1. health and fitness
2. drugs

NEWSLETTER FOR NH PHARMACY PROFESSIONALS
Volume 4, Issue 3
2014
Distributed as a service to the professionals of pharmacy
Prescription Drug Monitoring Program (PDMP)
Went Live October 16, 2014
than 20 states including our neighbors in Maine and
Vermont.
The NH PDMP began operating on October 16, 2014.
Based on RSA 318-B:31, this means that all
prescriptions for Schedules II-IV that are dispensed,
shall be reported to the program. The intent of the
program is to reduce the abuse, overuse, and diversion
of controlled substances. It will also assist prescribers
and dispensers (pharmacist) determine the legitimate
pain needs of their patients versus the increasing
challenges surrounding diversion and abuse. When the
program launched in October, data as far back as
March 1, 2014 was preloaded into the system. New
Hampshire is the 49th state to initiate this type of
program, and its operational parameters are somewhat
unique to this state.
HID began assisting with the registration process of
pharmacists this Fall. This process involved the PDMP
(through the vendor, HID) sending out credentials for
each pharmacist. The pharmacist was then assigned a
USER ID and initial password. The password was then
personalized and changed in a fashion similar to the
process used by online banking or other websites.
Once established, the pharmacist is able to access the
PDMP during the dispensing process, and use his or her
best professional judgment regarding any intervention.
Certain chain pharmacies may also have their own IT
groups assist with registration centrally; however, that
has not been finalized.
In May, the Board of Pharmacy’s Advisory Council
interviewed interested candidates for the Director’s
position and unanimously chose Michelle Ricco Jonas
to lead the project. Ms. Ricco Jonas brings a wealth of
project management skills and experience in health
related state and local government initiatives. The
PDMP office resides in Concord, NH at the Board of
Pharmacy located at 121 South Fruit Street. You may
contact by telephone (603) 271-6980, fax (603) 2712856 or by email at michelle.riccojonas@nh.gov.
New Hampshire has contracted with Health
Information Designs, LLC (HID) as a vendor to develop
a prescription database and help move the project
forward. HID is a nationally recognized leader in
automated healthcare solutions and also serves more
What’s next?
At this point, we need to look at ways to tweak the
program due to the ongoing dynamics of the
environment. Some grants and funding options dictate
certain requirements for extension of the monies
needed to sustain the program. This means that we
need to look at ways to satisfy that grant requirement
by including changes involving, for example, interstate
data sharing. Most changes of this type will require the
introduction of new legislation and additional
rulemaking.
The success of this program depends upon one factor,
and that one factor is using it! If pharmacists use the
program as it was intended, then its success will be
assured.
The NH Med Bank, formerly known as NH Rx Connects, is New Hampshire’s only first and only charitable pharmacy.
Their mission is to provide medication access to New Hampshire residents who cannot afford them and reduce
medication waste. NH Med Bank is currently seeking volunteer pharmacists. If you wish to find out more information,
please call or email the Program Coordinator, Dan Walsh, at (603) 415-4258 or at dwalsh@healthynh.com
NH Pharmacy News 1
NHPA Board Members:
Help us, help you! As an organization, NHPA is working on your behalf
to ensure the protection and advancement of the pharmacy profession.
This is only possible through membership dues from pharmacists like
you. NHPA board members volunteer their time on behalf of YOU!
On December 7, 2014 NHPA will sponsor a CE program at SERESC in
Bedford, New Hampshire. Topics include: Drug Diversion, NH BOP
Update, Update in COPD, Pediatric GERD and Therapeutic Monoclonal
Antibodies.
Check out NHPA’s newly redesigned
website at
www.nhpharmacists.net
Jay Calabro, President
Lorraine Radick, Past President
Cheryl Durand, Vice President
Joel Brown, Treasurer
Amanda Morrill, Secretary
Cheryl Abel
Andrew Brueckner (student)
Maryann Cooper
Christopher Lopez
Don Messina
Amanda Morrill
Regan Sevinsky (student)
Michael Viggiano
Visit our website at:
www.nhpharmacists.net
Contact us by phone:
603.229.0292, option 1
NHPA is proud to be a member of the National Alliance of State Pharmacy Associations (NASPA)
NHSHP Board Members:
Regina Kavadias, President
Jennifer Towle, President elect
Kerri Johnson, Immediate Past President
Tom Algozzine, Secretary
Linda Horton, Treasurer
Paul Belliveau
Denise Boulais (CPhT)
Dave DePiero
Tina Genovese
Marylou Kosmatka
Dave LaCoste
John Mini
Molly Mortimer
Ed Rippe
Jane Rippe
Diane Sadoski (CPhT)
Laura Stewart (CPhT)
Bob Theriault
Elizabeth Wade
Susan Ware
Kristine Willett
Visit our website at :www.nhshp.org
Contact us by email:
boardofdirectors@nhshp.org
Cabin Fever CE Weekend is coming!!
March 13-15, 2015
North Conway Grand Hotel
Book your
room now!
603-356-4200
Attendees will earn 5 hrs of LIVE CE, including 2 hrs of law, a
presentation on multiple sclerosis a new clinical pearls session!
NHSHP is proud to be affiliated with the American Society
of Health-System Pharmacists
NH Pharmacy News 2
Hydrocodone Rescheduling
By: Melissa Tutu, Pharm.D. Candidate 2015
On October 6,
2014
the
rescheduling of
hydrocodone
and
hydrocodone
combination
products (HCP)
went into effect.
These products
have
moved
from a schedule III to schedule II in the US federal
register. According to The Controlled Substance Act,
medications and prescription products with abuse
potential fall into one of the four classes of schedules
with schedule II including products with highest
potential for abuse.
Schedule II requirements,
including security protocols, packaging and labeling,
documentation and reporting, inventory count, DEA
registration requirements, and now apply to these
hydrocodone products.
The FDA has proposed this change of
schedule for almost ten years due to the drugs
addiction and abuse risk. The rescheduling of this
medication is predicated to save the lives of
hundreds.
Many people, including health care providers,
have opposed this schedule change. The DEA has
received over 600 statements in opposition of the
rescheduling. Organizations including the American
Pharmacist Association, American Academy of
Consultant Pharmacists, American College of Clinical
Pharmacy, Academy of Managed Care Pharmacy,
American Society of Consultant Pharmacists, National
Alliance of State Pharmacy Associations, National
Association of Chain Drug Stores, and National
Community Pharmacists Association openly opposed
the rescheduling. Some believe that even with
rescheduling, drug abuse may not decrease. Rather, it
may make it more difficult for those individuals with
legitimate pain to get access to necessary
medications.
Zyhydro, hydrocodone extended release, is already
a schedule II product. It will not be affected by this
change.
In Memoriam
John R. Mulkerron
(August 28, 1939 - June 20, 2014)
John R Mulkerron, 74, of New London,
NH, devoted husband and father, died
peacefully June 20, 2014 surrounded by
his family. John was born in Boston and
raised in Winthrop, MA. John’s pursuit
of
higher education began
at
Massachusetts College of Pharmacy
where he earned his BS in pharmacy and graduated
with honors. He then went on to earn his MBA from
Northeastern University. His career began at the U.S.
Food and Drug Administration as an inspector and
later opened several retail establishments throughout
the Boston area including Prudential Center Pharmacy,
Center Plaza and Park Plaza Pharmacy. In 1990, he
moved to NH as Director of Outpatient Pharmacy for
the Dartmouth-Hitchcock Medical Center in Lebanon.
John facilitated and led the opening of a successful
outpatient hospital based Pharmacy, and his model has
been replicated in many
hospital outpatient pharmacies. After his retirement in
2007, John continued his to work in pharmacies
throughout the Sunapee Region, acted as a consultant
for Planned Parenthood, and taught Pharmacy
Technician classes at Lebanon College. John was able to
find the time to volunteer as an active member of the
Board of Health for both Lynnfield and Boxford, MA. In
addition, he lovingly spent thirteen years building a
stunning Friendship Sloop sailboat with his father in
law that is still sailing on the Chesapeake Bay. He was
an active member of the NH Pharmacists Association,
American Pharmacist Association, and the NH Society
of Health-System Pharmacists. John also was an avid
historian and expert on World War II. Although John’s
business endeavors and other efforts were successful,
his most notable legacy is the family that he was so
immensely dedicated to; the lessons he left each
member of his family about respect, loyalty, tolerance,
and unconditional love will live on forever. Expressions
of sympathy may be made in John’s name to the Jimmy
Fund.
NH Pharmacy News 3
Synthetic Marijuana
Summary of New
Recommendations for
Pneumococcal Vaccines
By: Melissa Tutu, Pharm.D. Candidate 2015
The use of synthetic marijuana has
been increasing in the Granite State
in the last several months. In
response, Governor Hassan issued a
state of emergency. Dozens of
people have been seen in the
emergency department due to
overdoses of the popular drug. The item was
originally created and marketed for its sweet
fragrance as a potpourri. However, the item was
found to create a feeling of euphoria when smoked or
ingested. “Smacked” or “Spice”, as many call it, was
available at many convenience stores. In the past
month, law enforcement officials throughout the state
have raided convenience stores and gas stations to
search for the drug to make sure that this item was off
the streets.
What is Spice?
“Smacked” or “Spice” is a mixture of spices and herbs
covered and sprayed with a chemical compound that
is similar in structure to tetrahydrocannabinol, the
active ingredient in marijuana that causes the
individual to be in the state of euphoria or altered
mental status.
Side Effects
Inappropriate use of the product such as smoking or
ingesting can cause various symptoms such as suicidal
thoughts, hallucinations, confusion, seizures, agitation,
paranoia, fatigue, nausea and vomiting, increase heart
rate and blood pressure, pale skin color, bloodshot
eyes, and tremors. In some severe situations,
inappropriate use of the drug can cause brain damage
and even blindness. The package of this product does
indicate “NOT FOR HUMAN CONSUMPTION.” Spice
binds to the same receptors as tetrahydrocannabinol
but does so with stronger affinity, causing a greater
pharmacologic effect.
As a pharmacist, it is always wise to educate your
patients on hazards to the community. For more
information regarding clinical management, please
call the Northern New England Poison Center at 1800-222-1222.
By: Hayam AlRasheed, Pharm.D.
Candidate 2015
Pneumococcus
(Streptococcus pneumoniae)
is a leading cause of
infectious disease and can
lead
to
pneumonia,
bacteremia, and meningitis.
In order to reduce the
number of infections, the 7valent pneumococcal conjugate vaccine (PCV7) has
been used since 2000. Another vaccine, 13-valent
pneumococcal conjugate vaccine (PCV13), has been in
use since 2010. The two vaccines have resulted in a
reduction of pneumococcal infections. According to
Centers for Disease Control and Prevention (CDC),
cases of invasive pneumococcal disease (IPD) have
declined approximately 50% in adults over the age of
65 years of age for serotypes unique to PCV13 relative
to what was observed before 2010 when PCV7 was
replaced by PCV13 in pediatric immunization
schedule. Despite the reduction, cases of IPD that
occurred among adults of 65 years and above still
came to approximately 13, 500, in 2013.
According to the CDC, an estimated 20% - 25% of
invasive pneumococcal disease (IPD) cases and 10%
of community-acquired pneumonia cases in adults
ages 65 years and above is as a result of PCV13
serotypes, which can be averted by using PCV13 for
the population. In 2013, 38% of IPD cases in adults
ages 65 years and older were also found to have been
due to serotypes that were unique to 23-valent
Pneumococcal Polysaccharide Vaccine (PPSV23). As a
result, the Advisory Committee on Immunization
Practices (ACIP) has changed their recommendations
for pneumococcal vaccination in adults. ACIP now
recommends that both PPSV23 and PCV13 should be
administered routinely to all adults that are aged 65
years and above. This is a broad measure that aims to
prevent IPD cases that are as a result of serotypes
unique to either PCV13 or PPSV23. The vaccines
should be given in a series.
PCV, Continued on page 5
NH Pharmacy News 4
Ebola Outbreak
By: Melissa Tutu, Pharm.D. Candidate 2015
The 2014 Ebola outbreak
is said to be one of the
largest infectious disease
outbreaks to hit the
globe; it is also West
Africa’s first outbreak.
The US is known for its
diverse
and
unique
population,
hailing
citizens from all over the
world, including the West
African
nations
of
Nigeria, Liberia, Ghana,
Sierra Leone. Thousands travel back and forth from
the US every year to visit their country of origin. This
may pose a threat to the US. Already there have been
missionaries returning to the US from their field
work in West Africa who have been infected by the
Ebola virus.
What is Ebola?
The Ebola virus causes hemorrhagic fever that can be
deadly. The virus requires 8 to 21 days for
incubation. Researchers believe that many patients
became infected through direct contact with an
infected animal or from consumption of meat from an
infected animal. Once the virus has infected a human,
it is easily transmitted via direct contact. This may
include contact of broken skin or mucous membranes
of the non-infected patient or mucous membranes
come into contact with infected bodily fluids, such as
urine, semen, feces, vomit, or saliva.
Are you at risk?
People such as family and friends of the Ebola
infected individual along with healthcare providers
are at the highest risk for the transmission of the
virus because they may come into contact with the
infected patients bodily fluids or blood. At a health
care facility, the virus can be spread. Hence, proper
protective equipment and sterilization procedures
are essential.
What’s the pharmacist’s role?
Infected patients may come to the pharmacy seeking
advice from a pharmacist on their symptoms. The
patient
may report symptoms such as fever, diarrhea,
vomiting, weakness, headache, abdominal pain, red
eyes, bleeding, or raised rash. Pharmacists play an
important role, as they remain the number one most
accessible healthcare professional. Pharmacists also
should follow safety procedures at their pharmacies.
For instance, sterilizing blood pressure cuffs before
and after each patient use.
Be sure to educate your patients on how severe this
infectious disease is. Simple educational poster
boards go a long way. These boards can present
information on what Ebola is, how it is contracted,
and signs & symptoms that are usually exhibited.
Other ways to educate patients include providing
general Ebola information and prevention measures,
which include avoiding contact with body fluids and
blood, making sure to practice good hygiene such as
washing hands frequently, using hand sanitizers, and
proper food handling and preparation.
PCV, Continued from page 4
In cases where adults at 65 years and above have not
been previously vaccinated, or their pneumococcal
vaccination history is unknown, a PCV13 dose
should be administered first, followed by PPSV23
after 6-12 months. These vaccines should not coadministered; administration must be separated by
a minimum of eight weeks.
In the case where a patient has been previously
vaccinated with PPSV23, a dose of PCV13 should also
be administered if it had not been given. A dose of
PCV13 should be given at least a year after receipt of
the last PPSV23 dose. In cases where an extra dose
of PPSV23 is indicated, a subsequent dose of PPSV23
needs to be given 6-12 months after the
administration of PCV13, and not less than five years
after the latest dose of PPSV23.
The recommendations by ACIP for regular use of
PCV13 among adults of ages 19 years and above
with
immunocompromised
conditions,
cerebrospinal fluid leak, cochlear implants, or
anatomic asplenia remain the same.
NH Pharmacy News 5
Medication Safety Corner
By: Elizabeth Wade, PharmD, BCPS
Clinical scenario: A patient was admitted to the
hospital with chest pain. His past medication history
from a nursing home medication administration
record (MAR) prior to admission indicated the
patient’s home dose of Xarelto (rivaroxaban), a new
oral anticoagulant, as 15 mg PO daily. The Discharge
Summary from this hospital listed the home does of
Xarelto as 50
mg PO daily.
Upon
admission to
the
hospital,
the admitting
provider used
the
nursing
home MAR to
dictate
the
medication list,
dictating 15 mg. However, transcription heard and
transcribed 50 mg. Additionally, the discharge
summary from the nursing home was used to enter
the home medications on the patient’s home
medication list. In order to make a Xarelto 50 mg
dose, it was entered as Xarelto 10 mg tablets, dosed
five tablets oral once daily at bedtime.
The medication was held while the patient was in the
hospital, so the patient did not receive any incorrect
doses.
On the day of discharge, two astute providers
reviewed the admission medication list, noted the
dosing error, and corrected the dose to 15 mg. It is
important to remember that because reports such as
History and Physicals, Consults and Discharge
Summaries are generally transcribed from a
recording or dictation, there may be errors present.
Actions:
Sources of home medication information are now
prioritized when generating the home medication list
such that nursing home MAR’s are the most reliable
source of information.
Other medications reported to have been involved in
“15” versus “50” mix-ups include insulin, oxycodone,
and olanzapine, where 50 mg or units may be a more
commonly believed dose.
ISMP SAFE PRACTICE RECOMMENDATION:
Verbal communications for drug doses should be
stated the way pilots state numbers (“15 mg” is “onefive mg”). This method is especially important when
stating doses of critical medications such as insulin.
Records of medical dictations must be carefully
checked by the practitioner who dictates them,
especially drug doses. Practitioners giving dictation
should assume that medical records won’t always be
transcribed correctly. Other care givers should also
be aware of the potential errors during the
transcription process and always question doses that
seem out of range or medications that do not “fit” or
make sense with the patient’s current condition.
An Update on Federal Provider Status (H.R. 4190)
The H.R 4190 bipartisan legislation which will
amend the Social Security Act has now increased its
number of cosponsors to over 120. APhA, ASHP,
along with other members of the Patient Access to
Pharmacists’ Care Coalition (PAPCC) have been
working together on bill, which will recognize
pharmacist as providers under Medicare part B.
The PAPCC consists of 20 pharmacy organizations
and was created to support federal policy proposals
to allow state-licensed pharmacist to perform
services in medically underserved communities. A
national advocacy campaign has begun and will
continue with a new
bill once the session
begins in January. We
urge you to reach out
to your Congressmen
and
Sentator
in
support of H.R. 4190!
NH Pharmacy News 6
DEA Final Rule on Disposal of Substances
By: Hayam AlRasheed, Pharm.D. Candidate 2015
The
United
States
Drugs
Enforcement
Administration (DEA), in its quest to expand the
available disposal options of unused, unwanted, or
expired pharmaceutical controlled substances, has
published the Final Rule which sets forth the
implementation of the Secure
and
Responsible
Drug
Disposal Act of 2010. The
implementation of the Final
Rule
permits
authorized
entities,
for
example
manufacturers,
reverse
distributors, retail pharmacies, distributors,
hospitals with on-site pharmacies, and narcotic
treatment programs (NTPs) to collect substances for
disposal purposes. The Final Rule, implemented on
October 9, 2014, aims to prevent and reduce
prescription drug abuse.
The DEA, under the Final Rule, required DEA
registrants to modify their registration so that they
become authorized collectors. The DEA has
expanded its registrants to include NTPs as well as
hospital or clinics with on-site pharmacies. The
expanded registrant categories provided more
options for ultimate users hence contributing to
secure, safe, responsible and convenient disposal of
unwanted controlled substances. NTPs are required
to have collection receptacles in rooms that are
securely locked, have controlled access, and do not
have other controlled substances.
The requirements are a security measure
necessitated by the nature of health care provided in
NTPs. NTPs and other collectors are not allowed to
collect schedule 1 controlled substances, and the
collectors have to ensure that illicit substances are
not collected inadvertently. Clinics and hospitals
with on-site pharmacies permitted to be collectors
will be
required to maintain receptacles in their registered
centers, and will conduct mail-back programs. DEA
registrants are not allowed to use collection
receptacles for disposal of unused controlled
substances that are in their inventory. The security
measures provided will discourage diversion in the
unique circumstances of hospital/clinics and NTPs.
Changes in the Final Rule also ensure that LongTerm Care Facilities (LTCFs) have enough disposal
options that expand disposal opportunities for its
residents. The law has permitted retail pharmacies
and hospitals or clinics to have collection
receptacles at affiliated LTCFs. For security
purposes, the DEA requires retail pharmacies and
hospital/clinics to store inner liners in secured
rooms that have controlled access for up to three
business days after removal from collection
receptacles in LTCFs. The collectors can also make
storage of inner liners unnecessary by scheduling
medication deliveries to coincide with transfer of
liners for destruction. To avoid transportation of
large consignments of controlled substances, the
collectors should deliver liners to a registered
distributor’s location or a reverse distributor using a
contract or common pick-up. Collectors should also
appoint a supervisor-level employee of the LTCF to
oversee the removal and transfer of inner liners
with an employee of the collector.
The 14-day destruction requirement has been
extended to 30 days to give the distributors and
reverse distributors’ ample time to collect and
destroy the substances. For practitioner's physical
security, a clarification has been added to the
existing rule. The rule restricts the storage of inner
liners and mail-back packages that contain the
collected substances to secure cabinets and locked
rooms that have controlled access. Institutional
practitioners and pharmacies are not allowed to
store mail-back packages and inner liners by
dispersing them in the inventory of non-controlled
substances.
NH Pharmacy News 7
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Capsule
2014 (Third Quarter)
Pharmacy Time Capsule
1989
There were 74 accredited colleges of pharmacy in the United States (including Puerto Rico).
1989 graduates figures included: 5721, BS; 836 PharmD (1st professional degree); and 222 PharmD (2nd degree).
The conservative Heritage Foundation published "Assuring Affordable Health Care for All Americans," which called for a mandate
to purchase health insurance.
Losec (omeprazole) was first marketed in U.S. by Astra. In 1990, FDA required name change to Prilosec to avoid confusion with
Lasix.
1964
1964 graduates figures included: 2029 BS and 166 PharmD (1st professional degree).
Keflin (cephalothin sodium, Lilly) was the first cephalosporin to be marketed in the Unites States.
Average cost of prescription was $3.41
Luther L. Terry, M.D., Surgeon General of the U.S. Public Health Service, released the first report of the Surgeon General's Advisory
Committee on Smoking and Health linking cigarette smoking to lung cancer and other lung problems.
1939
The first Blue Shield plan was begun as an insurance to cover physicians’ fees.
1914
Cocaine, used in many patent medicines and tonics, was widely available in pharmacies and other retail establishments until
banned in 1914.
By: Dennis B. Worthen, PhD, Cincinnati, OH
One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to
assuring that the contributions of your profession endure as a part of America's history. Membership offers the
satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your
door each year. To learn more, check out: www.aihp.org
NH Pharmacy News 8