Pharmacy News

Entries for January 2018

Tech Spotlight: Tisha Lewis

Tech Spotlight: Tisha Lewis, CPhT, pharmacy technician Coordinator, Munson Medical Center

How did you get into pharmacy technician practice?
Ten years ago I was looking for a part time job and walked into a CVS Pharmacy in North Carolina. They had a help wanted flier in the window. I spoke with the Assistant Store Manager and was immediately hired.

Did you work in a different industry or practice before becoming a pharmacy technician? If so, what prompted you to change career paths?

I was working for a property management company when I was hired as a part-time pharmacy technician. After working part-time for a few months, I found I loved my job and decided to go full-time.

What is your educational background?
I have completed classes in biology, chemistry, anatomy, physiology and calculus. I obtained my Certified Pharmacy Technician designation eight years ago. I was offered a position as a lead technician contingent on certification, so I studied for two weeks, took the test and received my certification.

What is your employment history?
I started in retail at CVS in North Carolina as a part-time technician. I moved into a full-time position and transferred to a store in Michigan. There I was promoted to lead technician. While at CVS, I became a conversion trainer and went to Northern California to train pharmacy staff as part of the Longs Drugs Acquisition. I also oversaw the annual inventories for all stores in the district. I really enjoyed my time training. It gave me a sense of accomplishment. 

After 2 ½ years I left CVS and took a position as a biller in a long-term care pharmacy. I realized my love of spreadsheets while working there. After two years, I started working on collections where I had to navigate probate court and insurance companies for past claims. I was there for three years and then took a position as the pharmacy technician instructor at Career Quest in Jackson, Mich. I loved it. I was able to introduce what I fell in love with to students that just wanted to make their lives better. I wrote the curriculum for the entire program, which was half online and half labs that were taught on campus. Writing the curriculum and brainstorming ways to teach compounding without medications was a challenge I enjoyed. I decided to relocate north, and accepted a position with Munson Medical Center as an inpatient pharmacy technician. Hospital pharmacy and sterile compounding was an avenue I wanted to explore. After working there for two years, I was promoted to Pharmacy Technician Coordinator.

What do you enjoy most about your current position and practice?
My favorite part of hospital pharmacy is the IV lab and sterile compounding. It’s a challenge every day, and I enjoy that aspect. My current position is very new. I look forward to developing a standardized training program across the health-system.

How did you get involved with MPA/MSPT, and why is it important for pharmacy technicians to be involved in professional associations?
I asked a member of the MSPT Executive Committee, Casey Sullivan, to be a guest lecturer in one of my classes. He invited me to Pharmacy Day at the Capitol and asked if I would be interested in becoming more involved. Prior to that, I really didn't know the opportunity was there. By being a part of MPA and MSPT I have learned so much about our profession that I didn't know was available to technicians. I have met some great and interesting people in the profession, and it continues to open doors for me. It’s also easy to reach out to those people that I have met to bounce ideas off one another. The world of pharmacy is huge, but it’s also very small. Everyone knows someone, and I want them to know me.

What else would you like to share?
I am about to be a first-time mother, and I am also getting married next year. My fiancée and I just bought a house outside of Traverse City with 20 acres. We have 2 dogs and love to take walks all together in the woods. My family is very close. My parents have always supported my decisions about my professional life even if sometimes it may have seemed flighty to them. Without the support from them, and my two sisters and their husbands, I may have ended up on a very different path, and I am grateful for them and the time I get to spend with my niece and nephew. They can't wait to meet their new cousin.

Posted in: Member News
Drug Shortages and the Role of Pharmacy Technicians

By Erith Welch, B.S., CPhT, pharmacy manager, Munson Medical Center, Traverse City

The role of a pharmacy IV compounding technician is vital to every successful healthcare system. Those that choose this rewarding career field will be challenged by the demands of a fast-paced, patient oriented environment. They must possess strong math, computer and interpersonal skills and demonstrate these abilities all while exercising extreme aseptic protocols. Even though IV compounding pharmacy technicians work under the supervision of a registered pharmacist, at Munson Medical Center they must complete rigorous training. This training focus on patient safety and care along with specific processes required to meet all required IV compounding standards. All healthcare team members and patients depend on these technicians to detect and correct critical errors. The satisfaction that comes from meeting this expectation along with so many others is what makes this career in healthcare so rewarding.

Health-systems are facing severe lifesaving drug shortages. The destruction caused by Hurricane Maria in Puerto Rico in September 2017 shut down several major pharmaceutical manufacturers and exponentially increased global need and driving much of today’s global drug shortages. Products such as emergency syringes, sodium bicarbonate, carpujects, small volume normal saline bags (< 150mL), amino acids and total parenteral nutrition (TPN) components are no longer readily available. IV compounding pharmacy technicians met this challenge of shortages and brought to light the vital role technicians play on the healthcare team. IV compounding pharmacy technicians met this challenge. Now, hospital systems depend on their skill set and IV compounding expertise to adjust current processes and explore new methods to provide products in the same safe and timely manner.

Managing these major drug shortages has become the focal point to all pharmacy operations. Hospital pharmacies continue to educate and advise healthcare teams to explore alternative therapies and drug utilization to ensure resources are being used conservatively and appropriately. Major shifts in product preparation and drug utilization have created domino effects that make anticipating future drug shortages challenging. One detailed example would be the shortage of 50mL and 100mL bags of normal saline (0.9 percent NaCl). Where these products were once easily procured, IV technicians now have to batch 50mL and 100mL bags of normal saline solutions via repeater pumps or by hand, depending on available resources, to keep up with hospital demands. Batched bags of normal saline are used to prepare final patient specific products. The batching process is extremely labor intensive as managing shortened stability requires diligent stock rotation and a close eye to utilization to ensure minimal waste. This shift in preparation used by the majority of the nation’s healthcare systems has created a shortage of empty sterile IV bags which in turn affects all products prepared in empty sterile IV bags. This one example highlights the pendulum that continues to swing from one drug and supply shortage to the next due to the ever-changing demands of today’s drug shortages. 

Pharmacist and pharmacy technicians work collaboratively and creatively to ensure that safe high-quality patient care stays at the center of everything they do. However, as drug shortages continue to set the tone and pace for continued changes to pharmaceutical care practices, it will become more difficult to meet demands. It is imperative that healthcare systems continue to support growth in all pharmacy-related career fields, especially the one of pharmacy technicians, as they are the cornerstone of this field’s success. 

Posted in: Professional Practice
What’s Your Number: A1C and Blood Glucose

By Keith Binion, B.S., CPhT, pharmacy technician program director, MedCerts, Livonia

For those who are faced with the challenge of managing their blood sugar, glucometers have proven to be important and useful tools when used correctly. Although used daily, they may still only touch the tip of the iceberg as to what underlying problems can really be going on.

To identify and diagnose long term information, prescribers might consider administering what’s called an A1C test. This test provides insight as to how a current treatment plan is working, and what modifications can be made.

But what is A1C and its relationship to diabetes? A1C is abbreviated for glycated hemoglobin. Glycated hemoglobin is the result of glucose (a sugar) binding to hemoglobin. Hemoglobin is a protein in red blood cells. As large amounts of glucose enter the blood stream, the amounts of glycated hemoglobin increase.

Rising blood glucose levels are directly proportional to the percentage of glycated hemoglobin. Thus, the A1C Test is used as a means for measuring diabetes control. A normal A1C level is considered below 5.7 percent. Someone who might be classified as pre-diabetic would have an A1C reading in the range of 5.7 to 6.4 percent. A person with an A1C of 6.4 or higher is diagnosed as Type II Diabetes.

If an individual is diagnosed with pre-diabetes or Type II Diabetes, it’s not the end of the world. While diabetes can be a bit challenging to manage, it can be brought under control. Ultimately, to be successful a person must be committed and disciplined to lifestyle modifications. Several factors can be taken into consideration and implementing into their lifestyle:

  1. Adherence and compliance. When your prescriber provides you with a medication regimen, it is imperative to stick with it. While it can be challenging and frustrating, following the recommendations of your prescriber will prove beneficial in the long run.
  2. Exercise. This doesn’t necessarily mean getting a membership to a gym, but finding some type of movement you can do consistently for at least 30 minutes five times a week. Activities like walking the dog or riding a bike prove to do wonders.
  3. Meals. Cutting back on portions, as well as the types of foods you eat, can prove to be beneficial. Eliminating sugars, such as pop and juice, is a start. 
  4. Don’t skip. Missing meals or eating too frequently can contribute to an inconsistent blood sugar level. 
  5. Check your sugar. Knowing your sugar level is important. It’s not wise to rely on inconsistent readings.

Making these modifications can all contribute to lowering your A1C, bringing it under control, and allow you to regain a sense of properly managing and stabilizing your sugar levels.

Posted in: Professional Practice
Pharmacy Practice and USP

By Sister Phyillis Klonowiski, Pharm.D., pharmacist, HealthFirst Pharmacy, Owosso

The United States Pharmacopeial Convention (USP) is something most pharmacists (outside of hospital and IV compounding pharmacies) know exists, but rarely ever directly reference. The USP is a scientific nonprofit organization that sets standards for the identity, strength, quality and purity of medicine, food ingredients and dietary supplements. These standards are enforceable by both state and federal law and are given force of law by their incorporation into existing laws by reference. We have heard of <795> (non-sterile compounding) and <797> (sterile compounding), but now on our doorstep is USP <800>. USP <800> focuses especially on healthcare worker safety in handling of hazardous drugs throughout the healthcare system. Their expert committee for USP <800> is comprised of 14 pharmacists, one epidemiologist, USP staff, the Food and Drug Administration and Centers for Disease Control and Prevention representatives who have input but no voting power. Before final implementation (currently set for December 1, 2019), there will opportunity for public comment in the fall of 2018. The date of implementation of USP <800> has been pushed back so there will comprehensive and consistent alignment with the USP <797> upgraded standards for all sterile compounding and patient safety. 

USP <800> describes requirements including responsibilities of personnel handling hazardous drugs, facility and engineering controls, procedures for deactivating, decontaminating and cleaning, spill control and documentation. These standards apply to all healthcare personnel who receive, prepare, administer, transport or otherwise come in contact with hazardous drugs and all the environments in which they are handled. The National Institute for Occupational Safety and Health (NIOSH) considers a drug to be hazardous if it exhibits one or more of the following characteristics in humans or animals: carcinogenicity, teratogenicity or developing toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity or structure and toxicity profiles of new drugs that mimic existing hazardous drugs. With this definition, the current listing of medications include:

  1. Oncology medications both oral and injectable 
  2. HIV and hepatitis C antiviral medications oral and injectable
  3. Sexual hormones: testosterone, estrogen and their derivatives, i.e., birth control
  4. The hematology stimulants: epoetin, filgrastim, etc.
  5. Autoimmune therapy: dupilumab, anakinra, certolizumab, etanercept, golimumab, etc.
  6. Interferon and other neurologics
  7. Non-oncology with reproductive affects
  8. The non-oncologic with pregnancy/reproductive warnings:

Drug

AHFS classification

clonazepam

28:12:08 benzodiazepines

colchicine

92:16 antigout agents

dinoprostone

76:00 oxytocics

dronedarone

24:04:04 antiarrythmics

dutasteride

92:08 5-alpha reductase inhibitors

ergonovine/meth- ylergonovine

76:00 oxytocics

finasteride

92:08 5-alpha reductase inhibitors

fluconazole

8:18.08 azoles

ganirelix

92:40 gonadotropin-releasing hormone antagonists

gonadotropin, chorionic

68:18 gonadotropins

icatibant

92:32 complement inhibitors

mentropins

68:18 gonadotropins

methyltestos- terone

68:08 androgens

mifepristone

76:00 oxytocics

misoprostol

56:28.28 prostaglandins

nafarelen

68:18 gonadotropins

oxytocin

76:00 oxytocics

paroxetine

28:16:04:20 selective serotonin uptake inhibitors

pentetate calcium trisodium

NA

plerixafor

20:16 hematopoietic agents

ribavirin

8:18:32 nucleosides and nucleotides

telavancin

8:12:28 glycopeptides

testosterone

68:08 androgens

topiramate

28:12.92 anticonvulsants, miscellaneous

tretinoin

84:16 cell stimulants and proliferants

ulipristal

68:12 contraceptives

valproate/valproic acid

28:12:92 anticonvulsants, miscellaneous

vigabatrin

28:12:92 anticonvulsants, miscellaneous

voriconazole

8:14.08 azoles

warfarin

20:12.04.08 coumarin derivatives

ziprasidone

28:16:08:04 atypical antipsychotics

zoledronic acid

92:24 bone resorption inhibitors

zonisamide

28:12:92 anticonvulsants, miscellaneous

 

Below are some of the common drugs with cautions, listed alphabetically:

Generic

Trade Drug

clonidine

Catapress

conjugated estrogens

Premarin

divalproex

Depakote ER

estradio

Estrace

etanercept

Embrel

febuxostat

Uloric

finesteride

Proscar

fluconazole

Diflucan

methotrexate

Rheumatrex tab

methylprednisolone

Medrol

paroxetine

Paxil

phenytoin

Dilantin

prednisolone

Omnipred

prednisone

Deltasone

raloxifene

Evista

testosterone topical

Androgel

topiramate

Topamax

waarfarin

Coumadin

spironolactone

Aldactone


These lists may not be complete and because some are designated by a drug class, there may an entire group of medications such as ARB inhibitor that comes under consideration.

Preliminary considerations may mean a biologic safety cabinets set to the side with special air exchanges to handle and count. Protective clothes may include: a gown, gloves, bootie and hair covering with mask to work with when an open bottle enters the picture. Because we are looking at oral as well as injectable medication, we are in unfamiliar territory. It pays to stay forewarned and prepared. The USP site does have free updates for your review. View that information at www.USP.org

Posted in: Professional Practice
A New Option for Shingles Prevention

By Lindsey Ghiringhelli, Pharm.D., BCGP, consultant pharmacist, PharMerica, Midland and chair, Consultant and Specialty Pharmacists of Michigan

Shingrix is a new vaccine approved in October 2017 for Shingles which is caused by reactivation of the latent varicella zoster virus. The manufacturer reports a 97 percent overall efficacy in preventing infection and 85.5 percent for postherpetic neuralgia compared to placebo over a three to four year period in adults over 50. Studies show an efficacy of 90 percent for patients over 70 for herpes zoster prevention. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has voted to recommend Shingrix as the preferred vaccine for Shingles prevention over Zostavax, and it is also recommended in patients who’ve already received Zostavax and wait for at least eight weeks afterward. 

Shingrix is a non-live recombinant vaccine plus an adjuvant to boost immunity, but studies are ongoing to determine if Shingrix can be administered to immunocompromised patients. It is a two-shot series administered two to six months apart, given intramuscularly to adults ages 50 and above and is stored in the refrigerator. Side effects of Shingrix are similar to Zostavax, including fatigue, headache, shivering, GI adverse effects, fever, myalgia and injection site reactions. Insurers are expected to begin covering Shingrix once the CDC updates their guidelines in early 2018.

 

Zostavax

Shingrix

Single shot

Two-shot series, given two to six months apart

Subcutaneous

Intramuscular

51 percent effective

97 percent effective

ACIP recommended at or after age 60

ACIP recommended at or after age 50

Live vaccine

Inactive vaccine

Reconstituted vaccine good for 30 min

Reconstituted vaccine good for six hours

Stored in freezer

Stored in refrigerator


References:

  1. CDC. Shingles (Herpes Zoster). https://www.cdc.gov/shingles/vaccination.html (Accessed December 30, 2017).
  2. Product information for Zostavax. Merck & Co., Inc. Whitehouse Station, NJ 08889. http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf. (Accessed December 30, 2017)
  3. Product information for Shingrix. GlaxoSmithKline. Research Triangle Park, NC 27709. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Shingrix/pdf/SHINGRIX.PDF. (Accessed December 30, 2017)
  4. Pharmacist’s Letter. Dec 2017, No. 331201. https://pharmacist.therapeuticresearch.com/Content/Articles/PL/2017/Dec/Immunize-Against-Shingles-With-the-New-Vaccine-Shingrix. (Accessed December 30, 2017)
Posted in: Professional Practice
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