The Georgia Pharmacy Journal: November 2011

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The Georgia Pharmacy Journal November 20113

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

7 BlueCross BlueShield Insurance Information

10 NCPA Elects New Officers and Board Members Including Chancy and Sherrer

11 VIP Day at the Capitol Save-the-Date

18 Memo to Pharmacists: Security Paper for CII Hard Copy Required

23 Leadership Georgia 2012 Class includes 2 GPhA Members

24 CPE Opportunity: Dietary Supplementation of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty Acids

C O L U M N S

4 President’s Message

6 Editorial

15Smyrna Interstate Bridge Named for William A.

“Bill” Atkins, Sr., R.Ph.

Departments5 NPLC Nomination Form12 Pharm PAC Contributors14 Pharm PAC Contribution Card16 GPhA New Members16 Hit Us with Your Best Shot22 2012 Award Nomination Form30 GPhA Board of Directors30 Masthead

Advertisers2 Pharmacists Mutual Companies10 Financial Network Associates13 Logix, Inc.13 Melvin Goldstein, P.C.16 Barbara Cole, Attorney at Law17 AIP21 GPhA Workers’ Compensation23 Frances Cullen, PC23 Winter CPE Ski Trip32 UBS

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

P R E S I D E N T ’ S M E S S A G E


Iam so blessed to have the involvement of the GPhAboard of directors, the staff, and the executivecommittee to help govern this professional

association. This past week the members of the executivecommittee attended the last region meetings, speakingabout the association updates and the legislative agenda. Iwould like to thank the members of the executivecommittee for their help in making the region meetings asuccess.

Last year, as you recall, GPhA was instrumental in thepassing of 3 bills in the legislature that promoted ourprofession and assisted all pharmacists in their ability tocare for their patients. These bills were vaccinations, PBMaudits and the drug monitoring bill. As a result of thepassage of these three bills, GPhA is eager for this year’slegislative session to begin.

We are ready to further advance our profession bypromoting the passage of legislation to increase thenumber of immunizations allowed by pharmacists, theability to bill all insurance companies for immunizations(any willing provider), mail order and increased PBMlegislation. Your involvement in this process, along withthe GPhA executive committee, is imperative to ensurethat we are successful in this endeavor. As an executivecommittee member, I want to thank you for yourinvolvement in your professional association and, withyour help we will push this profession to greater heights.

On a personal note, with the holidays upon us I would askthat everyone take some time during this month of

Thanksgiving and spend some time with family, friends,neighbors, and your colleagues. Be thankful for yourprofession and the friendships that your profession hasmade possible. Remember the theme of GPhA, “There aremany practices but one profession.” God bless each andevery one of you. Have a great Thanksgiving.

L. Jack Dunn, Jr., R.Ph.GPhA President

November: A Time to be Thankful


Would You Like to Help Jump Start the Future of a PharmacyLeader?The Georgia Pharmacy Foundation New Practitioner Leadership Conference will expose the attendee to thedevelopment of personal and professional leadership skills.

This could be a decisive step in the leadership career of a young pharmacy professional.

Three Top Desired Qualities of Nominees1. Leadership potential2. Active Involvement in Student Activities and or Professional Organizations3. Activity in Community Organizations

Nominees may not have practiced more than 10 years in pharmacy.

The 2012 class will not exceed 20 in total.

Conference Location:Legacy Lodge & Conference CenterLake Lanier Islands, GAConference Dates: April 13-15, 2012

If there is a person you would like to nominate, please complete the form below and return it by January 23, 2012.

Nominee’s Name: _________________________________________Address: _____________________________________________________________________________________________________Phone: ________________________________________________Email: _________________________________________________

Nominator Name: _________________________________________Address:______________________________________________________________________________________________________Phone: ________________________________________________Email: _________________________________________________

Return to :Georgia Pharmacy Foundation50 Lenox PointeAtlanta, GA 30324OrFax 404-237-8435

If you need additional information contact Regena Banks at 404-237-8435 or email [email protected].

That is not a rhetorical question, but a very goodquestion as we approach the end of 2011 andmany of you consider gifts to various charitable

organizations. Most of these organizations have a greaterneed this year than ever before.

All gifts to the Georgia Pharmacy Foundation are fullytax deductible just like a gift to your church,synagogue or your college foundation.

As a pharmacist you know the value of a scholarship orsome financial help at a crucial time in your education andwhat it meant. Or perhaps you were fortunate enough tohave resources from family, work and loans, nonethelessyou knew others who struggled and without some help atthe right time may not have made it to graduation.

The Georgia Pharmacy Foundation annually providestwelve scholarships: four to the University of Georgia,four to Mercer University and four to South University.In just a couple of years the foundation will add four to thePhiladelphia College of Osteopathic Medicine School ofPharmacy as they graduate their first class of pharmacists.The number and values of these scholarships are directlydependent on the generosity of our membership andfriends of the Georgia Pharmacy Association.

The Foundation also annually hosts the SoutheasternProfessional Recovery Network Conference in Atlanta.The Foundation brings in participants from many states tohelp address this need in our profession. If you lost yourlicense to practice pharmacy and were faced with hugebills for treatment I am sure life would seeminsurmountable. Your foundation helps examine the latesttreatments and causes of impairment. Countless familiesand lives have been saved by these efforts. If you know of

someone who has had to deal with this issue then youknow the value of this annual conference.

Each spring, the foundation hosts the New PractitionersLeadership Conference, bringing together up to 20 ofthe brightest young pharmacy professionals for training inleadership skills that will advance our profession. Over athird of the board of directors of GPhA are graduates ofthis conference. Perhaps you know someone deserving ofthis opportunity. If so go to the www.gpha.org and make anomination.

I hope you will make a year-end charitable contribution tothe Georgia Pharmacy Foundation. You can go to theGPhA website at www.gpha.org or call the GPhA officeand we can take your gift by phone or you can always dropa check in the mail to Georgia Pharmacy FoundationAnnual Fund at 50 Lenox Pointe, Atlanta, Georgia30324. Whatever the amount, you will know your gift iswell invested in your our profession and its future.

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

Jim BracewellExecutive Vice President / CEO

6The Georgia Pharmacy Journal November 2011

How is my Contribution to the GeorgiaPharmacy Foundation Used?

For the January 2012 Open Enrollment period, the Georgia

Pharmacy Services Insurance Agency will be offering

BlueCross BlueShield of Georgia Medical and Dental Benefits.

To find Blue Cross and Blue Shield

of Georgia Medical or Dental

Providers, simply follow these

easy steps:

See other side for a brief description of the medical and dental benefits.

Open Access Point of Service (POS)

1. Go to bcbsga.com

2. Select “Find a Doctor” and choose

“Go”

3. Select the Medical Tab

4. Select (Blue Open Access POS)

and follow the steps outlined on the

screen

Health Savings Account (H.S.A.)

1. Go to anthem.com.


“Go”

3. Select your state

4. Select (Anthem Lumenos Open

Access POS H.S.A)

and follow the steps outlined on the

screen

Dental

1. Go to bcbsga.com


“Go”

3. Select the Dental Tab

4. Select (Dental Complete) and follow

the steps outlined on the screen

Discounts on healthy living

products and services through

Healthy Extensions like Jenny

Craig®, Weight Watchers Online®,

fitness club memberships,

acupuncture, massage therapy and

chiropractic services

Pharmacy programs designed to

educate: Half-Tablet and

GenericSelectSM

Walking programs

Free Women’s Health e-Newsletter

Worksite wellness programs

Latest health care news on

bcbsga.com

Better networks equal lower costs

Our partnerships with Georgia’s

doctors and hospitals saves your

employees money because we’ve

negotiated better fees for the

services they provide.

360° Health program® This brand

new integrated group of health care

services is the industry’s first

comprehensive approach to help

you and your employees achieve

better health. It’s simple; if you’re

healthier, then your health care

costs are lower.

Call monitoring, 100 percent of calls

recorded

Local walk-in customer service in

Atlanta and Columbus

Employer Reference Guide

available 24/7 at bcbsga.com

Download commonly used forms

Review enrollment and billing

guidelines

Tips on using your coverage

Weekly updates to online provider

directories

We do this by giving your employees the

tools and resources they need to take

control. For example:

We want to ensure that you attract and retain

the people needed to carry out your mission

by offering a competitive benefits program.

More than 14,600 POS heath care providers

in Georgia

Largest provider network in the country with

more than 900,000 BlueCard© providers

Worldwide networks with providers in 200

countries and territories

Blue members accepted by 89% of doctors

and territories

24/7 NurseLine (888-724-BLUE)

Preventative benefits in every plan

360o Health® our innovative health services

programs is an integrated group of health

care services designed to help your

employees:

Manage and maintain their health

Make more informed health decisions

Maximize the value of their health care

benefits

Early detection/targeted health screening

reminders

Health education and disease prevention

programs; maternity management, breast

cancer care program & smoking cessation

programs

MyHealth Record: a safe and secure place

to store your personal health information

online (we’ll even help by uploading claims

every week to each member’s personal

record)

Power of the most recognized name in

health care; 1 in 3 Americans carry a Blue

member ID card!

Better networks equal lower costs. Our

partnerships with Georgia’s doctors and

hospitals saves your employees money

because we’ve negotiated better fees for the

services they provide.

Online self-service tools for employers and

members that simplify benefit administration

Multi-lingual capabilities

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Blue Cross and Blue Shield of Georgia Medical PlansYou will have the option to enroll in one of the following four (4) medical plans: Open Access Point of Service (OA POS) – The plan provides benefits both in and out of network. The

plan does not require a referral to see a specialist who participates in the BCBS Open Access network. Health Savings Account (HSA) – This plan provides you with the flexibility to use a health care provider

either in or out of the network without a referral.

Blue Cross and Blue Shield of Georgia Dental Plans

Medical Plan Highlights OA POS OA POS OA POS HSA

Medical deductible – In network

$500 $1,500 $1,000 $3,000 $1,500 $4,500 $2,500 $5,000

Medical deductible – Out of network

$1,000 $3,000 $1,000 $3,000 $1,500 $4,500 $5,000 $10,000

Out-of-pocketmaximum – In network

$1,000 $3,000 $1,000 $3,000 $1,000 $3,000 $5,000 $10,000

Out-of-pocketmaximum – Out of network

$4,000 $12,000 $4,000 $12,000 $4,000 $12,000 $10,000 $20,000

Primary care physician visit

$25 copayDed. waived



40% Ded. waived

$0 Ded.waived

40% after ded.

Specialist visits $35 copayDed. waived



40% Ded. waived

20% Ded.waived

40% after ded.

Coinsurance 20% after deductible

20% after deductible


40% Ded. waived

20% Ded.waived

40% after ded.

Emergency room $100 copayDed. waived




20% Ded.waived

40% after ded.

Generic $15 copay Ded.then 40%

$15 copay Ded.then 40%


Ded.then 20%

Ded.then 40%

Dental coverage

Calendar year deductible

Single $50

Family $150

Deductible applies to Type II and III

Coinsurance

Preventive services (Type I) 100%

Basic Services (Type II) 80%

Major Services (Type III) 50%

Periodontics and Endodontics 80%

Annual maximum $1,000

Out of network usual and customary 90%

GAD\1-hda\ebpg\Clients\GA Pharmacy Association\GA Pharm Assoc NL attachment 2011_2


Do you want more information on the Blue CrossBlue Shield GPhA Plans?Who do I contact for information?

Email Ruth Ann McGehee at [email protected] or call on her direct line at 404-419-8104

“The responses from our currently insured groups have been overwhelmingly positive. This plan in many respects mirrorsthe plan of the Georgia Dental Association that has long been a successful plan for dentists across Georgia. I am proud theleadership of GPhA was able to put together such a quality offering for the pharmacists and pharmacies of ourassociation,” said GPhA Executive Vice President Jim Bracewell. “Morgan Kendrick, the president of Blue Cross BlueShield and I serve on the board of the Georgia Healthcare Information Exchange. Morgan is a leader in healthcare and itsfuture in our state.”

Who will administer the plan for us?

Georgia Pharmaceutical Services, GPhA wholly owned subsidiary and insurance agency will provide the administrationfor the plan as they have in the past for The Insurance Trust.

Who are the board members of Georgia Pharmaceutical Services, Inc.?

The board of directors of the GPhS are elected by the GPhA board of directors and the current board is made up of RobertBowles, Dale Coker, Jack Dunn, Robert Hatton, Eddie Madden, Pam Marquess, Bobby Moody, and Sharon Sherrer.Executive Vice President Jim Bracewell serves as the secretary in an ex-officio non-voting position.

New Health Insurance Benefit From GPhA Plan FactsEffective October 1, 2011, Blue Cross & Blue Shield of Georgia will be GPhA’s Plan Administrator.

Members of the GPhA health care plan will have four plans to choose from.

Dental will be included.

Guaranteed rates through December 31, 2012.

Blue Cross and Blue Shield of Georgia Medical PlansYou will have the option to enroll in one of the following four (4) medical plans:

Open Access Point of Service (OA POS) – The plan provides benefits both in and out of network. The plan does not require a referral to see a specialist who participates in the BCBS Open Access network.Health Savings Account (HSA) – This plan provides you with the flexibility to use a health care provider either in or out of the network without a referral.

Blue Cross and Blue Shield of Georgia Dental Plans

Medical Plan Highlights OA POS OA POS OA POS HSA

Medical deductible – In network

$500 $1,500 $1,000 $3,000 $1,500 $4,500 $2,500 $5,000

Medical deductible – Out of network

$1,000 $3,000 $1,000 $3,000 $1,500 $4,500 $5,000 $10,000

Out-of-pocketmaximum – In network

$1,000 $3,000 $1,000 $3,000 $1,000 $3,000 $5,000 $10,000

Out-of-pocketmaximum – Out of network

$4,000 $12,000 $4,000 $12,000 $4,000 $12,000 $10,000 $20,000

Primary care physician visit




40% Ded. waived

$0 Ded.waived

40% after ded.

Specialist visits $35 copayDed. waived



40% Ded. waived

20% Ded.waived

40% after ded.

Coinsurance 20% after deductible



40% Ded. waived

20% Ded.waived

40% after ded.

Emergency room $100 copayDed. waived




20% Ded.waived

40% after ded.

Generic $15 copay Ded.then 40%



Ded.then 20%

Ded.then 40%

Dental coverage

Calendar year deductible

Single $50

Family $150

Deductible applies to Type II and III

Coinsurance

Preventive services (Type I) 100%

Basic Services (Type II) 80%

Major Services (Type III) 50%

Periodontics and Endodontics 80%

Annual maximum $1,000

Out of network usual and customary 90%

GAD\1-hda\ebpg\Clients\GA Pharmacy Association\GA Pharm Assoc NL attachment 2011_2

Alexandria, Va. - October 25, 2011 -- The NationalCommunity Pharmacists Association (NCPA) installednew Officers and its Board of Directors for 2011-2012 atits 113th Annual Convention and Trade Exposition, heldOct. 8-12, in Nashville, Tenn. They are the association'sgoverning body, which represents the voice of themembers and direct the association's objectives. All arepracticing pharmacists.

The convention marked the beginning of the one-yearterm for new NCPA president, Lonny Wilson, DPh, ofOklahoma City, Okla. Wilson has long been a fixture ofOklahoma health care and pharmacy circles. He iscurrently CEO of Pharmacy Providers of Oklahoma(PPOk).

"We congratulate Lonny Wilson on becoming NCPApresident," said NCPA CEO, B. Douglas Hoey, R.Ph.,MBA. "He has been a tireless advocate for helping betterposition independent community pharmacies, with theirfocus on providing numerous patient care services, for thefuture. Part of those efforts also requires pushing state andfederal officials to implement common-sense policies thatlevel the playing field."

"Community pharmacists play a vital role in improvinghealth outcomes while reducing costs," Wilson said. "First,local pharmacists help maximize the appropriate use oflower-cost generic drugs by dispensing 20 percent moregeneric drugs than out-of-state mail order facilities.Second, pharmacists provide critical, face-to-face patientcounseling on the proper use of medications, and oncombating diabetes and other common conditions.

In addition, the following independent communitypharmacy owners were designated to the followingpositions:

Board of DirectorsPresident - Lonny Wilson, Oklahoma City, Okla.President-Elect - Donnie Calhoun, Anniston, Ala.Chairman - Mark Riley, Little Rock, Ark.

John Sherrer, Marietta, Ga.Bradley Arthur, Buffalo, N.Y.Keith Hodges, Gloucester, Va.DeAnn Mullins, Lynn Haven, Fla.David Smith, Indiana, Pa.Immediate Past President - Robert J. Greenwood,Waterloo, Iowa

OfficersFirst Vice President - Bill Osborn, Miami, Okla.Second Vice President - Brian Caswell, Baxter Springs,Kan.Third Vice President - Michele Belcher, Grants Pass, Ore.Fourth Vice President - Hugh Chancy, Hahira, Ga.Fifth Vice President - Jeff Carson, San Antonio, Tex.


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NCPA Elects New Officers and Board Members IncludingChancy and Sherrer


2012 VIP Day at the Capitol Save-the-Date

Notice to all Pharmacists and Pharmacy Technicians: All members and potential members arewelcome to attend.

Register online today at www.gpha.org or by calling 404-231-5074.

When: Thursday, February 09, 2012

Where: The Georgia Railroad Freight Depot - Freight Room65 Martin Luther King, Jr., Drive, S.E.Atlanta, GA 30334

Schedule of Events *NOTE: This schedule is tentative. We will continue to update you as it becomes more permanent.

6:00 a.m.: Registration & Exhibit Hall Opens with Coffee6:30 a.m.: GPhA Attendee Orientation7:00 a.m.: Breakfast with Your Legislator(s) 8:00 a.m.: Presentation of GPhA Legislator of the Year Award & Closing Remarks 9:15 a.m.: Group Photo on the Capitol Steps 10:00 a.m.: Tour the Georgia Capitol BuildingSpecial GPhA Recognitions to be made by GA House and Senate Members

Wear your white coat to make our presence more effective!

Parking directions available online.

If you have any questions please contact Sarah Bigorowski at [email protected] or 404-418-8126.


Titanium Level($2400 minimum pledge)T.M. Bridges, R.Ph.Michael E. Farmer, R.Ph.David B. Graves, R.Ph.Raymond G Hickman, R.Ph.Robert A. Ledbetter, R.Ph.Jeffrey L. Lurey, R.Ph.Marvin O. McCord, R.Ph.Scott Meeks, R.Ph.Judson Mullican, R.Ph.William A Murray, R.Ph.Mark Parris, Pharm.D.Fred F. Sharpe, R.Ph.Jeff Sikes, R.Ph.Dean Stone, R.Ph., CDM

Platinum Level($1200 minimum pledge)Barry M. Bilbro, R.Ph.Robert Bowles, Jr., R.Ph., CDM, CftsJim R. BracewellLarry L. Braden, R.Ph.William G. Cagle, R.Ph.Hugh M. Chancy, R.Ph.Keith E. Chapman, R.Ph.Dale M. Coker, R.Ph., FIACPPatrick DunhamJack Dunn, Jr. R.Ph.Neal Florence, R.Ph.Andy FreemanMartin T. Grizzard, R.Ph.John Hansford, R.Ph.Robert M. Hatton, Pharm.D.Ted Hunt, R.Ph.Alan M. Jones, R.Ph.Ira Katz, R.Ph.Hal M. Kemp, Pharm.D.J. Thomas Lindsey, R.Ph.Brandall S. Lovvorn, Pharm.D.Eddie M. Madden, R.Ph.

Jonathan Marquess, Pharm.D., CDE, CPTPam Marquess, Pharm.D.Kenneth A. McCarthey, R.Ph.Drew Miller, R.Ph., CDMLaird Miller, R.Ph.Cynthia K. MoonJay Mosley, R.Ph.Allen Partridge, R.Ph.Houston Lee Rogers, Pharm.D., CDMTim Short, R.Ph.Danny Toth, R.Ph.Tommy Whitworth, R.Ph., CDM

Gold Level($600 minimum pledge)James Bartling, Pharm.D., ADC, CACIILarry Batten, R.Ph.Liza G. Chapman, Pharm.D.Mahlon Davidson, R.Ph., CDMJames Gordon Elrod, R.Ph.Kevin M. Florence, Pharm.D.Robert B. Moody, R.Ph.Sherri S. Moody, Pharm.D.Jeffrey Grady Richardson, R.Ph.Andy Rogers, R.Ph.Daniel C. Royal, Jr., R.Ph.Michael T. Tarrant

Silver Level($300 minimum pledge)Renee D. Adamson, Pharm.D.Chandler M. Conner, Pharm.D.Terry Dunn, R.Ph.Marshall L. Frost, Pharm.D.Johnathan Wyndell Hamrick, Pharm.D.Michael O. Iteogu, Pharm.D. - NEWJames E. Jordan, Pharm.D.Willie O. Latch, R.Ph.W. Lon Lewis, R.Ph.Kalen Porter Manasco, Pharm.D.Michael L. McGee, R.Ph.

William J. McLeer, R.Ph.Albert B. Nichols, R.Ph.Richard Noell, R.Ph.William Lee Prather, R.Ph.Sara W. Reece, Pharm.D., BC-ADM, CDEEdward Franklin Reynolds, R.Ph.Sukhmani Kaur Sarao, Pharm.D.David J. Simpson, R.Ph.James N. Thomas, R.Ph.Alex S, Tucker, Pharm.D.Flynn W. Warren, M.S., R.Ph.William T. Wolfe, R.Ph.

Bronze Level($150 minimum pledge)Monica M. Ali-Warren, R.Ph.Fred W. Barber, R.Ph.John R. Bowen, R.Ph.Ben Cravey, R.Ph.Michael A. Crooks, Pharm.D.William Crowley, R.Ph.Charles Alan Earnest, R.Ph.Randall W. Ellison, R.Ph.Mary Ashley Faulk, Pharm.D.Amanda R. Gaddy, R.Ph.Ed KalvelageJohn D. KalvelageSteve D. KalvelageMarsha C. Kapiloff, R.Ph.Joshua D. Kinsey, Pharm.D.Brenton Lake, R.Ph.William E. Lee, R.Ph.Michael Lewis, Pharm.D.Ashley Sherwood LondonCharles Robert Lott, R.Ph.Max A. Mason, R.Ph.Amanda McCall, Pharm.D.Susan W. McLeer, R.Ph.Mary P. Meredith, R.Ph.Rose Pinkstaff, R.Ph.Leslie Ernest Ponder, R.Ph.

Current Pharm PACMembers

If you made a gift or pledge to Pharm PAC in the last 12 months and your name does not appear above, please contactAndy Freeman at [email protected] or 404-419-8118. Donations made to Pharm PAC are not considered charitabledonations and are not tax deductible.


Pharm PAC Contributors’ List ContinuedKristy Lanford Pucylowski, Pharm.D.Leonard Franklin Reynolds, R.Ph.Laurence Neil Ryan, Pharm.D.Richard Brian Smith, R.Ph.Charles Storey, III, R.Ph.Archie Thompson, Jr., R.Ph.Marion J. Wainright, R.Ph.Jackie WhiteCarrie-Anne WilsonSteve Wilson, Pharm.D.Sharon B. Zerillo, R.Ph.

Members(no minimum pledge)John J. Anderson, Sr., R.Ph.Mark T. Barnes, R.Ph.Henry Cobb, III, R.Ph., CDMCarleton C. Crabill, R.Ph.Wendy A. Dorminey, Pharm.D., CDMDavid M. Eldridge, Pharm.D.James Fetterman, Jr., Pharm.D.Charles C. Gass, R.Ph.Christina GonzalezChristopher Gurley, Pharm.D.Ann R. Hansford, R.Ph.Joel Andrew Hill, R.Ph.Carey B. Jones, R.Ph.Susan M Kane, R.Ph.Emily KrausCarroll Mack Lowrey, R.Ph.Tracie Lunde, Pharm.D.Roy W. McClendon, R.Ph.Tom E. Menighan, R.Ph., MBA, ScD, FAPhAWilliam Moye, R.Ph.Darby R. Norman, R.Ph.Christopher Brown Painter, R.Ph.Steve Gordon Perry, R.Ph.Whitney B. Pickett, R.Ph.Michael Roland Reagan, R.Ph.James L. Riggs, R.Ph.Victor Serafy, R.Ph.James E. Stowe, R.Ph.James R. Strickland, R.Ph.Celia M. Taylor, Pharm.D.Leonard E. Templeton, R.Ph.Heatwole C. Thomas, R.Ph.Erica Lynn Veasley, R.Ph.William D. Whitaker, R.Ph.Elizabeth Williams, R.Ph.Jonathon Williams, Pharm.D.

GPhA would like to welcome thefollowing new PharmPac members as ofNovember 1, 2011:Michael O. Iteogu, Pharm.D.


Circle the Level in which you would like to participate with a monthlycontribution:

Titanium ($200/month) Platinum ($100/month) Gold ($50/month)

Silver ($25/month) Bronze ($12.50/month)Or

If you wish to make a one time contribution write the amount you wish tocontribute here: _____________________________________________

If you are making a monthly contribution you will be contacted for additional information to set upyour monthly contribution. If you are making a one time payment please mail your check in with

your form.

Join Pharm PAC Today!Pharm PAC is GPhA's Political ActionCommittee, providing the resources for theassociation to lobby and advocate on behalfpharmacy. GPhA leads the way in influencingpharmacy-related legislation in Georgia. Thereare two ways in which to become a member.Once you have completed this form please mailit to Pharm PAC, 50 Lenox Pointe, NE, Atlanta,GA 30324.

Name: __________________________________________________Address: _________________________________________________Phone#: _________________________________________________Email Address: ____________________________________________


The state of Georgia honored retired state Rep.William A. “Bill” Atkins, Sr., R.Ph., of Smyrnaby naming the Windy Hill Road bridge over I-75

named after him during an Oct. 17 ceremony. For safetyconsiderations (it is a rather busy stretch of road), thenoon ceremony took place at Howard’s Deli at 652Concord Road in Smyrna. Many of Bill’s friends, familyand colleagues joined him to celebrate this happyoccasion.

Bill graduated from Mercer University Southern School ofPharmacy in 1954, and served patients in the Smyrna areain his practice. He represented Smyrna for several decadesin the legislature, and served as the Director of GeorgiaDrugs and Narcotics for a number of years until hisretirement. The resolution to name the bridge after himwas sponsored by Democratic state Sens. Doug Stoner ofSmyrna and Steve Thompson of Powder Springs.

Windy Hill Road Bridge Over I-75 Named for Bill Atkins, R.Ph.

Former state representative Bill Atkins is presented with a copyof the sign from long time friend Senator Steve Thompson.(Left)Staff/Todd Hull

Former state representative Bill Atkins thanks all of his familyand supporters for thier hard work during his time in office.(Below) Staff/Todd Hull

Cake provided by friends and family honoring the long-timedirector of the Georgia Drugs and Narcotics Agency duringwhich time he earned the nickname “Drug Czar.” (Left)

Individual Pharmacist MembersShirmil Clark, Pharm.D., NorcrossSusan Lynn Sinclair, Sharpsburg

New Graduate Pharmacist Members Fasika T. Yigezu, Pharm.D., Austell

Pharmacy School Student MembersSonali Barkat Dinani, Villa Rica

Nathan Greenfield, SuwaneeElizabeth Ashley Hickman, Augusta

Marybeth T. Isley, AthensOluwatobi Oluwaseyi John, Cumming

Jis K. Joseph, Norcross

Pharmacy Technician MembersJanet Denise Jackson, C.Ph.T, Athens

Shlonda Merriweather, C.Ph.T., ThomsonLatonya Tuwan Sheppard, C.Ph.T., Augusta


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

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

professional pharmacy association! If you or someone you know would like to joinGPhA go to www.gpha.org and click “Join” under the GPhA logo.

BARBARA COLEATTORNEY AT LAW, LLC

539 Green Street, NWGainesville, GA 30501

678-971-9088email [email protected]

All Aspects of Representation of Health CareProfessionalsLicensure MedicareAdministrative MedicaidCriminalBankruptcyCompliance

State Bar Health Law SectionFormer Chief Magistrate Judge

Hit us With Your BestShot!Summit a photo of a GPhA member doing agreat job in their practice along with asentence telling us what is special about thispharmacist and their practice. We will publishthe photo and the sentence in a future issue ofthe Journal.

Please send the high resolution (300 dpi orhigher) photo and the sentence (100 words orless) to [email protected].

If you have questions about this please contactKelly McLendon at [email protected] or404-419-8116.

We look forward to seeing what you are doing!

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237 Coliseum Drive ● Macon, Georgia 31217 ● (478) 207-2440 www.sos.ga.gov

MEMORANDUM

TO: Georgia Pharmacists

FROM: Georgia Board of Pharmacy

DATE: September 22, 2011

RE: Use of Security Paper for Hard Copy Prescription Drug Orders

Effective July 1, 2011, O.C.G.A.§ 26-4-80.1 was signed into law requiring that certain Schedule

II prescriptions must be written on Board of Pharmacy approved security paper.

O.C.G.A. § 26-4-80.1. Use of security paper for hard copy prescription drug orders.

(a) Effective October 1, 2011, every hard copy prescription drug order for any Schedule II

controlled substance written in this state by a practitioner must be written on security paper.

(b) A pharmacist shall not fill a hard copy prescription drug order for any Schedule II controlled

substance from a practitioner unless it is written on security paper, except that a pharmacist may

provide emergency supplies in accordance with the board and other insurance contract

requirements.

(c) If a hard copy of an electronic data prescription drug order for any Schedule II controlled

substance is given directly to the patient, the manually signed hard copy prescription drug order

must be on approved security paper that meets the requirements of paragraph (38.5) of Code

Section 26-4-5.

(d) Practitioners shall employ reasonable safeguards to assure against theft or unauthorized use

of security paper and shall promptly report to appropriate authorities any theft or unauthorized

use.

(e) All vendors shall have their security paper approved by the board prior to marketing or sale in

this state.

(f) The board shall create a seal of approval that confirms that security paper contains all three

industry recognized characteristics required by paragraph (38.5) of Code Section 26-4-5. The

seal shall be affixed to all security paper used in this state.

(g) The board may adopt rules necessary for the administration of this Code section.

(h) The security paper requirements in this Code section shall not apply to:

(1) Prescriptions that are transmitted to the pharmacy by telephone, facsimile, or electronic

means; or

(2) Prescriptions written for inpatients of a hospital, outpatients of a hospital, residents of a

The Office of Secretary of State


nursing home, inpatients or residents of a mental health facility, or individuals incarcerated in a

local, state, or federal correctional facility when the health care practitioner authorized to write

prescriptions writes the order into the patient's medical or clinical record, the order is given

directly to the pharmacy, and the patient never has the opportunity to handle the written order.

HISTORY: Code 1981, § 26-4-80.1, enacted by Ga. L. 2011, p. 659, § 5/SB 36.

On September 22, 2011, the Georgia Board of Pharmacy revised its policy regarding the Board’s

seal for tamper resistant prescription paper:

Georgia State Board of Pharmacy Policy on Approval of Security Paper for Prescription Pads or Paper

Adopted on 9-22-2011

All vendors, which produce security paper used in the printing or creation of pads of

prescriptions to be used in this state, and which security paper contains all of the following

criteria will be deemed to be an approved vendor by the Georgia State Board of Pharmacy:

(1) One or more industry-recognized features designed to prevent unauthorized copying of a

completed or blank prescription form;

(2) One or more industry-recognized features designed to prevent the erasure or modification of

information written on the prescription form by the practitioner; and

(3) One or more industry-recognized features designed to prevent the use of counterfeit

prescription forms.

By meeting all of the criteria identified above, a vendor may market and sell security paper for

use in the production of prescriptions and prescription pads in this state provided the vendor

notifies the Board in writing and provides the Board a copy of the product. If the Board

determines that the paper submitted does not meet the requirements listed above, the Board will

notify the vendor in writing. The Board will maintain a list of approved vendors.

All approved security paper shall have the Board’s seal of approval affixed to the paper. The

Board’s seal of approval, as shown below, will be ½ inch in diameter, with the text in the seal

being Georgia font, with the Rx within the circle being a size of 9 pt, with the text “GEORGIA

STATE BOARD OF PHARMACY” within the circle capitalized with a size of 4 pt, and the text

“SEAL OF APPROVAL” underneath the Rx with a size of 3 pt and capitalized.

The seal as shown below is the official seal:


All approved security paper used to print or create a prescription shall bear an identifying lot

number, and each individual prescription shall be numbered sequentially beginning with the

number one.

The security paper requirements shall not apply to:

(1) Prescriptions that are transmitted to the pharmacy by telephone, facsimile, or electronic

means; or

(2) Prescriptions written for inpatients of a hospital, outpatients of a hospital, residents of a

nursing home, inpatients or residents of a mental health facility, or individuals incarcerated in a

local, state, or federal correctional facility when the health care practitioner authorized to write

prescriptions writes the order into the patient's medical or clinical record, the order is given

directly to the pharmacy, and the patient never has the opportunity to handle the written order.

In the event a prescription pad or paper containing the Board seal, sequential numbering, and lot

number is not available for the prescription and a medical health emergency exists, a prescription

may be issued on paper meeting the requirements for approval for an amount of medication to

cover not more than 30 days. The prescription must contain a statement that an emergency

exists. All providers must have the board-approved security paper by December 31, 2011. This

exception for emergencies only applies to prescriptions written before December 31, 2011.


Call for awards nominations...The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the GPhA137th Annual Convention in 2012. A brief description and criteria of each award is included below. Please select the awardfor which you would like to nominate someone and indicate their name on the form below. Deadline for submitting thecompleted nomination form is March 1, 2012. Nominations will be received by the Awards Committee and an individualwill be selected for presentation of the Award at GPhA’s 137th Annual Convention at the Hilton Head Marriott Resort &Spa on Hilton Head Island

Bowl of Hygeia AwardRecognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by GPhA and all state pharmacyassociations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously;3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within theimmediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee; 5) The nominee has anoutstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist AwardCreated in 1987 to recognize the achievements of young pharmacists in the profession, the Award has quickly become one ofGPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) The encourage new pharmacists to participate inassociation and community activities, and 2) To annually recognize an individual in each state for involvement in and dedicationto the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten yearsago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4)Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in pharmacy association programsor activities and community service projects.

Innovative Pharmacy Practice Award This Award is presented annually to a practicing pharmacist who has demonstrated innovative pharmacy practice which hasresulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practicewhich has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a memberof the GPhA in the year of selection.

2012 Awards Nomination FormBowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Award

Nominee’s Full Name _______________________________________________ Nickname ___________________

Home Address _________________________________________ City _______________ State _____ Zip ______

Practice Site __________________________________________________________________________________

Work Address __________________________________________ City _______________ State _____ Zip ______

College/School of Pharmacy _____________________________________________________________________

List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:

____________________________________________________________________________________________

____________________________________________________________________________________________

Supporting information: _________________________________________________________________________

____________________________________________________________________________________________

Submitted by (optional): _________________________________________________________________________

Submit this form completed by March 1, 2012 to:

GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.


20th Annual Winter CE Seminar Westin Riverfront Resort & Spa at Beaver Creek Mtn. in the Vail Valley-Avon, CO

January 8-11, 2012

15 hours of CE 7-9 am & 4:30-6:30 pm Full, "First Tracks" and other CE

registration options Gondola at Ski Valet door

Social dinner & reception; Lodging, rental & lift discounts.

Visit www.copharm.org to JOIN US! [email protected] 303-756-3069 "As a first time attendee, this program FAR exceeded my expectations. Its no wonder you’re

celebrating the 20th one next year.” ....2011 guest

Leadership Georgia is delighted to announce its 2012Class. This group of 60 leaders selected fromnominations and individual applications were

impressive and the process yielded a high caliber group ofrepresentatives from our growing state. This group ofleaders includes the Georgia Pharmacy Associationmembers Liza Chapman of Dawsonville and Kasey Knightof Quitman.

Liza has served in many leadership positions within GPhAand is an employee pharmacist with the Kroger Company,Atlanta Division.

Kasey is a member of the staff of Lee & Pickels Drugstoreand has been a member of GPhA since 2009.

We congratulate these two leaders and look forward to theirfuture role in GPhA.

M e m b e r N e w s

Leadership Georgia Class of2012 Includes GPhA MembersChapman and Knight

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Table 2Organizations that verify dietary

supplement manufacturing

Organization WebsiteConsumer Lab www.consumerlab.com

lent and effectively raise [25(OH)

calcitriol. It is the result of two hy-

the liver and second in the kidney.

known for its role in allowing the absorption of calcium from the gut, and for enabling normal bone growth and bone remodeling by osteoclasts and osteoblasts. It has an accepted role in the prevention and treatment of osteoporosis, and

role in decreasing bone fractures. -

clude adjusting cell growth, neu-romuscular and immune function,

While some foods naturally

tuna, and mackerel; cheese; and

as milk, orange juice, yogurt and breakfast cereals provide most of

diet. An eight-ounce glass of milk

Also, sun exposure initiates

recommended by the American

the risk of skin cancer, can reduce

from sun exposure.

persons with limited skin exposure, dark skin, or malabsorption of vi-

who have undergone gastric bypass

surgery, as well as those who are taking medications that accelerate

the attention of the medical, public health, and lay communities for its

well as in the prevention and treat-ment of other conditions including diabetes, glucose intolerance, hy-pertension, multiple sclerosis, and cardiovascular disease.

The Institute of Medicine (IOM) assembled a committee to essentially determine which health

-

In November of 2010, the IOM released a report concluding that bone health was the only outcome that was supported by research and established a cause and effect,

dose-response relationship with

For cancer, cardiovascular dis-ease, diabetes, falls, autoimmune disorders, and other extraskeletal disease outcomes, the evidence was inconsistent and inconclusive. Therefore, despite the eagerness

must still be viewed as hypothesis. Large scale randomized clinical trials, designed with these primary outcomes mentioned, have not yet been conducted and are desired. The IOM report also suggested a U-shaped risk analysis curve for several outcomes related to vitamin

-mal, and that the risk of disease increased at both low and high

agree that serum concentration of

than 20 supports healthy bones), and new data suggest that there may be health risks associated

The committee also updated

examined in 1997. The adult values

the total amount that should be consumed through diet and supple-mentation.

Various repletion regimens

Table 3Calcium and vitamin D dietary reference intakes

by life stage

Life stage Calcium Vitamin D and gender

19-30 yr (M+F) 1000 2500 600 400031-50 yr (M+F) 1000 2500 600 400051-70 yr (M) 1000 2000 600 400051-70 (F) 1200 2000 600 400071+ (M+F) 1200 2000 800 400019-50 yr pregnant 1000 2500 600 4000 or lactating

continuing educat ion for pharmacistsDietary Supplementat ion of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty AcidsMona T. Thompson, R.Ph., PharmD

Goal. The goal of this lesson is to provide information on select vitamins and supplements, with emphasis on the current consump-tion recommendations in adults.

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

1. list the recommended daily allowance, adequate intake, and tolerable upper intake level for each supplement discussed;

that each supplement provides, as well as the risk of excessive use;

3. identify the current indica-tions for which supplementation is supported, based on recent evi-dence-based literature; and

4. demonstrate an understand-ing of pertinent patient counseling advice regarding selection and use of over-the-counter (OTC) supple-ments, including drug-drug inter-actions, and regulatory informa-tion.

Background and General Information Regarding Supplementation

National Institute of Health (NIH), reported that in 2004, Americans spent 20.3 billion dollars on dietary supplements. Among Americans 20 years of age and older, 52 percent reportedly are taking at least one supplement with the greatest percentage found in adults greater than 60 years. In addition, in 2007,

a survey conducted by the Centers -

out-of-pocket dollars were spent by Americans on complementary and alternative medicine self-care products. In the midst of a media

and self-care, health-seeking popu-lation, it is important that health care professionals assist the lay public in deciphering the data in order to make sound and healthy decisions about OTC supplementa-tion.

In order to assess and guide nutrient intake, the Food and Nutrition Board (FNB) has devel-oped reference intake values. These

It is important to note that while dietary supplements are

regulated in the same manner that medications are. In fact, dietary supplements do not require pre-market review or approval. Manu-facturers do have a responsibility to ensure that their products are safe and that the labeling is clear and truthful. However, they do

not need to provide this informa--

are also permitted to print health

as it is followed by the words, “This statement has not been evaluated

-tion. This product is not intended to diagnose, treat, cure, or prevent any disease.” Consumers should be advised that not all supplements may be manufactured to the same standard. A list of independent organizations that offer “seals of approval” can be found in Table 2. These organizations only test the product to verify that it is free of contaminants and contains the in-gredients listed on the label. They do not test the product for safety or

Vitamin D

that is obtained endogenously when ultraviolet radiation strikes the skin initiating synthesis, or when it is consumed through food and supplements. In supplements

ergocalciferol and cholecalciferol. The forms are considered equiva-

Table 1 Dietary reference intakes

nearly all healthy people

assumed to ensure nutritional adequacy

Tolerable Upper Intake Level (UL) Maximum daily intake unlikely to cause adverse health effects


Table 2Organizations that verify dietary

supplement manufacturing

Organization WebsiteConsumer Lab www.consumerlab.com

lent and effectively raise [25(OH)

calcitriol. It is the result of two hy-

the liver and second in the kidney.

known for its role in allowing the absorption of calcium from the gut, and for enabling normal bone growth and bone remodeling by osteoclasts and osteoblasts. It has an accepted role in the prevention and treatment of osteoporosis, and

role in decreasing bone fractures. -

clude adjusting cell growth, neu-romuscular and immune function,

While some foods naturally

tuna, and mackerel; cheese; and

as milk, orange juice, yogurt and breakfast cereals provide most of

diet. An eight-ounce glass of milk

Also, sun exposure initiates

recommended by the American

the risk of skin cancer, can reduce

from sun exposure.

persons with limited skin exposure, dark skin, or malabsorption of vi-

who have undergone gastric bypass

surgery, as well as those who are taking medications that accelerate

the attention of the medical, public health, and lay communities for its

well as in the prevention and treat-ment of other conditions including diabetes, glucose intolerance, hy-pertension, multiple sclerosis, and cardiovascular disease.

The Institute of Medicine (IOM) assembled a committee to essentially determine which health

-

In November of 2010, the IOM released a report concluding that bone health was the only outcome that was supported by research and established a cause and effect,

dose-response relationship with

For cancer, cardiovascular dis-ease, diabetes, falls, autoimmune disorders, and other extraskeletal disease outcomes, the evidence was inconsistent and inconclusive. Therefore, despite the eagerness

must still be viewed as hypothesis. Large scale randomized clinical trials, designed with these primary outcomes mentioned, have not yet been conducted and are desired. The IOM report also suggested a U-shaped risk analysis curve for several outcomes related to vitamin

-mal, and that the risk of disease increased at both low and high

agree that serum concentration of

than 20 supports healthy bones), and new data suggest that there may be health risks associated

The committee also updated

examined in 1997. The adult values

the total amount that should be consumed through diet and supple-mentation.

Various repletion regimens

Table 3Calcium and vitamin D dietary reference intakes

by life stage

Life stage Calcium Vitamin D and gender

19-30 yr (M+F) 1000 2500 600 400031-50 yr (M+F) 1000 2500 600 400051-70 yr (M) 1000 2000 600 400051-70 (F) 1200 2000 600 400071+ (M+F) 1200 2000 800 400019-50 yr pregnant 1000 2500 600 4000 or lactating


shared electron. Free radicals damage cells and may contribute to the development of cardiovascu-lar disease and cancer. Unshared electrons are highly energetic and react rapidly with oxygen to form

when it converts food to energy, and antioxidants might protect cells from the damaging effects of

when fat undergoes oxidation. In addition, vitamin E increases the expression of two enzymes that suppress arachidonic acid metabo-lism, which increases the release of prostacyclin from the endothelium, leading to dilated blood vessels and inhibition of platelet aggregation.

In 2003, the Agency for Health-

published two evidence reports resulting from extensive literature searches examining the effects of vitamin E (as well as vitamin

report was focused on the preven-tion and treatment of cancer, and the second looked at the prevention and treatment of cardiovascular

Neither evaluation concluded with support for vitamin E supplemen-tation.

-maturely halted in 2008. The trial was designed to show a 25 percent reduction in prostate cancer with each supplement alone or in com-bination. When the Independent

-mittee met in 2008 to review an

of data, they found that the vita-min E or selenium taken alone, or in combination with each other, did not prevent prostate cancer. There-fore, study participants were told to discontinue their supplements.

differences were found between the groups, there was a larger num-ber of cases of prostate cancer in men taking vitamin E alone. This difference could have occurred by chance.

Another published clinical trial in 2008 that examined the use of vitamin E (400 IU every other day)

men’s cardiovascular health found no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, or cardiovascular mortality. In addition, the use of vitamin E was associated with a

-orrhagic stroke.

However, a formulation consist-ing of vitamin E (400 IU), vitamin C (500mg), beta-carotene (15mg), zinc (80mg), and copper (2mg) was clinically proven to slow the pro-gression of age-related macular

vision loss in older adults. The

trial that concluded that partici-

slow the progression of their dis-ease by taking this combination for an average of 6.3 years, compared to participants taking a placebo.

marketed by Bausch and Lomb ®

eye vitamin and is recommended

only for those with

one or both eyes, or

an eye care profes-sional.

Most vitamin E supplements provide at least 100 IU of the nutrient, which

is substantially greater than the

tocopherol supplementation may cause hemorrhagic effects. Table 5 lists the established adequate intake and upper tolerable limit for vitamin E.

Omega-3 Fatty Acids (Fish Oil)The supplement omega-3 fatty ac-ids is known in most households as

acid (ALA) is a polyunsaturated fatty acid structurally recognized as an omega-3 fatty acid. It is converted in the body to eicosa-

-

herring; hence the term . In addition, ALA is also present in leafy green vegetables, nuts, veg-etable oils such as canola and soy,

as an omega-6 fatty acid with a slightly different structure and is converted to arachidonic acid (AA). AA is further converted to leuko-trienes and prostaglandins which

will be discussed later in this les-son. Omega-6 fatty acids are more convenient to eat as LA is found in meat as well as soybean, saf-

processed foods. Neither form can be synthe-

sized by the body and both are an important part of our diet. Most Americans consume far more ome-ga-6 fatty acids than is required and not enough omega-3. The IOM has established the adult adequate

Table 5Adult dietary reference intake for vitamin E

Male Female Pregnant Lactating

UL (14-18 yrs) 800mg (1200 IU) 800mg (1200 IU) 800mg (1200 IU) 800mg (1200 IU)UL (19 yrs+) 1000mg (1500 IU) 1000mg (1500 IU) 1000mg (1500 IU) 1000mg (1500 IU)

UL refers to all forms of supplemental alpha-tocopherol

have been found to be effective for

50,000 units (calciferol or ergo-calciferol) weekly for six to eight weeks, followed by 600 to 800 units

and the dose may require further adjustment. However, healthy

day for supplementation do not require lab monitoring.

-mentation is associated with nega-tive consequences. It can cause anorexia, weight loss, polyuria, and heart arrhythmias. It can also raise blood levels of calcium leading to

damaging the heart, blood vessels, and kidneys.

CalciumCalcium is an essential dietary mineral that is commonly found in milk, yogurt, cheese, and dark green vegetables. Many foods are

orange juice, cereal and bread. An eight ounce glass of milk or forti-

elemental calcium. It is not pro-duced by the body and, therefore, must be consumed through food and supplements. Calcium is a ma-jor component of bones and teeth and is needed for proper function of the heart, muscle, and nerves.

In recent years, calcium has been studied for its potential role

colorectal cancer. Numerous large scale randomized studies have been conducted to determine if an association between calcium supplementation ranging from 500-

existed. Although the studies did not consistently result in a statisti-cal difference in colorectal cancer risk reduction, the World Cancer

a report in 2007 concluding that calcium probably has a protective effect against colorectal cancer.

Other studies suggest that high calcium intake may increase the risk of prostate cancer while the available information regarding a relationship between calcium and breast cancer is inconsistent.

Institute does not recommend calcium supplements to reduce the incidence of colorectal or any other type of cancer due to inconsistent data.

In patients requiring calcium supplementation for the preven-tion or treatment of osteoporosis, calcium carbonate and calcium citrate are most often used. Cal-cium carbonate is generally more affordable. It is absorbed better when taken with a meal, and requires the presence of chloride. Calcium citrate is well absorbed in both the fasting and fed state. Its absorption is not affected in pa-tients taking proton pump inhibi-tors or H2 blockers where chloride is decreased.

-ances for calcium are based on elemental calcium and are listed on Table 3. Calcium carbonate con-tains only 40 percent elemental cal-cium which means that a 1250mg tablet actually delivers 500mg of

of elemental calcium should be divided.

While calcium supplementa-tion is generally considered safe when the UL (tolerable upper intake level) is not exceeded, those consuming calcium supplements in addition to substantial amounts through the diet, or even multivita-min products, may be at risk of de-veloping kidney stones. Other risks of excessive calcium consumption, especially in the presence of kidney disease, include hypercalcemia and kidney failure. Excessive intake of milk and some types of antacids (which contain calcium carbonate or sodium bicarbonate) over an ex-tended period of time can result in milk-alkali syndrome, an acquired condition in which there are high levels of calcium and a shift in the

alkaline (metabolic alkalosis). This

condition can also lead to calcium deposits in the kidneys and other tissues, as well as kidney failure. Table 4 includes adverse outcomes associated with excessive intake of

Vitamin EVitamin E is a fat-soluble anti-oxidant that is found naturally in some foods, added to others, and available as a dietary supplement. It occurs in eight different forms, while only the alpha-tocopherol form is recognized to meet human requirements. Nuts, seeds, veg-etable oils, green leafy vegetables,

sources of alpha-tocopherol. Vita--

been found in healthy individuals who obtain little vitamin E from their diets.

Vitamin E’s potential to pre-vent and treat disease is based on its function as an antioxidant, as well as its role in the anti-

of platelet aggregation, and im-mune enhancement. Antioxidants protect cells from the damaging effects of free radicals, which are molecules that contain an un-

Table 4Potential indicators of

adverse outcomes associated with excess intake of calcium and

vitamin D Calcium HypercalcemiaHypercalciuria

Nephrolithiasis (kidney stones)

Interactions with iron and zincConstipation

Vitamin D Intoxication and related hypercalcemia and hypercalciuria Elevated serum calcium Emerging evidence for all cause mortality, cancer, cardiovascular risk, falls, and fractures

JAMA, February 2, 2011 Vol 305, No. 5


shared electron. Free radicals damage cells and may contribute to the development of cardiovascu-lar disease and cancer. Unshared electrons are highly energetic and react rapidly with oxygen to form

when it converts food to energy, and antioxidants might protect cells from the damaging effects of

when fat undergoes oxidation. In addition, vitamin E increases the expression of two enzymes that suppress arachidonic acid metabo-lism, which increases the release of prostacyclin from the endothelium, leading to dilated blood vessels and inhibition of platelet aggregation.

In 2003, the Agency for Health-

published two evidence reports resulting from extensive literature searches examining the effects of vitamin E (as well as vitamin

report was focused on the preven-tion and treatment of cancer, and the second looked at the prevention and treatment of cardiovascular

Neither evaluation concluded with support for vitamin E supplemen-tation.

-maturely halted in 2008. The trial was designed to show a 25 percent reduction in prostate cancer with each supplement alone or in com-bination. When the Independent

-mittee met in 2008 to review an

of data, they found that the vita-min E or selenium taken alone, or in combination with each other, did not prevent prostate cancer. There-fore, study participants were told to discontinue their supplements.

differences were found between the groups, there was a larger num-ber of cases of prostate cancer in men taking vitamin E alone. This difference could have occurred by chance.

Another published clinical trial in 2008 that examined the use of vitamin E (400 IU every other day)

men’s cardiovascular health found no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, or cardiovascular mortality. In addition, the use of vitamin E was associated with a

-orrhagic stroke.

However, a formulation consist-ing of vitamin E (400 IU), vitamin C (500mg), beta-carotene (15mg), zinc (80mg), and copper (2mg) was clinically proven to slow the pro-gression of age-related macular

vision loss in older adults. The

trial that concluded that partici-

slow the progression of their dis-ease by taking this combination for an average of 6.3 years, compared to participants taking a placebo.

marketed by Bausch and Lomb ®

eye vitamin and is recommended

only for those with

one or both eyes, or

an eye care profes-sional.

Most vitamin E supplements provide at least 100 IU of the nutrient, which

is substantially greater than the

tocopherol supplementation may cause hemorrhagic effects. Table 5 lists the established adequate intake and upper tolerable limit for vitamin E.

Omega-3 Fatty Acids (Fish Oil)The supplement omega-3 fatty ac-ids is known in most households as

acid (ALA) is a polyunsaturated fatty acid structurally recognized as an omega-3 fatty acid. It is converted in the body to eicosa-

-

herring; hence the term . In addition, ALA is also present in leafy green vegetables, nuts, veg-etable oils such as canola and soy,

as an omega-6 fatty acid with a slightly different structure and is converted to arachidonic acid (AA). AA is further converted to leuko-trienes and prostaglandins which

will be discussed later in this les-son. Omega-6 fatty acids are more convenient to eat as LA is found in meat as well as soybean, saf-

processed foods. Neither form can be synthe-

sized by the body and both are an important part of our diet. Most Americans consume far more ome-ga-6 fatty acids than is required and not enough omega-3. The IOM has established the adult adequate

Table 5Adult dietary reference intake for vitamin E

Male Female Pregnant Lactating

UL (14-18 yrs) 800mg (1200 IU) 800mg (1200 IU) 800mg (1200 IU) 800mg (1200 IU)UL (19 yrs+) 1000mg (1500 IU) 1000mg (1500 IU) 1000mg (1500 IU) 1000mg (1500 IU)

UL refers to all forms of supplemental alpha-tocopherol


whether a desirable ratio of ome-ga-3 to omega-6 fatty acids exist, or to what extent excessive intakes of omega-6 fatty acids interfere with

-tion since their byproducts are metabolized by the same pathways and competition may exist.

The role of omega-3 fatty acids,

-vascular disease has been well accepted. In the 1970s, it was noted

-sumption, such as Eskimos, experi-enced relatively low cardiovascular mortality.

A systematic review of studies examining the dietary and supple-mental omega-3 fatty acids affect on primary and secondary cardio-vascular outcomes was conducted

The evidence supported the hy-pothesis that the consumption of omega-3 fatty acid supplements,

mortality and outcomes such as sudden death, cardiac death, and myocardial infarction, with the strongest evidence in support of

thought to occur within weeks of routine consumption and are likely a result of altered cell membrane

following the incorporation of polyunsaturated fatty acids into cell membranes. At typical dietary intakes, antiarrhythmic effects predominate, which is presumed to be responsible for the decreased incidence of sudden cardiac death

triglyceride levels may be reduced by as much as 25 to 30 percent in a dose dependent fashion. Also,

approximately 3 to 5mm Hg, and

3mm Hg. This is due to reductions in systemic vascular resistance,

with a dose-response that appears more linear at lower (dietary) dos-es, and plateaus at higher (supple-ment) doses. Although not found

rate may also be reduced by 1.6 beats per minute. The clinical risk decrease associated with reduced triglycerides is a result of a higher dose and longer duration of supple-mentation than what is required to reduce coronary mortality.

-

gained the attention of pregnant -

tural component of the brain and eye. While data are limited, they

-ing the pre- and post-natal periods

-ment and cognitive outcome of

intake remains controversial as

organic methyl mercury. Exposure to mercury in fetal life causes wide-spread neurological damage, such as delayed developmental mile-stones, blindness, deafness, and cerebral palsy. Methyl mercury is well absorbed following ingestion and readily crosses the blood brain barrier and placenta. It cannot be

to assist pregnant and lactating

risks caused by methyl mercury -

ently, worldwide expert panels have recommended that pregnant and lactating women should aim

contain low levels of mercury.

algae are also available in a variety of doses and special formulations for pregnant women. Because these supplements are low in mercury and contaminants, they provide

consumption even though some

recommended by experts. -

esized to reduce the synthesis of

prostaglandins and leukotrienes, by competitive inhibition. These lipid compounds are otherwise a product of the oxidation of arachi-

have been postulated to play a role

such as asthma, rheumatoid arthri-

and systemic lupus erythematosus. Currently, no conclusions have

evidence that support supplemen-tation for these diseases with the exception that these fatty acids can reduce joint tenderness and the need for corticosteroids in rheuma-toid arthritis.

oil supplements are available in various doses and formulations. Currently, one prescription formu-

Table 6Joint EPA and FDA dietary fish intake

advisory

The following advisory has been is-sued for women who might become pregnant, women who are pregnant, and nursing mothers.

king mackerel. They contain high levels of mercury.2. Eat up to 12 ounces (2 meals) per

that are low in mercury. Five of the

low in mercury are shrimp, canned light tuna, salmon, pollock, and

NOTE. Albacore “white” tuna has more mercury than canned light tuna – limit albacore consumption to 6 ounces (1 meal) per week. 3. Check with local advisories about

and friends in local lakes, rivers, and coastal areas. If no advice is avail-able, limit weekly consumption to 6 ounces (1 meal) for that week. Adapted from “What you need to know


lation is available. LOVAZA® (ome-ga-3-acid ethyl esters) is indicated as an adjunct to diet to reduce triglyceride (TG) levels in adult

hypertriglyceridemia. It is avail-able in a 1gm soft gelatin capsule; the daily recommended dose is 4gm which can be divided in two doses if desired. LOVAZA® contains ethyl esters of omega-3 fatty acids

supplements, patients with aller-

an increased risk of allergic reac-tions and should use the product with caution.

--

ally mild and include eructation (belching), dyspepsia, vomiting,

day) does increase bleeding time; however, it has not been associ-ated with higher rates of clinical bleeding. Consumers taking other medications that alter coagula-tion should be monitored and take

healthcare provider.

Summary In summary, dietary supplementa-tion has dramatically increased over the last decade and consum-ers are taking a more active role in self care and preventing disease.

role in assisting the lay public in understanding not only the safety

also the indications for which supplementation is supported. All supplements are not alike and pharmacists should aid consumers in selecting products from reliable manufacturers.

-rently indicated for skeletal disease only and play a critical role in bone health. Large scale randomized trials are underway to determine

cardiovascular disease. While anti-oxidant therapy seemed promising at one time, vitamin E studies have failed to provide consistent data in their role in the prevention of

Table 7Select drug interactions with vitamins D and E,

calcium, and fish oil

Supplement Second agent Interaction

antibiotic

hormone

Vitamin E Vitamin K antagonists May increase the effect of warfarin (warfarin)

by inhibiting oxidative damage to cancerous cells Tipranavir oral solution Oral solution contains vitamin E; therefore additional vitamin E should be avoided

anticoagulant effect

cardiovascular disease and cancer. Yet, a combination product contain-ing vitamin E has been shown to slow the progression of age-related macular degeneration. Finally,

their contribution to cardiovascu-lar health and reduction of sudden death, cardiac death, and myocar-

generally recommended for preg-nant and lactating mothers for its

-velopment, and cognitive outcome of the offspring.

with the agents listed in the lesson are listed in Table 7.

Program 0129-0000-11-052-H01-P

Expiration date: 8-15-14CE Hours: 1.5 (0.15 CEU)

--

This lesson is a knowledge-based CE activity and is targeted to phar-macists in all practice settings. To receive CE credit, your quiz must be postmarked no later than August 15, 2014. A passing grade of 80% must be attained.

is accredited by the Accreditation Coun-

of continuing pharmacy education.

Dietary Supp CE

continuing educat ion quiz Dietary Supplementat ion of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty Acids

Program 0129-0000-11-052-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

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

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

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

1. According to the Food and Nutrition Board, the recom-mended dietary allowance (RDA) for a supplement is:

health effects.

nutrient requirements of nearly all healthy people. c. the daily intake amount recommended by the manufac-turer. 2. An important counseling point for pharmacists to convey to patients regarding supplements is that: a. they are regulated by FDA in the same manner as prescription medications.

and offer “seals of approval.” c. they are regulated by FDA, but safety information need not be provided prior to marketing.

3. All of the following individuals are at risk of vitamin D

b. those who have undergone gastric bypass surgery. c. those who are obese. d. those with light skin color.

4. In a recent IOM report, the only outcome establishing a cause and effect relationship with vitamin D and calcium intake was: a. cancer. c. cardiovascular disease. b. bone health. d. AMD.

that serum concentration of vitamin D, [25(OH)D], should be maintained between: a. 50-100ng/ml. c. 100-150ng/ml. b. 10-20ng/ml. d. 20-40ng/ml.

a 51-year-old female is: a. 1200mg/600 IU. b. 1000mg/400 IU.

7. Although the National Cancer Institute does not recom-mend calcium supplementation for the prevention of any type of cancer, there is evidence suggesting it may have a protective effect against: a. breast cancer. c. colorectal cancer. b. prostate cancer. d. ovarian cancer.

8. Calcium citrate: a. is generally more affordable than calcium carbonate. b. does not require the presence of chloride in order to be absorbed. c. is not well absorbed in the fasting state.

b. bruising. d. drowsiness.

10. Vitamin E’s potential to prevent and treat disease is based on its function as an:

b. antiarrhythmic. d. antilipidemic.

risk of: a. renal disease. c. hemorrhagic stroke. b. colorectal cancer. d. rheumatoid arthritis.

that participants with early-stage AMD could slow the progression of their disease by taking a combination product containing which of the following? a. Vitamin E c. Vitamin D b. Calcium d. Omega-3 Fatty Acids

13. Fish oils have been postulated to play a role in: a. multiple sclerosis. c. osteoarthritis. b. rheumatoid arthritis. d. Alzheimer’s disease.

14. LOVAZA® (omega-3-acid ethyl esters) is indicated for: a. hypertension, 1gram once daily. b. angina, 2grams twice daily. c. hypertension, 4grams once daily. d. hypertriglyceridemia, 4grams once daily or 2grams twice daily.

counseled on which of the following potential side ef-fects? a. Kidney stones, hypercalcemia, milk-alkali syndrome

The Georgia Pharmacy Journal November 2011 30

The Georgia Pharmacy JournalEditor: Jim Bracewell

[email protected]

Managing Editor & Designer: Kelly [email protected]

The Georgia Pharmacy Journal® (GPJ) is the official publication of theGeorgia Pharmacy Association, Inc. (GPhA). Copyright © 2011, GeorgiaPharmacy Association, Inc. All rights reserved. No part of this publicationmay be reproduced or transmitted in any form or by any means, electronicor mechanical including by photocopy, recording or information storageretrieval systems, without prior written permission from the publisher andmanaging editor.

All views expressed in bylined articles are the opinions of the author anddo not necessarily express the views or policies of the editors, officers ormembers of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose who are interested in writing for this publication are encouraged torequest the official GPJ Guidelines for Writers. Artists or photographerswishing to submit artwork for use on the cover should call, write or e-mailthe editorial offices as listed above.

SUBSCRIPTIONS AND CHANGE OF ADDRESSThe Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed asa regular membership service, paid for through allocation of membershipdues. Subscription rate for non-members is $50.00 per year domestic and$10.00 per single copy; international rates $65.00 per year and $20.00single copy. Subscriptions are not available for non-GPhA memberpharmacists licensed and practicing in Georgia.

The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is publishedmonthly by the GPhA, 50 Lenox Pointe NE, Atlanta, GA 30324.Periodicals postage paid at Atlanta, GA and additional offices.POSTMASTER: Send address changes to The Georgia PharmacyJournal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

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Print: Star Printing - 770.974.6195

2011 - 2012 GPhA BOARD OF DIRECTORS

Name PositionDale Coker Chairman of the BoardJack Dunn PresidentRobert Hatton President-ElectPam Marquess First Vice PresidentBobby Moody Second Vice PresidentRobert Bowles State At LargeHugh Chancy State At LargeKeith Herist State At LargeEddie Madden State At LargeJonathan Marquess State At LargeTim Short State At LargeRichard Smith State At LargeChristine Somers 1st Region PresidentFred Sharpe 2nd Region PresidentRenee Adamson 3rd Region PresidentAmanda Gaddy 4th Region PresidentJulie Bierster 5th Region PresidentAshley Faulk 6th Region PresidentAmanda McCall 7th Region PresidentLarry Batten 8th Region PresidentKristy Pucylowski 9th Region President Christopher Thurmond 10th Region PresidentAshley London 11th Region President Ken Eiland 12th Region PresidentThomas Jeter ACP ChairmanJosh Kinsey AEP RepresentativeSonny Rader AHP ChairmanIra Katz AIP ChairmanGail Lowney APT ChairmanChristina Gonzalez ASA ChairmanJohn T. Sherrer Foundation ChairmanMichael Farmer Insurance Trust ChairmanSteve Wilson Georgia State Board of Pharmacy

RepresentativePatricia Knowles Georgia Society of Health Systems

PharmacistsAmy Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeSukh Sarao UGA Faculty Rep.Negin Sovaidi ASP Mercer University Rep.Annie Tran ASP South University Rep.David Bray ASP UGA Rep.Jim Bracewell Executive Vice President

Dietary Supp CE

continuing educat ion quiz Dietary Supplementat ion of Vitamin D, Calcium, Vitamin E, Omega-3 Fatty Acids

Program 0129-0000-11-052-H01-P0.15 CEUPlease print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

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

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

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

1. According to the Food and Nutrition Board, the recom-mended dietary allowance (RDA) for a supplement is:

health effects.

nutrient requirements of nearly all healthy people. c. the daily intake amount recommended by the manufac-turer. 2. An important counseling point for pharmacists to convey to patients regarding supplements is that: a. they are regulated by FDA in the same manner as prescription medications.

and offer “seals of approval.” c. they are regulated by FDA, but safety information need not be provided prior to marketing.

3. All of the following individuals are at risk of vitamin D

b. those who have undergone gastric bypass surgery. c. those who are obese. d. those with light skin color.

4. In a recent IOM report, the only outcome establishing a cause and effect relationship with vitamin D and calcium intake was: a. cancer. c. cardiovascular disease. b. bone health. d. AMD.

that serum concentration of vitamin D, [25(OH)D], should be maintained between: a. 50-100ng/ml. c. 100-150ng/ml. b. 10-20ng/ml. d. 20-40ng/ml.

a 51-year-old female is: a. 1200mg/600 IU. b. 1000mg/400 IU.

7. Although the National Cancer Institute does not recom-mend calcium supplementation for the prevention of any type of cancer, there is evidence suggesting it may have a protective effect against: a. breast cancer. c. colorectal cancer. b. prostate cancer. d. ovarian cancer.

8. Calcium citrate: a. is generally more affordable than calcium carbonate. b. does not require the presence of chloride in order to be absorbed. c. is not well absorbed in the fasting state.

b. bruising. d. drowsiness.

10. Vitamin E’s potential to prevent and treat disease is based on its function as an:

b. antiarrhythmic. d. antilipidemic.

risk of: a. renal disease. c. hemorrhagic stroke. b. colorectal cancer. d. rheumatoid arthritis.

that participants with early-stage AMD could slow the progression of their disease by taking a combination product containing which of the following? a. Vitamin E c. Vitamin D b. Calcium d. Omega-3 Fatty Acids

13. Fish oils have been postulated to play a role in: a. multiple sclerosis. c. osteoarthritis. b. rheumatoid arthritis. d. Alzheimer’s disease.

14. LOVAZA® (omega-3-acid ethyl esters) is indicated for: a. hypertension, 1gram once daily. b. angina, 2grams twice daily. c. hypertension, 4grams once daily. d. hypertriglyceridemia, 4grams once daily or 2grams twice daily.

counseled on which of the following potential side ef-fects? a. Kidney stones, hypercalcemia, milk-alkali syndrome

31The Georgia Pharmacy Journal November 201131

Introducing the GPhA/UBS Wealth Management Program

UBS has agreed to provide all members of the Georgia Pharmacy Association with exclusive access

been recognized as one of Barron’sGroup is the endorsed wealth management provider for the Georgia Dental Association and also

Harris Gignilliat, CRPS®

Vice President–Investments

ubs.com/team/wile

exclusively for GPhA members at a group discount rate

discount rate

income replacement system

– Lending capabilities with competitive interest rates

Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®.

UBS Financial Services Inc. is a subsidiary of UBS AG. Financial Services Inc. All rights reserved. Member SIPC.

UBS has agreed to provide

Introducing the GPhA/UBS

members of the Georgia Pharmacy Association all UBS has agreed to provide

Introducing the GPhA/UBS

members of the Georgia Pharmacy Association

Wealth Management ProgramIntroducing the GPhA/UBS

access exclusive with members of the Georgia Pharmacy Association

Wealth Management Program

access

Wealth Management Program

is the endorsed wealth management provider Group been recognized

is the endorsed wealth management provider sBarron’Barron’sof as one been recognized

ice VHarris

for the Georgia Dental Association is the endorsed wealth management provider

President–Investmentsice

®CRPSGignilliat, Harris

and for the Georgia Dental Association

also

Lending capabilities with competitive interest rates–


discount rate


Lending capabilities with competitive interest rates


discount rate


Lending capabilities with competitive interest rates


ubs.com/team/wile

ice V

ubs.com/team/wile

President–Investmentsice

eserved. Member SIPC. Financial Services Inc. All rights r

and CRPSSMement Plans Specialisted RetirCharter

eserved. Member SIPC.

ed service marks of the College for Financial Planningegistere r ar® and CRPS

.®ed service marks of the College for Financial Planning

UBS Financial Services Inc. is a subsidiary of UBS AG.

UBS Financial Services Inc. is a subsidiary of UBS AG.

Georgia Pharmacy Association50 Lenox Pointe, NEAtlanta, GA 30324

The Georgia Pharmacy Journal: November 2011

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