The CPhA Western Pharmacy Exchange (WCE) was held February 23-26, 2017 at the Palm Springs Convention Center & Renaissance Hotel.  The WesternU College of Pharmacy students and faculty were actively involved in the program as speakers, delegates and award honorees.  The WesternU also had a booth in Exhibit Hall and hosted a Dessert Reception.  
Janice Hoffman, PharmD, WesternU presented "New Treatments and Drugs on the Horizons for Alzheimer's Dementia" and Tony Park, PharmD, WesternU lectured on "Corresponding Responsibility in Light of New Opiod Prescribing Guidelines and Mandatory CURES Lookup by Prescribers" and "2017 New Laws Update".
WesternU Dean's Advisory Council Member, Victor Law, RPh was awarded the "Pharmacist of the Year", Rudolph Mirales, PharmD received the "Steven C. Feldman Award" for being a leader in compounding and Elizabeth Akhparyan, PharmD Candidate 2017 was honored as "Student Pharmacist of the Year".  In addition, the "CPhA-ASP Innovative Chapter of the Year" award also went to WesternU.  Congratulations!

DIR fees are taking a toll on many independent community pharmacies across the nation but what exactly are DIR fees, how is it impacting the practice of independent community pharmacy owners, and what can they do for now? DIR stands for “Direct and Indirect Remuneration”, and was initially created by the Centers of Medicare and Medicaid Services (CMS) to keep track of money collected by Medicare Part D to offset members’ costs. However, this term has somewhat turned into a misnomer since it encompasses a number of different fees such as the cost a pharmacy pays to participate in a network, the cost of filling a prescription, and reimbursements or fees for meeting or failing to meet quality measures. To make matters worse, these fees are not adjudicated at the point of sale; they are calculated retroactively. In addition, these fees are not disclosed transparently, meaning pharmacy owners don’t know what, why, when, or how much are being taken. This can impact the practice of community pharmacy owners in different ways. Due to the lack of information about how much and when the fees are collected and assessed, it is impossible for pharmacies to determine if the reimbursements will cover the cost of dispensing a prescription which can significantly affect the pharmacy’s ability to provide quality patient care and to remain in business. Many independent pharmacies cater to an underserved population; if these pharmacies opt out of certain plans and networks, not only would it limit the customer base for the pharmacy, it would also increase copay for patients. This just shows how many implications there are to these fees. NCPA has been advocating for greater transparency and to prohibit retroactive DIR fees addressed in senate bill 3308 and companion legislation H.R. 5951 which was introduced in September of 2016. Their advice for pharmacy owners now is to be aware and understand the different terms and conditions when evaluating contracts, and to have any contracting entity
explain the parameters of all contractual terms.

References:
Do DIR Fees Threaten the Viability of Independent Pharmacies?
http://www.specialtypharmacytimes.com/news/do-dir-fees-threaten-the-viability-of-independent-pharmacies

NCPA Backs New Senate Bill
http://www.ncpanet.org/newsroom/news-releases/2016/09/12/ncpa-backs-new-senate-bill-to-en

Image: http://www.ncpanet.org/advocacy/pbm-resources/lack-of-transparency-and-higher-costs/dir-fees

 Posted by Astrid Thio, PharmD Candidate 2018

Pregnant women tend to fall under either one of two extremes: they either avoid all OTC medications to avoid any harmful risks that may afflict their fetus or they believe that since a drug is available as OTC, it must have been approved by the FDA and therefore is safe for all consumers.
While pregnant women should proceed with caution with any OTC medication since there is not enough data to say for certain if a drug is entirely safe to take during pregnancy due to ethical reasons, sometimes the potential benefit of taking a medication outweighs any potential risk to the baby. OTC medications may be needed during pregnancy to treat or alleviate symptoms of allergy, respiratory, gastrointestinal, general analgesia, and fever. If non-pharmacological therapies are ineffective or have failed, here are the top OTC medications that are safer to use during pregnancy:
-For constipation, which is common during pregnancy, Polyethylene glycol 3350 (Miralax), Pregnancy Category C, is the drug of choice, especially for chronic constipation since it has minimal systemic absorption. Stool softeners such as Docusate Sodium (Colace), Pregnancy Category C, are also safer to use.
-Heartburn is another condition that most pregnant women experience, and selective histamine H2 antagonists (Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid), Ranitidine (Zantac), Pregnancy Category B, are safer to use in all trimesters and have no known teratogenic effects.
-For allergic rhinitis, first-generation antihistamines Diphenhydramine (Benadryl), Pregnancy Category B, and second generation antihistamines Cetirizine (Zyrtec), and Loratadine (Claritin) (Pregnancy Category B) are safer to use and have also shown to have no known teratogenic effects.
-For treatment of fever, acetaminophen (Tylenol), Pregnancy Category B was shown to be the safer. While there is still debate about the use of acetaminophen during pregnancy among health professionals, data has shown that when used specifically for fever and as a single agent without routine use, acetaminophen is actually protective against birth defects that fevers may cause. Acetaminophen is also the safest agent to use for pain as long as it is used occasionally.
However, pregnant women should always consult their healthcare professional first, especially during their third trimester, to avoid any interactions, adverse effects, or misuse.  For more information about the pregnancy categories and the safety of other OTC medications, see article below.
References: Servey J, Chang J. Over-the-counter medications in pregnancy. http://www.aafp.org/afp/2014/1015/p548.html#afp20141015p548-c1. Accessed February 17, 2017.
Picture: http://www.drugsdb.com/blog/are-medications-safe-during-pregnancy.html
Posted by Christine Choe, PharmD Candidate 2018

Is the systolic or the diastolic more important in a blood pressure reading? Or is there really no difference? According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, an elevated systolic reading serves as a more significant risk factor for cardiovascular disease compared to an elevated diastolic reading. Systolic blood pressure is the first number in a blood pressure reading that measures the pressure in the blood vessels when the heart beats, and tends to rise with advancing age while diastolic blood pressure tends to decrease with advancing age. This can lead to a phenomenon known as Isolated systolic hypertension, which is when the blood pressure is >140/<90 mmHg, and is subsequently more common in older adults 50 years or older.
Increasing arterial stiffness associated with age is what leads to a rise in systolic blood pressure and the development of isolated systolic hypertension, consequently leading to heart failure and other cardiovascular events. Secondary causes of isolated systolic hypertension include anemia, aortic insufficiency, Paget’s disease, beriberi, and hyperthyroidism, all of which increase cardiac output.
While JNC 8 does not discriminate among ACE inhibitors, calcium channel blockers, or diuretics as initial treatment options for this population, the ESH/ESC guideline recommends a calcium channel blocker or diuretic. Given the age of this population and current studies on this population, a long-acting dihydropyridine calcium channel blocker such as amlodipine is recommended as the initial agent, followed by an ACE inhibitor (Lisinopril) or low-dose thiazide diuretic (chlorthalidone) if necessary.
References:
On Hypertension in the Elderly: An Epidemiologic Shift. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2015/02/19/14/55/on-hypertension-in-the-elderly. Accessed February 21, 2017.Expert Review of Cardiovascular Therapy. Treatment of Isolated systolic hypertension in the elderly: Expert Review of Cardiovascular Therapy: Vol 10, No 11. http://www.tandfonline.com/doi/abs/10.1586/erc.12.117?journalCode=ierk20. Accessed February 21, 2017.
Blood pressure. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets: Blood Pressure: Vol 25, No 6.http://www.tandfonline.com/doi/abs/10.1080/08037051.2016.1236329?journalCode=iblo20. Accessed February 21, 2017.
Picture from:  http://www.idealbloodpressureinfo.com/high-systolic-blood-pressure/
Posted by Christine Choe, PharmD Candidate 2018

On February 22, 2017, Commander Thomas Addison gave a presentation on "US Public Health Service Pharmacy" as part of the Noon Professional Development elective series.  Dr. Addison is a PharmD graduate of the UCSF School of Pharmacy and is now based in the Phoenix, AZ area.  A couple of reflections by students taking the course are posted below:
​Reflection #1:  Minh Luu, PharmD Candidate 2020
Commander Thomas E. Addison gave a lecture on 02/22/2017 about the topic of US Public Health Service Pharmacy and how pharmacists are currently contributing to the healthcare field through the federal programs. This is an interesting topic as it further expanded the role of the pharmacists beyond being a healthcare provider in direct patient care to fields that affect public health culture in the United States. Commission officers are dispatched to several federal programs, most of which are working with the Indian Health Service (I.H.S), Food and Drugs Administration (FDA), and the Federal Bureau of Prisons (BOP). The end goal is to promote improved public health culture in all stages of life  through various means and approaches, ultimately with the intention of preventing diseases on top of  treating at the community level. Students also have various opportunities to work as commission officers through internships opportunities with the Commissioned Officer Student Training and Extern Programs (COSTEP) and rotations with the USPHSP. The COSTEP programs are paid internships and scholarships programs that are aimed at providing further services to the underserved communities.
​Reflections #2:  Andrea Ly, PharmD Candidate 2020
Today, we had a speaker who was exceptionally unique compared to other speakers. Dr. Addison spoke to us as a commander and a pharmacist specializing in US public health services. An interesting topic was surgeon general initiatives. These people guide patients in being compliant with their medications as well as recommend healthy lifestyle. They have other duties such as serving underserved communities, delivering top notch health care, providing behavioral therapy for wounded warriors and their families, and researching new ways to provide help. He informed us of the various federal agencies with career opportunities. There are student rotations at the IHS, FDA, NIH, CDC, USCG and other federal agencies. I am especially interested in FDA because there are many branches to utilize my clinical knowledge. I am, however, intimidated and am not sure how to put my foot in the door. Luckily, Dr. Addison provided websites to refer to. I am also interested doing a residency for IHS since I am challenged to work in a rural area. They also hire many people for these positions.

Mario Jimenez, PharmD gave a presentation about owning your own pharmacy.  He is a former pharmacy owner who now teaches an Advance Elective in Independent Community Pharmacy Ownership.  A couple of reflections from the student taking the Professional Development Elective are posted below:
Reflection #1:  Anahit Tivriktsyan, PharmD Candidate 2020
This seminar was very interesting to me, presented by Dr. Jimenez. I have considered to open my own independent pharmacy after graduation, and Dr. Jimenez gave us a preview of what it would be like. He offers an elective 4th year of pharmacy school, which I wish was offered before. I will be looking forward to taking his elective because they explain how to start from scratch. This includes, how to staff, seek loans, bring in a CPA, wholesaler, human resources peaker, worker’s comp. and so much more. He said when you have your own pharmacy, you get to develop what you want in the pharmacy and what you want to do. Dr. Jimenez was working at Kaiser Permanente Pharmacy and did not realize the opportunity and pros of having your own pharmacy offered, until one day a relative asked him if he thinks work is more important than spending more time with your family. After this, he realized that if he had his own pharmacy he would have flexible hours, draw his own line, and be able to spend more time with family. This is also very important to me and that is one of the main reasons why I would love to open my own independent pharmacy. I am looking forward to taking Dr. Jimenez’s elective.
Reflection #2:  Kwame Quansah, PharmD Candidate 2020
Dr. Jimenez graduated from USC before getting employed at Kaiser for 13 years. He expected to be at Kaiser for the rest of his career until 2010 when he decided to quit.  A friend suggested community pharmacy and offered a store. He felt in the beginning that it was the best decision of his life; he worked there for 28 years and served many patients. This was the beginning of MTMs  and immunizations.  At WesternU, he teaches and prepared students especially those interested in community pharmacy. We all have in our mind that we want to be clinicians and work in hospitals but there are many schools out there. Opening a store is huge commitment but pays off in the end. Working in private community pharmacy is way more satisfying than working in chain retail. It takes a lot to run a community pharmacy, it also takes a lot to work for chain retail stores. Things change quickly in places like Kaiser because the hospital seeks to lower costs and this leads to frustration and uncertainty when it comes to job security. He works with Dr. Mireles to guide and help students to know what to look for, how to run the business and what business plan you can take. Professionals are invited to these lectures to guide and educate students on various aspects of running a business .

On February 8, 2017, Professor Roger Klotz gave a presentation as part of the Noon Elective series on "A Brief History of Pharmacy".  A couple of reflections written by student pharmacists taking the course are posted below:
Reflection #1:  Leticia Arreola, PharmD Candidate 2020
Professor Klotz, started his pharmacy career as a high school freshman working at a community pharmacy.  The owner and pharmacist Doc Kopp took Professor Klotz under his wing.  He taught him that it is very important for the pharmacist to consult, even on over the counter medications and points out that most over the counter medications were once prescription.  He emphasizes the need to assess a patient visually when consulting.  From his lecture I understand how pivotal it is to be a diversified pharmacist specializing in more than one branch of pharmacy and knowing about accreditation to continue practicing as a pharmacist.      As a student pharmacist he learned compounding.  After graduating, he learned about INR testing, billing and TPN, starting a weight loss program, billing for medical services.  He has also gotten involved in home care infusion.       He is one of the most diversified pharmacist I have ever known of.  This is nothing like what I thought a pharmacist’s job would entail, it is so much more.  However, it is enlightening to see a preview of what will be expected of me when I graduate.  Documenting is a must.
Fadi Hasso, PharmD Candidate 2020
Listening to Professor Klotz was an inspiration to say the least. It was all based on his personal experience as a successful and a well-rounded pharmacist who had entered the profession with one mission, helping others. He explained how he got involved in the field and how his mentor (Doc Kopp) manifested something much bigger in him for the profession through an ethical and moral approach. Professor Klotz seems to really cherish Doc Kopp’s ideology to the extent of adapting it himself and passing it on. The ideology basically embraces the profession of a pharmacist to its full extent which includes and not limited to compounding, clinical practice, communication with other healthcare professionals, and most importantly with patients to provide the utmost quality healthcare. Professor Klotz stressed the importance of assessing all patients and their profiles from every angle to make the best conclusions. He also gave multiple examples of how such practice saved so many lives, especially when it is practiced by pharmacists, the professionals whom are readily available to the community and thereby can make all the difference. Professor Klotz also spoke about the impact that an expert pharmacist can have at hospital settings, where a pharmacist can solve drug related mysteries physicians are simply not trained to solve. He also spoke of his own experience of owning a pharmacy and discussing all the services that he made readily available to the public from personalized weight control and smoking cessation programs, basic laboratory tests and screenings, medical supplies, immunizations, sterile compounding, and lastly but not least medication therapy management.