MAR. 2010

PRSRT STDUS POSTAGEPAIDTALLAHASSEE, FLPERMIT NO. 801

Seasonal and H1N1 Influenza Immunizations: Perspective and Guidance for Florida Pharmacists

2 | F l o r i d a P h a r m a c y T o d a y

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Vol. 73 | No. 3march 2010 The oFFicial PublicaTioN oF TheFlorida Pharmacy associaTioNP H A R M A C Y T O D A Y

florida

Departments 4 calendar

4 advertisers

5 President’s Viewpoint

7 executive insight

18 Poster abstracts

23 buyer’s Guide

FeaturesFPa officer and director Nominations

seasonal and h1N1 influenza immunizations: Perspective and Guidance for Florida Pharmacists

ed hamilton completes Term as aPha President

1011

26

4 | F l o r i d a P h a r m a c y T o d a y

E-MAil youR suggEstions/idEAs to

dave@fiorecommunications.com

Mission Statements:of the Florida Pharmacy Today JournalThe Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic is-sues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congru-ent with its expressed mission.

of the Florida Pharmacy Today boardof directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capac-ity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Associa-tion members to secure appropriate advertising to assist the Journal in its goal of self-support.

AdvertisersASCP ................................................................... 24Dr. OJO ................................................................ 2HeAlTHCAre COnSulTAnTS ....................... 3KAHAn ◆ SHIr, P.l. ........................................ 14MCKeSSOn ......................................................... 9PHArMACY PrOVIDer

SerVICeS (PPSC) .......................................... 2PHIlADelPHIA COllege ............................. 13rx relIeF ......................................................... 14

2010

FPA Calendar MARch

23 - 25 Pharmacy LegisLative Day at the FLoriDa caPitaL

24 FLoriDa Pharmacists heaLth Fair

27 - 28 FPa committee anD counciL meetings anD BoarD oF Directors

APRil

2 FPa oFFice cLoseD (gooD FriDay)

13 - 14 FLoriDa BoarD oF Pharmacy meeting

Ft. Lauderdale, Florida

16-18 FPa cLinicaL consuLtant conFerence Tampa Airport Marriott

30 LegisLative session enDs

MAy

2-4 nasPa LeaDershiP conFerence

Austin, Texas

10 - 12 2010ncPa LegisLative conFerence

Washington, DC

15 FPa LeaDershiP retreat

19 aDvisory counciL on Pharmacy Practice - FLoriDa Pharmacy counciL Post session conFerence caLL

26 - 28 ascP miDyear cLinicaL conFerence

Phoenix, Arizona

31 memoriaL Day, FPa oFFice cLoseD

JunE

8-9 FLoriDa BoarD oF Pharmacy meeting

Tampa, Florida

30 - 1 FPa annuaL meeting anD convention, marco isLanD marriott

July

5 FPa oFFice cLoseD

10 - 14 aacP annuaL meeting

Seattle, Washington

30 FPa LegisLative committee meeting Orlando, Florida

cE cREdits (Ce cycle)The Florida Board of Pharmacy requires 10 hours lIVe Continuing education as part of the

required 30 hours general education needed every license renewal period.Pharmacists should have satisfied all continuing education requirements for this biennial

period by September 30, 2011 or prior to licensure renewal.*For Pharmacy Technician Certification Board Application, exam Information and Study

materials, please contact ranada Simmons in the FPA office.For More Information on Ce Programs or events:Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www.

pharmview.com

contActsFPA — Michael Jackson (850) 222-2400FSHP — Michael McQuone (850) 906-9333u/F — Dan robinson (352) 273-6240FAMu — leola Cleveland (850) 599-3301nSu — Carsten evans (954) 262-1300

disclAiMER Articles in this publication are designed to provide accurate and authoritative information with re-spect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

For a complete calendar of events go to www.pharmview.com

m a r c h 2 0 1 0 | 5

The Florida State Pharmaceutical Association (now known as the Florida Pharmacy Association)

was founded on June 9, 1887, by a ded-icated group of Duval County phar-macists in the Board of Trade Rooms in Jacksonville, Florida. Since its incep-tion, the Association has been a driv-ing force in implementing the highest standards for the practice of pharmacy, the educational requirements for phar-macists and the quality of care for the citizens of Florida. The mission then was much the same as the FPA mission now, which is to serve, represent and assist Florida pharmacists to advance the profession and practice of pharma-cy.

Dr. Hy Robinson, the first president of the Florida State Pharmaceutical As-sociation, initiated the first important event in Florida’s pharmacy history during his presidential address at the second annual meeting in Tallahassee in 1888. He stated that the current leg-islation pertaining to dealers in drugs and medicines were useless and that the state needed a Board of Pharmacy.

Armed with $500 allocated by the Association members, the Legislative Committee pursued legislation and the Florida Legislature passed a bill in 1889 creating the Florida Board of Pharma-cy. Before passage of this legislation, a person wishing to become a phar-macist was required to appear before three physicians in the county in which he lived and pass whatever kind of ex-amination they wished to give him. This new law certainly was a huge step forward to ensure standardization of educational requirements and the com-petency of pharmacists.

The second important event in Flor-

ida’s pharmacy history was the estab-lishment of a School of Pharmacy at the University of Florida on Septem-ber 10, 1923. In advocating for a School of Pharmacy, President William G. Per-ry stated, “So we should work for our University School of Pharmacy. Recon-struction of educational methods since the World War has given a new impe-

tus to the study of pharmacy, and the ablest thinkers in the calling are unani-mous in the belief that higher entrance requirements and more scientific train-ing are necessary to meet the demand for well trained pharmacists.”

He appointed a committee to work for the establishment of the school. They were successful in obtaining the necessary appropriations by the Legis-lature but had to obligate the pharma-cists of the state to underwrite any ad-ditional amount over $10,000 and up

to $15,000 to equip the school of phar-macy. The total amount contributed by the Association was $5,104.40 to estab-lish the school. In 1935, a bill sponsored by the Association was passed by the Florida Legislature permitting women to enter the University of Florida Col-lege of Pharmacy, which made the Col-lege of Pharmacy the first coeducation-al College at the University.

As the University grew and higher academic standards were required of the graduates of the College of Phar-macy, an increased need for education-al requirements for practicing pharma-cists was identified by the Association. This led to a third important event in Florida’s pharmacy history when Pres-ident Felix Donatelli recommended in 1966 that continuing education be a prerequisite for pharmacy license re-newal. In 1968, the state of Florida passed the first law in the nation mak-ing continuing education mandatory for license renewal.

Armed with $500 allocated by the

Association members, the Legislative

Committee pursued legislation and the Florida Legislature

passed a bill in 1889 creating the Florida Board of Pharmacy.

Florida Pharmacy Association Through the Years

The President’s ViewpointguEst coluMnist KAthy PEtsos, B. PhARM

Kathy Petsos, B. Pharm

6 | F l o r i d a P h a r m a c y T o d a y

The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.

Norman Tomaka ....................................Chairman of the Board of DirectorsKaren Whalen ..............................................................................................FPA PresidentDon Bergemann ....................................................................................................TreasurerAlexander Pytlarz .................................Speaker of the House of DelegatesDean William Riffee ..................Vice Speaker of the House of DelegatesPreston McDonald, Director ...........................................................................Region 1Marcus Dodd-o, Director .................................................................................Region 2Al Tower, Director .................................................................................................Region 3 Raul N. Correa, Interim Director ................................................................Region 4 John Noriega, Director ......................................................................................Region 5 Chris Lent, Director ..............................................................................................Region 6Kim Murray, Director ........................................................................................... Region 7Joy Marcus, Director...........................................................................................Region 8Ayala Fishel, Director ..........................................................................................Region 9Peter Iafrate ............................................................................................ President FSHPMichael Jackson .......................................Executive Vice President and CEO

Florida Pharmacy today Journal Board

Chair Designate ...................................... Betty Harris, beejpharm@gmail.comTreasurer ...................Stephen Grabowski, sgrabowski@seniormmc.comSecretary ..................................................................Stuart Ulrich, Stuarx@aol.comMember ............................................................ Don Bergemann, don@bceinfo.comMember ................................................Joseph Koptowsky, docjik1215@aol.comMember ..............................................Jennifer Pytlarz, jlc_rxdoc@hotmail.comExecutive Editor ...............Michael Jackson, mjackson@pharmview.comManaging Editor ..................Dave Fiore, dave@fiorecommunications.com

2009/2010 FPA Board of directors The next step forward in education came in 1983 with the passage of the Consultant Pharmacist Act. This law allowed for collaboration with phy-sicians under protocol and allowed pharmacists to order lab tests and ad-just medications for patients. Then in 1985, the Pharmacist Selfcare Consul-tant Act was passed by the Associa-tion allowing pharmacists to prescribe higher doses of medications available over the counter in lower dosages, i.e. the pharmacist could prescribe 600 mg of Ibuprofen for short-term use. This necessitated increased educational re-quirements for pharmacists to ensure proper assessment of the patient.

In 1998, the Association advocated before the Board of Pharmacy to re-quire that five of the 15 hours need-ed per year for license renewal be ob-tained through live sources such as a seminar. The Association was success-ful as the prevailing view was that the interaction between pharmacists and the networking these type of venues provide is as important to the educa-tional process as the content of the lec-ture.

The last important event in Florida’s Pharmacy history as far as increased educational requirements are con-cerned was the enactment of the Phar-macist Immunization Services Bill in 2007 by the Florida Legislature. This was a hard fought battle but necessary to the quality of and accessibility to life-saving health care for the citizens of Florida. This has put pharmacists on the front line of caring for patients and increased our role on the health care team.

Other initiatives that the Associa-tion has undertaken to improve the quality and safety of care to patients are the Quality Related Events Project (2003), Continuous Quality Improve-ment (2004), Behavioral Health Project with USF (2006), the APhA Diabetes 10 Cities Challenge (2006) and the Techni-cian Registration Law (2008 in collabo-ration with FSHP).

Our Association has a proud legacy of advancing the profession, promoting the highest educational standards for pharmacy practice and improving the quality of care for our patients. n

m a r c h 2 0 1 0 | 7

At the risk of sounding elit-ist, I will take this opportuni-ty to share with my pharma-

cist brethren that business as usual is at the frontier of change. We all know that traditional health care is going to be different regardless of what the “Rs” or “Ds” in Washington do. While both significant political parties in our na-tion’s capital are squabbling over who has the best reform plan, our patients are living in a nightmare of medical misadventure reality.

Our current medical model has been built on a foundation of silo manage-ment with walls so thick that the only way to deal with the bureaucracy and hurdles is to own your own health care company, self insure or throw up your hands in despair. This was not that much of an issue when the patient had more to say about their health care de-cision making. With managed care or-ganizations heavily involved in the fi-nancing of health care, the medical home model has been driven by dol-lars with little emphasis on outcomes. This has been apparent with pressure on pharmacy providers to drive criti-cal revenue through increasing volume in the face of declining reimbursement. There is almost a disincentive to take time to actually drill into a patient’s medical history if there is evidence of a clinical problem.

Patients admitted to inpatient in-stitutions these days have their stays shortened. This means that they are re-leased into the community with a hope that the right decisions will be made. Sometimes these decisions are execut-ed with less-than-optimal information and without benefit of provider collab-oration on the clinical issues. Remem-

ber that our theme this year is collabo-ration is key.

During the FPA’s 2009 annual meet-ing and convention, we heard a presen-tation by FPA member Mary Kay Ow-ens. In that presentation, there was a study performed in which the medi-cal costs related to patients whose care was uncoordinated was $15,100 com-pared to $3,116 for patients whose care was being coordinated. Some of this uncoordinated care behavior included (but was not limited to):

n using many different prescribers and pharmacies,

n accessing the ER for primary care, n avoidable ER and hospitalization

visits, n excessive narcotic use, n excessive and/or duplicative drug

use, n excessive and/or random drug

changes within therapeutic classes by different prescribers, and

n inconsistent drug usage and adher-ence patterns.

Policy discussions in Washington, D.C., and to a lesser extent here in Tal-lahassee, have begun focusing on a physician-centered medical home mod-el. During the 2009 legislative session, we reported that in Senate Bill 1986 the Agency for Health Care Adminis-tration was directed to develop a plan to implement a medical home pilot project that utilizes primary care case management enhanced by medical home networks to provide coordinat-ed and cost-effective care that is reim-bursed on a fee-for-service basis. The purpose of the pilot project is to com-pare the performance of medical home networks with other existing Medic-

aid managed-care models. Language in the bill specifically states that each medical home network SHALL provide pharmacy services in addition to other services.

There are published principles for the inclusion of pharmacist services in patient center primary care medical home. We believe that the most suc-cessful models will have considerable pharmacist involvement. The princi-ples are as follows:

Principles for inclusion of Pharmacists’ clinical services in the Patient-centeredPrimary care Medical home

Consistent with the perspective and recommendations of the Institute of Medicine (IOM), pharmacists’ clinical services that enhance the quality, safe-ty, and effectiveness of medications -- the principal treatment modality for the vast majority of chronic diseases -- should be considered an integral com-ponent of the patient centered primary

Executive InsightBy MichAEl JAcKson, RPh

Your Pharmacist is Critical to a Successful Medical Home Model

By MichAEl JAcKson, FPA ExEcutivE vicE PREsidEnt/cEo

Michael Jackson, B.Pharm

8 | F l o r i d a P h a r m a c y T o d a y

Executive Vice President/CEOMichael Jackson

(850) 222-2400, ext. 200Director of Continuing Education

Tian Merren-Owens, ext. 120Controller

Wanda Hall , ext. 211Membership CoordinatorRanada Simmons , ext. 110

Educational Services Office AssistantStacey Brooks , ext. 210

FloRidA PhARMAcy todAy BoARdChair Designate .......Betty Harris, Lighthouse Point Treasurer ..............................Stephen Grabowski, TampaSecretary ........................Stuart Ulrich, Boynton BeachMember ................Don Bergemann, don@bceinfo.comMember .................................... Joseph Koptowsky, MiamiMember ..................................... Jennifer Pytlarz, BrandonExecutive Editor ........Michael Jackson, TallahasseeManaging Editor ........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2010, FLORIDA PHARMACY JOURNAL, INC.ARTICLE ACCEPTANCE: The Florida Phar-macy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today.

The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board.

FLORIDA PHARMACY TODAY, Annual sub-scription - United States and foreign, Indi-vidual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax.

Florida Pharmacy association

610 N. Adams St. • Tallahassee, FL 32301850/222-2400 • FAX 850/561-6758

Web Address: http://www.pharmview.com

FPA STAFF care medical home. The effective inte-gration of pharmacists’ clinical servic-es within the patient-centered primary care medical home should be based on the following essential principles:

Access to pharmacists’ clinical ser-vices: provision of pharmacists’ clinical services should be a fundamental com-ponent of the patient-centered primary care medical home;

Patient-focused collaborative care: development, implementation, and monitoring of medication treatment plans, including an effective system for medication reconciliation that supports patients in their transitions among care settings, should be accomplished through a patient-focused, collabor-ative process of clinical consultation and decision making that incorporates the synergistic and complementary knowledge and skills of the prescribing professional(s) and pharmacists within the medical home practice;

Flexibility in medical home design: innovative and flexible practice struc-tures that integrate pharmacists’ clin-ical services should be encouraged to meet the needs of individual pa-tients being cared for within the med-ical home. Incorporation of pharma-cists and their services either by their physical presence within the practice or through the design of effective “com-munity linkages” should be considered to meet geographic and practice setting needs and variations;

Development of outcome measures: objective measures for assessing the clinical outcomes, safety, and cost-ef-fectiveness of medication use in the population being served by the patient-centered medical home must be a com-ponent of the practice’s broader quality performance measurement system;

Access to relevant patient informa-tion: all members of the medical home patient care team, including pharma-cists, must have access to necessary and appropriate patient health and medi-cal records to support and inform their clinical service and decision-making functions. This access must also include the authority and responsibility to in-put information into these records to facilitate enhanced team-based knowl-edge and information support for the

respective clinical and decision-making responsibilities of team members;

Effective health information tech-nology: expansion and effective use of health information technology must be promoted to support more complete in-tegration of pharmacists as care provid-ers within the medical home practice structure; and

Aligned payment policies: payment policies should be aligned to (1) effec-tively support the medical home, (2) provide reasonable and adequate pay-ment for pharmacists’ clinical servic-es as an element of the scope of ser-vices that are eligible for payment to either the providers or the practice, and (3) promote the achievement of higher quality, safer, and more effective ther-apeutic outcomes from medication use through enhanced provider collabora-tion.

You cannot build a home that can withstand the elements without a sol-id foundation and a durable roof struc-ture. Such a structure in Florida should include hurricane clips, lots of masonry and wind-resistant windows. In a med-ical home you need just as much med-ical protection that can be provided by today’s practicing pharmacist. With high-powered complex medication de-livery systems on the market and the clinical issues that can occur from the absence of a comprehensive review by a clinical pharmacist, a medical home model will struggle to achieve its po-tential for success.

Pharmacists who would like to in-sert themselves into a medical home model that includes medication thera-py management services will need to consider spending June 30 – July 4, 2010 with us at our annual meeting in Marco Island. We have over 30 hours of con-tinuing education that will be available with a number of programs geared to-ward preparing you to provide medica-tion therapy management services. See you in Marco Island. n

m a r c h 2 0 1 0 | 9

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10 | F l o r i d a P h a r m a c y T o d a y

cAll FoR FPA oFFicER And diREctoR noMinAtions for 2011 Elections

The FPA By-Laws specify that any subdivision or any member in good standing may nominate one per-son for the office of President-Elect and one person for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The trea-surer shall serve a two year term and may succeed to one consecutive term of office in that capacity. Nomi-nees must be Florida registered pharmacists in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Nominees for presi-dent-elect should have a good understanding of how the Association functions and should be current on the issues impacting pharmacy. Nominees for trea-surer should have good analytical skills and experi-ence and ability in financial management and budget preparation.

There are nine regional Board Directors who shall serve two year terms. Nominees must be a Flori-da registered pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Additionally, Board Directors must be a member of at least one the FPA Unit Associations within their region. Board Directors terms are stag-gered such that even numbered regions shall be elect-ed in even numbered years and odd numbered re-gions shall be elected in odd numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annu-al meeting of the second ensuing year.

FPA CANDIDATE NOMINATION FORMI AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

NAME:

ADDRESS:

FOR THE FOLLOWING OFFICE:(Nomination Deadline September 1, 2010)

q President-Electq Treasurerq Board Director Region 1 (Units: Escambia, Okaloosa-Walton, Leon,

Alachua) Region 3 (Units: Pasco-Hernando, Pinellas) Region 5 (Units: Hillsborough, Polk) Region 7 (Units: Palm Beach, Gulfcoast) Region 9 (Units: Broward)

NOMINATED BY:

NAME:

DATE SUBMITTED:

SIGNATURE:

MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301

(850) 222-2400 FAX (850) 561-6758

DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2010

FPA Officer and Director NominationsAlthough we have just finished the election for a president-elect and directors for the even num-bered regions to be installed at the 2010 annual meeting, it is time to start thinking about nominees for the 2010 election since the nomination deadline is September 1 of this year (9/1/10). As the form below indicates, this year we will need candidates for president-elect, treasurer, and directors for the odd numbered regions. Please note that you may nominate yourself.

m a r c h 2 0 1 0 | 11

The 2009-2010 season has been marked with the resur-gence of a swine influenza virus and the need to mass vac-cinate many individuals (not only with one vaccine, but with two). Educational programs are in place for Florida pharma-cists to receive certification—and to properly manage vac-cine storage and handling, and to submit for billing. Many pharmacists, however, have been largely preoccupied with the fear of anaphylactic reactions, thimerosal, Guillain-Barre Syndrome (GBS), and uncertainty surrounding the H1N1 vac-cines. While the topics of anaphylaxis and GBS are broached during educational programming, it is usually from a per-spective of screening and management rather than placing focus on the root etiology (GBS), or the real risks (anaphy-

laxis). And, unless pharmacists have been afforded the time to independently research the development of the new H1N1 vaccines, they will have limited information to share with patients. Therefore, many pharmacists (even if not admin-istering vaccinations) may unknowingly provide misguid-ed or incomplete information to patients when asked about H1N1 vaccines, GBS, risk of anaphylaxis from vaccine ingre-dients, or vaccine safety when patients present with specific concomitant health states. Some adjunctive background and additional information can fill in this gap and allow pharma-cists greater confidence when providing information to pa-tients, and to assist in optimal decision-making when admin-istering vaccines.

In addressing these concerns individually, first discussion will be given to thimerosal—as one of the greatest concerns for pharmacists is patient allergy to thimerosal. It is beyond the scope of this article to force a conclusion or dissuade a link between thimerosal and ‘health disorders;’ however, the issues of ‘anaphylaxis’ and other potential ‘health disorders’ from exposure to thimerosal need to be distinctly separated for discussion. thimerosal

Thimerosal, used as a preservative, is a mercury-contain-ing organic compound (~50% mercury by weight) which is metabolized to ethyl mercury and thiosalicylate. Ethyl mer-cury is different than methylmercury (in which toxicity oc-curs through consumption of seafood, through industrial discharge or accidental release into the environment). The two forms have different toxicological profiles an in patient populations, and specific pharmacy/pharmacist protocols may exclude vaccinating certain patient populations (such as pregnant women), it is still important for pharmacists to know the current agency positions regarding use of thimer-osal-containing H1N1 vaccines. The statement of the USPHS, Advisory Committee on Immunization Practices (ACIP), American Academy of Pediatrics ( AAP), American Acad-emy of Family Physicians (AAFP), and other experts is that use of vaccines that contain thimerosal is preferable to with-holding vaccination. ACIP further states that benefits of in-fluenza vaccination for all recommended groups (including pregnant women and young children) outweigh concerns related to theoretical risks of vaccination with preparations containing thimerosal. AAP further states that the benefits of protecting children (including children at high risk with un-

Seasonal and H1N1 Influenza Immunizations: Perspective and Guidance for Florida Pharmacists By April s. Brown, Pharm.d.FPA Member and immunizing Pharmacist, Palm Beach Atlantic Alumnus

SEASONAL IMMUNIZA T IONS

12 | F l o r i d a P h a r m a c y T o d a y

derlying CNS disorders) outweigh the hypothetical risks as-sociated with the minute amounts of thimerosal contained in currently available influenza vaccine preparations.

Anaphylactic Reactions As far as the risk of ‘anaphylaxis’ from thimerosal, phar-

macists should be aware of clinical distinctions from vaccine additives which are likely to evoke a sensitivity response, and additives which are likely to elicit anaphylaxis (if underlying patient allergy exists).

Thimerosal is used [in low concentrations] not only in vac-cines, but in cosmetics, ophthalmic and otolaryngolic medi-cations, antitoxins, topical and intramuscular steroid prepa-rations, and intradermal tests. Thimerosal has two distinctive components, an organic mercury compound and thiosalicy-late, both of which are involved in thimerosal allergy.

Thimerosal is the fifth most common allergen, according to the North American Contact Dermatitis Group (NACDG). However, the rate of reactivity is 10.2% with a designated clinical relevance of 7.2%, making it one of the ‘least’ clinical-ly relevant of the 65 allergens tested by the NACDG. Most pa-tients with a clinically relevant thimerosal allergy are women with a periorbital dermatitis from thimerosal in eye cosmet-ics or contact lens solutions. These manifestations are local, delayed-type hypersensitivity reactions. Thimerosal, when administered as components of vaccines, have only extreme-ly rarely been reported to cause generalized reactions mani-fested as pruritus and an erythematous, maculopapular rash on all four extremities.

Even when patch or intradermal tests for thimerosal sensi-tivity are positive, most individuals do not develop immedi-ate hypersensitivity reactions to thimerosal in vaccines. Fur-ther, the Advisory Committee on Immunization Practices (ACIP) states that a history of delayed-type hypersensitivity to thimerosal is not a contraindication to use of vaccines con-taining thimerosal.

Of the approximately 235 million doses of (all) vaccines given annually in the U.S., only 1 dose per million causes anaphylaxis from any vaccine component. Allergic reactions may be caused by the vaccine antigen itself (although this is extremely rare), or to residual animal protein (antigen har-vested from chick embryos), antimicrobial agents (neomycin/ polymyxin), preservatives (thimerosal), stabilizers (gelatin), or other vaccine components. Again, while immediate hyper-sensitivities are rare to thimerosal from vaccines, precaution should be used to identify individuals who have allergies to chicken/egg protein, neomycin, polymyxin, and gelatin—as these are responsible for most immediate, life-threatening anaphylactic reactions. A very thorough screening for these allergies is of pinnacle importance. While unexpected aller-gies can and do occur, most individuals will know whether they can safely eat eggs or Jell-O and can be screened rath-er easily. When screening for allergy to neomycin and poly-myxin, patients most readily identify these substances when prompted that they are antibiotics found in Neosporin.

To reiterate, the risk of anaphylaxis is extremely remote.

Only about 1 vaccination per million will result in anaphy-laxis. And, the majority of these reactions are to egg, antibi-otic, or gelatin substances—not to thimerosal. Any patient stating an allergy to these components should be referred to an allergist for possible confirmation of IgE, and administra-tion of vaccine in graded doses while the patient is under ob-servation.

guillain-Barre syndrome GBS is a demyelinating disease where segments of myelin

are stripped from their insulating position around nerves. This causes loss of reflexes, muscle weakness, and tempo-rary paralysis (loss of muscle strength). The main symptoms of GBS are symmetrical weakness, numbness, tingling, and prickling. Muscle weakness typically begins distally and is most common in the legs, often spreading proximally to the arms. Pain is experienced in about half of all patients, which is sometimes described as severe with even the slight-est of movements—similar to muscular discomfort following strenuous exercise.

In the U.S. an estimated 3,000 to 6,000 people develop GBS each year on average, whether or not they received a vaccina-tion. This is about 1 to 2 cases of GBS per 100,000 people. GBS is generally considered an autoimmune disease, with the im-mune system mistakenly attacking myelin (axons). Symp-toms can progress within a matter of hours or days and usu-ally peak with a nadir of muscle weakness within two to four weeks. A plateau with unchanging symptoms follows, and improvement begins within days of the plateau. The recov-ery period may be as little as a few weeks to several months. About 85% of patients achieve a full and functional recov-ery from GBS within 6 to 12 months, but others have some degree of extended or permanent nerve damage. Relapse oc-curs in a small percentage of patients (3-5%). Patients may ex-perience muscle weakness and tingling sensations years after the initial attack. The mortality rate is less than 5% in tertiary care centers with medical professionals who are familiar with GBS management.

All GBS cases need to be admitted to a hospital for close observation for respiratory compromise, cranial nerve dys-function, and autonomic instability (e.g. fluctuations in blood pressure, and cardiac dysrhythmias), and possible need for intubation and mechanical ventilation. Immunotherapy should be initiated early after motor symptoms appear but is unnecessary in mild cases where no motor symptoms are exhibited. There is no cure for GBS. Treatment is supportive and includes plasmapheresis and high-dose IV immunoglob-ulin (IVIG). Predictors for poor outcome include age great-er than 60, rapidly progressing disease, mechanical ventila-tion for more than one month, and preexisting pulmonary disease. In general, poor long-term prognosis is directly re-lated to the severity of the acute episode and delay in onset of specific treatment. Therefore, pharmacists should be dili-gent in instructing patients to report any symptoms of mus-cle weakness accompanied by tingling in the extremities to their health care provider immediately.

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m a r c h 2 0 1 0 | 13

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While the underlying pathophysiology and etiology of GBS (and its subtypes) are not completely understood, what researchers do know about GBS is that acute infectious ill-nesses are well-known antecedent events. About two-thirds of all cases of GBS follow an acute respiratory or gastroin-testinal/diarrheal infection. GBS symptoms appear several days or weeks after the illness. Infection with the bacterium Campylobacter jejuni is by far one of the most common risk factors for GBS. In one study of 103 patients with GBS, 26% were positive for C. jejuni compared with 2% of household

contacts and 1% of age-matched controls. 70% of the patients with C. jejuni infection reported a diarrheal illness within 12 weeks of GBS symptoms. The body’s immune system may mistakenly attack itself because the surface of Campylobacter bacteria contains polysaccharides that resemble formations on nerves. This has been called cross-reactivity or ‘molecu-lar mimicry.’

Other microbes confirmed to be associated with GBS in case-controlled studies or found in large number or series in-clude: Cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, HIV, and Mycoplasma pneumoniae. GBS occurs in all age groups (although rarely in infants), and the incidence is fairly uniform with the exception of two peaks. The first oc-curs in late adolescence/young adulthood, which likely cor-relates with increased risk of cytomegalovirus and C. jejuni infection. The second peak occurs in the elderly which is pos-tulated to be caused by failing immune suppressor mecha-nisms.

Since it is believed that immune stimulation plays a role in the pathogenesis, and since vaccines have an effect on the im-mune system it is biologically plausible that immunizations may be associated with subsequent development of GBS. Many researchers continue to look for evidence to support or reject causal associations between various vaccines and GBS. In general, literature reviews indicate that, with rare excep-tions (e.g. rabies vaccine used in U.S. prior to 1980 in which an association may have been present due to contamination

In general, literature reviews indicate that, with rare exceptions (e.g. rabies vaccine used in U.S. prior to 1980 in which an association may have been present due to contamination with myelin antigens from the animal tissue which acted as the viral culture media), associations between vaccines and GBS have been largely temporal.

SEASONAL IMMUNIZA T IONS

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with myelin antigens from the animal tissue which acted as the viral culture media), associations between vaccines and GBS have been largely temporal.

The evidence for a causal association is strongest for the swine flu vaccine that was used in 1976-77. Because a pan-demic similar to the swine flu of 1918 was expected in 1976-77, the government had set an unprecedented goal for immu-nization and instituted a special surveillance program. This may have contributed to increased physician questioning of muscle weakness or caused physicians to diagnose oth-er neurologic disorders as GBS if patients had documenta-tion of swine flu vaccination. After many analyses, howev-er, most scientists who have studied the data conclude that the 1976 influenza vaccine and GBS were linked. But, most also conclude that if an influenza epidemic had materialized, the level of GBS may well have been considered acceptable in exchange for a lower death rate from influenza. When the threatened pandemic did not materialize the swine-flu vacci-nation program was abruptly terminated in mid-December 1976. The risk during the 1976-77 season increased by about 1 case per 100,000 vaccinations above the expected background rate. While CDC scientists found a slightly elevated rate of GBS among persons aged 18 to 65 during the 1990-91 influ-enza season, the only two influenza vaccination seasons (vac-cine strains based on the year’s circulating strains) which have been associated with GBS since 1976-77 were 1992-93 and 1993-94.

In a September, 2009 report, epidemiological and out-comes researchers used the Vaccine Adverse Event Report-ing System (VAERS) to determine rates of GBS after adminis-tration with various vaccines. In the years 1990 to 2005, 1,000 cases of GBS were reported (mean age, 47 years) after vac-cination. The highest number (n=632) of GBS cases was ob-served in subjects receiving influenza vaccine followed by hepatitis B vaccine (n=94). Researchers concluded that death and disability rates were comparable to the reported rates in the general GBS population. Spontaneous reports to VAERS shortly after introduction of quadrivalent conjugated menin-gococcal vaccine (MCV4) raised concerns of a possible asso-ciation with GBS. Comparisons with expected rates were in-conclusive and the lack of controlled epidemiological studies makes it difficult to draw a conclusion about a causal associ-ation.

Two vaccines, which the Institute of Medicine (IOM) had previously favored a causal relationship (oral polio vaccine and tetanus toxoid-containing vaccine) have subsequent-ly been found to have no correlation. Large epidemiologi-cal studies from immunization campaigns in different coun-tries concluded that earlier data suggesting elevated risk of GBS with oral polio vaccine may have been confounded by coincidental exposure to wild-type poliovirus or an influen-za epidemic. Therefore, investigating influenza infection as an antecedent event to GBS, and remembering the concept of molecular mimicry (with configuration differences in natu-

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ral strain vs. inactivated vaccine strain), some additional points of interest may be found in another recent study. This may ul-timately change the way health care providers and the public view the risk and relationship between influenza vaccines and GBS.

Unlike the VAERS study which studied ‘vaccination’ and GBS, another article published in January, 2009 presents data from French researchers who studied 406 GBS patients and the rate of ‘natural’ influenza infection. The study reports virologi-cal evidence that influenza infection is a trigger for GBS, with a frequency related to the level of influenza epidemics. Research-ers investigated the monthly incidence of influenza-like illness-es, and also analyzed anti-influenza antibodies. In all, 73 GBS cases were positively linked to influenza infection. Nearly 14%

had serological evidence of recent influenza A infection and nearly 5.5% had evidence of influenza B infection. Eight of the ten influenza A cases occurred during a major influenza season and antibodies specific to the current epidemic strain were seen in nine of these patients. The author concludes that ‘although the occurrence of GBS is rare, natural influenza infection may play an important role in triggering GBS during major influ-enza outbreaks’. In a later Reuters interview, researchers con-cluded that ‘GBS is by far more frequent with natural infection that that following influenza vaccine…[and that] The benefit of a large-scale influenza vaccination should also be considered as a means to protect against GBS.’

Whether or not future studies continue to shape the view of the relationship between influenza vaccination and GBS as protective, the current recommendations are congruent. For pa-tients with no history of GBS, the risk of GBS from vaccine is re-mote and does not outweigh the risk of serious adverse events from influenza infection.

h1n1 vaccines While pharmacists have been aware that younger individu-

als are target groups for H1N1 vaccination, the CDC statistics also pose some interesting points for consideration. The follow-ing graphs relate patient ‘age’ to H1N1 ‘infection’ rates, ‘hospi-talization’ rates, and ‘mortality’ rates.

While it is true that the highest infection rates occur in in-dividuals aged 0-24 years, the highest mortality rates occur in individuals aged 25-49 followed by 50-64 years. Florida phar-macists are in a prime position to highlight the importance of vaccination to these age groups. Due to fear of H1N1 vaccines, however, many pharmacists may find that patients are express-

h1n1 infection rates by age group

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While it is true that the highest infection rates occur in individuals aged 0-24 years, the highest mortality rates occur in individuals aged 25-49 followed by 50-64 years.

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16 | F l o r i d a P h a r m a c y T o d a y

ing interest only in receiving seasonal vaccination. Pharma-cists should convey that 90.8% of influenza specimens re-ported to WHO from December 6 to December 12, 2009 were pandemic (H1N1) 2009 influenza strain—not the seasonal strain. Another persuasive comment pharmacists can make to those patients who wish to ‘take their chances,’ is that ‘cold and flu’ season this year means just that. It is possible to be-come co-infected with seasonal flu, H1N1 flu, rhinovirus, and corona virus all at the same time. Complication and mortali-ty rates increase from co-infection, especially when there are other underlying health conditions. Barring a contraindica-tion, individuals should receive the vaccine if it is available to them.

Due to misperceptions regarding H1N1 vaccines in gen-eral, it is also important to include a few statements regard-ing the manufacturing and formulation of these vaccines. Much of the early speculation regarding the H1N1 vaccines was due to initial uncertainty as to whether the U.S. govern-ment would opt to choose to use ‘adjuvanted’ formulations for the H1N1 vaccines. However, clinical trials revealed that single-dose traditional formulation vaccines produced ade-quate antibody response to confer immunity to H1N1. There-fore, NO swine flu vaccines currently being used in the U.S. are adjuvanted formulations. Several other countries, includ-ing Canada, have opted to augment their supply with adju-vanted vaccines this season.

An adjuvant can be best described as something added to a vaccine to help the body achieve a more robust immune re-sponse while being able to use less of the vaccine antigen it-self. Using adjuvanted vaccines is good in cases where much vaccine needs to be produced rapidly (such as with swine flu), as the traditional method of growing virus in chick em-bryos is time consuming. Using adjuvanted vaccines makes the supply stretch to immunize a wider number of people.

There exists decades of information from other countries us-ing certain adjuvanted formulations and the adverse outcome rates are reported not to be statistically different than that of traditional formulations. The issue is that while there is some degree of safety data from other countries for several patient populations, there is no data for use in young children and infants (one of the groups which need greatest protection from swine flu). There is also some continuing debate about specific adjuvants and long-term, immune-mediated events. The adjuvants primarily in question are squalene-contain-ing, oil-in-water formulations. Two of these (M59 from No-vartis and AS03 from GSK) are already registered influenza vaccines in other countries, and one other (AF03 from Sano-fi Pasteur) has undergone extensive safety testing. Ultimate-ly because adequate immunity was found to be provided by single-dose conventional vaccine formulations, the U.S. had decided to use them for the 2009-2010 season. This may have not been the case if the strain had proven to be more viru-lent. If the U.S. chooses to use adjuvanted vaccines at a future point in time, the issue of adjuvant selection and safety can be further debated at that time.

Another misnomer is that the U.S. Government allowed current H1N1 vaccines to by-pass established approval pro-cesses as entirely new entities without appropriate studies. Clinical trials were completed for all H1N1 vaccines prior to approval. The safety information listed on the package in-serts are largely based on each U.S. approved manufacturer’s current seasonal influenza formulation. Therefore each U.S. manufacturer’s H1N1 formulation corresponds to the compo-sition of their U.S. seasonal brand —with substitution of the antigen strain only.

Adverse outcomes from U.S. H1N1 vaccines have not been, thus far, statistically different than that of seasonal vaccines. The U.S. recall on a limited supply of preservative-free vac-cine was not for safety issues, but for slight loss of potency. The recent Canadian recall of Arepanrix, however, a Glaxo-SmithKlein (GSK) vaccine (adjuvanted with AS03), was due to an elevated rate of anaphylaxis. The European Medicines Agency (EMEA) is also cautioning practitioners about use of GSK’s Pandemrix (another oil-in-water adjuvanted vaccine), which is causing elevated rates of febrile reactions. As a pre-caution in general, U.S. health care providers had been ad-vised prior to release of H1N1 vaccine to be vigilant in moni-toring and reporting, and researchers are poised to identify any VAERS trends which may reveal any adverse outcome el-evations above background rates.

Whether or not pharmacists are engaged in the direct ad-ministration of vaccines or only respond to queries, it is im-portant to convey accurate and current information to pa-tients—and to offer useful monitoring parameters patients can use ‘post-vaccination.’ This includes educating patients on early symptoms of adverse outcomes (e.g. tingling, mus-cle weakness) which may warrant further clinical evaluation. While Florida pharmacists may be among the newest health care members to provide vaccinations, our pharmacists can also be the most knowledgeable and best prepared to edu-

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cate patients on the benefits of receiv-ing vaccination, separating fact versus myth on vaccines, and early identifi-cation for intervention of adverse out-comes.

REFERENCES

Food and Drug Administration. Thimerosal in Vaccines; 2003. www.fda.gov/cber/vaccine/thimerosal.htm#1/. Accessed December 19, 2009.

Magos L, Brown AW, Sparrow S, Bailey E, Snowden RT, Skip WR. The comparative toxicology of ethyl and methyl mercury. Arch Toxicol 1985, 57:260-7.

Mahaffey KR, Rice G, et al. An Assessment of Exposure to Mercury in the United States: Mercury Study Report to Congress. Washington, DC: U.S. Environmental Protections Agency; 1997. Document EPA-452/R097-006.

McCormick M, Bayer R, Berg A, et al. Report of the Institute of Medicine. Immunization Safety Review: Vaccines and Autism. Washington, DC: National Academy Press; 2004.

Centers for Disease Control and Prevention. Thimerosal in vaccines: a joint statement of the American Academy of Pediatrics and The Public Health Service. MMWR 1999;48:563-5.

AHFS. Drug Information [monograph]. Influenza A (H1N1) 2009 Vaccine Inactivated. Vaccines 80:12 (AHFS primary); im100 (VA primary). Oct, 2009.

Cox NH, Forsyth A. Thimerosal allergy and vaccination reactions. Contact Dermatitis 1988; 18:229-33.

Centers for Disease Control and Prevention. Prevention and Control of Seasonal Influenza with Vaccines. MMWR 2009;58(Early Release):1-52.

Aberer W. Vaccination despite thimerosal sensitivity. Contact Dermatitis 1991;24:6-10.

Grabenstein JD. Immunologic necessities: Diluents, adjuvants, and Excipients. Hosp Pharm.1996;31:1387-92, 1397-1401.

Grabenstein JD. Clinical Management of hypersensitivities to vaccine components. Hosp Pharm. 1997;32:77-87.

Heidary N, Cohen DE. Hypersensitivity Reactions to Vaccine Components: Thimerosal. Dermatitis. 2005;16:115-20.

Cox NH, Moss C, Forsyth A. Allergy to non-toxoid constituents of vaccines and implications for patch testing. Dermatitis.1988;18:143-6.

Kelso JM, Li JT, Nicklas RA, et al. Joint Task Force on Practice Parameters for Allergy & Immunology. Adverse reactions to vaccines. Ann Allergy Asthma Immunol. 2009 Oct; 103(Suppl 2):S1-14.

Marks JG, Belsito DV, DeLeo VA, et al. North

American Contact Dermatitis Group Patch-Test Results, 1998-2000. Am J Contact Dermat. 2003;14:59-62.

Pratt MD, Belsito DV, Deleo VA, et al. North American Contact Dermatitis Group Patch-Test Results, 2001-2002. Dermatitis. 2004;15:176-83.

Ockenfels HM, Seemann U, Goos M. Contact allergy in patients with periorbital eczema: an analysis of allergens. Dermatology. 1997;195:119-24.

Tosti A, Melino M, Bardazzi F. Systemic reactions due to thimerosal. Contact Dermatitis. 1986;15:187-8.

Centers for Disease Control and Prevention. General Questions and Answers on Guillain-Barre Syndrome (GBS). http://www.cdc. gov/h1n1 flu/vaccinations/gbs_qa.htm. Accessed December 1, 2009.

NINDS. Guillain-Barre Syndrome Fact Sheet. NIH Publication No. 05-2902. http://www.ninds. nih.gov/disorders/gbs/gbs.htm. Accessed November 27, 2009.

Rees J, Soudain SE, Gregson NA, Hughes RA. Campylobacter jejuni infection and Guillain-Barre syndrome. N Engl J Med 1995;333:1374-9.

Steinberg JS. Guillain-Barre Syndrome: An Overview for the Layperson. 9th ed. Wynnewood, PA: Guillain-Barre Syndrome Foundation International; 2000.

Hahn AF. Guillain-Barre Syndrome. Lancet. 1998;352:635-41.

Hund EF, Borel CO, Cornblath DR, et al. Intensive management and treatment of severe Guillain-Barre Syndrome. Crit Care Med 1993;21:443-6.

Lasky T, Terracciano GJ, Magder L, et al. The Guillain-Barre Syndrome and the 1992-1993 and 1993-1994 influenza vaccines. N Engl J Med. 1998;339:1797-802.

Hilleman MR. Cooperation between government and industry in combating a perceived emerging pandemic: The 1976 swine flu vaccination program. JAMA. 1996;275:241-3.

Safranek TJ, Lawrence DN, Kurland LT, et al. Reassessment of the association between Guillain-Barre syndrome and receipt of swine flu influenza vaccine in 1976-1977:Results of a two-state study. Am J Epidemiol. 1991;133:940-51.

Grabenstein JD. Guillain-BarreSyndrome and Vaccination: Usually Unrelated. Hosp Pharm. 2000;36:199-207.

The prognosis and main prognostic indicators of Guillain-Barre Syndrome: a multicentre prospective study of 297 patients. The Italian Guillain-Barre Study Group. Brain 1996;119(pt6):2053-61.

Ropper AH. The Guillain-Barre syndrome. N Engl J Med 1992;326:1130-6.

Haber P, Sejvar, Mikaeloff Y, SeStefano F. Vaccines and Guillain-Barre syndrome. Drug

Saf. 2009;32(4):309-23.

Souayah N, Nasar A, Suri MF, Qureshi AL. Guillain-Barre syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). J Clin Neuromuscul Dis. 2009 Sep;11(1):1-6.

Sivadon-Tardy V, Orlikowski D, Porcher R, et al. Guillain-Barre Syndrome and Influenza Virus Infection. Clin Infect Dis. 2009;48:48-56.

“Influenza may trigger Guillain-Barre syndrome,” Reuters. January 28, 2009. http://www.reuters.com/article/idUSTRE50R6IK 20090128. Accessed January 10, 2010.

Summary of: WHO Virtual Consultation on the Safety of Adjuvanted Influenza Vaccines. Held by teleconference on June 3 2009 15:30-17:30 CET. www.who.int/vaccine_ research/documents/ Report_on_consultation_on_adjuvant_safety_2.pdf. Accessed January 6, 2010.

Centers for Disease Control. 2009 H1N1 Flu: International Situation Update. Jan 4, 2010, 5:00pm ET. http://www.cdc.gov/h1n1flu /updates/international/. Accessed January 3, 2010.

Centers for Disease Control and Prevention. Non Safety-Related Voluntary Recall of Certain Lots of Sanofi-Pasteur H1N1 Pediatric (0.25ml, for 6-35 month olds) Vaccine in Prefilled Syringes Questions & Answers. http://www. cdc.gov/h1n1flu/vaccination/ syringes_qa.htm. Accessed January 3, 2010.

Batch of H1N1 vaccine pulled: Manitoba notic-es spike in severe allergic reactions. The Cana-dian Press. November 19, 2009, 10:30pm ET. http://www.cbc.ca/health/story/2009/11/19/man-cp- flu-vaccine-hold.html. Accessed January 3, 2010.

GSK Press Release Issued: Friday 4 December 2009, London UK

H1N1 pandemic update on paediatric data for Pandemrix http://www.gsk.com/media/flu/GSK-statement-H1N1-pandemic-update-on-paediatric-data-for-Pandemrix%204_12_09.pdf. Accessed January 6, 2010.

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The FPA Poster Presentations are open to PHARMACY STUDENTS ONLY. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Monday, May 3, 2010. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to:

Tian Merren Owens, MS, PharmD, Director of Continuing Education Florida Pharmacy Association

610 N. Adams Street Tallahassee, FL 32301

tmerren@pharmview.com PLEASE TYPE Contact Information: Presenter's Name (MUST BE A STUDENT):________________________________________________________________

□ Entry Level Pharm.D. □ Post B.S. Pharm.D. Address: ________________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ Abstract Title: ____________________________________________________________________________________

Poster Type: □Clinical Research

□Basic Science Research

□Translational Research (Basic Science and Clinical Research) Primary Author: __________________________________________________________________________________

(Students must be listed first to be considered for the Award. Presenter will be notified by mail of acceptance). Co-Author(s): _________________________________________________________ Student □YES □NO

Awards: Posters will be eligible for 1st, 2nd, and 3rd place prizes to be presented at Convention. (Only one prize is given for each winning poster)

Free Registration: Three entry level students from each Florida College of Pharmacy will be eligible for a complimentary Florida Pharmacy Association Convention Student registration.

(Student Registration does not include CE or hotel accommodations) I am interested in being considered for this registration: □YES □NO

College: _____________________________________________________________________________

The abstract form submitted should be the equivalent of one page. The abstract should include: Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions.

Abstracts will not be accepted if it is not in this format. Do not include figures or graphs.

Please direct all questions and concerns to: Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ tmerren@pharmview.com

CALL FOR ABSTRACTS FOR POSTER PRESENTATIONS For Florida Pharmacy Students

FLORIDA PHARMACY ASSOCIATION 120TH ANNUAL MEETING AND CONVENTION

June 30 - July 4, 2010 Marco Island Marriott Resort, Golf Club & Spa ♦ Marco Island, Florida

Poster Session: Friday, July 1, 2010, 4:30-6:00PM

ABSTRACT FORMAT

DEADLINE DATE: MONDAY, MAY 3, 2010

m a r c h 2 0 1 0 | 19

20 | F l o r i d a P h a r m a c y T o d a y

m a r c h 2 0 1 0 | 21

22 | F l o r i d a P h a r m a c y T o d a y

At the recently completed American Pharmacists Association (APhA) Annual Meeting and Exposition in Washington, DC, our own, FPA Past President Ed Hamilton completed his term as the APhA president. We congratulate Ed on a successful year and thank him for his willingness to serve our profession.

One of the events held during that meeting was a reception for Ed as the outgoing president. That annual event is co-spon-sored by APhA and the state association with which the outgo-ing president is affiliated. This year that was the FPA.

The FPA through an ad-hoc committee comprised of the fol-lowing four past presidents (Don Bergemann, Betty Harris, Kathy Petsos, and Theresa Tolle) raised the FPA co-sponsorship fee privately. Our thanks to the following for their generous con-tributions:

n Pasco-Hernando Pharmacy Association n The Healthcare Acquisitions Group n Clinical Pharmacology Services n Hoye’s Pharmacy

Visit our Facebook page to see APhA convention photos.

Ed Hamilton Completes Term as APhA President

m a r c h 2 0 1 0 | 23

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