Volume 25, No. 4 September/October 2015

Editor: Dana Jamero djamero@xula.edu www.lshp.org

FROM THE DESK OF THE PRESIDENT

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Upcoming Events………………………………….

SELSHP Update…………………………………...

Suvorexant (Belsomra© ): An approved treatment

for Insomnia………………………………………..

Mid Year Meeting Recap and Photos…………….

Board of Director Meetings Motions Passed……..

INSIDE

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Dear Members,

I hope this letter finds you and your family

well. As I write this we are preparing for our 2015

Midyear meeting (October 3rd) having just come off

our annual strategic planning retreat and Board

Meeting held August 15-16th. The retreat was well

attended and highly energetic!

Our first order of business was the

installation of new board members. Jennifer Smith

was installed as President-Elect; Scott Dantonio and

Roxie Stewart were installed as Board Members at

Large-Elect; and Alexis Horace was installed as the

South Central LSHP Chapter President. The new

members were installed by Tommy Mannino.

Thank you for your time and service!

The retreat marked the beginning of a “new”

year for the organization and we hope it to be a

productive and rewarding one. We discussed

multiple issues with regards to attracting new

members to LSHP and new/old members to our

Midyear and Annual meetings. I call for you to

assist us in that endeavor and if you have ideas/

suggestions please forward them to the LSHP office.

Part of that plan involves new marketing ideas,

especially in the areas of social media, so visit our

Facebook page and give it a “like”!

The liveliest discussion revolved around the

50th ASHP Midyear meeting in New Orleans. We

have a special subcommittee headed by Monica

Morgan, Alexis Horace and Jennifer Smith working

on LSHP’s plans for participating in the opening

ceremonies. If anyone is interested in helping

please contact them ASAP. Please join us for this

special occasion.

I’d also like to take this time to remind you

of the new program we started last year to help

students attend LSHP Annual and Midyear

Meetings. Sponsorship Levels have been setup for

these complimentary student registrations with a

designation of Platinum for sponsorships of $100

and above, Gold $50-99, Silver $25-49, and Donor

under $25. It is hoped that involvement in LSHP as

students and new practitioners will translate into

active membership throughout their careers.

Shawn M. Manor, Pharm.D., BCPS

LSHP President

2015-2016

Louis iana Society of Heal th -System Pharmacists

LSHP Bimonthly Newsletter LA HEALTH-SYSTEM PHARMACISTS Publisher Information

The LA Health-System Pharmacist is published 6 times a year by the LSHP, 8550 United Plaza Blvd., Suite 1001, Baton Rouge, LA 70809.

Subscription to the LA Health-System Pharmacist is a benefit of LSHP membership. All articles published represent the opinions of the authors

and do not reflect the policy of the LSHP unless so specified. All student submissions must be reviewed by a pharmacist mentor whose name will

be included on the article.

Copy, advertising and nonmember subscription inquiries should be directed to the Copy Editor, Lauren Landry, at (225) 922-4520. Advertising

rate sheets and deadlines are available upon request.

Please send article submissions to the newsletter editor, Dana Jamero, via email at djamero@xula.edu.

Page 2

LOUISIANA SOCIETY OF HEALTH-SYSTEM PHARMACISTS

2015-2016 BOARD OF DIRECTORS

PRESIDENT Shawn Manor, Pharm.D., BCPS Shreveport (318) 632-2007 smanor@lsuhsc.edu PAST PRESIDENT Fancy Manton, RPh, Pharm.D. Baton Rouge (225) 231-5271 fancy.manton@womans.org TREASURER Tommy Mannino, RPh Baton Rouge (225) 765-8441 tommann40@aol.com

PRESIDENT-ELECT Jennifer Smith (225) 346-5961 smith@ulm.edu SECRETARY Helen Calmes, PharmD New Orleans (504) 430-6730 hmcalmes@ejgh.org

MEMBER AT LARGE Frank McCloy, RPh Covington (985) 875-7291 Ext 7594 fmccloy@warmsprings.org MEMBER AT LARGE Teresa Nash, PharmD, BCPS New Orleans (504) 842-3119 tnash@ochsner.org MEMBER AT LARGE Monica Morgan, PharmD Lafayette (337) 289-7886 mdmorgan@lgmc.com

MEMBER AT LARGE Elizabeth Perry, PharmD Shreveport (318) 632-2007 ext. 245 eperr5@lsuhsc.edu BOARD MEMBER ELECT Roxie L. Stewart, PharmD Monroe (318) 342-1703 BOARD MEMBER ELECT Scott Dantonio, RPh Lutcher (225) 746-2945 sdantonio@sjph.org

CENTRAL-LSHP Joseph Gary LeBlanc (318) 769-3070 leblanjg@gmail.com

NORTH-LSHP Elizabeth M. Lafitte, PharmD, BCPS (318) 632-2007 lafitte@ulm.edu NORTHEAST-LSHP Vacant

SOUTH CENTRAL-LSHP Jennifer Smith (225) 346-5961 smith@ulm.edu SOUTHEAST-LSHP Kisha O’Neal Gant (504) 520-7971 kishamgant@aol.com SOUTHWEST-LSHP Vacant

If you are interested in joining a committee, please contact the LSHP office at 225-922-4520 or

office@lshp.org.

Upcoming Events

December 6-10, 2015 The 50th ASHP Midyear Meeting

Ernest N. Morial Convention

Center

New Orleans, LA

May 26-28, 2016 2016 LSHP Annual Meeting

Hyatt Regency

New Orleans, LA

If you like LSHP then “like” our

Facebook page!

www.facebook.com/LSHP1

Louis iana Society of Heal th -System Pharmacists Page 3

SELSHP Update By Kisha Gant, Chapter President

Greetings! As I reflect upon the year, I am

appreciative of the opportunity to serve as President.

The thing I am most grateful for is the interaction

with my fellow pharmacists, pharmacy technicians,

pharmacy residents, and others. Through the

experience and knowledge of fellow professionals

dedicated to their craft, I have gained many

perspectives that cannot be learned in books.

I would like to thank the members of the Southeast

Chapter of the Louisiana Society of Health-System

Pharmacists for making this year a success by

participating in the five meetings we have had this

year. Four of those meetings included ACPE

accredited continuing education sessions presented by

Drs. Ogechi Iwuorie, Katrina Nguyen, Joseph

LaRochelle, and Lori Gordon. I would also like to

thank Gilead and Camtu Ho for sponsoring a talk on

HIV Long-Term Health. Of course all of this would

not have been possible without the assistance and

dedication of my fellow officers – Drs. Lori

Crawford, Secretary/Treasurer and Christopher

Gillard, President-Elect.

As the year comes to an end, the chapter has the

following activities planned. Dr. Ashley Taylor will

present a talk on diabetes drugs on November 19,

2015. For those considering giving back to the

profession, SELSHP officer elections will be held in

November 2015 with officer installment occurring in

January 2016.

I have truly enjoyed serving as President. Even

though I will no longer be an officer, I am eager to

serve LSHP in other capacities to promote and

support the organization. Thank you for allowing me

to serve.

Suvorexant (Belsomra© ): An approved treatment for Insomnia By Theresa Doan, Pharm.D. candidate and Courtney Payne, Pharm.D. candidate

Insomnia is a ubiquitous disorder affecting 10

to 15% of the adult population.1 It involves various

factors such as genetic, environmental, behavioral and

physiological that result in hyperarousal.2 Between 30

to 60% of the elderly population experiences chronic

insomnia.1 According to Riemann et al, DSM-5 has

now introduced insomnia disorder as an umbrella

category rather than primary and secondary insomnia.

Under the umbrella category, it includes daytime (e.g.

fatigue, decreased attention, and mood irritability) and

nighttime (prolonged sleep onset latency, difficulties

in sleep maintenance, early morning awakening)

symptoms.3

Drugs currently on the market to treat

insomnia include benzodiazepine and benzodiazepine-

like receptor agonists (eg. temazepam, zolpidem and

zopiclone), melatonin receptor agonists (eg.

ramelteon), and histamine H1 receptor antagonists (eg.

doxepin).2,5 Specifically benzodiazepine and

benzodiazepine-like agents are thought to promote

sleep by increasing the GABA function, the major

inhibitory neurotransmitter in the brain.4 However,

these agents have shown mixed efficacy and

undesirable effects such as tolerance, potential for

abuse and physical dependence, hangover effects with

psychomotor impairment, increased falls, and rebound

insomnia.

Therefore, recent interest in a new therapeutic

class called rexin receptor antagonist is growing.

Orexin (hypocretin) is a hypothalamic neuropeptide

that targets a different mechanism of action and plays

a critical role in promotion and maintenance of

wakefulness as well as regulating feeding behavior.

Orexin neurons (Orexin A and Orexin B) are referred

to as dual orexin receptor antagonists. They bind

selectively to orexin 1 receptor (OX1R) and orexin 2

receptor (OX2R). They are presumed to follow the

circadian rhythm and be active during wakefulness

and inactive during sleep.2, 5

Survorexant is the first FDA approved orexin-

receptor antagonist drug for the treatment of adult

patients with insomnia. It is an orally active dual agent

treating insomnia defined as difficulties with sleep

onset and/or sleep maintenance.2 Survorexant received

approval in August 2014 and is placed into Schedule

Continued on page 4

Louis iana Society of Heal th -System Pharmacists Page 4

IV of the Controlled Substances Act.

Suvorexant is available as a 5-, 10-, 15-, and 20

-mg oral tablet in blister packs of 30 each.6 The

recommended starting dosage for most patients is

10mg. Patients are instructed to take one tablet orally

within 30 minutes prior to bedtime and with at least 7

hours remaining before the planned time of

awakening. If the 10mg dose is well tolerated and not

effective, the dose may be increased to the maximum

dose of 20mg once per night. However, the FDA

strongly advised against next-day activities that

require full mental alertness such as driving.2 If a

patient is receiving concomitant therapy with drugs

that inhibit the cytochrome P-450 isoenzyme system,

initial treatment should be at 5mg and take no more

than 10 mg per night.

The most common reported adverse events

include somnolence, dizziness, diarrhea, and fatigue.5

Headache, abnormal dreams, dry mouth, cough, and

upper respiratory tract infection occurred more

frequently in women than men.6 There may be a risk

for depression, sleep paralysis, and complex behaviors

such as “sleep driving”. It is not associated with a

significant risk for abuse for most patients, but there

remains a concern that individuals with a history of

abuse or addiction to alcohol or other drug may be

increased risk for abusing suvorexant.

Contraindications include patients with

narcolepsy. Also, because suvorexant has not been

studied in patients with severe hepatic impairment, it is

not recommended for these patients. For renal

impairment, no dose adjustment is required.5

Survorexant has not been studied in patients with

severe obstructive sleep apnea or severe chronic

obstructive pulmonary disease.

A recent systematic review was conducted to

determine the efficacy and safety of suvorexant.5

Results showed that suvorexant was superior to

placebo for sleep latency and sleep maintenance.

Also, the efficacy was similar to both men and women

and Caucasians and non-Caucasians. As for safety

information, clinically meaningful impairment driving

performance was observed in non-elderly patients who

had taken either a 20 or 40 mg dose of suvorexant.

However for 15 or 30 mg dose, there was no

statistically significant effect in elderly patients. They

also evaluated the effects of taking suvorexant at night

and testing patients on their memory and balance the

next day. In three different trials, results showed no

significant effects on memory or balance compared to

placebo. In the fourth trial, there was significant word

recall difficulty and body swaying in healthy non-

elderly patients when taking a single dose of

suvorexant 20 or 40 mg.

Suvoxerant’s approval provides clinical

professionals another option when choosing the right

treatment for patients with insomnia.

References

1. Winrow CJ, Gotter AL, Cox CD, et al;

Promotion of sleep by suvorexant- A novel

dual orexin receptor antagonist. Journal of

Neurogenetics. 2011; 25(1-2):52-61.

2. Yang LPH; Suvorexant: First global approval.

Drugs. 2014; 74(15): 1817-22.

3. Riemann D, Spiegelhalder K, Feige B, et al;

The hyperarousal model of insomnia: a review

of the concept and its evidence. Sleep Medical

Review 2010; 14:19-31.

4. Michelson D, Snyder E, Paradis E, et al; Safety

and efficacy of suvorexant during 1-year

treatment of insomnia with subsequent abrupt

treatment discontinuation: a phase 3

randomized, double-blind, placebo-controlled

trial. Lancet Neurology 2014; 13: 461-71.

5. Citrome L; Suvorexant for insomnia: a

systematic review of the efficacy and safety

profile for this newly approved hypnotic- what

is the number needed to treat, number needed

to harm and likelihood to be helped or harmed?

The International Journal of Clinical Practice;

2014; DOI: 10.111/ijcp.12568.

6. Traynor K. Suvorexant approved for insomnia.

American Journal of Health-Systems

Pharmacy; 2014; 71: 1524.

Suvorexant continued...

Louis iana Society of Heal th -System Pharmacists Page 5

The 2015 Midyear Meeting was a great success and we want to thank all who attended at the

Shreveport Convention Center! This year we had 11 CE sessions, a Reverse Expo, Exhibit

Hall and great opportunities for networking. We also want to thank our Midyear Meeting

Sponsor, Morris & Dickson!

Thank you to all who attended the 2015 Midyear Meeting!

Listed below are the motions passed from the 2015 Board of Directors Retreat on August 16, 2015:

All Board members and Board member-elects are “Editors” on the LSHP Facebook page and can edit and

make additions to the page.

A $500 dollar budget for social media promotions

Anne LaVance was nominated and elected as Technician on the Board of Directors

A budget of $2,000 for the ASHP Midyear meeting.

Listed below are the motions passed from the 2015 Board of Directors Meeting during the Midyear meeting on

October 2, 2015:

A 1 year CD and a 2 year CD will be purchased to put a sum of LSHP’s revenue in to hold until needed.

LSHP will join ASHP on the Patient Access to Pharmacists’ Care Coalition.

Motions Passed Board of Director Meetings

Save the Date! 2016 LSHP ANNUAL MEETING

HYATT REGENCY 601 LOYOLA AVE

NEW ORLEANS, LA

MAY 26-28, 2016