Janfeb2013

Palmetto Pharmacist • Volume 53, Number 1 1

PharmacistPalmetto

The Official Journal of the South Carolina Pharmacy Association • Vol. 53, Num. 1

Also inside: Spa Weekend Wrap Up • Convention Registration • Pharmacy Day at the State House • Membership Update • Info for New Practitioners • Journal CE • More!

2013 Former President Reunion

2 Palmetto Pharmacist • Volume 53 Number 1 Palmetto Pharmacist • Volume 53, Number 1 3

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Palmetto PharmacistVolume 53, Issue 1 Jan/Feb/March 2013The Palmetto Pharmacist, the official publication of the South Carolina Pharmacy Association, is distributed to association members as a membership service. Statements of fact and opinion are made by the authors alone and do no imply an opinion on the part of the officers or members of SCPhA. For advertising rates and other information, contact SCPhA.

Board of Directors

President/Chairman of the Board

John Pugh, PharmD, RPh

Immediate Past President Terry Blackmon, RPh

President-Elect Steve McElmurray, RPh

Treasurer Pamela Whitmire, PharmD, RPh

Low Country Region Kristy Brittain, PharmD, RPh

Pee Dee Region Jarrod Tippins, PharmD, RPh

Midlands Region Patti Fabel, PharmD, RPh

Upstate Region Ed Vess, PharmD, RPh

At-Large DirectorWilliam Wynn, PharmD, RPh

Speaker, House of Delegates Bryan Amick, PharmD, RPh

Speaker-Elect, House of Delegates Michael Gleaton, PharmD, RPh

REGION DELEGATESLow Country Region Midlands Region Don Neuroth, RPh Craig Harmon, RPhDavid Proujan, RPh Sarah Braga, PharmD, RPh Tray Till, RPh Lynn Connelly, RPhWayne Weart, PharmD Michael Gleaton, RPh Herb Hames, RPh Upstate Region Pee Dee Region David Banks, RPh Jarrod Tippins, PharmD, RPhSteve Greene, PharmD, RPh Spencer Morris, PharmD, RPhWalter Hughes, RPh Jim Shuler, RPh

SCPhA STAFF John Pugh, PharmD Interim Chief Executive Officer Jennifer Simmons Director of CommunicationsLaura Reid Director of EventsKeenan Grayson Director of Membership Lauren Sponseller Administrative CoordinatorJon Wallace, BS Pharm, JD SCPhA General CounselCecily DiPiro, RPh PPN Network Coordinator

PALMETTO PHARMACIST STAFF

Jennifer Simmons Editor-In-Chief

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What’s Inside...

5 Pharmacy: You Can’t Beat the Real Thing President John Pugh discusses the importance of the role of the pharmacist

9 Pharmacy Day 2013 Registration form for SCPhA’s 2013 Pharmacy Day at the SC State House

10 Memembership Update Membership Director Keenan Grayson visits across the state 12 Southeastern “Girls of Pharmacy” Leadership Weekend Didn’t make it to this awesome event? Find out what you missed!

18 Creating Competitive Success Strategy for Independent Pharmacies Roland Thomas presents his third installment in a series of articles that give independent pharmacists an edge

29 Journal CE Returns! SCPhA brings back home study CE for you!

Regular Columns 14 SCCP 28 Financial Forum 29 Journal CE 39 Classifieds

Advertisers 2 Smith Drug Company 4 Pharmacists Mutual 14 Mutual Drug of North Carolina 22 Assured Pharmaceuticals 25 Display Options 38 PACE 39 Jon Wallace, Attorney at Law


PRESIDENT’S PLATFORM

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P harmacyYou Can’t Beat The Real Thing

On April 23, 1985, the Coca-Cola Company announced that they would be changing the formulation of their flagship beverage, Coke. Because the company had been losing market share to Pepsi over the years, they concluded from taste tests that a new, sweeter formula would sell better, thus preventing Pepsi from overtaking their brand. In fact, in these taste tests, consumers preferred “New Coke” over both Coca-Cola and Pepsi. However, when the product hit the market, consumers pushed back. People protested, called the company, and boy-cotted Coke. After 79 days, Coke reintroduced Coca-Cola Classic, returning the formula used for 99 years back to the shelves of American stores.

Interestingly, the story of New Coke illustrates that Coca-Cola sales were the result of more than the taste of the beverage -- consumers were looking for the experience of having a Coke. When Coke wasn’t Coke anymore, the experience was gone.

In the same way that people wanted more from their Coca-Cola than just quenching a thirst, people want more from their medicine than just a bottle of pills. In fact, people really don’t want medicine at all! What they demand is health, and medicine is a pathway to this outcome. We must keep this fact in mind when we strive to fill more prescriptions and to input chart orders faster. We have the knowledge to make a difference. We, as pharmacists, are able to provide the information patients need so they get what they really want from their medicine: health! Without pharmacists, medicine is like New Coke…the product may meet the goals of a surrogate marker (like a taste test, or lower cost to dispense), but it is not what people are looking for. Just as Coke

PRESIDENT’S PLATFORM

continued on page 6SCPhA President John Pugh challenging members at the 2012 Annual Convention to “Be Someone’s Pharmacist”


JOHN PUGH

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us on Pinterest?

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cannot sell empty cans, we must continue to dispense medications. However, we must be there for our patients to help them achieve optimal outcomes from their medications. We must vaccinate them. We must counsel them about adherence. We must help them live healthier lives.

Many payers and Pharmacy Benefit Managers be-lieve “New Pharmacy” (using automation and ship-ping instead of pharmacists) could provide medica-tion to people cheaper, and they want to push us out of the picture. For this reason, it is critical that we demonstrate our value and advocate for things like provider status. While I believe “New Pharmacy” would go the way of “New Coke,” we don’t need to put ourselves or our patients through such a misstep. Whether you’re talking about Coke or pharmacy, you just “Can’t Beat the Real Thing!”

Name

License/Registration Number Degree(s)

Address

City State Zip

Phone Fax

Email

Company/Pharmacy Name

Address

City State Zip

Work Phone Work Fax

NABP eID Birth Date and Month (DDMM)

NEW FOR 2011-2012: SCPhA has established Spe-cial Interest Groups (SIGs) as a peer resource andsounding board for niche issues and activities. Fordetailed information about SIGs, please visitwww.scrx.org. Sign up for as many of the SIGs be-low as you wish and additional information will besent to you.

□ Membership Development□ Employee Pharmacists□ Pharmacists in the Community (Outreach)□ Technicians□ Academia□ New Practitioners□ Compounding Pharmacists□ Independent Pharmacists□ Hospital Pharmacists

Membership Type: (Please select one)Regular RPh Member ($150)Associate (Non-RPh) Member ($150)Vested Member ($2000 one-time fee, no additionaldues)First Year Practicing RPh Member ($75)Retired RPh Member ($75)Pharmacy Technician Member ($35)Spouse/Joint Membership ($250 per couple):

Spouse Name:__________________

Additional Contribution:

SC Pharmacy Advocacy Committee: While your SCPhAdues automatically assist pharmacy advocacy efforts, youradditional contribution to the Pharmacy Advocacy Com-mittee supports greater advocacy in the legislative arena.Contribution Amount: $50 $100 $250$500 $1000 Other $______

SC Pharmacy Foundation: Help preserve the past andinvest in the future of pharmacy. Contributions to the SCPharmacy Foundation are completely tax deductible.Contribution Amount: $50 $100 $250$500 $1000 Other $______

Payment Information:

Total Due to SCPhA: $___________________

Check; check #__________ (made payable to SCPhA)

Credit Card: MC Visa AMEX Discover

Card Number____________________________________Exp. Date___________ CCV #____________________

Ready to be a part of South Carolina’s leading professional pharmacy association? Fill out the form below and return to SCPhAwith payment to join for 2012-2013 today. SCPhA’s membership year is from October 1, 2012-September 30, 2013.

Please return to SCPhA, along with payment, to:1350 Browning Road, Columbia, SC 29210

Or you can fax credit card payments to 803.354.9207Register online at www.scrx.orgFor questions, call 803.354.9977

SCPhA dues are NOT tax deductible as charitable contributions for incometax purposes. However, they may be tax deductible as ordinary and necessarybusiness expenses subject to restrictions imposed by law with respect to asso-ciation lobbying activities. The Revenue Reconciliation Act of 1993 states thatAssociation dues used for lobbying activities are not deductible as a businessexpense. As a result 35% of SCPhA dues cannot be deducted as a businessexpense for federal income tax purposes.

Are you getting all your SCPhA benefits?

If you aren’t getting Small Doses, you are missing out on one of SCPhA’s greatest benefits.

If you haven’t been getting SmallDoses via fax or email, let us know by emailing [email protected].


Support Pharmacy in South Carolina

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will help us protect and defend pharmacy in South Carolina

Help us have a stronger voice at the SC State House.

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Contribute to the SC Pharmacy Advocacy Committee today!

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Contribution Amount $____________Payment type: Check enclosedCredit Card: Visa AMEX MC DiscoverCard #______________________________________Exp. Date____________________ CCV#__________

Return to SCPhA: 1350 Browning Road, Columbia, SC 29210, or fax to 803.354.9207.


MEMBERSHIP MEMBERSHIP


SPA WEEKEND

Southeastern “Girls of Pharmacy” Leadership Weekend 2013 In January 2013, pharmacists from the Southeastern region were treated to a fantastic weekend getaway at the Grove Park Inn in Asheville, North Carolina. The Southeastern “Girls of Pharmacy” Weekend has become one of the premiere events for pharmacy leaders to attend each year. The 2013 event was certainly no exception.

The weekend featured fantastic CE from leaders like Kayce Shealy, Ally Derring-Anderson, Jenelle Sobotka, Kathryn Freeland, and Lindsy Meadow-craft. In addition, there was a fantastic CE panel with female pharmacists, moderated by Patti Fabel, and featuring Jessica Puckett-Beasley, Sarah Braga, Pamela Whitmire, and Jenelle Sobotka.

The weather for the event could not have been more beautiful! In years past, attendees have been treated to snow, slush, and super cold weather. This year, at-tendees were able to truly get out and explore Ashe-

ville in warm weather. Attendee Joanne Epley was even able to get in a round of golf on their gorgeous Bob Timberlake designed course!

The highlight of the weekend, however, was the addition of the Paint and Mingle event on Friday evening. Attendees could pre-register to attend a fun instructor-led painting class. Each person was supplied with the materials and canvas. Every one painted along, under the direction of an instructor. Even those attendees who thought that they were not artistic at all turned out a fantastic masterpiece! Everyone had a great time with this event and they were able to take home a wonderful memento of the weekend.

SCPhA is already making plans for the 2014 event. We hope that you will join us next year and experi-ence this wonderful event!

SPA WEEKEND


SCCP

The harm caused by contaminated medications produced by the New England Compounding Cen-ter (NECC) is a dramatic example of how much the public depends on pharmacists to produce safe medi-cations, and the consequences when there are unac-ceptable workplace conditions, inadequate attention to standard procedures and poor quality control over products.

It appears that the NECC was producing medicines as a manufacturer under a pharmacy license. The lapses in product safety are unacceptable to patients who relied on these medications and to those in the phar-macy profession who are committed to strict safety standards. It is now up to our profession and regula-tory agencies to help restore the public’s confidence that medications are safe.

Colleges of pharmacy play a vital role in educat-ing pharmacists who apply proper standards to their work. At the South Carolina College of Pharmacy (SCCP), all pharmacy graduates receive many hours of training in sterile and non-sterile compound-ing. They also learn current regulations and the ethical standards that all pharmacists must live by.

Teaching Students About Compounding StandardsBy Joseph DiPiro, PharmD, Executive Dean of the SC College of Pharmacy

The purpose of this training is to produce pharmacists for South Carolina who prepare safe medicines.

At SCCP training in compounding begins in the first semes-ter with non-sterile formulations. The students are taught: • how to apply good compounding practices in the

preparation of non-sterile compounded formula-tions according to USP 795

• that they must prepare products with accept-able strength, quality, purity and pharmaceutical elegance

• appropriate packaging and labeling as required by state and federal laws and are taught the dif-ference between manufacturing vs. compounding

The students must maintain a log on every prepara-tion they make.

SCCP students receive two full semesters of training in hospital pharmacy which includes sterile com-pounding. We have the good fortune to have instruc-tors with many years of sterile product experience who closely monitor student technique in applying USP 797 principles. Students learn: • the proper ways to don the personal protective

equipment, handwash, make sterile products, and check sterile products

• proper techniques to work in both horizontal laminar air flow hood and the vertical air flow hoods and learn not only how to make a product, but how to check someone else who might make them

• TPN with lipids, PCA syringe, mock-chemother-apy IV solution in a primed bag and in a syringe, and a home infusion dose

Students are also required to successfully pass one product of the PATT (Personal Aseptic Technique

Test) 2 Media Fill kit which is used to test their asep-tic technique skills.

In addition to training within the College, students learn from programs offered by the Pharmacy Compounding Centers of America (PCCA). PCCA has come to our USC and MUSC campuses to offer the Student Introduction Compounding Lab Boot-camp. Through the Kennedy Lecture series, we have brought to campus compounding experts Chris Sim-mons, RPh of PCCA and Loyd Allen, PhD, editor-in-chief of the International Journal of Pharmaceutical Compounding.

Students get 300 hours of introductory practice expe-rience and 1,400 hours in advanced practice experi-ence. These rotations bridge what is taught in the labs

to the implementation of concepts in practice ac-cording to USP and JCAHO standards. In addition to advanced institutional rotations, some of our students complete compounding rotations at PCCA and at home-infusion companies such as Intramed Plus and Infusion Care of SC.

The New England Compounding Center brought to light tragic lapses in production of sterile products. The public should be assured, however, that what happened at the New England Compounding Center is not representative of the high standards used by their pharmacists and pharmaceutical manufacturers and taught to our students.

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NEW PRACTITIONERS PARTNERSHIPS

In today’s competitive job market, you have to do things to set yourself apart from others. The follow-ing is some advise for setting yourself apart from the competition.

1. Take ResponsibilityYou want to be a leader at work, learn to take respon-sibility for anything that has your fingerprint on it. That means, as long as you participate in the project, you have a hand at the failure of the project. Learn to take responsibility for not just the good things, but even bad ones. Admit to your mistakes because it’s okay to be wrong. You cannot learn if you have not made any mistakes.

2. Believe In Win-WinA rising tide lifts all boats – always think win-win. It exists. Just because the world thinks the business world is nasty, and that you need to be manipulative and maneuvering to win, you need not participate in it. In fact make it your contribution not to be nasty and bullying in your ways. You want to be a leader at work, believe in your hands as leader to change the world. The power of positive influence you have on the people around you and the power to inspire people to greater heights is in front of you.

3. Push The EnvelopeTry new things. Take some risk. Make yourself un-comfortable. Do the things that may risk making you look foolish - what do you have to lose? Leaders take risks. They are not afraid of doing what they believe. What do you believe in that you are willing to take some risk? To be a leader at work, you need to take even simple risks like taking on the project no one wants.

3. Do It, Write ItI have often said this. This world is full of people who talk too much and don’t do enough. If you want to be a leader at work, act upon something. Work that plan. If you have any ideas that are simmering in your mind, write it down. It doesn’t matter if it is not a plan yet, just write it down. If you don’t write it down, there is no one to present to and there is no record of the idea. How can it count? If you want to

be a leader at work, you have practice writing down everything.

4. See Opportunities EverywhereThere is no need to create opportunities for yourself to lead. The opportunities to lead are everywhere. You need to be mindful of these opportunities. I have just mentioned one earlier. Are there any opportuni-ties to take on the project no one wants? If you don’t see opportunities everywhere, you are missing the point.

5. Be OpenBe open to criticism, otherwise you are just living off yourself. What does it mean? When you are open to feedback, you are being fed ideas from others that are free. Often times, these ideas come from people smarter than you. They will give you tips on how to improve and how to be better. That’s what a leader needs - constant feedback. You need feedback to be a leader at work, otherwise you are “feed-own” (I just created that word to mean feeding yourself) and you will go hungry soon. With no new ideas, a leader dries up.

6. Give, Give, GiveThat’s how you open up. Pour out all you got from inside you. Give all you have ideas, thoughts, plans. Feel the vulnerability and learn to like it. When you pour all your ideas out you will need new ones. Where do new ideas come from? From critics who want to tear you down, from well-meaning support-ers and from people you least expect. More comes back to you. You have more to input. It enriches you. That’s how you become a leader at work.

These are the six actions to position yourself as a leader at work. You want to be a leader at work? Do not be afraid of taking risks. You have more to gain than lose when you open up.

Reprinted from http://www.career-success-for-newbies.com/be-a-leader-at-work.html.

Be A Leader At Work – 6 Actions To Position Yourself As A Leader At Work


Pharmacy Time Capsules1988—Twenty-five years ago:Medicare Catastrophic Health Care Act passed by Congress but repealed also immediately after outcry by a groundswell of negative reactions.

Board of Pharmacy Specialties (BPS) recognizes Pharmacotherapy and Nutritional support as phar-macy practice specialties.

1963—Fifty Years Ago:The first measles vaccine was licensed for use in the U.S. in 1963. John Enders developed the vaccine from a strain of measles isolated by Thomas Peebles.

Valium (diazepam) marketed by Hoffman-LaRoche.

1938—Seventy-five Years Ago:The Federal Food, Drug, and Cosmetic Act was passed in response to deaths from the use of Massen-gill’s Elixir of Sulfanilamide.

Albert Hofmann of Sandoz Laboratories in Switzer-land synthesized LSD (lysergic acid diethylamide).

1913—One hundred Years Ago:Alaska passed territorial practice act.

1888—One hundred twenty-five years ago:First class of pharmacy students enrolled in the South Dakota State College (then the State Agricultural Col-lege) in Brookings, SD.

By: Dennis B. Worthen, PhD, Cincinnati, OH

STORE PLANNING

Creating a Competitive Strategy for Independent Pharmacy Success By Roland Thomas

This is the Third of a Series of Topics that began with creating a Business Model followed by developing the optimum size for your pharmacy. We now tackle one of the most important steps when planning a new pharmacy or relocating an existing one.

DEMOGRAPHICS In this session we will not cover the Medical Center, Hospital or Clinic locations because those are highly dependent on the Physi-cians within or adjacent to the Institution and adopt an entirely different set of principles. Therefore, we will limit our location evaluation to Community Pharmacies that make up the vast majority of the 24,000 Independent Phar-macies. They depend on people who reside close to the area under consideration. Obviously, you will need to have enough people to support your phar-macy and your competitors.

Having familiarity with the area is an important first step. Is the specific area expanding or declining in terms of residential growth? The local Chamber of Commerce, Post Office and other resources are available to help you gather vital statistics. If you know the population in the area, simple mathemati-cal formulas can be applied to calculate the potential Rx volume available. Our approach to evaluating a location has changed dramatically over the past two decades. For example, the ratio between the number of Independents and chain pharmacies, grocery and big box stores nearby should be taken into account. If you emphasize your uniqueness in the services and products you provide that others may not offer or offer as well, that will be a feather in your cap. There are several underlying factors that can be just as important as the demographics in your evaluation

process and all should be viewed long term. We all know Independent Pharmacies that have good geo-graphical locations but may not be convenient in the minds of their potential customers.

CONVENIENCE Convenience has become increasingly important to all of us. Convenience has several components:

(1) Easy ingress and egress (2) Private parking opposed to public parking and (3) A drive-thru window. All three have become huge assets when people are deciding where they shop. It is not unusual for people to drive further if they consider the destination more convenient. Knowing they will find a parking space plays a big part in their selection process.

VISIBILITY OR EXPOSURE Exposure, or Visibility, has become one of the most often overlooked potential assets by many Inde-pendent Pharmacies. Why do chain drug stores spend millions to acquire those corner locations on a primary street or intersection, preferably with a traffic signal? Through long-term experience, they know how people respond to everything they do and they utilize every opportunity to draw customers to their stores. And, they never skimp on their outdoor identification. People, on average, move to a differ-ent community every 8-10 years while others age out. This varies considerably from metropolitan areas to small towns or rural areas. The reality is that you must replace 100% of your existing customers in a specific time span just to stay even. When chain pharmacies evaluate a location they are looking at 5 to 20 years in the future. They realize the value of providing as much convenience and exposure as pos-sible to overcome any advantages their competitors may have.

It is crucial that your Pharmacy is readily visible by passersby when they are not looking for a pharmacy. Mental Impressions are very powerful. Once you establish a location, preferably on a primary street or road, you have to make sure that people notice your presence. Proper Outdoor Identification is one of the best investments you will ever make. I have seen new Independent Pharmacies locate their business in a very attractive building with adequate parking but overlook the importance of proper outdoor identifica-tion. The fact remains that a free-standing building has greater exposure than one in a business district or shopping center where sign restrictions are more rigid and you are only one among many stores. In terms of your outdoor identification, it is more important, in my opinion, to emphasize PHARMACY or DRUGS than the name itself. Sign ordinances exist in most areas and having a delivery vehicle parked next to the street, when not in use, can add to your exposure without violating sign restrictions. Or, as some have done, buy an old clunker, have it parked near the street. Having a great location is certainly important but if you lack proper exposure, your Pharmacy will never reach its’ maximum growth potential.

RECAP Convenience, in the minds of the consumer, ranks high on where they decide to shop. Second is selec-tion and third is price. Independent studies have shown that 94% of respondents prefer an Indepen-dent Pharmacy over its larger competitors but you must make convenience and visibility a high priority. Providing the advantages outlined above will help you attract new customers. They will never know how great you are until they make that first visit to your pharmacy.

Our next topic will deal with pharmacy layout or floor plan and how best to utilize the space.

Roland G Thomas is a Pharmacy Planning Spe-cialist with Rx Planning Solutions – a division of Display Options in Charlotte, NC. Roland has had the privilege of working with pharmacists all of the Southeastern United States, planning and design-ing pharmacies for over 35 years. Independent and multiple location owners both, have relied on his expertise in this field.

STORE PLANNING


I may not be a pharmacist, but there is something that I do have in common with many of our members: being a working mom.

Before I go any further, let me preface this article with a warning. As I have been on way too many websites, message forums, and blogs for my own good, I know that this topic is somewhat contro-versial. There are always comments from the other perspectives (non-parents, working dads, etc.). My intent is not to alienate all of the other hard-working individuals out there – it is just to reach out a hand to those I can relate to.No matter what situation you are in, there is one thing that is glaringly obvious: there are just too many things to do and not enough hours in the day to do it. I have never in any situation overheard anyone saying “gosh – I just have SO much free time!”. According to a recent survey conducted by the Bureau of Labor and Statistics, the next page features a chart of how the aver-age American adult with children spends a typical 24 hour time period.

Keep in mind that this is an average of everyone who is em-ployed, regardless of whether they are working part-time or full-time, and regard-less of the number of kids that they have.

Recently, at the Southeastern “Girls of Pharmacy” Leadership Weekend event, SCPhA hosted a panel of female pharmacy leaders. One of the biggest top-ics discussed was time management and learning to prioritize.

For working moms, I would err to say that this is the biggest challenge that we all face. There’s the mad rush in the morning to get not only yourself ready

and out the door, but also the kid(s). If you have pets as well, you might as well

carry around a sign that says “please excuse me for being late” be-

cause chances are you have a difficult time getting any-

where on time. For example, last week I

was getting ready in the morning. My son, who is the typical three-year-old boy, came down stairs after a successful night of not wetting the bed. However, the glory of that mo-ment quickly faded when he laughed and announced “I peed on the floor.”

In my rush to get out the door, I tossed a

towel on the spot, got my son cleaned up and

dressed, and headed off to work. When I got home

that day, my husband (who happened to be absent during

the pee incident) asked me if I had actually cleaned up the mess or

just left the towel there. That was when I told him that at that moment, I had literally

and metaphorically thrown in the towel.

Then there is the craziness dur-ing the day that can often in-clude, along with work, emails/calls to and from the school or day care about different things, planning for other activities and after school events, etc. If your child is involved with any sort of extracurricular activity, your day will include games, practice, rehearsal, classes, and more.

That means that after work, your afternoon is probably filled with running around from here to there or stopping by the store to pick up snacks for that special class-room event your kid has the next day. Somehow, the family gets fed and then the kids get off to bed. Once that happens, mommy finally has some time…to do the laundry, dishes, housework that wasn’t done earlier. I cannot even imagine how single mommies manage – or mommies with more than one kid!

Not to mention the mommy-guilt. While there are probably exceptions out there, I have yet to talk to a working mom who hasn’t dealt with some form of mommy-guilt. Personally I get hit with mommy guilt all of the time. I have a wonderful child care provider for my three-year old. She is great and sends me pic-tures sometimes during the day of my son. A couple of weeks ago, she sent me a photo of him eating a cupcake with a giant smile on his face. While I was so happy that he was having a great time there (what more could a mommy ask for?), I couldn’t help but to be hit with an enormous feeling of jealousy and guilt: That is MY son. He’s supposed to be having fun with ME. I’m supposed to be having cupcakes with him.

However, please don’t think that this is all a “poor mommy” article. There are so many wonderful advantages of being a working mom. First of all, being a mom is hands down the most rewarding thing anyone can do, period.

While it isn’t glamorous by any means, the interac-tion that I have when I go to work is awesome. I am fortunate to work with some great people and to work

This One Goes Out to the Working MommiesAn editorial by Jennifer Simmons, SCPhA Director of Communications

for some wonderful pharmacists. Having that experi-ence is really great.

Being a mom has truly helped me master multitask-ing skills. I can handle 5 things at once while plaing a game of Candy Land without batting an eye. Being in school as well, I cannot tell you the countless times that I have sat next to the bathtub while my son takes his bath, reading or working on homework, while waiting for my toe nail polish to dry!Perhaps one of my favorite benefits is that, because I know I have limited time with my son, I strive for quality time. Since I can’t have quantity with him, by golly I am going to have some wonderful quality time with him.

So the point of this article is to perhaps make you chuckle (I will settle for a small smirk). Maybe you can relate to it. If you are a working mommy, I just want you to know that you are incredible. There are people out there, like me, who truly appreciate all that you do and are able to do and thank you! We’re here for you – to be a hand to help, a shoulder to cry on, or a just an ear to listen.

If you are not a working mommy – thank you too! I think I can speak for the rest of us when I say that we sure are thankful for you all too. Your help, support, and patience when we walk in with baby food on our blouse means so much to us!

Household activities (1.1 hours)

Leisure and sports (2.5 hours)

Eating and drinking (1.1 hours)

Caring for others (1.2 hours)

Other (1.7 hours)

Total= 24.0 hours

NOTE: Data include employed persons on days they worked, ages 25 to 54, who lived in households with children under 18. Data include non-holiday weekdays and are annual averages for 2011. Data include related

travel for each activity.

Working and related activities

(8.8 hours)

Sleeping (7.6 hours)

Time use on an average work day for employed persons ages 25 to 54 with children

SOURCE: Bureau of Labor Statistics, American Time Use Survey

STAFF UPDATE STAFF UPDATE


PARTNERS

March 23, 2013 9 AM—1 PM

SCPhA Office, 1350 Browning Road, Columbia, SC 29210

TABloid News: Spring 2013 Edition (1 hour) 1. Summarize events in the headlines that have an impact on pharmacy practice. 2. Describe why the events are news-worthy. 3. Identify issues that may be headliners in the future.

It’s the Law in Hospitals and Retail Pharmacies (2 hours) 1. Summarize Federal and State laws impacting hospital pharmacy practice. 2. List and describe Federal and State laws impacting retail pharmacy practice. 3. Describe situations in daily pharmacy practice and the impact of laws and regulations.

The Misses in Miscommunication (1 hour) 1. Define miscommunication. 2. Describe examples of miscommunication. 3. Identify ways to improve communication.

South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Programs must be fully attended and an online evaluation completed in order to receive credit for participation. Statements of continuing education credit will be distributed by mail to program attendees within4-6 weeks of this program. Grievances regarding the education program must be submitted in writing to the SCPhA ACPE Coordinator immediately following the program. Please go to www.scrx.org for complete registra-tion information.

Name:___________________________________________________________________ Registration Number_________________

Address:____________________________________________________________________________________________________

City:__________________________________________ State:_______________ Zip:_____________________________________

Email: _____________________________________________________________ Phone:__________________________________

NABP eID:____________________________________ Birth Month/Birth Date (MMDD):___________________________________

□ Member: $50 □ Non-Member: $80 □ Join SCPhA AND Register: $85

Check; #______________ or Credit Card: □ MC □ AMEX □ Visa □ Discover

Credit Card Number:__________________________________________________________________________________________

Exp Date_____________________________ CCV_________________________

Cancellation Policy: To receive a refund for this program, minus a $5 processing fee, you must cancel your registration with the SCPhA at least 5 business days before the program date. Cancellations made within 5 days of the program are not eligible for a refund.

To Register: Complete the form below and return to SCPhA at 1350 Browning Rd., Columbia, SC 29210, fax to 803.354.9207 or register online at www.scrx.org.

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Please look through the following registration types to learn what is included in each option. Limited ticket sales will be available on site, therefore we suggest you try to purchase all of the tickets you need in advance to ensure availability. Basic Full Registration Whether you are a pharmacist or technician looking to attend the convention, this is the basic full package for you. This option includes:

15 hours of Continuing Education available Welcome Reception Thursday, Breakfast Friday-Sunday Ticket to State Phair event (includes dinner) Ticket to Exhibit Hall (includes lunch) Event T-Shirt

VIP Full Registration Whether you are a pharmacist or technician looking to attend the convention, this is the basic full package for you. This option includes:

All of the items listed above in the Basic Full package Ticket to the Awards Dinner Ticket to either MUSC or USC Alumni Luncheon

Student Registration Calling all students: Here is your chance to attend the event. We do have limited student scholarships available. Visit www.scrx.org to apply. Student registration includes the following:

Attendance at all continuing education programming (CE credit not included)

Student specific events, including student trivia night and lunch and games on the beach

Welcome Reception Thursday, Breakfast Friday-Sunday Ticket to State Phair event (includes dinner) Ticket to the Awards Dinner Ticket to the Exhibit Hall (includes lunch) Event T-Shirt

Guest Registration If you are a guest of a registered attendee, we have the option for you:

Attendance at all continuing education programming (CE credit not included)

Welcome Reception Thursday, Breakfast Friday-Sunday Ticket to State Phair event (includes dinner) Ticket to Exhibit Hall (includes lunch) Event T-Shirt

Daily Registration

Can’t stay for the whole party? Come for just a day or two: Credit for continuing education programs for the day(s) you

attend Breakfast for the day you attend Friday attendees receive ticket to State Phair event

(includes dinner) Saturday attendees receive ticket to Exhibit Hall (includes

lunch)

Registration Types

SCPhA’s 2013 Annual Convention: State Phair June 6-9, 2013 Marriott, Hilton Head, SC

Hotel Information Join us as we enjoy our new location for 2013: The Marriott Resort and Spa, Hilton Head, SC. We are excited about the new facility. Rooms start at $199 per night. Visit scrx.org for a link to the registration website, or call 1-843-686-8400 to make your reservations today. You must book by May 6, 2013 to take advantage of the savings. Continuing Education Information Attendees will have the opportunity to earn 15 hours of continuing education credit, upon completion of event evaluation. South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is eligible for ACPE credit; see www.scrx.org and the final program brochure for specific details. Cancellation To receive a refund for this program, minus a $10 processing fee, you must cancel your registration with the SCPhA at least 5 business days before the program date. Cancellations made within 5 days of the program are not eligible for a refund.

The South Carolina Pharmacy Association 1350 Browning Road Columbia, SC 29210 800.532.4033 toll free/ 803.354.9977 phone 803.354.9207 fax [email protected]


Gorilla Photo Courtesy: Ron Brasington/Riverbanks Zoo and Garden

State Phair 2013 SCPhA’s 2013 Annual Convention

Registration Form Attendee Info

Name:______________________________________________

Nick Name:__________________________________________

Please check one: □Pharmacist □Technician □Student □Other

NABP eID:______________________ DOB:_______________

License/Registration Number:___________________________

Address:____________________________________________

City:_____________________ State_______ Zip___________

Phone:_____________________________________________

Email:______________________________________________

Do you have any special dietary, learning or accessibility

accommodations?____________________________________

___________________________________________________

Students, which school do you attend?

□SCCP-USC □SCCP-MUSC □South □Presbyterian

Graduation Year:____________

Full/VIP/Student/Guest Registrants Get a Free T-Shirt!

Please Select Size: □S □M □L □XL □2XL

Registration type MEMBERS Registration Type* Before May 10 After May 10 Basic Full □ $209 □$259 VIP Package □ $329 □$349

Select Dinner: □ Beef □ Chicken Select Alumni Lunch: □ USC □ MUSC

Student Registration □$99 □$99 Select Dinner: □ Beef □ Chicken

Thursday only □$69 □ $89 Friday only □$89 □$109 Saturday only □$89 □$109 Sunday only □$69 □$89 Guest Pass □$169 □$169 NON-MEMBERS Registration Type* Before 5/10 After 5/10 Basic Full □$269 □$329 VIP Package □$379 □$399

Select Dinner: □ Beef □ Chicken Select Alumni Lunch: □ USC □ MUSC

Thursday only □$89 □$109 Friday only □$109 □$129 Saturday only □$109 □$129 Sunday only □$89 □$109

*PLEASE SEE REVERSE FOR A DESCRIPTION OF REGISTRATION TYPES AND WHAT EACH INCLUDES.

Payment Info Total to be billed: $______________ Check, Check #___________ CC type: □MC □Visa □AMEX □Discover Card #_________________________________ Exp. Date:_______________ CVV#__________ Name on card:___________________________ Billing address:__________________________ City/State/Zip:____________________________ PROMO CODE: _________________________ Return to SCPhA at 1350 Browning Road, Columbia, SC 29210, Fax to 803.354.9207, or Register Online at www.scrx.org.

Additional Options:

Awards Dinner Tickets Beef: Qty___x $79 = $____ Chicken: Qty___x $79 = $____ Add’l Student: Qty___x $49 = $____ Child: Qty___x $29 = $____ Alumni Luncheon Tickets MUSC: Qty___x $40 = $____ USC: Qty___x $40 = $____ Additional Exhibit Hall Pass Exhibit Hall: Qty___x $39 = $____ Additional SC State Phair Tickets Adults: Qty___x $49 = $____ Children: Qty___x $19 = $____ Additional T-Shirts Small: Qty___x $15 = $____ Medium: Qty___x $15 = $____ Large: Qty___x $15 = $____ X Large: Qty___x $15 = $____ 2X Large Qty___x $15 = $____ Add A Guest

Guests: Qty___x $169 = $____ Guest name: _____________________

Student Scholarships: We have a goal of sending all students to Convention at no cost to them. We hope that you will help us keep up our tradition of supporting our upcoming leader’s in pharmacy by donating to our student scholarship fund. Full scholarship: Qty___x $250 = $____ Other contribution amounts: □$50 □□$100 □ $150 □$200 Other amount: $_____ This year, we have many fun and free events! Please check all activities that you plan to attend: □Yoga on the Beach □Phun Run □Golf tee times □Welcome reception (Thursday Evening) □Sunrise Choir Exclusively for students: □Trivia □Lunch and games on the beach

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Objectives: After completing this activity, partici-pants should be able to:1. Recognize the signs and symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD).2. Describe the clinical practice guideline changes for diagnosing and treating ADHD.3. Explain the role of pharmacologic treat-ments, including mechanisms of action, dosing, side effects, and drug interactions.4. Identify and recommend pharmacologic and nonpharmacologic treatment interventions for patients with ADHD.

Data sources: Recently published articles in Med-line and PsychInfo, reviews in the Cochrane Data-base, and resources on various government, propri-etary, and pharmaceutical manufacturer websites, identified using search terms such as ADHD, atten-tion deficit hyperactivity disorder, pharmacotherapy, and the names of specific drugs and drug classes, as well as bibliographies of gathered articles.

Summary: ADHD is a common disruptive behav-ioral disorder that presents in childhood and frequent-ly persists into adolescence. It is one of the most prevalent psychiatric disorders and is now understood to be a lifelong condition for most individuals, with many more adults being diagnosed today. An in-crease in the prescribing of ADHD medications has also become more prevalent, with the use of stimu-lant medications on the rise. As a practicing South Carolina pharmacist, one must become well-informed about the many treatment options for ADHD and apply the most recent clinical guideline updates for managing ADHD in children and adolescents to cur-rent practice.

Conclusion: Although it is one of the most com-mon behavioral disorders in childhood, ADHD often progresses into adolescence and even adulthood and may cause significant distress in a person’s life. The criteria for diagnosing ADHD are listed in the DSM-IV-TR, with changes to the subtypes in the upcom-

JOURNAL CEADHD Diagnosis & Treatment: A Review for Pharmacists By Erika E. Tillery, PharmD, Assistant Professor of Pharmacy Practice SouthUniversity School of Pharmacy - Columbia Peer Reviewed by Patti Fabel, PharmD

ing DSM-5 (scheduled for May 2013), and include symptoms of hyperactivity, impulsivity, and inatten-tion. Upon completion of this learning activity, one will be able to identify the signs and symptoms of ADHD, understand the diagnostic criteria and vari-ous subtypes, and make treatment recommendations to prescribers to include pharmacologic and nonphar-macologic therapy with an overall goal of improving the quality of life of the patient. Updates to clinical practice guidelines for the diagnosis, evaluation, and treatment of ADHD in children and adolescents will also be reviewed.

Keywords: ADHD, attention-deficit/hyperactiv-ity disorder, adult, pediatric, adolescent, stimulants, alpha adrenergic agonists, norepinephrine reuptake inhibitor

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD), sometimes referred to as Attention Deficit Disorder (ADD), is the most common neurobehavioral disor-der of childhood.1 ADHD can make it difficult for children to do well in school, in their ability to make and keep friends, and in their ability to function in society. Boys are four times more likely to receive a diagnosis of ADHD than girls as they usually present with more disruptive behaviors. ADHD is a lifespan condition not only affecting children and adoles-cents, but also adults of all ages.2 According to data from the National Health and Nutrition Examination Survey (NHANES) in 2009, the prevalence of ADHD in children and adolescents was almost nine percent with symptoms persisting into adulthood in approxi-mately four percent of adults.3 To appreciate where South Carolina compares to the national average of ADHD prevalence, the community-based Project to Learn About ADHD in Youth (PLAY) study found the ADHD prevalence in SC school-aged children to be 8.7% and the prevalence of ADHD medication use was 10.1%.4 The PLAY study also reported that only 39.5% of patients medicated in SC met the case

inancial orumThis series, Financial Forum, is presented by Pro Advantage Services, Inc., a subsidiary of Pharmacists Mutual Insurance Company, and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

FINANCIAL FORUM

HOW MUCH RETIREMENT INCOME SHOULD YOU WITHDRAW?

The big question: how much is too much? In the first few years of retirement, some couples really “live it up” … and some of them risk spending down their retirement savings. Their portfolios aren’t earning enough to make back the income they’re withdraw-ing.

Some new retirees end up withdrawing as much as 7-10% of their retirement assets annually. A bull market tends to encourage this kind of exuberance. But what happens when the bulls don’t run? What if your portfolio only returns 1-2% this year? Can you see the potential problem?

Ultimately, the answer is highly personal. There is no “standard” retirement income withdrawal rate. Your withdrawal rate should be determined in con-sultation with your financial advisor, who can help you evaluate some very important matters: your risk tolerance, your age and health, and your lifestyle needs.

Many new retirees are told that a 4-5% annual withdrawal rate makes sense. If you withdraw 4-5% from your retirement nest egg annually and your investments steadily earn about 5-6% year-to-year, it is quite possible that your invested assets will last a quarter-century or longer given mild inflation.But that’s a rather stable scenario. Even more vari-ables come into play.

Consumer costs. Over the past 50 years, consumer prices have increased (on average) about 4% annu-ally. So you might assume that your portfolio should generate at least a 4% annual return just to help you keep up with the cost of living. But if you retire with that assumption and inflation should spike notably

higher for some reason after you retire, you may need to adjust your withdrawal rate.

Now consider the price of health care. In recent years, health care costs have increased at a much greater rate than inflation. The same goes for nursing home care.

Market dips. When you are 35 or 40, your invest-ments have time to rebound from a market downturn. When you are 70, things are different.

Let’s cite an example: let’s say you are 70 years old, and you have $250,000 in your portfolio. All of a sudden, your portfolio has two really bad years: you lose 12% in Year 1 and 7% in Year 2. So at 72, your portfolio is now worth $204,600. You want to get back to $250,000 or better. How long will that take? Well, your portfolio would have to gain almost 23% in Year 3 to get back to that $250,000 level. So if you suffer through a couple of bad years with ill-chosen investments or ill-advised asset allocations, your nest egg may be considerably smaller and your income withdrawal rate may have to change.

*This is a hypothetical example and is not intended to imply the performance of any specific investment.The merit of conservative withdrawals. With ongoing improvements in healthcare, today’s retirees stand a good chance of living into their eighties and nineties (and perhaps even longer). This is a good reason to exercise a little moderation when scheduling retire-ment income.

Provided by courtesy of Pat Reding, CFP of Pro Advan-tage Services Inc., in Algona, Iowa. For more information, please call Pat Reding at 1-800-288-6669.


JOURNAL CEdefinition of an ADHD diagnosis.4 Pharmacists, as medication experts, can fulfill the need for accu-rate counseling on pharmacotherapy used to man-age ADHD and provide assistance to patients with ADHD and their parents or caregivers as well as as-sist practitioners in appropriate medication selection.DIAGNOSIS OF ADHD There is no single diagnostic test for ADHD. A thor-ough diagnostic evaluation uses medical, psychologi-cal, educational, and social resources. A complete history and evaluation of the patient are critical in determining a diagnosis of ADHD.1 The criteria for diagnosing ADHD are described in the Diagnostic

and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).5 One must have at least six (or more) symptoms of inattention OR at least six (or more) symptoms of hyperactivity/impulsivity that are present for at least six months. Table 1 categorizes symptom descriptions. The symptoms must be present before seven years of age, although new ADHD clinical practice guidelines will extend the age to 12 years.1 The symptoms must in-terfere with or reduce the quality of social, academic, or occupational functioning. Also, the symptoms should be witnessed in two or more settings (e.g., at school and at home) in order to meet the criteria for ADHD diagnosis.5 These symptoms cannot be due

Table 1: ADHD Symptoms (Adapted from DSM-IV-TR)5

Table 2: ADHD Subtypes5, 6

ADHD Subtype Symptom Presentation

Combined 6 or more symptoms present for past 6 months from each

category (hyperactivity/impulsivity & inattention)

Predominately Inattentive 6 or more symptoms of inattention met and 3 or more

hyperactivity/impulsivity symptoms present for past 6 months

Inattentive Restrictive* 6 or more symptoms of inattention met but no more than 2

hyperactivity/impulsivity symptoms present for past 6 months

Predominately Hyperactive/Impulsive 6 or more symptoms of hyperactivity/impulsivity present but

symptoms of inattention not met for past 6 months

*Designates new subtype in upcoming DSM-5

Inattention:Carelessness

Reduced attention Hyperactivity:Poor listening skills Fidgets with hands/feet or

squirms in seat

Failure to complete tasks or follow

instructions

Inability to remain seated in

classImpulsivity:

Difficulty organizing Uncontrolled restlessness Difficulty waiting for turn

Avoidance of chores/homework Difficulty playing or engaging

in leisure activities quietly

Interrupts or intrudes on

others

Loses items frequently (i.e., books,

homework, tools)

Often “on the go” Blurts out answers prior to

completion of question

Easily distracted by extraneous

stimuli

Excessive talking

Forgetful in daily activities

ADHD is a chronic condition and data collected from multiple prospective longitudinal studies of ADHD children followed 10 to 20 years into adulthood have shown that up to 65% of these children will continue to have persistent ADHD symptoms that cause impairment.7,8 ADHD symptoms observed in adulthood include poor planning and organizational skills, forgetfulness, intense procrastination, and poor family and work dynamics.7 Medical conditions that may mimic adult ADHD such as hyperthyroidism, seizure disorders, hearing deficits, lead toxicity, and sleep apnea should be ruled out as potential causes.9 High rates of psychiatric comorbidities including op-positional defiant disorder, conduct disorder, bipolar disorder, major depressive disorder, and anxiety dis-orders add complexity to the diagnosis and are fairly prevalent across the lifespan of patients with ADHD.9 Comorbid conditions such as substance abuse and anxiety disorders are present in 30% to 50% of adult patients with ADHD.8 Although treatment of patients with comorbid psychiatric disorders is often convo-luted, typically the symptom-predominant disorder is treated first.10

ADHD ETIOLOGY AND PATHOPHYSIOLOGY

The specific cause of ADHD is unknown, but it ap-pears to be multifaceted. Twin studies have shown the heritability of ADHD to be about 90%, although no single gene has been identified.10 A positive fam-ily history for ADHD is a risk factor, and children with a first-degree relative with the diagnosis have up to eight times an increase in the chance of develop-ing ADHD versus the general population.10 Other risk factors for the development of ADHD include maternal smoking, alcohol exposure during preg-nancy, perinatal stress, low birth weight, exposure to lead, severe traumatic brain injury, and early social deprivation.11

The neurobiology and pathophysiology of ADHD is complex in nature and is not completely understood. Imbalances in dopaminergic and noradrenergic systems are implicated in the core ADHD symptoms and support the dysfunctional catecholamine neuro-transmission theory.10 ADHD is primarily viewed as a disorder where norepinephrine and dopamine signals in the cerebral cortex are weak, resulting in an inefficient processing of information and difficulty sustaining attention, resulting in ADHD symptoms.12

Increasing the activity of dopamine at the postsyn-aptic D1 receptor and norepinephrine at the postsyn-

aptic alpha2A receptor has shown to help alleviate the symptoms associated with ADHD.12 However, overstimulation at these receptors may result in dete-rioration of symptom control and also lead to symp-toms of poor attention and impulsivity.12 Therefore, the primary goal of ADHD symptom control involves maintaining an adequate equilibrium of catechol-amine neurotransmission in the prefrontal cortex.12

PHARMACOTHERAPY

Currently available Food and Drug Administration (FDA) approved medications for treating ADHD target catecholamine neurotransmission in the central nervous system.10 Most of the agents work by block-ing the presynaptic reuptake of dopamine, norepi-nephrine, or both in the prefrontal cortex.10 Other agents target postsynaptic alpha2A receptors, acting as agonists, and mimic the action of norepinephrine.11 To date, no FDA-approved agents exist that specifi-cally act as agonists at D1 receptors. Pharmaco-therapy is an important component of treatment, with stimulants serving as first-line treatment options in the majority of patients.10 According to the American Academy of Pediatrics 2011 clinical practice guide-lines for the treatment of ADHD in children and ado-lescents, new recommendations allow for evaluating and treating children and adolescents in the 4-year to 18-year range as opposed to the much more limited 6-year to 12-year range previously.1 FDA-approved medications for ADHD are recommended as first-line interventions for children ages six to 11 years of age as well as adolescents (12 to 18 years of age).1 Care-ful dosage titration to FDA-approved dose ranges should occur in order to achieve the desired effect while minimizing side effects.13

Treatment recommendations for preschool children, ages four to five years, have also been revised. Be-havioral therapy is recommended as first-line treat-ment, and may include parent training, classroom management, and peer interventions.1 Treatment with methylphenidate is recommended in children who do not respond to behavioral techniques.1 Cur-rently there are no FDA-approved methylphenidate preparations for use in children under six years of age, thus stimulant treatment in this patient popula-tion remains controversial, and should be carefully reviewed.13,14 Some believe that preschoolers should only be treated with medication in special circum-stances by expert clinicians in the field of ADHD in order to ensure the diagnosis is indeed correct.13

JOURNAL CE


Parents should be counseled on the overall benefits and risks of using stimulants as their preference is critical in determining the overall treatment plan for the child.1

StimulantsStimulants are considered a first-line intervention for ADHD, unless there are comorbidities or safety issues that preclude their use.9,11 The two categories of stimulants used in the treatment of ADHD are methylphenidate and amphetamines. Both classes of medications work by blocking the reuptake of do-pamine and norepinephrine in the prefrontal cortex, and amphetamines additionally cause the release of catecholamines from vesicular storage sites.12 Meth-ylphenidate and amphetamines are equally effective in controlling ADHD symptoms, with efficacy rates ranging from 70% to 90%.15 Treatment failure is defined by lack of satisfactory improvement in core symptoms of ADHD while on the maximum dose or the occurrence of intolerable side effects.9,16 When a patient experiences treatment failure, a switch between stimulant classes is recommended (e.g., if a patient failed treatment with an amphetamine prod-uct, then switch to a methylphenidate product and vice versa).9

Stimulants are available in many different formula-tions including short-acting, intermediate-acting, and long-acting preparations. Various delivery devices such as the wax-matrix systems, beaded delivery sys-tems, osmotic release oral system (OROS), and trans-dermal patches exist among the intermediate- and long-acting preparations.11 Another unique delivery device is the prodrug lisdexamfetamine which has a lysine residue attached to its amphetamine structure.17 Once ingested, the lysine residue is cleaved via enzymatic hydrolysis and transformed into an active amphetamine.17 The enzymatic process results in lisdexamfetamine’s long half-life, and the novel de-livery system is thought to have lower abuse potential compared to immediate-release stimulants.11,17 See Table 3 for detailed descriptions of currently avail-able stimulants in the U.S.

Although short-acting agents exist, treatment may begin with long-acting preparations of stimulants in order to improve adherence, allow for ease of once-daily administration, and provide overall benefit. It is not necessary to initiate treatment with short-acting products and transition to long-acting products.18 Long-acting formulations also prevent children in

school from having to receive mid-day doses of immediate-release stimulants, and may decrease the stigma of the disorder in this population.11 Because pharmacists are aware of the mechanisms of side ef-fects and are easily accessible healthcare profession-als, they can assist in guiding patients and caregivers in appropriate treatment selection by discussing the overall risks and comparing the benefits of treat-ment.10,19

Adverse Effects - StimulantsThe stimulant medications are fairly well tolerated. The primary adverse effects reported include insom-nia, appetite suppression, weight loss, headache, stomach upset, and slight increases in blood pres-sure and pulse.9,11,26 These adverse effects typically subside over time as patients become tolerant, but options are available to minimize them. Pharmacists may counsel patients to take their medicine with a meal if gastrointestinal upset persists, although the time to effect may be delayed.10 Insomnia is more noticeable with long-acting preparations, especially the long-acting amphetamine products.19 Pharmacists may advise patients to try nonpharmacological strate-gies for controlling insomnia secondary to stimulants (e.g., do not watch TV in bed, do not exercise right before bedtime, bedroom should only be used for sleep, etc). Other possible pharmacist recommenda-tions include moving the dose to an earlier time in the day or reducing the total daily dose of the stimulant.27 If insomnia persists despite interventions, then a switch to an immediate-release formulation may oc-cur. Adjunctive agents may be used if nonpharmaco-logical treatment strategies fail. Adjunctive treatment options include melatonin, diphenhydramine, cypro-heptadine, clonidine, and guanfacine.19

Appetite suppression is an adverse effect that can be challenging for caregivers and patients alike.11 A recommendation to patients by pharmacists should include eating their highest calorie containing meal of the day at breakfast, before taking the medica-tion. High calorie drinks or snacks may also be used throughout the day when the stimulant has worn off if weight loss is an issue. If weight loss continues to be problematic and is impacting growth, then a switch to another stimulant or nonstimulant medica-tion is indicated.12 Frequent monitoring of height and weight is recommended in children and adolescents during treatment, and an interruption in therapy may be necessary if a patient is not gaining adequate weight or growing.1,11

JOURNAL CE JOURNAL CE


Patients may express concern about the potential car-diovascular effects associated with stimulant use. In patients with underlying structural heart abnormali-ties, or cardiomyopathies, sudden cardiac death has occurred.26,28 Stimulant therapy should be avoided in patients with underlying cardiac problems.28 A com-plete patient and family history should be assessed prior to stimulant initiation. An EKG should also be performed if high-risk conditions are suspected based on the patient’s history or clinical findings.26 Blood pressure and pulse should be monitored routinely at each follow-up, especially if dizziness is pres-ent.28

Because stimulants have a high potential for abuse, a black-box warning for drug dependence is listed under each amphetamine and methylphenidate preparation.21,24 Stimulants should be prescribed cau-tiously to patients with a history of drug dependence. Particular attention should be paid to the possibility of subjects obtaining stimulants for non-therapeutic use or distribution to others.21,24 Although the ma-jority of stimulant medications for ADHD are used appropriately by individuals, survey studies have indicated that approximately 5% of college students have misused stimulants.29 Chronic abusive use can lead to marked tolerance and psychological depen-

JOURNAL CE

dence, with varying degrees of abnormal behavior.24 Psychotic episodes can occur, especially with paren-teral abuse.24

NonstimulantsNonstimulant medications approved by the FDA for the treatment of ADHD include atomoxetine, clonidine extended release, and guanfacine extended release. Atomoxetine is a selective norepinephrine reuptake inhibitor used in the treatment of ADHD in children and adults.30 Atomoxetine increases the lev-els of norepinephrine in the prefrontal cortex by bind-ing to the norepinephrine transporter and blocking reuptake.30 Despite atomoxetine’s proof of efficacy from multiple double-blind, randomized, placebo controlled trials, it has shown to be inferior when compared to stimulants such as long-acting meth-ylphenidate OROS and mixed-amphetamine salts.31 Atomoxetine may be used as a first- or second-line treatment option for children and adults, but the ef-ficacy rates are lower compared with stimulants.32 The primary advantage of atomoxetine is that it is not a controlled substance, and it can be used safely in patients with substance use disorders.1

Two alpha2-adrenergic agonists have been approved by the FDA for the treatment of ADHD in children

JOURNAL CETable 4: Nonstimulant Medications Approved by FDA for ADHD

30, 34, 35, 36, 37

Medication FDA

Approval

Available

Formulations

Dose Onset of

Action

Patient Counseling

Atomoxetine

(Strattera®

)

Age ≥ 6

years

10, 18, 25, 40,

60, 80, 100

mg capsules

0.5 mg/kg/day

titrated up to 1.2

mg/kg/day

(children &

adolescents

<70kg); 40 mg

QD, max of 100

mg/day (adults)

2 – 4

weeks

Reduce dose with strong

CYP2D6 inhibitors

(paroxetine, fluoxetine); may

divide doses BID, but give 2nd

dose in early evening; black-

box warning for increased

suicidal thinking in children

and adolescents

Clonidine

extended

release

(Kapvay®

)

Age 6 –

17 years

0.1, 0.2 mg

tablets

0.1 mg at bedtime,

max 0.4 mg/day

2 – 4

weeks;

12 h

duration

Must taper dose when

discontinuing therapy; give

BID if >0.1 mg/day needed

Guanfacine

extended

release

(Intuniv®

)

Age 6 –

17 years

1, 2, 3, 4 mg

tablets

1 mg QD, max 4

mg/day

2 – 4

week

onset;

16 h

duration

Less sedation compared to

clonidine; must taper dose

when discontinuing therapy;

do NOT crush, chew or split;

do NOT administer with high

fat meal because of increased

exposure

six to 17 years old: clonidine extended release and guanfacine extended release.29 As with atomoxetine, neither agent is a stimulant or a controlled substance. Both clonidine and guanfacine immediate-release have been used for many years as off-label treat-ments in ADHD. Although the exact mechanism of action for controlling ADHD symptoms is not well understood, it is most likely due to their binding to post-synaptic alpha2A receptors in the prefrontal cortex.33 Often, these agents are used in conjunction with stimulants for their sedating effects and help with sleep or rebound symptoms; however, they may be used first line in ADHD if there is a concern about substance abuse, drug diversion, or if contraindica-tions to stimulant use exist.1 See Table 4 for detailed descriptions of currently available nonstimulants used for ADHD in the U.S.

Antidepressants such as bupropion, desipramine, clo-mipramine, imipramine, nortriptyline, and amitripty-line have also demonstrated efficacy in improvement of ADHD symptoms in both pediatric and adult populations.38,39 None are FDA-approved for the treatment of ADHD, and they are not recommended as first-line treatment options.39 However, patients with comorbidities, substance abuse, or patients who have failed stimulants or have contraindications to


JOURNAL CEstimulants, may benefit from their use.40 It is important to note side effects, delayed response time (three to four weeks), contraindi-cations, and black-box warnings associated with the antidepressants before recommending their use.40

Adverse Effects – NonstimulantsAdverse effects of atomoxetine include nausea, vomiting, and somnolence and usually occur upon initiation of therapy or dose increases which tend to resolve af-ter several days of therapy.30,32 De-creased appetite can occur, but it is much less of a problem than with stimulants.32 Since atomoxetine undergoes hepatic metabolism via CYP2D6, caution is advised when given with strong CYP2D6 inhibitors such as fluoxetine and paroxetine and a reduction in dose may be necessary.18 Patients with a genetic polymorphism for the allele that codes for CYP2D6 that makes them poor metabolizers of the drug may also require a dose reduction, since the half-life of atomoxetine can be prolonged resulting in increased serum con-centrations.18 Adverse effects of the alpha2-ad-renergic agonists include somno-lence (especially with clonidine), bradycardia, and syncope.26,36 It is recommended that blood pressure and heart rate are monitored upon initiation and discontinuation of therapy.26 EKG monitoring is not necessary with either agent.11 It is important to note that the extended release tablets for both guanfa-cine ER and clonidine ER are not bioequivalent to their immediate release counterparts, therefore, one should not be substituted milligram-per-milligram for the other.18

SummaryThe past decade has seen several new pharmacotherapeutic inter-ventions for ADHD treatment. ADHD diagnostic criteria have been updated with the official changes expected to be published in the fifth edition of the DSM in May 2013.6 The symptoms of ADHD can be debilitating and cause significant impairment in one’s daily life. Children, adoles-cents, and adults may be affected with this disorder.38 Emphasis of treatment should be placed on appropriate diagnosis and man-agement of ADHD symptoms in order to improve patient outcomes. Stimulant medications can be ef-fective treatment for ADHD, when used as directed, but they can also have negative side effects, such as nervousness, insomnia, dizziness, and cardiovascular or psychiatric problems.41 Whether ADHD stim-ulant medications are misused or adverse reactions occur when the medication is taken as prescribed, monitoring dangerous health ef-fects that may necessitate imme-diate medical attention can help guide intervention efforts. 41 Phar-macists must stay up-to-date with current evidence and be familiar with the various agents available in order to provide accurate and consistent education, training, and counseling to patients, providers, and caregivers.

REFERENCES1. Wolraich M, Brown L, Brown RT, et al. Subcommittee on at-tention-deficit/hyperactivity disorder, ADHD: clinical practice guideline for the diagnosis, evaluation, and treat-ment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011;128:1007-1022. 2. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD). Available at http://www.chadd.org/AM/Template.

cfm?Section=Understanding Accessed October 21, 2012. 3. Diagnosis of AD/HD in Adults. National Resource Center on AD/HD. Available at www.help4ad-hd.org. Accessed October 18, 2012.4. Wolraich ML, McKeown RE, Visser SN, et al. The Prevalence of ADHD: Its Diagnosis and Treat-ment in Four School Districts Across Two States. J Atten Disord. 2012; September 12 (epub ahead of print)5. American Psychiatric As-sociation. Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psy-chiatric Association; 2000. 6. Tanzi MG. Psychiatry update: APA releases draft DSM-5. Pharmacy Today. May, 2010: 11-12. 7. National Institute of Mental Health. Attention Deficit Hyperac-tivity Disorder (ADHD). Available at: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperac-tivity-disorder/complete-index.shtml. Accessed November 18, 2012.8. Goodman DW. The Black Book of ADHD. Primary Psychiatry. 2010;21:46-63.9. National Institute for Health and Clinical Excellence Attention deficit hyperactivity disorder: Diag-nosis and management of ADHD in children, young people and adults. Available at: www.nice.org.uk/CG72. Accessed October 21, 2012.10. Dopheide JA, Pliszka SR. Childhood Disorders. In: Phar-macotherapy: A Pathophysiologic Approach, 8th ed. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. New York, NY: Mc-Graw Hill; 2011: 1087-95.11. English CD. Treatment op-tions for attention deficit hyperactivity disorder. DSN Collaborative Care. 2012; 1(1):22-28.12. Stahl SM. Attention deficit hyperactivity disorder and its treat-ment. Stahl’s Essential Psycho-pharmacology Online. Available at: http://stahlonline.cambridge.org/ Accessed October 16, 2012.13. Pliszka SR, Greenhill LL, Crismon ML et al. The Texas Chil-

dren’s Medication Algorithm Proj-ect: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part II: Tactics. J Am Acad Child Adolesc Psychiatry. 2000;39:920-7. 14. Pliszka SR, Greenhill LL, Crismon ML et al. The Texas Chil-dren’s Medication Algorithm Proj-ect: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part I. J Am Acad Child Adolesc Psychiatry. 2000;39:908-19.15. Arnold LE. Methylphenidate vs. amphetamine: comparative review. J Atten Disord. 2000;3:200-11. 16. Adult attention deficit hyper-activity disorder. UpToDate. Avail-able at: www.uptodate.com. Accessed on October 17, 2012.17. Cowles BJ. Update on the management of attention-deficit/hy-peractivity disorder in children and adults: patient considerations and the role of lisdexamfetamine. Ther Clin Risk Manag. 2009;5:943-948.18. Drugs for Treatment of ADHD. Med Lett Drugs Ther. 2011;9:23-28.19. Kratochvil CJ, Lake M, Pliszka SR, Walkup JT. Pharmacolog-ical management of treatment-induced insomnia in ADHD. J Am Acad Child Adolesc Psychiatry. 2005;44:499-501.20. Methylphenidate. Lexicomp electronic database. Available at: http://www.crlonline.com.southuni-versity.libproxy.edmc.edu/lco/action/doc/retrieve/docid/patch_f/7281#f_brand-names. Accessed October 22, 2012.21. Methylphenidate monograph. Facts and Comparisons electronic database. Available at: http://online.factsandcomparisons.com.southuni-versity.libproxy.edmc.edu/MonoDisp.aspx?monoID=fandc-hcp13360&quick=499899%7c5&search=499899%7c5&isstemmed=True#firstMatch. Accessed October 22, 2012.22. Concerta medication guide. Janssen Pharmaceuticals, Inc. Avail-able at: http://www.concerta.net/adult/prescribing-information.html.

Accessed October 22, 2012.23. Daytrana prescribing infor-mation. Noven Pharmaceuticals, Inc. Available at: http://www.daytrana.com/ Accessed October 22, 2012. 24. Amphetamine mixtures monograph. Facts and Comparisons electronic database. Available at: http://online.factsandcomparisons.com/MonoDisp.aspx?monoID=fandc-hcp10129. Accessed October 22, 2012.25. Vyvanse prescribing infor-mation. Shire US, Inc. Available at: http://www.vyvanse.com/. Accessed October 29, 2012.26. Nissen SE. ADHD drugs and cardiovascular risk. N Engl J Med. 2006;354:1445-8.27. Wilens TE, Morrison NR, Prince J. An update on the pharmaco-therapy of attention-deficit/hyperac-tivity disorder in adults. Expert Rev Neurother. 2011;11(10):1443-1465.28. Vetter VL, Elia J, Erickson C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving medications for at-tention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac De-fects Committee and the Council on Cardiovascular Nursing. Circulation. 2008;117:2407-23. 29. McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Ad-diction. 2005;99(1):96-106. 30. Strattera. Lexicomp elec-tronic database. Available at: http://www.crlonline.com.southuniversity.libproxy.edmc.edu/lco/action/doc/re-trieve/docid/patch_f/6398. Accessed October 22, 2012.31. Newcorn JH, Kratochvil CJ, Allen AJ, et al. Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute compari-son and differential response. Am J Psychiatry. 2008;165:721-30. 32. Simpson D, Plosker GL. Atomoxetine: a review of its use in

adults with attention deficit hyperac-tivity disorder. Drugs. 2004;64:205-22. 33. Dowben JS, Grant JS, Keltner NL. Biological Perspectives: clonidine: diverse use in pharmaco-logic management. Perspectives in Psychiatric Care. 2011;47:105-108.34. Kapvay. Lexicomp elec-tronic database. Available at: http://www.crlonline.com.southuniversity.libproxy.edmc.edu/lco/action/doc/retrieve/docid/patch_f/6643. Accessed October 22, 2012.35. Kapvay. Facts and Compari-sons electronic database. Available at: http://online.factsandcomparisons.com.southuniversity.libproxy.edmc.edu/MonoDisp.aspx?monoID=fandc-hcp13223&quick=902845%7c5&search=902845%7c5&isstemmed=True#firstMatch. Accessed October 22, 2012.36. Croxtall JD. Clonidine extended-release in attention-deficit hyperactivity disorder. CNS Drugs. 2012;26(3):277-79.37. Intuniv. Lexicomp elec-tronic database . Available at: http://www.crlonline.com.southuniversity.libproxy.edmc.edu/lco/action/doc/re-trieve/docid/patch_f/7012#f_dosages. Accessed October 22, 2012.38. Shaffer D. Attention deficit hyperactivity disorder in adults. Am J Psychiatry. 1994;151:633-8. 39. Spencer T, Biederman J, Wilens TE, et al. Adults with atten-tion-deficit/hyperactivity disorder: a controversial diagnosis. J Clin Psy-chiatry. 1998;59(7):59-68. 40. Popper CW. Antidepressants in the treatment of attention-deficit/hyperactivity disorder. J Clin Psychia-try. 1997;58(14):14-29. 41. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statis-tics and Quality. (January 24, 2013). The DAWN Report: Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimu-lant Medications. Rockville, MD. Available at: http://www.samhsa.gov/data/2k13/DAWN073/sr073-ADD-ADHD-medications.htm. Accessed February 15, 2013.


BOOKS FOR SALEChristian Book Available at Amazon, Barnes and Noble, and etc. It is Called Choices ( The secret to Making Wise Choices) by Carolyn Gault wife of pharmacist Horace Gault Jr. The book is about our moments in history as we face choices that are confusing, in out rapidly changing culture. The proceeds will go to Mission to the World to help missionaries and their families.

OXYGEN EQUIPMENT18-Portable oxygen cylinders, 1 devilbiss oxygen conservator, 1-3 liter concentrator invacare, 1-5 liter concentrator invacare, 7-oxygen regulators,1-Salter labs ultrsonic oxygen indicator. Call 864-843-9207, liberty family pharmacy $900.00

ADHD Diagnosis & Treatment: A Review for PharmacistsCorrespondence Course Program Number: 0171-9999-13-002-H01-P1. Complete and mail entire page. SCPhA members can take the Journal CE for free; $15 for non-members. Check must accompany test. You may also complete the test and submit payment online at www.scrx.org.2. Mail to: Palmetto Pharmacist CE, 1350 Browning Road, Columbia, SC 29210-6309.3. Continuing Education statements of credit will be issued within 6 weeks from the date the quiz, evaluation form and payment are received.4. Participants scoring 70% or greater and completing the program evaluation form will be issued CE credit. Participants receiving a failing grade on any examination will have the examination returned. The participant will be permitted to retake the examination one time at no extra charge.

South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as providers for continuing phar-macy education. This article is approved for 1 contact hour of continuing pharmacy education credit (ACPE UPN 0171-9999-13-002-H01-P). This CE credit expires 1/18/2016.

Name: _______________________________________________ License #: __________________________

Address: ________________________________________________________________________________

City: ____________________________________________ State: _____ Zip: ________________________

Phone: _______________________________________ Email:____________________________________

NABP eID: _________________________________ Birth Month/Birth Date (MMDD): ________________Evaluation: Circle the appropriate response Did the article achieve the stated objectives? Not at all 1 2 3 4 5 CompletelyOverall evaluation of the article? Poor 1 2 3 4 5 ExcellentWas the information relevant to your practice? No 1 2 3 4 5 YesHow long did it take you to read the article and complete the exam? ______________CE credit will ONLY be awarded when a submitted test is accompanied by completing the evaluation above or online at www.scrsx.org

LEARNING ASSESSMENT QUESTIONS:1. Which of the following statements about ADHD are true?a Diagnosis of ADHD requires at least 6 symptoms of hyper-activity, impulsivity, and/or inattentiveness to be present for at least 6 months.b. Girls are diagnosed with ADHD more often than boys in the U.S.c. Nonstimulants may be abruptly discontinued if no improve-ment of symptoms is seend. All of the above

2. All of the following FDA-approved medications for ADHD are classified as Schedule II controlled substances except:a atomoxetine b. dextroamphetaminec. lisdexamfetamine d. methylphenidate

3. Which of the following would be the best choice for initial treatment of a 4-year-old boy recently diagnosed with ADHD?a. atomoxetineb. behavioral parent training programc. long-acting methylphenidated. short -acting methylphenidate

4. Which of the following medications for ADHD should be tapered upon discontinuation?a. clonidine extended releaseb. dextroamphetamine extended releasec. methylphenidate extended released. all of the above

5. Adverse effects of stimulants used for the treatment of ADHD include all of the following except:a. appetite suppression b. headachec. insomnia d. weight gain

6. Which stimulant medication is a prodrug that is acti-vated in the gastrointestinal tract once the lysine residue is cleaved?a. Concerta® b. Focalin®c. Kapvay® d. Vyvanse®

7. Antidepressants such as bupropion and desipramine may be used for the treatment of ADHD in which of the follow-ing instances?a. An instant response is neededb. Comorbid substance use disorder is presentc. First-line FDA-approved treatment is requiredd. All of the above

8. Which agent used to treat ADHD is a selective inhibitor of norepinephrine reuptake?a. Adderall®b. Intuniv®c. Strattera®d. Vyvanse®

GAMECOCK/USC MERCHANDISEOfficial collegiate licensed merchandise for sale. T-shirts, car flags, tailgate gear. All de-signed by a SC Pharmacist. Please email Daniel Bundrick at [email protected] or call/text 803.603.8622. Original designs, unique, edgy new designs too. Also look for our two mobile stores, our huge vans that go to events and football games. Check us out online at www.carolinagamecocktees.com STORE FIXTURES/PLANNING

Planning to expand, remodel or open a new pharmacy? Since 1973 Display Options, Inc. has provided professional store planning, In-stallation, quality store fixtures and customer service to Pharmacies across the Southeast. Please allow us the opportunity to assist you with your plans & dreams. Call us toll free at (800)321-4344 or visit our web site at www.displayoptions.com.

TRANSFORMING THE SOUL OF PHARMACY, BY MINISTERING TO THE

HEARTS OF PHARMACISTSChristian Pharmacists Fellowship International, a nonprofit organization, is a worldwide fellow-ship of individuals working in all areas of phar-maceutical services and practices. For member-ship information, call (888) 253-6885 or visit our website at www.cpfi.org.

FOR SALENEED HELP WITH MEDICATION

THERAPY MANAGEMENT?Contact: Bryan Ziegler, PharmD, MBA, Pharmacy Service Consulting, LLC Phone: (803) 269-6333 Email: [email protected] Provided: MTM education, Identifi-cation of MTM Opportunities, Staff Training, Workflow Analysis, Business Analysis

PHARMACY OPERATIONS CONSULTANTPharmacists interested in changing you existing design and operation of your pharmacy - let the best in the business help you make those changes. Contact: Paul J. Hyer, Jr., RPh, PD at 843-814-2542 or write to 301 S. Magnolia St. Summerville, SC 29483.

PHARMACIST SEEKING EMPLOYMENTSouth Carolina Licensed Pharmacist would like to work in an independent pharmacy, prefer small-town setting. Tim McKittrick 704-585-6690

FOR SALE: MORTAR AND PESTLESSet of 8 Schering Pharmaceutical Corporation commemorative bronzed-like metal mortar and pestles, dated from the late 1960s and 1970s. They have been on display in our independent pharmacy in Florence, SC for over 40 years. We know those who are familiar with these will appreciate them and want them for their collections. They are all about 4 inches tall by 4 inches wide. They are in good condition. Call 843-992-0981 with offer, plus $30 ship-ping. Nights and weekends call 843-669-7439 or email [email protected]

RELIEF RPh

Services

RELIEF PHARMACIST AVAILABLEExperienced (retail, clinic, consulting, nursing home)pharmacist available on PRN or regular basis. Will travel. Competitive Rate. M-F, oc-casional Sat. JOHN W. OWEN, [email protected], (H)803-783-2979 (C)803-466-4783

ETC.

Want to place an ad here? Mem-bers can post classified ads for free. Please visit www.scrx.org and fill out our online classified form to get your ad posted here!

FOR SALE: PRO ROBOTScript Pro Robot For Sale Model SP200, Excellent Condition. 110K. Send inquiries to [email protected].

FOR SALE: OWENS ILLINOIS PROMOTIONAL CHINA

Owens Illinois Promotional China, glass ware and “silver” cutlery. About 85 assorted pieces. Please e-mail me at [email protected] if you are interested. I can send you a list if you wish. Ralph Wilkie, 843-884-5751

CLASSIFIEDS

BEACH HOME FOR SALE OR RENTPawley’s Island Beachhome - 5 Bedroom and 5 Baths. Beautiful view on the creek with eleveator. For sale or rent. Checkout [email protected].

GATLINGBURG CONDO FOR SALEGatlinburg, TN condo for sale. 3 BR & 3 Bath condo. Fully furnished. Beautiful views of pool, downtown, and mountains. Use for va-cations or rental. Priced at $225,000.00. Call 843.908.3488 or email [email protected]

♦ South Carolina Board of Pharmacy/licensing matters

♦ Corporate legal counsel specific to pharmacies including purchase and sale

♦ OBRA-90 and South Carolina patient counseling requirements

♦ HIPAA and related privacy issues

♦ Third Party issues including pharmacy benefit managers

♦ Medicaid audits

♦ DHEC and DEA/controlled substances

♦ Risk management

♦ Pharmacy Technicians

♦ Federal compliance

Jon A. Wallace, B.S.Pharm., J.D.

602 Rutledge Avenue ♦ Charleston, SC 29403 ♦ (843) 266-2626 ♦ [email protected]

40 Palmetto Pharmacist • Volume 53 Number 1

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