Illinois Council of Health-System Pharmacists
4055 North Perryville Road
Loves Park, IL 61111-8653
Phone: (815) 227-9292
Fax: (815) 227-9294
www.ichpnet.org

KeePosted
Official Newsjournal of the Illinois Council of Health-System Pharmacists

EDITOR
Jacob Gettig

ASSISTANT EDITOR
Jennifer Phillips

MANAGING EDITOR
Scott Meyers

ASSISTANT MANAGING EDITOR
Trish Wegner

DESIGN EDITOR
Amanda Wolff

ICHP Staff
EXECUTIVE VICE PRESIDENT
Scott Meyers

VICE PRESIDENT - PROFESSIONAL SERVICES
Trish Wegner

DIRECTOR OF OPERATIONS
Maggie Allen

INFORMATION SPECIALIST
Heidi Sunday

CUSTOMER SERVICE AND
PHARMACY TECH TOPICS™ SPECIALIST
Jo Ann Haley

ACCOUNTANT
Jan Mark

COMMUNICATIONS MANAGER
Amanda Wolff

LEGISLATIVE CONSULTANT
Jim Owen

ICHP Mission Statement
Advancing Excellence in the Practice of Pharmacy

ICHP Vision Statement
ICHP dedicates itself to achieving a vision of pharmacy practice where:

Pharmacists are universally recognized as health care professionals and essential providers of health care services.
Patients are aware of the training, skills, and abilities of a pharmacist and the fundamental role that pharmacists play in optimizing medication therapy.
Formally educated, appropriately trained, and PTCB certified pharmacy technicians manage the medication distribution process with appropriate pharmacist oversight.
Pharmacists improve patient care and medication safety through the development of effective public policies by interacting and collaborating with patients, other health care professionals and their respective professional societies, government agencies, employers and other concerned parties.
Evidence-based practices are used to achieve safe and effective medication therapies.
There are an adequate number of qualified pharmacy leaders within the pharmacy profession.
Pharmacists take primary responsibility for educating pharmacy technicians, pharmacy students, pharmacist peers, other health professionals, and patients about appropriate medication use.

KeePosted Vision
As an integral publication of the Illinois Council of Health-System Pharmacists, the KeePosted newsjournal will reflect its mission and goals. In conjunction with those goals, KeePosted will provide timely information that meets the changing professional and personal needs of Illinois pharmacists and technicians, and maintain high publication standards.

KeePosted is an official publication of, and is copyrighted by, the Illinois Council of Health-System Pharmacists (ICHP). KeePosted is published 10 times a year. ICHP members received KeePosted as a member benefit. All articles published herein represent the opinions of the authors and do not reflect the policy of the ICHP or the authors’ institutions unless specified. Advertising inquiries can be directed to ICHP office at the address listed above. Image disclaimer: The image used in the Pharmacy Tech Topics advertisement is the property of © 2014 Thinkstock, a division of Getty Images.

Features

Join Us for the Residency Showcase!

Saturday, September 13, 2014

1:00 pm - 3:00 pm

Held in conjunction with the ICHP Annual Meeting, September 11 - 13, 2014 at Drury Lane in Oakbrook Terrace, IL

The Illinois Council of Health-System Pharmacists invites you to showcase your residency program to students from pharmacy schools in Illinois including:

Chicago State University College of Pharmacy
Midwestern University Chicago College of Pharmacy
Roosevelt University College of Pharmacy
Rosalind Franklin University College of Pharmacy
Southern Illinois University Edwardsville School of Pharmacy
University of Illinois at Chicago College of Pharmacy
University of Illinois at Rockford College of Pharmacy

After a morning of educational programming, student attendees at the ICHP 2014 Annual Meeting will be ready to meet and greet residency directors and representatives from around the Midwest and Great Lakes regions. Many of these students will be completing their formal education within the year and will be considering residencies as a serious step in their career.

RESIDENCY SHOWCASE LOCATION

The ICHP Residency Showcase will be held at Drury Lane Conference Center, 100 Drury Lane, Oakbrook Terrace, IL 60181 in the Oak and Brook Rooms. Space assignments will be made on a first-come, first-serve basis. The ICHP registration desk will be located in the foyer for your convenience.

REGISTRATION FEE

The registration fee for the ICHP 2014 showcase is $100.00 and includes a 2’ x 6’ table top and 2 chairs.

HOW TO APPLY

To register your residency program for a showcase table, you must complete the Residency Showcase Registration Form and submit a residency description no later than Friday, August 15.

For maximum recognition of your residency program, we are asking that you submit a brief summary of your residency. This summary should include:

The name of your facility and location (city and state)
The number of residency program positions available
A brief description of your facility
A brief description or goal(s) of your residency program

Save the description as a Word document and email this information to JHaley@ichpnet.org by August 15 to ensure your residency description is included in the 2014 Annual Meeting program materials.

For more information, a detailed schedule and hotel accommodations, please download the Residency Showcase Form (PDF).

Nominate a PTCB-Certified Pharmacy Technician Today!
Call for Nominations for the 2014 PTCB CPhT of the Year©

PTCB is now seeking nominations for the 2014 PTCB CPhT of the Year©!

The nomination period is open through August 8. The PTCB CPhT of the Year program aims to honor the achievements and recognize the contributions of outstanding CPhTs. Active CPhTs who have been certified for at least two years are eligible to be nominated. Finalists will be selected by PTCB and featured in an online ballot, and the honoree will be chosen through open online voting. The 2014 honoree will receive:

a $500 honorarium
registration, travel, and accommodations to attend the ASHP Midyear in December in Anaheim, CA, including participation in CE programs at the conference

If you would like to nominate a qualified PTCB CPhT, please review the Official Description and Official Rules, and then submit your nomination online. When nominating a CPhT, you will be asked to provide information and answer a brief series of questions to describe the accomplishments and workplace contributions of the nominee.

To keep up on the 2014 CPhT of the Year© selection process, please Like PTCB on Facebook, join the PTCB Group on LinkedIn, and follow PTCB on Twitter.

Submit a nomination!

Read the Official Description.

Read the Official Rules.

Read about last year’s CPhT of the Year.

PTCB looks forward to receiving your nomination. Thank you for advancing the roles of pharmacy technicians by recognizing innovative CPhTs through the 2014 PTCB CPhT of the Year© nomination process. CPhTs who feel their contributions are appreciated and respected experience higher job satisfaction in the workplace.

Pharmacy Technician Certification Board

2200 C Street, NW, Suite 101

Washington, DC 20037

Phone: (800) 363-8012 | Fax: (202) 888-1699

www.ptcb.org

Important Update and Reminders on Changes to ICHP’s Continuing Pharmacy Education Process

ICHP is transitioning to a new continuing pharmacy education (CPE) processing website over the summer. The new site is CESally.com. Participants in Champion webinars and NISHP CE programming have started using CESally.com for their credit processing as part of testing the new website. Soon everyone attending an ICHP CPE program will be using CESally.com.

How will this transition work for you?

As part of the transition process, ICHP will be sending out an email invitation to join CESally.com to all of our members sometime in August. Please watch for this email from CESally.com. When you receive the email invitation, please accept as an ICHP association member, and go to CESally.com to complete setting up your personal account. You will need to provide your NABP eProfile ID and birth date (MMDD). Once you are in the system as an ICHP member, you will have access to any of the free ICHP CE (such as Champion webinars and journal CE).

CESally.com will NOT be limited to ICHP members only. Managing your CESally.com account (up to date valid email address, username and password) will be your responsibility. ICHP will no longer be able to reset your passwords or usernames as part of the CESally.com privacy policy. So you will need to use the ‘forgot password / username’ function, for example, and will need a valid email address.

Just as with HealthsystemCE.org, CESally will automatically upload your credit to CPE Monitor upon successful completion of the evaluation requirements. A new feature of CESally.com is that you will know immediately if your CE was accepted, that way if there was a problem, you are able to fix your NABP eProfile ID # and birth date (MMDD) yourself in that moment, and then re-submit your credit.

Another benefit to the new site is the ability to select multiple programs from an event such as the Annual Meeting, add them to your To Do List, and then complete your Event evaluations in one seamless process.

Official Transcripts reminder

As a reminder, ACPE does not allow accredited providers to give statements of credit any longer. You may download an information sheet upon successful completion of your CE processing, but for an official transcript or statement of credit, you will need to go to NABP.net and go to your CPE Monitor account to review your official credit transcript.

ACPE CE Processing Deadlines reminder

Finally, ACPE has instituted a deadline for accredited providers to submit participant CE credit for their CE programs to CPE Monitor. This means you MUST pay attention to the accredited provider’s deadlines for any CE program you attend or complete online. CPE Monitor will reject any attempts to upload late credit reports.

So PLEASE make note of all CE processing deadlines. We do not want you to lose your credit!

Please send any questions to members@ichpnet.org.

Columns

President's Message
Are you an Engaging Speaker?

by Mike Fotis, ICHP President

Most of us appreciate a presentation that includes audience participation questions. Your questions provide a break in the routine, help the audience to maintain focus, and when properly written and presented, can help our members to go beyond fact recall and learn to apply the presented material. Your questions might even encourage a few in the audience to look away from their mobile phones!

Sometimes, however, speakers use this opportunity to question the audience about some facts that are about to be presented. Most of the audience resorts to guessing and each of the four possible choices ends up with 25% of the response. The same questions are repeated at the end of the lecture, usually the audience gets the right answers on the second attempt, and the speaker and ICHP can show that the audience learned something (outcomes data are required by ACPE). However, most of our members attend educational programming to pick up more than one or two new facts. If accumulating facts was the route to becoming an excellent pharmacist, well we all would be there, wouldn't we? No need for ICHP to offer continuing education at our annual meeting…right? No, there is a different purpose. I think most people attend our educational meetings to learn how to apply these new facts in their own clinical settings. The presented information can help us to set new priorities and to develop new ways of doing things. Learning to use the newly acquired information using evidence based principles is vital to our practitioners.

Of course the paved road is the smoothest route and too many speakers choose only fact based participation questions, and some speakers seem to think the more obscure the fact, the better. Readers likely remember that I believe it is a time to Be Bold, and I want to ask our speakers to minimize those fact-based questions and instead start your presentation with a summary of the facts. Point out the limitations of the latest evidence and move on to questions which are more applicable to practice. The application-type questions will help your audience to develop their own understanding of the material, including the limitations. Learning when to apply a rule, and when the new rule does not apply can avoid a very serious error.

As an example, suppose you were attending a discussion about medication therapy during pregnancy. A fact-based speaker might ask the audience “what happens to renal clearance during pregnancy?” Our choices might include a) clearance remains the same; b) clearance is reduced; c) clearance is increased; or d) none of the above. Those of you who are specialists or have a bit of experience in this area of practice will choose “c” as the correct response. The rest of us will guess and the result is the audience response chart will end up like this one.

Seem familiar? Great presentation, plenty of facts, everything is great…except the audience doesn’t leave knowing how to use this information!

On the other hand, an application-focused speaker might discuss the physiologic changes that occur during pregnancy, remind the audience of the inherent limitations of studies conducted during pregnancy and instead ask the audience to identify the medications that might be most significantly impacted by an increase in renal clearance. A question might ask, “Given that renal clearance for certain antibiotics or for low-molecular weight heparins is increased, what do you expect to happen to the half-life of these medications?” and later to ask the groups to discuss - “What are some likely situations where a dose adjustment may be necessary and how could one monitor these things?” Don’t these questions seem more applicable to what we do as pharmacists?

Moving away from our comfort zone is hard, but it is a lot more fun! Helping our members to develop their own understanding of the presented material helps ICHP to achieve our educational purpose and can lead to some interesting and engaging discussions both during and after your presentation. One of the best situations for a presenter is to see your colleagues continue to discuss the presented issues over coffee and a chocolate chip cookie during the break session.

Please let me know what you think, and I hope to see you all at this year’s ICHP Annual Meeting this September!

Directly Speaking
Medical Marijuana: It’s Time for the Federal Government to Step Up!

by Scott A. Meyers, Executive Vice President

The federal government has failed to act on so many important and life-changing issues over the past couple of decades. Issues like health care reform (yes, we have the ACA, but even many of the initial proponents are now abandoning critical elements), immigration reform, tort reform, tax reform, and many more. And it’s our own darn fault! We sit back and elect and then re-elect candidates from two parties who are more concerned about getting re-elected and building their own wealth and networks than they are about moving our great nation in the right directions! Does it sound like I’m frustrated? You bet! Does it sound like I’m blaming our legislators? Yes and no. We elect them, and if they can’t get the job done then we shouldn’t re-elect them. And because there are only two well-established parties in the US political system, there is now a very strong “us and them” mentality in Washington. There are no efforts to work together and more time and money is spent trying to further the divide.

So let’s get specific with medical marijuana. Currently the DEA classifies marijuana as a schedule I controlled substance, making it illegal to obtain or sell for any purpose including medical use and research. And yes, there is a new bill before Congress that would allow the sale of an oil extract of marijuana for use by children with severe epilepsy. But because the federal regulations are so stringent, even states that have legalized marijuana’s sale and use for medical and/or recreational uses have found that their laws aren’t enough.

Because marijuana is a schedule I controlled substance, banks and credit card companies initially refused to take deposits or accept purchases for illegal products. The dispensaries in California, Washington State and Colorado were forced to receive all payments in cash. This created huge sums of cash on hand within dispensaries that had to be transported to owners’ homes or turned into money orders. Recently the Obama administration issued some executive orders to the FDIC and others so that other payment forms could be used. But if the current schedule for marijuana is not changed by the next presidential election, a new administration could have a completely different perspective on this issue and rescind the previous executive orders.

Hospitals and other patient care facilities face a different problem in that payments made for medical marijuana or merely actively allowing of use of an illegal substance on hospital premises could jeopardize payments made to them by CMS for Medicare and Medicaid patients. No hospital can survive without that funding.

Pharmacists currently can’t dispense medical marijuana without fear of losing their federal controlled substance license and then potentially their state license, too. And while again, the Obama administration has issued executive orders similar to those for the banking industry to protect pharmacists in Connecticut where state law requires pharmacist dispensing, there is no guarantee that a new administration might not rescind those orders, too!

There is substantial research going on abroad on the active components of marijuana and yet little or no research is being conducted here in the US, again, because possession of it is illegal at the federal level. The limited studies that are out currently show that marijuana or the chemical components of the plant have medical value and anecdotal exchanges support the use even more.

So what should Washington do? The DEA needs to reclassify marijuana as a schedule II controlled substance immediately. Congress and the President need to work together (we wish!) and pass and sign legislation that immediately allows for the medical use of marijuana and allows for wide spread research on all the active chemical components for use medically and industrially. The medical use legislation should also provide banks and credit card companies with protection from other conflicting federal and state laws so that payments can be made safely and securely.

It seems, from all that I have read, that there is too much potential in this particular plant for the government to continue to block research and clinical use. Yes, the current forms we have available are not standardized like the medications we normally work with and yes, there is a huge potential for abuse in this form. So that’s exactly why Washington needs to get off their tails and move us forward…to find answers to all the questions scientifically and to prove or disprove what many believe to be the redeeming qualities of a plant we’ve had around this country for forever! And then, if specific components are found to provide great benefits, produce the products commercially, have physicians write prescriptions for them, control them by dispensing them from pharmacies, and if marijuana is found to be safe for recreational sale and use, tax the heck out of it just like we do liquor! But don’t just let this issue sit and smolder like every other burning issue placed before Congress for the past two decades! It’s time for the federal government to step up!

Board of Pharmacy Update
Highlights from the July Meeting

by Scott A. Meyers, Executive Vice President

The July 8th Board of Pharmacy Meeting was held at the Bilandic Building, 160 N LaSalle St. in Chicago. These are the highlights of that meeting.

NABP Diversion Video – The National Association of Boards of Pharmacy has released a new video on preventing the filling of fraudulent prescriptions. The “Red Flag” program is designed to help pharmacists more quickly identify fraudulent prescriptions. It is now available on the NABP website and is 12:37 minutes long. The IDFPR staff encourages all pharmacists to view the video.

PMP Reporting – There have been several attempts by law enforcement to obtain information from Illinois’ Prescription Monitoring Program. Law enforcement is allowed to ask for specific information on specific patients or prescribers but may not ask for large amounts of unrelated data that can be used as a phishing expedition to possibly identify controlled substance violations. Any request by law enforcement of information from a pharmacy from the PMP should be directed to the Department of Human Services. Pharmacies and other health care facilities are not required nor allowed to provide information directly to law enforcement from the PMP. This could result in HIPAA violations and other breaches in patient privilege.

Pharmacy Practice Act Rules – The new draft rules for the Pharmacy Practice Act were published in the Illinois Register on Friday, May 16th. ICHP provided written comments to the Department but found very few issues with the published draft. The Department worked diligently with all pharmacy organizations to make the first draft a document of significant agreement. The Department staff will evaluate all written comments received and will publish a second draft which will go to the Joint Committee on Administrative Rules for final approval. All those who comment will receive written responses to their comments at the time of second publication. It is expected that the final rules will go into effect sometime this fall.

Controlled Substance Act Rules – Final publication of the revised rules for the Illinois Controlled Substance Act are expected shortly. ICHP will let you know when they have been approved. ICHP commented on these rules in April.

Illinois Legislative Update – Scott Meyers, ICHP Executive Vice President provided this meeting’s legislative update. The update highlighted a few of the key bills ICHP monitored this spring and those may be found in this issue’s GAS From Springfield column.

Visitor Question and Comment Section – The Board entertained questions and comments from the visitors present at the meeting. The Teamsters Union was represented in force at this meeting and asked to address the Board. Representing over 700 pharmacists working for CVS Pharmacies in Illinois, they urged the Board to consider drafting workload regulations in order to better protect the public from overworked and understaff pharmacists and pharmacies. They believe that chain pharmacies in general, have cut both pharmacist and technician staffing levels to create unsafe conditions in many Illinois pharmacies. A CVS pharmacist also addressed the Board to personally share his experiences and fears that someday he will cause patient harm because of these cuts.

A compounding pharmacist from downstate Illinois addressed the Board and urged them to review the first draft of USP Chapter 800 Handling of Hazardous Substances. He expressed concerns that no pharmacy in Illinois would be able to meet these requirements without a substantial expenditure and increase in pharmacy space. These proposed regulations require that all hazardous substances be packaged in negative pressure air flow rooms rather than the current positive pressure air flow of today’s clean rooms. In addition, venting is required to the outside which may require many pharmacy departments to relocate in their facilities. Finally, USP 800 does not take into consideration existing EPA standards for venting of hazardous materials and could be in direct conflict with them. This should be a major concern for all pharmacy organizations.

A question was raised about the number of inspectors currently employed by the Department, and staff informed the Board and the audience that a fifth inspector has been hired and will be on staff shortly. The Department staff also informed the audience that the Hospital Self-Inspection Form will be ready shortly. Staff acknowledged and thanked ICHP for providing an initial draft that they are using to create the final form. Additional Self-Inspection Forms will be developed for other practice settings in the near future. ICHP will inform members when the hospital form is available online at the IDFPR website.

Next Board of Pharmacy Meeting – Is scheduled for Tuesday, September 9th at 10:30 AM on the 3rd floor of the Illinois Department of Professional Regulation Building on Washington Street in Springfield. The September meeting is the only meeting held in Springfield annually. Pharmacists, pharmacy students and pharmacy technicians are welcome to attend the open portion of the meeting.

Medication Safety Pearl
Look-A-Like Products and Packaging in the Time of Drug Shortages: Implications and Safety Steps for Imported Products Used in Total Parenteral Nutrition

by Crystin Gloude, PharmD, Caryn Dellamorte Bing, RPh, MS, FASHP

Total parenteral nutrition (TPN) formulations are complex compounded sterile preparation (CSP) prescriptions made under the most optimal conditions. For the past several years, ongoing shortages of many electrolytes, trace elements, and TPN base solutions have complicated the compounding and clinical processes for TPN in all practice settings. The critical shortage of clinically essential parenteral phosphate and trace elements has led some pharmacies to use imported products temporarily allowed into the USA by the Food and Drug Administration (FDA). Three of these imported TPN component products are Glycophos® (sodium glycerophosphate), Addamel-N®, and Peditrace® distributed by Fresenius Kabi.^1,2,3

In a recent Institute for Safe Medication Practice (ISMP) quarterly agenda, these three products were noted as high-alert medications due to their look-a-like nature, and it was suggested that methods such as physical separation and auxiliary labels be used in order to distinguish the products.⁴ In a survey that was conducted by ISMP, some of the cited errors relating to the use of foreign products were due to different salts, different concentrations, lack of alterations in protocols to account for changes in products, and inability to use a barcode.⁵

U.S. healthcare professionals must be extra vigilant when using these alternate products in TPN and other CSP formulations. The packaging (i.e. color, label format) of all three products is very similar, creating the possibility for mix-ups in the staging, compounding, and final check process (see Figure 1). Additionally, the formulation of these preparations may be very different from the currently approved U.S. products, which remain in short supply. These product differences create the potential for compounding and dispensing errors and call for special preventive steps in order to mitigate the risk.

Figure 1. Three imported small volume parenteral products

In most pharmacies, the components for TPN (and other CSPs) are stored in close proximity to each other. The close physical proximity of products with similar appearances increases the possibility of errors when pulling medications for compounding as part of the sterile processing workflow. When these products were initially imported beginning in May 2013, pharmacists and pharmacy technicians who work with TPNs and other CSPs were notified of their availability and the clinical differences between the new products and similar U.S. approved products.^1,2,3 Once all three of the products were brought into pharmacies, the importance of flagging them as look-a-like/sound-alike (LASA) products became apparent.

Product differences

Phosphate source:

The Fresenius Kabi product Glycophos® is an organic phosphate compared to U.S. marketed inorganic phosphate solutions. When Glycophos® is used as a replacement phosphate, the concentration and cation content differ from FDA-approved parenteral additives. Pharmacists should be aware of these differences, including the higher volume of Glycophos® required for an equivalent phosphate dosage (see Table 1).¹

Table 1. Product differences between Glycophos® and U.S. commercial parenteral phosphates¹

Product	Phosphate Content (mmol/ml)	Sodium Content (mEq/ml)	Potassium Content (mEq/ml)
Glycophos®	1	2	---
Sodium Phosphate	3	4	---
Potassium Phosphate	3	---	4.4

Trace element sources:

Addamel-N® is an adult multi-trace product with 9 trace elements, and includes iron, molybdenum, iodine, and fluorine salts that are not in the U.S. multitrace-4 and 5 products (Table 2).² Peditrace® does not contain chromium but does contain fluorine, selenium, and iodide salts (Table 2).³

Table 2. Product differences between U.S. multi-trace elements, Addamel-N® and Peditrace®^2,3

Adult

Pediatric

U.S. Adult Multi-trace	Addamel-N®	U.S. Pediatric Multi-trace	Peditrace®
Zinc sulfate Cupric sulfate Manganese sulfate Chromic chloride Selenious acid	Zinc chloride Copper chloride Manganese chloride Chromic chloride Sodium selenite Potassium iodide Sodium fluoride Ferric chloride Sodium molybdate	Zinc sulfate Cupric sulfate Manganese sulfate Chromic chloride	Zinc chloride, Copper chloride, Manganese chloride, Sodium selenite, Potassium iodide Sodium fluoride (No chromium)

*See package inserts for specific content quantities

Clinical and operational challenges:

Glycophos®, Addamel-N®, and Peditrace® do not follow U.S. labeling standards and cannot be directly used in compounding systems that depend on barcode scanning for identity verification. The required dosage should be manually added during the CSP process.^1,2,3 Manual addition to each TPN bag increases CSP production time, especially for pharmacies that prepare many TPNs and rely on automated compounding devices (ACDs) with barcode scanning technology. Manual addition also increases the possibility for human error, in particular with the look-a-like labeling noted earlier.

Safety and quality steps:

In this home infusion pharmacy practice setting, the safety and quality checks of all TPN preparations include a pharmacist double check of the formulation documents and components prior to compounding for new or changed TPN orders, and review of the final compounder reports generated by the ACD (which deploys barcode scanning technology as a safety and quality check). For every manual addition to a TPN or pool bag, the compounding personnel provide the vials and syringes drawn back to the volume added to facilitate the final TPN check. These routine quality and safety steps are designed to minimize the possibility of staging, compounding, and dispensing errors.

The introduction of these imported products presented an opportunity to reinforce the existing policies and process while informing staff of the possible risks with their use. Prior to the initial use of these imported products and after the FDA allowed importation, the home infusion pharmacy ordered a minimal quantity for inspection, confirmation of additional supply availability, and introduction to the staff before use. Additional internal communications outlined each product’s use, content, and required quality checks. Home infusion dieticians and pharmacists compiled comparative supplemental lists of U.S. and imported product content that highlighted their differences (Tables 1 and 2). This comparative information was posted for staff that processed TPN orders. Pharmacists introduced the need for these new products to the ordering physicians and faxed a product information sheet. Consistent with LASA risk management steps, the home infusion pharmacy placed these three TPN ingredients two shelves apart from each other as an additional preventive step to avoid mix-ups when pulling the components prior to TPN compounding.

Pharmacist and pharmacy technician continued diligence is essential for safe preparation of these complex, multi-ingredient products in every workplace where TPNs are compounded. Practitioners should be alerted to and educated on the nuances of preparation with these alternate products. While the specific shortages requiring the use of these alternate products will eventually end, the practice of managing for safety during a shortage will continue to be a daily activity for pharmacy personnel.

References:

Phosphate Injection Availability. Fresenius Kabi. Food and Drug Administration Drug Safety. 2013 May 29. www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM354277.pdf. Letter.
Addamel-N Multi-Trace Element Availability. Fresenius Kabi. Food and Drug Administration Drug Safety. 2013 May 29. www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM355392.pdf. Letter.
Peditrace Multi-Trace Element Availability. Fresenius Kabi. Food and Drug Administration Drug Safety. 2013 May 29. www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM354267.pdf. Letter.
ISMP Quarterly Action Agenda. ISMP. 2014 Apr 10 www.ismp.org/Newsletters/acutecare/articles/ActionAgenda1402.doc.
Survey Links PN Components Shortages to Adverse Outcomes. ISMP Medication Safety Alert! Acute Care. 2014 Feb 13. http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=70.

The GAS From Springfield
It’s Summer - It’s Time for Fun, but Don’t Forget Your Connections!

by Jim Owen and Scott Meyers

With the Spring Session of the Illinois General Assembly in the books and the veto session months away, there’s not a lot we can report this month. But that doesn’t mean it’s time to sit back and relax. While we don’t expect any pharmacy bills to suddenly surface during the veto session, there’s always a chance for a surprise. So the best way we know to prevent surprises is to get close to our legislators so that they know we will be paying attention with both eyes wide open following the election.

Now that can sound kind of threatening or ominous…like we’re watching for them to slip up or let us down. If you take one or more of the many chances they will offer you this summer to join them at a fundraising event, you can send them a positive message, help them get re-elected or elected and bolster your relationship with them.

Many summer fundraising events are inexpensive, like barbecues, picnics, breakfasts, etc. Others may take a little more of an investment like golf outings or a day at the ballpark or racetrack, but either way, if the event sounds fun by itself, then it’s a great opportunity to mix business with pleasure. Taking your spouse, significant other, a first date or even the kids can be fun and provide some great food while making your presence known, reinforcing your willingness to support them and sharing your message.

We’re sure you’ve heard us mention attending the Mautino Italian Open over the course of the last 12-15 years. It’s a fundraiser for State Rep. Frank Mautino held in Spring Valley each August. Since somewhere around 1999, representatives of ICHP have played in Rep. Mautino’s golf outing to thank him initially for carrying ICHP’s first solo legislative effort and later for supporting many of our positions over the years. We’ve participated almost every year with at least a group of four members, only missing a couple in those 15 years. And one year we brought 14 ICHP polo shirt clad golfers to show a significant commitment to one of our legislative friends.

We do, however, spread the wealth around. We make sure that both sides of the aisle receive campaign contributions, primarily to leadership and those individual members of the General Assembly who show support of our pharmacy initiatives. The ICHP Pharmacy Action Fund uses your contributions to make sure that the General Assembly knows we are watching closely and appreciates those who listen.

So even though it’s summer and even though there are no current bills to monitor or lobby for or against, it doesn’t mean it’s time to sit back and relax. Take these summer days to make your connections, make your contributions and fortify your commitment to your profession. Every other profession and industry isn’t taking the time off. Neither should we. If you don’t know who your local legislators are or if they have a “pro-pharmacy” loyalty, call or email us. We’ll be happy to fill you in. If you’re looking for fundraising opportunities, call your legislators’ local campaign office or check on the internet. Their websites will list them all.

And if your legislators aren’t the pro-pharmacy heroes we support, send a contribution to the ICHP Pharmacy Action Fund. Actually, do that in addition to whatever you do locally! This summer and early September, your contributions can be made toward the $1K Raffle or the Auction With A Twist, both great chances to win some cash or serious prizes. Check out ICHP’s website under Public Policy to find out how to participate there!

It’s summer - it’s time for fun, but don’t forget your connections!

ICHPeople

ICHP staff said farewell to our summer intern, Kelly Delehanty, on August 5. You did a fantastic job this summer, Kelly! We wish you luck and hope you keep us updated on your career in pharmacy!

New Practitioners Network
Top Five Tips For Surviving Residency

by Jason A. Morell, Pharm.D., OSF St. Francis Medical Center

Starting residency is both a challenging and joyful occasion. The purpose of residency is to learn and grow as a pharmacist at a fast pace in essentially three dimensions, clinical skills, operational skills and leadership skills. This will form a successful graduate into a pharmacist competent in patient centered care.^1-2 The following are the top five lessons I have learned on how to be a successful resident:

Use a calendar, preferably in Microsoft Outlook®. The preceptors all have high expectations of the resident. There are many time-consuming responsibilities with tight deadlines. A calendar can help aid one in prioritizing their time and understanding how much can feasibly get done in 24 hours. It also ensures one is not double-booked, as there are often longitudinal rotations, block rotations, and other activities going on concurrently.
Own your mistakes. Pharmacists make mistakes, just like any other human. When there is a mistake, it too is a learning opportunity and should be viewed just as that. It is always best to own the mistake and develop a plan for improvement. Resi Trak® is a great place to document progress towards an area of weakness and show improvement from a mistake. Conversely, one’s preceptors and colleagues are not perfect at every moment of every day. If someone else makes a mistake, realize they are also only human. Most often, preceptors appreciate the ability to have constructive feedback to improve the learning experience for future learners.
Maintain work-life balance. Residency is very stressful. There are many competing priorities. The hours are long. The preceptors have high expectations, which may not all be met at first. It is important to have an outlet so that on rounds when a physician wants to continue an unnecessary antibiotic, one can keep their reaction contained. The “life” part of the balance need not be excessive to reap benefit. Simply taking time to enjoy friendships or even exercise has tremendous value.
Develop strong drug information skills. These are important skills needed early on in residency. Try to go to as many journal clubs and case presentations as possible and critique what was excellent and what needed improvement. Incorporate that into one’s own presentations. Key issues include internal vs. external validity, statistical vs. clinical significance, type I and type II error, sources of bias and study design, to name a few. The most important factor is the learner’s ability to state the implication of the research into practice in a manner that the audience can follow.
Show appreciation. Pharmacy technicians, lab technicians, nursing staff, dieticians and other staff in the hospital have a marked ability to improve the resident’s day. Perhaps not everything goes according to plan each time, but by learning what one can from each discipline and appreciating everyone’s part in improving patient care, one can be a valued team member. Buying simply a soda for a technician or even just saying “thank you” at the end of a staffing shift will impart a strong impression. Everyone deserves positive feedback.

Residency is a place in the continuum of life-long learning that starts in school and continues throughout one’s professional career. Residency was by far one of the best choices I have made. I can definitely say I enjoyed residency more than anything, but never worked harder. I hope that these tips will help all the new residents starting this year.

References:

Murphy JE, Nappi JM, Bosso JA, et al. American College of Clinical Pharmacy’s vision for the future: postgraduate pharmacy residency training as a prerequisite for direct patient care practice. Pharmacotherapy. 2006;26:722-733.
ASHP Accreditation Standard for Postgraduate Year One (PGY1) Pharmacy Residency Programs; American Society of Health-System Pharmacists; 2012. American Society of Health-System Pharmacists Home Page [resource on World Wide Web]. URL: http://www.ashp.org/DocLibrary/Accreditation/ASD-PGY1-Standard.aspx. Available from Internet. Accessed 2014 July 8.

Educational Affairs
Therapeutic Management of Vitamin D Deficiency in Chronic Kidney Disease

by Betty Nakitende, PharmD*; Brandon Orawiec, PharmD*; Jadwiga Zawada, PharmD*; Sharon Joseph, Pharm D*; Janene L. Marshall, PharmD, BCPS

Vitamin D deficiency has been reported in many different age groups, highlighting what remains a common problem amongst the general population.¹ However, in patients with chronic kidney disease (CKD) this deficiency may be more pronounced and even more important to prevent.² The major function of vitamin D is believed to be the maintenance of homeostasis among calcium and phosphorus. Emerging evidence demonstrates that vitamin D plays a more extensive role in other physiologic activities, such as regulation of renal, cardiovascular, and immunological functions via the vitamin D receptor (VDR), which is expressed in virtually all body tissues.^3-6 Studies in animals have shown that vitamin D may be a negative regulator of the renin-angiotensin-aldosterone system (RAAS) and therefore may play a critical role in blood pressure homeostasis and water retention.^3,5 Also, vitamin D may influence NF- KB, a regulator of the immune response, that is involved in inflammation and fibrogenesis.⁵ In a retrospective study by Teng et al, CKD patients (including those on hemodialysis) who received vitamin D therapy had a 20% increase in survival when compared to those who did not receive the therapy.⁶ Additionally, it has been shown in renal disease modeling studies conducted in rodents that vitamin D analogs are renal protective and inhibit common pathways of kidney injury that can lead to inflammation, proteinuria, and fibrosis.^5,6 Furthermore, in CKD, kidneys frequently do not produce enough active vitamin D, which leads to hypocalcemia; causing an increase in parathyroid hormone (PTH) levels and bone resorption, which can result in bone fractures and deformities.^2,7-8 For these reasons, it is imperative that vitamin D deficiency be carefully managed to reduce morbidity and mortality in the CKD population.

The K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease and Kidney Disease Improving Global Outcomes (KDIGO) in Chronic Kidney Disease-Mineral and Bone Disorder recommend that patients with stages 3, 4, or 5 CKD (GFR <60/mL/min/1.73m² ) have calcium, phosphorus, and intact PTH levels evaluated every 12 months, 3 months, and 1 month respectively (Table 1).⁹

Table 1. Frequency of PTH and calcium/phosphorus monitoring based CKD stage

CKD stage	GRF Range (mL/min/1.73 m²)	Measurement of PTH	Measurement of Calcium/Phosphorus
3	30-59	Every 12 months	Every 12 months
4	5-29	Every 3 months	Every 3 months
5	< 15 or dialysis	Every 3 months	Every month

National Kidney Foundation. Am J Kidney Dis. 2003;42:S1-S202 (suppl 3).

A vitamin D level should be assessed when an intact plasma PTH level is detected above the target range. In cases of elevated PTH despite normal active vitamin D levels, therapy with active vitamin D (calcitriol) or its analogs (paricalcitol or doxercalciferol) is warranted (Tables 2 and 3) followed by quarterly measurements of calcium, phosphorus, PTH and a yearly active vitamin D test.¹ Then, based on the laboratory value trends for calcium, phosphorus, and intact PTH vitamin D supplementation may need to be adjusted. On the other hand, when intact PTH falls below target levels or when total corrected calcium rises above the recommended level of 9.5mg/dL, it is important to hold vitamin D supplementation and resume treatment only once the PTH level normalizes or total corrected calcium levels fall below 9.5mg/dL. When resumed, it is advisable to initiate therapy at half the original dose. Likewise, if phosphate levels rise above 4.6mg/dL, vitamin D therapy should be held and therapy should be initiated with a phosphate-binder. Once levels normalize, the original dose of vitamin D may be restarted. However, if the active vitamin D (serum 25 hydroxyvitamin-D) level is <30 ng/mL, which is defined as vitamin D deficiency, therapy would then depend on the CKD stage and could be given in the form of vitamin D precursors such as the plant-based ergocalciferol (vitamin D₂) or animal-based cholecalciferol (vitamin D3) (Table 4).⁹ These vitamin D sources are converted to 25-hydroxyvitamin-D in the liver, and then transported to the kidneys to be further transformed into the active form of vitamin D known as calcitriol or 1,25-hydroxyvitamin-D.³

Table 2. Active vitamin D and analogs

Stages 3 and 4

Plasma PTH
pg/mL or [pmol/L] Serum Ca
mg/dL [mmol/L] Serum P
mg/dL [mmol/L] Dose
Oral
Calcitriol Dose
Oral
Doxercalciferol

> 70 [7.7]
(CKD stage 3)
Or
> 110 [12.1]
(CKD stage 4) < 9.5
[2.37] <4.6
[1.46] 0.25 µg/day 2.5 µ 3x/week

National Kidney Foundation. Am J Kidney Dis. 2003;42:S1-S202 (suppl 3).

Treatment for vitamin D insufficiency/deficiency in patients with CKD stage 3-4 require supplementation with ergocalciferol (D₂) or cholecalciferol (D₃) and should be integrated with treatment for calcium and phosphorus abnormalities.¹ Ergocalciferol can be dosed easily to meet the amount recommended by giving one 50,000 IU capsule monthly for 6 months to treat 25-hydroxyvitamin-D levels < 30 ng/mL. The dose of ergocalciferol may be increased to 50,000 IU once weekly if 25-hydroxyvitamin-D level is < 15 ng/mL (Table 4).⁹ It is important to monitor vitamin D levels every 6 months. Likewise, intact PTH levels must be monitored every 3 to 6 months and calcium and phosphorus levels every 3 months.⁹ Once the patient’s vitamin D level is repleted (>30 ng/mL 25-hydroxyvitamin-D), then it is safe to transition to an over the counter vitamin D-containing multivitamin while continuing to monitor calcium and phosphate every 3 months and 25-hydroxyvitamin-D levels yearly.^8,9

On the contrary, treatment for vitamin D insufficiency/deficiency in CKD-5 patients by supplementation with ergocalciferol may confer no additional benefit. Therefore, supplementation in CKD stage 5 patients should be done with active vitamin D or analogue and only in cases of elevated intact PTH (Table 3).⁹

Table 3

Active vitamin D analogs dosing: Stage 5

Plasma
PTH
pg/mL or
[p/mol/L] Serum Ca
mg/dL
mmol/L Serum P
mg/dL
mmol/L Ca-P
Product Dose per HD
Calcitriol Dose per HD
Paricalcitol Dose per HD
Doxercalciferol

300-600
[33-66] <9.5
[2.37] <5.5
[1.78] <55 IV: 0.5-1.5µg
Oral: 0.5-1.5µg IV:2.5-5.5µg IV: 2µg
Oral :5 µg

600-1000
[66-110] <9.5
[2.37] <5.5
[1.78] <55 IV: 1-3µg
Oral: 1-4µg IV: 6-10 µg IV:2-4µg
Oral :5-10µg

>1000
[110] <10.0
[2.5] <5.5
[1.78] <55 IV: 3-5µg
Oral: 3-7µg IV: 10-15µg IV: 4-8µg
Oral:10-20µg

National Kidney Foundation. Am J Kidney Dis. 2003;42:S1-S202 (suppl 3).

Table 4

Ergocalciferol (Drisdol®) should be initiated in CKD stage 3 or 4 if 25-OH Vitamin D < 30 ng/mL:

Serum 25(OH)D (ng/mL) [nmol/L)	Definition	Ergocalciferol Dose (Vitamin D2)	Duration (months)	Comment
<5 [12]	Severe vitamin D deficiency	50,000 IU/wk orally x12 wks; then monthly 500,000 IU as single I.M. dose	6 months	Measure 25 (OH) levels after 6 months ------------------------------------------------ Assure patient adherence; Measure 25 OH levels at 6 months
5-15 [12-37]	Mild vitamin D deficiency	50,000 IU/wk x12 wks; then 50,000 IU/month	6 months	Measure 25 (OH) levels after 6 months
16-30 [40-75]	Vitamin D insufficiency	500,000 IU/ month orally	6 months	3:4

National Kidney Foundation. Am J Kidney Dis. 2003;42:S1-S202 (suppl 3).

The choice of agent for treatment is an active vitamin D analog, such as, calcitriol (Vectical), paricalcitol (Zemplar), or doxercalciferol (Hectorol). It is important to note that there are oral and IV formulations available (Table 3), and there may be dosing differences based on if the patient is receiving hemodialysis or peritoneal dialysis.⁸ Also, dosing may differ for mild (300-600pg/mL), moderate (600-1,000 pg/mL), or severe (>1,000 pg/mL) hyperparathyroidism. As for choosing an appropriate vitamin D sterol, it is important to look at which agents are available intravenously and orally, such as calcitriol and doxercalciferol; whereas, paricalcitol is only available orally. Additionally, calcitriol is the only agent that is available as a generic and may be used when cost is a barrier for the patient. Currently, there are limited trials to support that one agent is superior to the other. There are limited animal pharmacokinetic modeling studies that suggest cholecalciferol (vitamin D₃) is a better agent than ergocalciferol (vitamin D₂) due to a greater increase in serum 25-hydroxyvitamin-D.^10,11 The duration of therapy depends on the amount of time needed to suppress the PTH level, which can range from 12 to 24 weeks, or even longer. It is important to monitor calcium and phosphate levels, when vitamin D is initiated or increased at least every 2 weeks for the first month, then once a month thereafter.² The intact PTH levels should be measured monthly for the first 3 months, then once every 3 months thereafter.

Correcting vitamin D deficiency/insufficiency will help to fuel both renal and extra-renal pathways of vitamin D synthesis that will influence clinical outcomes in this high-risk group. Pharmacists can make important clinical interventions by making appropriate recommendations regarding the monitoring of lab values and appropriate choices for therapy by following the considerations mentioned above.

*Drs. Zawada, Joseph, Nakitende, and Orawiec were fourth year pharmacy students at Chicago State University College of Pharmacy at the time this paper was written.

References

Holick MF. Vitamin D Deficiency. N Engl J Med. 2007; 357:266-81.
K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease: Vitamin D Therapy in Patients on Dialysis (CKD Stage 5). Am J Kidney Dis. 2003;42(4 Suppl 3):S10-S195.
Williams S, Malatesta K, Norris K. Vitamin D and Chronic Kidney Disease. Ethn Dis. 2009;19:S5-8-11.
Nagpal S, Na S, Rathnachalam R. Noncalcemic Actions of Vitamin D Receptor Ligands. Endocrine Rev. 2005; 26(5): 662-687.
Chun Li Y. Renoprotective effects of vitamin D analogs. Kidney International. 2010;78: 134-139.
Teng M, Wolf M, Ofsthun MN et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol. 2005;16:1115–1125.
K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease: Active Vitamin D Therapy in Patients with Stage 3 and 4 CKD. Am J Kidney Dis. 2003;42:S10-S195.
Moe SM, Drueke TB, Block GA, et al. KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney International. 2009;76: S1-S140.
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J Kidney Dis. 2003;42: S1-S202.
Houghton LA, Vieth R. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006; 84(4):694-697.
Steddon SJ, Schroeder NJ, Cunningham J. Vitamin D analogues: how do they differ and what is their clinical role? Nephrol. Dial. Transplant. 2001;16(10):1965-1967. doi: 10.1093/ndt/16.10.1965.

College Connections

Welcome Midwestern University’s ICHP 2014-2015 E-Board!

President, Carolyn Toy – I served as President-Elect this past year and am excited to be the incoming President for Midwestern University's ICHP student chapter! This year, I hope to continue increasing student membership and awareness, and to encourage student involvement both on campus as well as nationally. As a student leader and a future pharmacist, I believe it is important to stay informed about major changes in pharmacy and to continue serving as advocates for our profession, one of which is the implementation of PPMI. I hope to raise awareness of this initiative, as it is a becoming a pivotal component in the advancement of health system pharmacy practice. I also hope to continue providing students with many resources, experiences, and networking opportunities while I am here at Midwestern University.

President-Elect, Jessica Peng - My main goal for the coming year is to prepare to take on the president position in the future. I will do this by exercising my skills with the other e-board members to continue to improve the success of this organization. So far, I plan on working with other e-board members to set up a new mentoring system, find more pharmacy-related volunteer opportunities, and provide more networking events with other student chapters of ICHP. Furthermore, I will uphold the President-Elect responsibilities by corresponding with ASHP, managing the Clinical Skills Competition, attending required retreats, and promoting our organization through the Organization Fair and Organization Showcase. As a team, we hope to provide an even better membership experience for the coming years!

Secretary, Lisa Marie Nguyen - I've been a member of ICHP since fall quarter. I was initially drawn to this organization because of opportunities given to its members to gain a better understanding of the various fields of pharmacy. I continued to stay on with ICHP because of its commitment to advancing excellence in the practice of pharmacy. My goals for this upcoming year are to keep organized records and work in partnership with the board members to ensure that the student chapter runs efficiently and effectively.

Treasurer, Peter Nguyen - My main goal for the upcoming year is to coordinate all aspects of ICHP’s finances and to ensure that concise and detailed records are always kept to enable the organization to run smoothly.

Historian, Saba Hamid – In this next year, I plan on documenting ICHP’s events and accomplishments through the KeePosted newsletter. I want to capture moments that will hopefully entice more people to join and actively participate in ICHP. It’s said that a picture is worth a thousand words, and as historian, I will make sure that the images I capture will tell a great story and represent ICHP in the best possible light.

Fundraising Chair, Lejla Catovic - My goals for the upcoming year include organizing successful fundraising events for ICHP. I also hope to make ICHP more well-known when promoting our fundraising events. I look forward to a great and productive year!

Professional Chair, Cassandra Phan - I'm a P3 at Midwestern University Chicago College of Pharmacy. My goal for the upcoming year is give our members more opportunities to build their networking skills with faculty members and ICHP practicing pharmacists. I want to provide our members with greater knowledge about pharmacists' roles and responsibilities in clinical settings such as critical care, acute care, and ambulatory care. I also hope our chapter can establish a mentorship program for our members with local pharmacists. I'm looking forward to working with the new e-Board and for us to have another exciting and successful year.

Social Chair, Dalila Masic - My goals for the upcoming year include a member social between our chapter and the UIC & Chicago State ICHP chapters for the Fall quarter. Also, I want to plan an evening social for our members with various pharmacists around the area most likely during the winter quarter.

Membership Chair, Kim Pham – I would like to see ICHP further expand their volunteer opportunities within our communities. This may include educating high school students about the profession of pharmacy and what kinds of job opportunities are available in pharmacy besides the retail setting. I would like to continue having new and returning members be more involved in ICHP. This may include participating in volunteer events or putting on a speaker event that may help educate pharmacy students about health-system pharmacy. I would like to hopefully recruit 75+ new members for the upcoming year. Lastly, my goal for this upcoming year is to support my fellow e-board members as needed with any planning or carrying out of each ICHP event. I strongly believe that where there is teamwork and collaboration, amazing things can be accomplished.

Philanthropy Chair, Chau Tran - My goals for the upcoming year are to come up with more hands-on volunteer opportunities involving patients and to be further involved with the community both on and off-campus. I believe that as pharmacy students, it is important to volunteer to practice the skills learned in lecture and to learn from one’s mistakes over time. I look forward to working with the e-board, faculty, and staff in making this year a productive one for our members.

Congenital Muscular Dystrophy: In the Heart of the Clinical Research

by Monal Punjabi, P4, Rosalind Franklin University College of Pharmacy

For the past eight weeks, I have been privileged to be a part of the nation’s largest clinical research center, the Clinical Center of the National Institutes of Health (NIH). I started working as a summer intern at the National Institute of Nursing Research (NINR) during the summer of 2013. After the internship, I continued to provide support for my research projects as a volunteer while I attended pharmacy school in Chicago. I was invited back to join the NINR team once again this summer. This year, my eight-week internship focused on both the validation of a Clinical Severity Score (CSS) for patients with Congenital Muscular Dystrophy (CMD) and the preparation of an investigational new drug application.

CMD is a group of degenerative neuromuscular diseases, which affects skeletal muscle development and function. One of my projects this summer was to develop and validate a CSS in patients with CMD. The goal of the CSS was to categorize patients by their disease severity based on their nutrition, motor function, forced vital capacity, number of contractures, and use of Bilevel Positive Airway Pressure. The Congenital Muscular Dystrophy-Comparative Outcome Measure (CMD-COM) study team evaluated 38 patients with CMD over a period of one week during my time at NIH. The study participants were 5-21 years old and had either Collagen VI related-myopathy or Laminin alpha 2-related dystrophy. Several tests, such as the pediatric quality of life; Egen Klassification; CSS; Brain, muscle and dynamic breathing MRI; muscle ultrasound and many others were administered to all the patients. During my time at NIH, I had the opportunity to work with a team of physical therapists, nurse practitioners, neurologists, nurses, genetic counselors, and many other healthcare professionals with varying expertise. Having been part of an inter-professional educational environment as a student at Rosalind Franklin University of Medicine and Science, it was great to see an inter-professional team at work in the real world setting.

Also during my internship at the NIH, I had the opportunity to attend the Institutional Review Board (IRB) meeting to evaluate a drug study protocol for congenital myopathy. Having never been to an IRB meeting in the past, I didn’t know what to expect. Roughly thirty board members attended the meeting, each with a different area of expertise. The members had reviewed the protocol, including the design, inclusion/exclusion criteria, outcome measures, and safety for the study population. They provided their feedback and asked my supervisor to address the concerns raised regarding the safety and tolerability of the drug in the study population. After the meeting, I was responsible for addressing the drug-related concerns of the IRB, including drug interactions, adverse drug reactions, optimal dose, monitoring for safety and efficacy, and pharmacokinetics and pharmacodynamics of the drug. My supervisor has always challenged, yet encouraged me, to use my classroom knowledge. For example, she asked me to determine the optimal dosing interval of the drug based on its half-life and renal clearance. I was quite excited to use what I earned in the classroom to help make this important study possible.

I realized that pharmacists, as medication experts, are in the perfect position to be a part of the IRB. Pharmacists can provide insight on whether a drug regimen is appropriate to study in a particular patient population. Pharmacists possess unique knowledge of various pathologies and their treatment, which makes them a valuable resource when it comes to clinical trials and protocol designs.

My experience at the NIH will help me become a well-rounded clinician and provide quality patient care. I gained remarkable insight into how research is conducted and all of the effort that goes into designing research studies. I have gained an incredibly different perspective on the role of the pharmacist in research after working at the nation’s largest clinical research center. Based on my experience, at some point in my career I would love to pursue research. The people I met and worked with were profoundly welcoming, motivating and enthusiastic about teaching and mentoring. They had a great impact on my professional and personal development. I am so grateful to have had the opportunity to complete my internship at the NIH and be a part of such an incredible team.

Special thanks to my supervisor, Dr. Katherine Meilleur and everyone on the team for the valuable experience.

What I Learned at the ASHP Summer Meeting

by Stephen Jankovic P3, Past SSHP Vice-President, Roosevelt University College of Pharmacy

Last month, I attended the Networking with Pharmacy Leaders Session and Student Development Workshop at the American Society of Health-System Pharmacists (ASHP) Summer Meeting. These sessions are specifically designed for pharmacy students who attend the ASHP Summer Meeting. The ASHP Summer Meeting is also a great way to gain exposure to national pharmacy conferences (which can seem overwhelming at first).

The first student session I attended was the “Networking with Pharmacy Leaders” session. This session consisted of a roundtable discussion with various pharmacy leaders stationed at tables that students rotated around every 20-30 minutes. There were representatives from almost every aspect of the field of pharmacy, so students were allowed to seek out the leaders in their particular areas of interest. The discussions were very informal and I found that, more often then not, the leaders were more interested in what the students had to say than just giving a generic lecture. I personally felt that this session was the most beneficial because I was able to gain very important insight from pharmacy professionals who have already progressed through their various careers. I was able to learn more about the various challenges that they had along their career path and important things that helped shape who they are today.

I had asked the group to offer one important piece of advice to us as students regarding something they had learned or wished they would have known while they were students that would have helped them throughout their careers. One of the responses was “expose yourself to every available opportunity, especially the ones that you may think you are sure to fail. You will often have to seek these opportunities out; they will not just present themselves. By exposing yourself to as many different things as you can, you end up gaining invaluable experience that you will use time and time again throughout your entire life. You will also come across many individuals who may have already been in your shoes and can lend their valuable advice based on their own past experiences.”

There was also another student program that ASHP had implemented this year that paired students up with a conference “mentor”. The student and mentor met on the first day of the conference to get to know each other and came up with a plan/goal for what they wanted to accomplish during the conference. I was unable to participate in this program this year, but I think it is a wonderful idea to help students gain the maximum amount of value from a national conference that may only offer limited student programming and would highly recommend students sign up for it.

Pharmacy school is a very short time period for us as students. It is also the best time for us to try new things and gain exposure to as many different opportunities as we can fit into our schedule. Didactic coursework is important because it gives us the knowledge that we will rely on as future pharmacists, but emphasis should also be placed on personal growth and development as future successful individuals. Be sure to take advantage of every available opportunity for personal growth and development; seek out every available opportunity. Never be afraid to try new things and never be afraid of failure. Failure is a key component in personal growth and development and should never be frowned upon. I have personally learned so much more from my past failures then I have in my successes. Failure forces you to closely analyze what went wrong and how it could be prevented or corrected in the future. As Winston Churchill once said, “Success consists of going from failure to failure without loss of enthusiasm.”

Officers and Board of Directors

MIKE FOTIS
President
michael.fotis@northwestern.edu

TOM WESTERKAMP
Immediate Past President
224-948-1528
tom_westerkamp@baxter.com

LINDA FRED
President-Elect

217-383-3253
linda.fred@carle.com

GINGER ERTEL
Treasurer
660-342-5022
gertel@msn.com

CAROL HEUNISCH
Secretary
847-933-6811
cheunisch@northshore.org

TRAVIS HUNERDOSSE
Director, Educational Affairs
thunerdo@nmh.org

JENNIFER ELLISON
Director, Marketing Affairs
Jennifer.C.Ellison@osfhealthcare.org

DESI KOTIS
Director, Professional Affairs

312-926-6961
dkotis@nmh.org

KATHY KOMPERDA
Director, Organizational Affairs
630-515-6168
kkompe@midwestern.edu

FRANK KOKAISL
Director, Government Affairs

fkokaisl@amerisourcebergen.com

MIKE WEAVER
Chairman, House of Delegates
815-599-6113
mweaver@fhn.org

ELIZABETH ENGEBRETSON
Technician Representative
847-570-4239
EEngebretson@northshore.org

DAVID TJHIO
Chairman, Committee on Technology
816-885-4649
david.tjhio@cerner.com

DIANA ISAACS
Chairman, New Practitioners Network
disaacs@csu.edu

JACOB GETTIG
Editor & Chairman, KeePosted Committee
630-515-7324 fax: 630-515-6958
jgetti@midwestern.edu

JENNIFER PHILLIPS
Assistant Editor, KeePosted
630-515-7167
jphillips@midwestern.edu

KATHRYN SCHULTZ
Regional Director North

312-926-6961
kathryn_schultz@rush.edu

JENNIFER ARNOLDI
Regional Director Central
jennifer.arnoldi@st-johns.org

KEVIN CHANG
President, Student Chapter
University of IL C.O.P.
kchang29@uic.edu

JULIA SAPOZHNIKOV
Student Chapter Liaison
University of IL C.O.P.
sapozhn1@uic.edu

NEHA KAPUR
President, Rockford Student Chapter
University of IL C.O.P.
kapur4@uic.edu

CAROLYN TOY
President, Student Chapter

Midwestern University C.O.P.
ctoy59@midwestern.edu

MARIA LAURA ITUAH
President, Student Chapter
Chicago State University C.O.P.

KIMBERLEE KABBES
President, Student Chapter
Southern Illinois University Edwardsville S.O.P
kikabbe@siue.edu

COURTNEY MAKOWSKI
President, Student Chapter
Roosevelt University C.O.P.

AMANDA OUTINEN
President, Student Chapter
Rosalind Franklin University C.O.P.
Amanda.outinen@my.rfums.org

SCOTT MEYERS
Executive Vice President, ICHP Office
815-227-9292
scottm@ichpnet.org

ICHP AFFILIATES

PETE ANTONOPOULOS
President, Northern IL Society (NISHP)

1panton@gmail.com

JULIA SCHIMMELPFENNIG
President, Metro East Society (MESHP)
jschimmelpfen@sebh.org

MEGAN METZKE
President, Sangamiss Society
memiller8@yahoo.com

ED RAINVILLE
President, West Central Society (WSHP)
309-655-7331x
ed.c.rainville@osfhealthcare.org

Vacant Roles at Affiliates —
President, Rock Valley Society; Southern IL Society; Sugar Creek Society; Regional Director, South

Welcome New Members!

New Member	*Recruiter*
Georgeta Titean
Heather Malcom
Jaime Kimmel
Sara Jones	Scott Bergman
Ryan Kates
Anne Misher
Erica Fernandez	Jennifer Splawski
Michael Cusumano	Brandi Strader
Meghan Glynn
Michelle Haby
Martina Novotny	Sheila Allen
Gail Lee	Huzefa Master
Kaitlin McArdle
Katie Wdowiarz	Susan Winkler
Carson Bechtold
Radhika Polisetty	Jennifer Phillips
Brad Cannon
Marc Abel	Jolee Rosenkranz
Anne Blackwell	Tim Dunphy
Dina Yousif	Diana Isaacs
Jennifer Pinto

ICHP Pharmacy Action Fund (PAC) Contributors

Names below reflect donations between August 1, 2013 and August 1, 2014. Giving categories reflect each person's cumulative donations since inception.

ADVOCACY ALLIANCE - $2500-$10000
Edward Donnelly

Dave Hicks

Frank Kokaisl

Michael Novario

LINCOLN LEAGUE - $1000-$2499
Scott Bergman
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James Owen Consulting Inc.

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CAPITOL CLUB - $500-$999
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UIC Student Chapter

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GENERAL ASSEMBLY GUILD - $250-$499
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Upcoming Events

Visit the ICHP Calendar for the most up-to-date events!

Thursday, August 14

Clinical Practice and Research Network: Reversal of Warfarin and Other Anticoagulants

Northwestern Memorial Hospital | Chicago, IL

Tuesday, August 19

CPE Event! Sangamiss Program: Practice in a Changing World: Responding to and Influencing Change

Fire & Ale | Sherman, IL

Wednesday, August 20

Deadline! Early Bird Deadline and Hotel Room Deadline for ICHP 2014 Annual Meeting

Thursday, September 11 - Saturday, September 13

ICHP 2014 Annual Meeting

Drury Lane | Oakbrook Terrace, IL

Tuesday, September 9 at 3:00pm & Wednesday, September 17 at 12:00pm

Champion Webinar: Women's Health
LIVE Webinar

Tuesday, November 4 at 3:00pm & Thursday, November 13 at 12:00pm (tentative)

Champion Webinar: Dosing in Hepatic Failure
LIVE Webinar

Print Entire Issue

Plasma PTH pg/mL or [pmol/L]	Serum Ca mg/dL [mmol/L]	Serum P mg/dL [mmol/L]	Dose Oral Calcitriol	Dose Oral Doxercalciferol
> 70 [7.7] (CKD stage 3) Or > 110 [12.1] (CKD stage 4)	< 9.5 [2.37]	<4.6 [1.46]	0.25 µg/day	2.5 µ 3x/week

Plasma PTH pg/mL or [p/mol/L]	Serum Ca mg/dL mmol/L	Serum P mg/dL mmol/L	Ca-P Product	Dose per HD Calcitriol	Dose per HD Paricalcitol	Dose per HD Doxercalciferol
300-600 [33-66]	<9.5 [2.37]	<5.5 [1.78]	<55	IV: 0.5-1.5µg Oral: 0.5-1.5µg	IV:2.5-5.5µg	IV: 2µg Oral :5 µg
600-1000 [66-110]	<9.5 [2.37]	<5.5 [1.78]	<55	IV: 1-3µg Oral: 1-4µg	IV: 6-10 µg	IV:2-4µg Oral :5-10µg
>1000 [110]	<10.0 [2.5]	<5.5 [1.78]	<55	IV: 3-5µg Oral: 3-7µg	IV: 10-15µg	IV: 4-8µg Oral:10-20µg

November 2021

KeePosted Info