically do not occur during it. Critical vari-ables that determine severity of the postexertional airway obstruction include the level of ventilation achieved and the temperature and

humidity of the inspired air. The higher the ventilation rate and the lower the temperature of the air, the greater the response. The mechanism involved in exercise-induced obstruction may be related to a thermally produced hyperemia (excess blood in a part) and capil-lary leakage in the airway wall.

Adult Asthma Since antiquity, asthma has been described as a disease of adults. Its clear recognition as a child-hood disease appears to date only from around 1760. In recent years, however, the pediatric onset of the illness has generally been empha-sized with relatively little attention being paid to asthma in elderly subjects, even though the problem has been noted to be relatively common. Indeed, asthma is given scant attention in standard text-books on geriatric medicine.

Asthma in adults and at older

morbidity and mortality. Most asthma-related deaths, in fact, occur in older adults. Although most patients with asthma de-velop their disease as children or younger adults, late-onset asthma may appear at any age, even in the eighth and ninth decades. Asthma onset at an advanced age correlates with symptoms that are typical of younger adults, but medication re-quirements for older patients often are greater than those for younger patients. Overall, there is no rela-tionship between severity and age of onset of asthma or duration of disease.

Asthma in older adults is as-sociated with considerable morbid-ity and lowered quality of life when compared with individuals of the same age who do not have the dis-ease. Asthma is often underdiag-nosed in this group and is frequent-ly associated with allergic triggers. A major objective of healthcare should be to preserve a satisfac-tory quality of life in persons with asthma, just as this has become an essential component of the healthcare protocol of patients with other chronic disorders. Numerous

investigations support the notion that health-related quality of life in patients with asthma should be measured and actively pursued in addition to conventional clinical parameters.

Long-Standing Versus Late-Onset Asthma. Older asthmatic patients can be divided into two categories: those diagnosed as children who carry the disease throughout life (long-standing asthma) and those who develop new symptoms later in life, that is, at age 65 years and older. This sec-ond group is challenging to recog-nize and accounts for the majority of undiagnosed cases. Numerous studies have suggested that indi-viduals with long-standing asthma have shorter symptom-free periods, a greater number of emergency interventions and hospitalizations, and a marked reduction in lung function than those who develop asthma at age 65 and older. Others suggest that there is no relation-ship between disease duration and severity. This theory is gaining broad acceptance, although some

include symptom appearance as early as age 30.

Atopy in Older Adults with Asthma. Atopic (extrinsic) asthma is associated with disease that is diagnosed primarily during child-hood. Its role in older adults with asthma is less well understood. The well documented triad (asthma, eczema and hay fever) of atopic asthma results in a number of cases, although isolated high IgE level against an allergen does not automatically result. The role of atopy in the pathogenesis of asth-ma is well established, and a high serum IgE level has been shown to be a risk factor for development of obstructive airway disease. Such an association is independent of smoking, but smoking does inten-sify symptoms. Atopy is age related with a high incidence in childhood, moderate risk in mid-life, and low-er occurrence in older age. There-fore, high IgE levels at any age increase the tendency for asthma to occur later in life. A past history


of atopy is one of the predictors of asthma that onsets at an older age. The Normative Aging Study showed that late-onset hypersen-sitivity to cat dander predicted asthma onset in older patients. Allergen sensitization in later life does occur and may be considered a predictor of asthma. It can be con-cluded that atopy is important in some but not all cases of older-age asthma. Moreover, rarely does an environmental source provoke an asthma attack in an older person.

Nonatopic (intrinsic) asthma is much more common in older patients, especially those with late-onset disease. When bronchial biopsies from the two groups are

-matory response can be seen in nonatopic asthma. A reason for this may include airway activation in response to viral or other unknown in vivo antigens. Individuals with late-onset asthma often present with initial symptoms leading to a subsequent diagnosis during or following upper respiratory tract infections.

Age-Related Changes in Lung Function. The chest wall becomes stiffer and less compli-ant with aging. This is likely due

and rib-vertebral articulations (joined together) and narrowing of intervertebral disc spaces. Because of age-related osteoporosis with subsequent vertebral collapse, the shape of the thorax changes, lead-ing to greater dorsal kyphosis (ab-normal backward curvature of the spine) and anteroposterior diame-ter. Not only is the chest wall more

mechanical disadvantage. Since the

to generate negative intrathoracic pressure is compromised. In addi-

in the strength of the diaphragm in older persons. Along with the anatomical changes in the chest wall and its greater stiffness, this reduces the force-generating capac-ity of the diaphragm. Nutritional

older patients, is also believed to contribute to altered respiratory muscle strength.

The normal aging process is associated with reduced elastic recoil of the lung parenchyma (the functional elements of an organ, versus its structural tissue), the precise mechanism for this being unclear. During expiration, there-fore, there is greater tendency for small airways to collapse, with resultant air trapping and an in-crease in residual volume. The stiff, poorly compliant chest wall of older

patients results in less outward recoil, especially marked at high lung volumes. This reduced recoil pressure leads to reduced vital capacity, which is balanced by the increase in residual volume. Older patients, therefore, have greater functional residual capacity with the net effect that they breathe at higher lung volumes than younger patients. This places increased elastic load on the chest wall and an additional burden on the respi-ratory muscles. This all leads to an increase in metabolic demand and symptoms.

Expert Panel Report 3 A major event to help in the under-standing and controlling of asthma was publication in August 2007 of the updated National Asthma Education and Prevention Program (NAEPP) treatment guidelines prepared by the National Institutes of Health. This report, the Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Manage-ment of Asthma provided updated information to improve the care of patients with asthma. Compared with its predecessor reports, EPR 3 included (1) more comprehensive discussion of asthma severity with expanded descriptions of impair-ment and risk, (2) increased focus on asthma control as a goal of therapy, and (3) expanded dis-cussion of pharmacotherapy for asthma with updated treatment al-gorithms. The completeness of the report was an indication of how far our understanding of the clinical syndrome that is called asthma has progressed in the past decade. The full 487-page report including a complete bibliography can be down-loaded without charge at www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. A 74-page summary is also available at the same site and is recommended reading for pharmacists who wish to pursue in-depth study of asthma that goes beyond this CE lesson. The EPR 3 Guidelines are impressive, but it is important to remember that the update has been assembled based on a multitude of studies conducted

Table 4Asthma education

resources

Allergy & Asthma Network Mothers of Asthmaticswww.breatherville.org

American Academy of Allergy, Asthma and Immunologywww.aaaai.org

American Association For Respiratory Carewww.aarc.org

American College of Allergy, Asthma, and Immunologywww.acaai.org

American Lung Associationwww.lungusa.org

Association of Asthma Educatorswww.asthmaeducators.org

Asthma and Allergy Foundation of Americawww.aafa.org

Food Allergy & Anaphylaxis Networkwww.foodallergy.org

National Heart, Lung, and Blood Institute Information Centerwww.nhlbi.nih.gov

National Jewish Health (Lung Line)www.nationaljewish.org

U.S. Environmental Protection AgencyNational Center for Environmental Publicationswww.airnow.gov


Please turn to CorrespondenceCourse Quiz on page 27.

Program 0129-0000-11-001-H01-PRelease date: 1-15-11

Expiration date: 1-15-14CE Hours: 1.5 (0.15 CEU)

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

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

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

worldwide that have led to cur-rent insights into pathophysiologic mechanisms, clinical medicine, evidence-based treatment recom-mendations, and novel therapies. Valuable information on asthma is available at the websites listed in Table 4.

Overview and Summary Asthma is a common chronic af-

that bears a high economic burden on the U.S. healthcare system. Asthma begins primarily during infancy. However, it is not uncom-mon for it to occur later in life and involve severe and persistent ven-tilatory impairment. The release of the EPR 3 guidelines from the NAEPP provides healthcare profes-sionals with updated information to improve the care of patients of all ages who suffer with asthma.

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The Georgia Pharmacy Journal May 201130 january 20111

continuing educat ion quiz Understanding Asthma in Children and Adults :A Primer for Pharmacists

Program 0129-0000-11-001-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

Return to Correspondence Course, OPA,2155 Riverside Drive, Columbus, OH 43221-4052

or fax to 614.586.1545

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

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

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

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. The occurrence of asthma increases to the greatest extent during adulthood in: a. females. b. males. 2. The single largest risk factor for the development of asthma is: a. atony. c. atoxia. b. atopy.

3. The condition referred to in question #2 involves a capacity to produce excessive amounts of: a. IgA. c. IgE. b. IgC. d. IgG. 4. A patient with asthma who has an abnormal suscep-tibility to a substance that is peculiar to that individual has: a. autoimmune asthma. c. eosinophilic asthma. b. congenital asthma. d. idiosyncratic asthma.

5. When activated, eosinophils become a rich source of: a. chemokines. c. leukotrienes. b. immunoglobulins. d. prostaglandins.

6. The triad of symptoms in patients with asthma in-cludes all of the following EXCEPT:

b. coughing. d. wheezing. 7. As an asthma attack begins, patients note a sense of constriction in the chest, often with a: a. productive cough. b. nonproductive cough. 8. Exacerbations of asthma in children and young adults in northern climates peak in: a. December. c. March. b. June. d. September.

9. A perennial form of asthma is one that is: a. nosocomial. c. nonseasonal. b. syncratic. d. rheumatoid.

10. There is a great amount of cross-reactivity between aspirin and other NSAIDs that inhibit cyclooxygenase type 1. a. True b. False 11. Which of the following is one of the most important infectious agents that evoke acute exacerbations of asthma in young children? a. Bacilli c. Pneumococci b. Haemophili d. Rhinovirus 12. Most asthma-related deaths occur in: a. pediatric patients. b. older adults.

13. The well documented triad of atopic asthma includes all of the following EXCEPT: a. asthma. c. hay fever. b. eczema. d. psoriasis. 14. Nonatopic asthma refers to: a. extrinsic asthma. b. intrinsic asthma. 15. The normal aging process is associated with reduced elastic recoil of lung: a. parenchyma. b. mesentery.


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BOARD OF DIRECTORS

Name PositionEddie Madden Chairman of the BoardDale Coker PresidentJack Dunn President-ElectRobert Hatton First Vice PresidentPamala Marquess Second Vice PresidentJim Bracewell Executive Vice President/CEOHugh Chancy State-at-LargeRobert Bowles State-at-LargeKeith Herist State-at-LargeJonathan Marquess State-at-LargeSharon Sherrer State-at-LargeLiza Chapman State-at-LargeMary Meredith State-at-LargeHeather DeBellis Region One PresidentFred Sharpe Region Two PresidentJohn Drew Region Three PresidentAmanda Gaddy Region Four PresidentShobhna Butler Region Five PresidentAshley Faulk Region Six PresidentMike Crooks Region Seven PresidentLarry Batten Region Eight PresidentDavid Gamadanis Region Nine PresidentChris Thurmond Region Ten PresidentMarshall Frost Region Eleven PresidentKen Eiland Region Twelve PresidentRenee Adamson ACP ChairmanJosh Kinsey AEP ChairmanDon Davis AHP ChairmanIra Katz AIP ChairmanDeAnna Flores APT ChairmanLance Faglie ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael Farmer Insurance Trust ChairmanSteve Wilson Ex Officio - President, GA Board of

PharmacySonny Rader Ex Officio - Chairman, GSHPGina Ryan Johnson Ex Officio MercerJill Augustine Ex Officio Mercer ASPRusty Fetterman Ex Officio South Olivia Santoso Ex Officio South ASPSukh Sarao Ex Officio UGADavid Bray Ex Officio UGA ASP

The Georgia Pharmacy Journal: May 2011

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