What Your Pharmacist Can Do for YOU

Alexandra Cambra & Anthony RenzoniUniversity of ConnecticutPharmD Candidates 2018

Agenda

The PharmD Program

Prescription Counseling

Over the Counter Medication Advice

Medication Reconciliation

Immunizations

Medication Disposal

87%of 1,160 people said that they trust pharmacist advice

Source: Jan 2015: http://www.pharmaceutical-journal.com/news-and-analysis/news/the-public-trusts-pharmacists-but-not-to-the-same-degree-as-other-health-professionals-survey-shows/20067576.article

The PharmD Program

What was pharmacy?

What is pharmacy now?

Where are pharmacists in the US?

The Evolution of PharmacyEducation

ApprenticeshipFormal Education

RPhPharmD

Perception● Apothecaries - no training

required● Pill Pushers/ Dispensary● Health Care Professionals

○ MTM

The PharmD ProgramWhat is a PharmD? → Doctorate of Pharmacy

6 year program: Accredited by the Accreditation Council for Pharmacy Education (ACPE)

2003PharmD became the entry level degree needed in order to sit for the NAPLEX (board

exam)Previously, Pharmacists graduating with a Bachelors of Science in Pharmacy Studies

were able to sit for the NAPLEX in order to become licensed.Pharmacists who were already practicing pharmacy before the requirement of the

PharmD were grandfathered in under the new education requirements.

What is the difference between an R.Ph. and a PharmD?RPh is a licensing process that both B.S. recipients and PharmD recipients must

completeB.S. in Pharmacy recipients were grandfathered into the new education requirements

with their work experience post-graduation as their clinical experience.

Where are Pharmacists?

CommunityCVS (new locations in Target)WalgreensRite AidStop & ShopBig Y SupermarketsWalmartIndependent Pharmacies

HospitalsDanbury HospitalHartford HealthYale-New Haven Hospital

IndustryBoehringer IngelheimPfizer

Managed Careeven provide services to prisons!

Government AgenciesFDANIH

Prescription Counseling

General Medications

Proper Administration

Possible Side Effects

Time to See Benefits

Missed doses

Common Medications

Diabetes Medications: Metformin, Glimepiride, Glyburide, Invokana, Januvia, Repaglinide, Nateglinide

Hypertension Medications (ACEi & ARBs): Amlodipine, Losartan, Lisinopril, Hydrochlorothiazide, Valsartan

Cholesterol Medications (statins): Atorvastatin, Lovastatin, Simvastatin

Administration of Medications

When and How:Food: empty stomach, with food, doesn’t matterOther Medications/Vitamins: separate by 1-2 hours, doesn’t matterWater: specific amount?Frequency: once a day, once a week, once a month?

For Example: Metformin is recommended with food to minimize GI upset

Repaglinide, and Nateglinide HAVE to be taken with food

Improper administration can lead to: Diminished desired effects

Doctor increasing the dose

Increasing risk of side effects

Possible Side Effects

Pharmacists can help you differentiate between side effects:Common and Dose-DependentSerious/ Alarming

Example: Metformin has common side effects of stomach upset and diarrhea, but uncommon and dangerous side effects like lactic acidosis

Bottom Line: Don’t Trust Commercials!

When Should You See A Result?

All medications take different amounts of time to show clinical impact:

DaysWeeks Months

Example: At full dose (after titration), Metformin effects on A1C may be seen within first 4 weeks, but may take 8-10 weeks for maximal effects.

Missed Doses

All medications are different:Take as soon as you remember (if it’s less than halfway to your

next dose)Double up next doseSkip and start up again next dose

Example: If a dose of Metformin is missed, it should be taken as soon as it is remembered (with food - as long as it’s not too close to the next dose). DO NOT double up doses.

Over the Counter

Counseling

Usage with certain disease states

Interactions with other medications

Combination products

Brand/Generics

Selection of vitamin supplementation

Usage with Specific Disease States

Patients with Hypertension should be aware of their cold/congestion medication selection:

Pseudoephedrine/phenylephrine may increase blood pressure

Coricidin HBP (High Blood Pressure Products) are designed for these patients

Pharmacists can help you select which product is best for YOU

Interactions with Other Medications

Without proper breakdown/digestion, medications have an increased risk of adverse effects within the body.

● St. John’s Wart for depression○ 3A4 metabolism

● CoEnzyme Q10 for heart health○ Warfarin

● Cranberry juice for UTIs○ Warfarin

● Primrose oil for decrease clotting○ anti-seizure medications

● Melatonin for sleep○ sedatives/pain medications

● Saw Palmetto for BPH health○ Warfarin/blood thinners

● Gingko bilboa for alzheimer’s ○ 500 drug interactions○ Diabetic drugs, blood thinners

Combination Products

Many prescription pain and over-the-counter cold/sinus combination products contain Acetaminophen (Tylenol)

There is a maximum daily dose recommendation 4g (4000mg/day)

Talk to your pharmacist to make sure you’re not overdosing on acetaminophen or any other over-the counter product.

Brand & Generics

There are many brands for the same active ingredient. Many companies market the same active ingredient under their brand to make money. Generics must have “bioequivalence” to Brand name medications, which means they must “perform in the same manner” as the brand. For all intensive purposes, brand and generic drugs are therapeutically the same.

Advil is Motrin which is ibuprofenClariSpray is Flonase which is Fluticasone nasal spray.

Selection of a Supplement

VitaminsFat vs. water soluble

General recommendations based on age

MineralsIf doctor recommends, pharmacist can help find and select proper dose

HerbalsCheck for interactions within medication list

Medication ReconciliationWhy you should fill all your

prescriptions with one pharmacy

Catching Duplicate Therapy

Discover Interactions

Medication Reconciliation ServicesCommunity Setting:● Duplicate Therapy: Many

specialists may overlap in treatment

● Drug-Drug Interactions: Interactions between medications

Hospital Setting:● Contact community pharmacies

regarding patient medications● Inpatient: Patients must be

converted to medications on the hospital’s formulary.

● Outpatient: Upon discharge, pharmacists work with insurance companies to put the patient on medications which their insurance will cover.

Immunizations

Which Pharmacists Can Administer

Which Need A Prescription, but can be Administered by a Pharmacist

Insurance Coverage

Immunizations Pharmacists can Administer in CT:All vaccines over 18 years oldNO PRESCRIPTIONS needed: Pharmacies have a protocol with a physicianImmunizations include:Influenza

Pneumonia 13Pneumonia 23Hepatitis AHepatitis BChicken Pox (Varicella)

HPVMeningitisMMRShingles (Zoster)Tdap / Td

Insurance Coverage

Medicare Part B:

Influenza

Pneumonia

Hepatitis B

Supplemental Medicare Part D:

Other vaccines are covered in full or partially

Plan-specific; contact your plan for more details

Medication Disposal

Why it’s Important

Proper Disposal of Medication

Importance of Proper Medication Disposal

Concern for Yourself:Avoids confusion and health problems from accidentally taking the wrong medicine, too much of the

same medicine, or a medicine that is too old to work well

Concern for Others:Children can get their hands on unused medication left in the house

AccidentAbuse

Pets could get to medications if you simply throw them away in the trash.Can poison the animal

Water supplies become contaminated if you flush medications down the drainInhalers & other aerosol products can be dangerous if disposed of improperly as they are unstable in

a fire or incinerator

How to Properly Dispose:Best Option: drop them off at a local drug disposal site

Participating pharmacy where professionals can handle them properly

Police stations

Locate a drug disposal site using by calling: 1-800-882-9539

Ask your local pharmacist: if they have mail-in boxes you can purchaseLow cost

How to dispose of your medications from home:If specific instructions are provided with your prescription, simply follow those.

To throw away in the trash* → SMART Disposal

SMART Disposal Method1. Scratch off any personal information2. Remove the medication from original packaging and mix them with coffee

grounds, dirt or kitty litter.○ Makes the drug unrecognizable & unappealing to people seeking drugs

3. Melt tablets & capsules with hot water first.4. Put the mixture in a sealable bag or empty container to prevent the drug

from leaking or breaking out of a garbage bag○ Such as Coffee Grind container○ ziploc-bag

5. Throw it away in your regular trash bin (Do not throw in recycling bins)

Any Questions?