IV Nutrition Therapies -...

Workshop Guide

CentralDrugsRx.com 877.447.7077

Mitchell Ghen, DO, PhD Nayan Patel, PharmDPaul S. Anderson, N.M.D.

IV Nutrition Therapies

Dear Practitioner,

Welcome to the IV Nutrition Workshop with Dr. Mitchell Ghen and Dr Paul Anderson presented by Central Drugs Compounding Pharmacy. IV Nutrition � erapy is an alternative and superior method of providing the body the vitamins, minerals, and/or amino acids that it needs. IV nutrients bypass the digestive system making IV Nutrition � erapy more e� ective than oral supplements for correcting intracellular nutrient de� ciencies. IV � erapy focuses nutrients on the precise location the body needs them – at the cellular level.

Central Drugs Compounding Pharmacy is proud to have the opportunity to partner with Dr. Mitchell Ghen for this extraordinary workshop. Dr. Ghen is known around the world for his expertise in anti-aging medicine including IV Nutrition � erapy.

We also are excited to be partnering with Dr. Paul Anderson, a naturopathic physician, who will be sharing his vast knowledge of IV and injection therapy and procedures through his work at Bastyr University and across the nation.

A� er attending this workshop, you will have the tools needed to begin incorporating IV Nutri-tion � erapy with your patients giving you a strategic advantage in growing a more e� ective, sustainable, and pro� table healthcare practice.

Congratulations on taking a giant leap forward in healthcare and becoming one of the few physicians capable of providing this advanced therapy. Your patients will thank you for coming.

Course Objectives:• Understand when and how IV nutrition therapy is beneficial to patients

• Learn how to make and administer IV Solutions

• Learn how to apply nutrients to specifi c conditions

• Learn to identify side eff ects

• Understand laboratory values and your patients’ progress

• Learn what to look for when working with a compounding pharmacy

• Learn how to calculate osmolarity and osmolality

Contents

The Central Drugs Team.........................................................................3,4

Workshop Schedule ..............................................................................5,6

IV Nutrition Therapy Lectures

by Mitchell J. Ghen, D.O. Ph.D.................................................Blue 1- 65

IV Nutrition Therapy Lectures

by Paul S. Anderson, ND........................................................Green 1-12

Legal Aspects in IV Nutrient Therapy Practice

by Nayan Patel, PharmD ..............................................................Lime1-4

Appendices..........................................................................................Yellow

How to Work With Central Drugs Compounding Pharmacy

Reaching out to Pharmacists

30/30 Prescriber Success Program, CD Smartpen

Central Drugs Pharmacy Account / Order Forms

Central Drugs Product List

Osmolarity Chart

Sample IV Consent Form

Sample IV Therapy Intake Form

Sample IV Treatment Record

Central Drugs Pharmacists Team

Dimpi Patel, PharmD Dr. Dimpi Patel received her Bachelor of Sci-ence in Chemistry from La Sierra University and Doctor of Pharmacy degree from Loma Linda University. Dr. Patel has a variety of experience in pharmacy including retail, managed care, compounding, management, and hospital. She is also trained to give im-munizations to pediatric and adult patients.

Nayan Patel, PharmD; CEO Dr. Nayan Patel is a recognized expert in clinical pharmacy services. Dr. Patel is a frequent guest lecturer internationally on topics such as hormone replacement therapy, menopause and andropause, osteoporosis, and breast cancer. He is passionate about working together with physicians, nutritionists, and patients to develop a comprehensive plan to improve each patient’s overall health and quality of

life. In addition to his work with patients and practitioners at Central Drugs, Dr. Patel is involved with the USC School of Pharmacy as a guest lecturer and faculty member.

Ashwin Patel, PharmD, CCN; COOAs a Certi� ed Clinical Nutritionist (CCN), Dr. Ashwin Patel is an expert in nutritional health. He is passionate about the role that alternative medicine can play in people’s health, especially when including a diet that emphasizes whole foods and nutrient supplements. His emphasis on patient care extends throughout Central Drugs, which unlike most pharmacies works directly with physicians to solve problems for patients, and

gives both physicians and patients more treatment options.

Peggy Chan, PharmD Dr. Peggy Chan graduated from the University of the Paci� c in Stockton, CA in 2010. She worked for a number of years in retail pharmacy before joining Central Drugs. Dr. Chan has experience operating immunization and blood pressure clinics and has a comprehensive knowledge of pharmaceuticals, OTC medications, and nutraceuticals.

Sheryll Castro-Ieng, PharmD Dr. Sheryll Castro-Ieng earned her Bachelor of Science degree in Physiology from UCLA and her Doctor of Pharmacy degree from Western University of Health Sciences in Pomona, CA. Dr. Castro-Ieng adds a wealth of valuable industry knowledge to the Central Drugs team through her experience in a variety of pharmacy settings including retail, HMO, and managed care. She has taught at Cerritos College in Norwalk, CA, worked as a clinical

consultant for a managed-care consulting � rm in Irvine, CA.

Keyur Patel, PharmD Dr. Keyur Patel received his Doctor of Pharmacy degree from University of the Paci� c, School of Pharmacy in Stockton, CA in 2001. He completed his 4th year clerkship rotations in Ventura County, and is licensed to practice pharmacy in CA. Keyur is involved with prescription processing, providing drug information to doctors, patient counseling, non-sterile compounding, and supervising

technicians and ancillary sta� .

Ilham Hassan, PharmD Dr. Hassan earned her Bachelor of Science degree in Biological Sciences from the University of Southern California and her Doctor of Pharmacy degree from Western University of Health Sciences. Ilham is committed to delivering the best possible pharmaceutical care. She is passionate about providing patient education and customizing drug therapy to meet each patient’s unique needs.

Avni A. Sheth, PharmDClinical Services Coordinator Dr. Sheth is a clinical pharmacist working with prescribers and their sta� to develop custom pharmaceutical formulations to help improve patient care. Her focus is on Women’s Health Compounding and Clinical Trials Research. She is a Lecturer at the University of California, Los Angeles (UCLA) School of Nursing, where she teaches Pharmacology in the Master of Science in Nursing – Advanced Practice

Program and is involved with Alzheimer’s disease research. Dr. Sheth holds a Doctor of Pharmacy degree from the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia.

Along with our Pharmacy & Lab Technicians, Customer Services, and Support Staff - We are Committed to Providing Quality Services and Products for our Practitioners and our Patients.

Helena Nguyen, PharmD Dr. Nguyen received her Doctorate of Pharmacy degree from the University of the Paci� c � omas J. Long School of Pharmacy and Health Sciences. She has extensive knowledge in multiple facets of pharmaceutical compounding including non-sterile and sterile compounding. She has gained this knowledge through work experiences in three compounding

pharmacies in Northern California. Helena is always looking to improve her patient care by gaining more knowledge in creating specialized and individualized medications for her patients.

Chinh Tran, RPh, PhD Dr. Chinh Tran received his Pharmacy Degree from Saigon University, School of Pharmacy in 1978. He received his PhD from the University of Southern California, Department of Physiology and Biophysics in 1993. His research has focused on utilizing Photo labile nucleotides analogues to study the relationship of structures and functions of various important biological enzymes. Dr. Tran’s work has been published in many international Journals such as the Journal of

Biological Chemistry, Biochemistry, Biophysical Journal, etc. He has helped establish Central Drugs as one of the nation’s leading companies in the compounding pharmacy industry.

Eric Buu, PharmDDr. Eric Buu graduated from University of California, Irvine with a Bachelor’s in Biological Sciences. He received his Doctor of Pharmacy degree from Je� erson School of Pharmacy in Philadelphia. He has great interest in research, precepting, and clinical pharmacy as a result of exposure to di� erent scopes of practice within pharmacy. His experience includes inpatient hospital, independent community pharmacy, as well

as pharmaceutical marketing. Eric is passionate about his practice and enjoys collaborating with his colleagues to optimize patient healthcare and education.

Manisha Patel, PharmD Dr. Manisha Patel graduated from Nova Southeastern University in Fort Lauderdale, Fl. Manisha has had over 17 years of retail experience. Her roles have included District Management,Immunization training, Management Rotation preceptor, Advisory Board positions with local pharmacy schools and technician schools. Manisha is certi� ed as an Immunization

trainer. Manisha is passionate about promoting medication compliance and educating patients to drive quality of life.

Alexander Semis, RPh, M.Sc., MHA Dr. Semis graduated from � e Hebrew University in Jerusalem, School of Pharmacy. Dr. Semis received his Master’s Degree from Tel-Aviv University , School of Medicine, with major in Pharmacy and Microbiology. His research focused on Combination anti-fungal therapy for systemic fungal infections. Dr. Semis has also earned Master of Health Administration Degree from Tel-Aviv University Business School. He has extensive experience in non-

sterile compounding as well as in pharmacotherapy.

Stephanie Gaherty, PharmD Dr. Stephanie Gaherty is a 1994 graduate of the University of Southern California School of Pharmacy. She is a registered pharmacist in both Nevada and California and has more than 20 years of experience in community pharmacy practice. Dr. Gaherty fi rst developed an interest in the art of compounding while working as an intern at a teaching hospital exploring alternative dosage forms for pediatric patients.

Creating Health One Person - One Family - One Community at a Time

IV Nutrition Therapies Course Outline Day One

7:00 am Registration and Breakfast

8:00am Evolution of Nutritional IV Therapy, ABCʼs of Giving an IV

Mitchell Ghen, DO,PhD

9:30am BREAK

10:00am Equipment / Supplies


11:00am Vitamins and Minerals and how to create targeted IV treatments


12:30pm LUNCH

1:30pm Legal Aspects in IV Nutrient Therapy Practice

Nayan Patel, PharmD

2:30pm Pharmacology: Compounding, Parenteral Base Solutions, Osmolarity & pH

Paul S. Anderson, ND

3:00pm Work Up: Diagnostic & Evaluation Testing Requirements


3:30pm BREAK

4:00pm Amino Acids and How to Tailor Formulations to Patient Conditions


4:30 pm Unique parenteral compounds and their role in a functional medicine practice


IV Nutrition Therapies Course Outline Day Two

7:00 am Breakfast

8:00am IV Vitamin C: Uses in Anti-Oxidant and Pro-Oxidant IV Therapy


9:30am BREAK

10:00am Vitamins and minerals and how to create targeted IV treatments


11:00am Chelation Therapy and specifi cs on how to remove toxic heavy metals


12:30pm LUNCH

1:30pm Chelation Therapy and specifi cs on how to remove toxic heavy metals (continued)


2:00pm Protocols for anti-aging, improved well-being, fatigue, detox & immune support


3:00pm BREAK

3:30pm Cancer Patient IV Therapy: Concerns, Latest Data Chemo/Radiation Interac-tions


4:30 pm Protocols for the Use of Low and High Dose IV Ascorbate


How to Work With Central Drugs Compounding Pharmacy

Reaching out to Pharmacists

30/30 Prescriber Success Program, CD Smartpen

Central Drugs Pharmacy Account / Order Forms

Central Drugs Product List

Osmolarity Chart




Appendices

We know how important it is for patients to receive their prescription medications on time. We’ve worked hard to develop e� cient processes to ensure that patients and practitioners receive medications when they expect them and in perfect condition.

For Physicianʼs Offi ce Orders: � e � rst step is to set up your account with us. Each Physical Address must have an active account with Central Drugs. Complete the Account Information form and provide us a photocopy of your DEA and State License. We will notify you to con� rm that your account has been established and provide you with our pricing, order form, and patient speci� c information form, if mandated by your state.

Once your account is approved, you may place an order. We will always call to con� rm receipt of an order and discuss the cost and estimated delivery date. Shipping options will also be arranged at the time of con� rming your order. We process orders between 9 am and 6 pm Monday through Friday, Paci� c Standard Time.

Have a question? Your Account Representative can answer your pricing questions and provide standard and customized order forms. For questions regarding your order you can reach a Phar-macy Tech/Customer Service Representative at 877 447 7077. Please ask to speak with someone to place an “Offi ce Order.”

If you prefer, you may leave a message at #104 or #105. You may email offi [email protected] providing no patient information is disclosed. We can email you price lists, but please understand that the price of compounds are subject to change.

All orders must be faxed to 562.694.3869. Order forms are available from your Account Rep-resentative or for download on our website. Please indicate the date on which you would like to receive the medications. We will do everything we can to deliver your medications by the request-ed date. Compounded Medications can take around 5-7 business days in production.

For Patient Prescriptions:When the prescription is submitted to Central Drugs, via, fax, e-script or phone, a pharmacy clerk calls the patient in under an hour to verify insurance information, discuss pricing and payment options, and con� rm the patient’s preferred method of shipment. We o� er very competitive pricing and help your patients with insurance

Our compounding lab team usually � lls each prescription within 3-5 hours (during normal oper-ating hours).

Shipping Options:a. Standard U.S. Mail: 3-5 business days and FREE for 3 or more compounded medications

( $3.00 fl at fee for 1-2 medications)b. Golden State Overnight (GSO) available in CA, NV, and AZc. Federal Express – ground, overnight, 2nd day, 3rd day

Over 99% of our prescriptions ship within 24 hours and arrive at your patient’s home in 3 days.

How to Work With Central Drugs

Central Drugs Compounding Pharmacy has a nationwide reputation for innovative and forward thinking in the � eld of compounding medications. Lead by Nayan Patel, we have grown over the past 13 years and our team is dedicated to applying our knowledge and innovation to help develop easier solutions and advances in medication delivery and compounding.

We value the relationships that we have established with our physicians as together we learn, challenge and enhance the lives of our patients. We welcome creativity - If you have questions about custom compounds or want to know if we can create something especially for you, we want to hear from you! We are fortunate to have an experienced sta� of over 14 PharmD’s with combined compounding experience of over many years. We can utilize their compounding expertise to � nd a solution that is just right for you.

If you would like to speak with a Pharmacist on Staff we have several options for you:

1. Call the main line and ask to speak to a Pharmacist - Let us know what is the nature of your question or inquiry and we will connect you with a pharmacist to your discuss options and solutions. 2. Request a personal IV Nutrition or Bioidentical Hormone Replacement Consultation with our Clinical Pharmacists by dialing extension 150. � ese services are of charge and scheduled for your convenience.

3. If you are local, or visiting Southern California, please visit us at our pharmacies in La Habra and Fullerton. We would be proud to o� er you a tour and a consult with one of our Pharmacists.

4. Join our 30/30 BHRT Prescriber’s Success Program. We have many Doctors across the nation who have bene� ted from our training and expertise by enrolling in our 30/30 program. We will review your BHRT patient cases and assist you in designing their bioidentical hormone therapy. You will become con� dent and pro� cient at prescribing BHRT within 30 days.

5. Participate actively in our upcoming Central Drugs Academy. Beginning in Late 2015. You will be contacted and invited to participate since you already are a workshop attendee.

We Invite you to Reach Out to Our Pharmacists

Osmolari ty Chart

Drug Strength (mg/ml) Osmolarity PF mOsm/ml Osmolarity with Preservative mOsm/ml

Acetyl-L-Carnitine 100 1.910 2.010

Arginine 50 0.197 0.287

Arginine 100 1.420 1.510

Ascorbic Acid (Non-Corn) 222 3.230 5.370

Ascorbic Acid (Non-Corn) 500 5.950 6.050

B-Complex 100 100 1.860 2.040

Biotin 10 0.120 0.220

Boron 2 0.370 0.460

Calcium Gluconate 100 0.630 0.720

Calcium-Disodium EDTA 300 2.300 2.390

Cesium Chloride 0.25 2.880 2.970

Chromium 0.2 0.003 0.100

Dexpanthenol 250 1.220 1.360

DMPS 50 0.520 0.610

Edetate Disodium (EDTA) 150 1.500 1.590

Folic Acid 10 0.190 0.330

Germanium Sesquioxide 100 1.290 1.390

Glutathione 100 0.880 1.060

Glutathione 200 2.060 2.160

Glycine 25 0.670 0.760

Glycyrrhizic Acid 8 0.060 0.160

Hydrochloric Acid 2 0.110 0.200

Hydrogen Peroxide 3% 1.760 1.850

Hydroxocobalamine 1 0.220 0.310

Hydroxocobalamine 5 0.400 0.410

Isoleucine 50 0.980 1.070

Lithium 5 0.028 0.118

Magnesium Chloride 200 2.860 2.950

Magnesium Sulfate 500 3.970 4.060

Manganese 2 0.048 0.138

Methylcobalamin 1 0.310 0.400

Methylcobalamin 5 0.380 0.400

Molybdenum 0.25 0.260 0.350

Niacinamide 100 0.870 0.960

Nickle Chloride 1 0.008 0.098

Potassium Chloride 2meq/ml 3.910 4.000

Procaine 20 0.220 0.310

Pyridoxine HCL 100 1.450 1.600

Selenium 0.2 0.010 0.100

Sodium Bicarbonate 8.40% 1.910 2.000

Strontium 1 0.019 0.109

Taurine 50 0.440 0.530

Taurine 75 0.600 0.690

� iamine Hydrochloride 100 0.920 0.950

Zinc Sulfate 10 0.125 0.215



Consent and Authorization for Intravenous Therapy Procedures

Name of Patient: _________________________________________________________________________

Procedure: _____________________________________________________________________________

Physician performing procedure: ____________________________________________________________

1. (Name of Clinic) provides facilities and personnel to assist your physician in the performance of intrave-nous therapy. You have the right to be informed of the procedure, any feasible alternative options, and the risks and benefi ts. Except in emergencies, procedures are not performed until you have had an opportunity to receive such information and to give your informed consent.

a. The procedure involves inserting a needle into your vein or muscle and injecting the formula de-scribed above by your physician.

b. Alternatives to intravenous therapy is oral supplementation and/or dietary and lifestyle changes.c. Risks of intravenous therapy include:

i. Discomfort, bruising and pain at the site of injection.ii. Infl ammation of the vein used for injection, phlebitis.iii. Severe allergic reaction, anaphylaxis, cardiac arrest and death.

d. Benefi ts of intravenous therapy include:i. Injectables are not affected by stomach or intestinal disease.ii. Total amount of infusion is available to the tissues.iii. Nutrients are forced into cells by means of a high concentration gradient.iv. Higher doses of nutrients can be given than possible by mouth without intestinal irritation.

2. You have the right to consent to or refuse and proposed treatment at any time prior to its performance. Your signature on this form affi rms that you have given your consent to the procedure(s) described above with any different or further procedures which, in the opinion of your physician, may be indicated.

3. The procedure will be performed by or under the direction of the physician named above with qualifi ed medical assistants.

Your signature below means that:

a. You understand the information provided on this form and agree to the foregoing.b. The procedure(s) set forth above has been adequately explained to you by your physician.c. You have received all the information and explanation you desire concerning the procedure.d. You authorize and consent to the performance of the procedure(s).

Date: ________________________ Time: _______________________

Patient/Representative Signature: ____________________________ Witness: ________________________

If signed by representative, indicate relationship: ___________________________ Date: _______________



Patient: ____________________________ Date: __________________ Age: ___________ Sex: _______

Referring Doctor:________________________________________________________________________________

Reason for referral including ICD-9 code: _____________________________________________________________

Prescription: ______________________________________ Frequency: ____________________________ Current health concerns: __________________________________________________________________

Current medications: _____________________________________________________________________

Date of last chemistry screen: ______________________________

Past Medical History – Has the patient ever been diagnosed with:

Hypertension _______ Angina _______ Ankle swelling _______

Arrhythmia _______ CHF _______ MI _______

Abnormal EKG _______ Kidney dz. _______ Gen. Edema _______

Bleeding disorder _______ Asthma _______ Pulmonary edema _______

Sudden wt. Loss _______ DM _______ Anxiety or panic attack _______

Is patient pregnant? _______ G6PD Defi ciency _______

Allergic reactions (specifi c) _________________________________________________

Pertinent details of conditions checked above:

Referring Dr. Signature: _____________________________________________

To Be Filled Out By IV Team

Date of 1st Intake: _________________________

Known allergens: __________________________

Allergy to Latex?: _______ Shellfi sh? _______ Iodine? _______

When indicated:

Presence of edema: _________________ Lung sounds: ____________________ Heart sounds: __________

Vital Signs:

BP: __________ Pulse: ___________ Resp: ____________ Temp: ____________ Weight: _______________

Progress Notes:



Patient Name: __________________________________ Date: ____________________ DOB: _________________

Protocol:

Nutrient mg/mL mL mOsm/mL mOsm*vol12345678

910111213

Totals:

Est. Treatment time: _______________________________ Check infusion method below.

Final osmolarity: _________________________________ 23g Butterfl y set: ________________________

Desired drip rate: ________________________________ 24g Angiocath: __________________________

Cath tip OK on removal: _______________

Site of injection: _________________________________ Time IV started: __________________________

IV Started by: ___________________________________ Time IV fi nished: _________________________

Vital signs before IV Tx.: BP_________ Pulse:__________ Resp__________ Temp__________ Taken by:_________

Vital signs after IV Tx.: BP_________ Pulse:__________ Taken by:_________

Check the following at specifi ed times:

Start of Tx 10 mins 30 mins 1 hour 2 hours 3 hours 3.5 hours

Progress Notes:

Number of treatments received: ___________________________________ Date: ____________________________

Nurse/Tech Signature: __________________________________________ Initials: ___________________________

Doctors signature: _____________________________________________ Initials: ___________________________


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