Pharmacy News

Entries for October 2018

What’s New with the Flu? Influenza Vaccine 2018-19 Update

By Lindsey Ghiringhelli, Pharm.D., BCGP, LTC consultant pharmacist, Pharmerica, Midland

Flu season is upon us again! To better protect against circulating flu viruses, the B/Victoria component and the influenza A (H3N2) were changed. This year’s recommended influenza vaccines include the inactivated quadrivalent influenza vaccine (IIV4) the inactivated trivalent (IIV3), the recombinant quadrivalent (RIV4) and the live-attenuated quadrivalent (LAIV4) nasal spray. The Centers for Disease Control and Prevention (CDC) recommends that everyone receive an influenza vaccine by the end of October.

Among the available trivalent vaccines are a high-dose product (Fluzone) with four times the amount of antigen and a vaccine with an adjuvant (Fluad), both available for patients over 65. The CDC estimates that 80 to 90 percent of flu-related deaths occur in patients aged 65 and over. The goal of these vaccines is to elicit a stronger immune response in the elderly population. The high dose vaccine has been associated with stronger immune response than the regular dose vaccine in the elderly, but the CDC indicates that studies are ongoing and is not recommending one vaccine over the over for elderly patients.

Though the CDC did not feel that the live-attenuated influenza vaccine (FluMist nasal spray) would be effective enough for use last year, it has made the cut for this flu season. It is approved for patients aged two to 49, but the American Academy of Pediatrics and American Academy of Family Physicians recommend reserving it for age-appropriate patients who refuse the injection. This vaccine is contraindicated in pregnancy, immunocompromised patients or those in close contact with immunocompromised patients, children aged two to four years with asthma, recent antiviral use (within 48 hours) or history of severe allergic reaction to any vaccine component. Please see the product labeling for additional precautions.

Patients with egg allergies are still recommended to receive the influenza flu vaccine. Patients who have developed only hives with egg exposure may receive any recommended vaccine. Those who report any other symptoms related to egg exposure, such as angioedema, respiratory distress, recurrent emesis, etc, should receive any appropriate vaccine under the supervision of a healthcare provider, in an inpatient or outpatient setting, who can recognize and manage severe allergic reaction. A prior severe allergic reaction to the influenza vaccine is a contraindication to future influenza vaccinations. There are two vaccines available which do not use any egg in their manufacturing processes, Flucelvax and Flublok, which can be offered to accommodate patient preference. Since the recombinant vaccine (Flublok) does not use any animal products, it may also be preferred for strict vegans.

Remind your patients, family and friends to vaccinate as soon as possible because it can take up to two weeks for antibodies to fully develop. Wash your hands frequently and stay home or wear a mask if you are sick. Though there are many different types of flu vaccines, the most important thing is that everyone over six months of age receives a flu vaccine every year. The vaccine protects you and everyone around you.


  1. Centers for Disease Control and Prevention. Influenza vaccines – United States, 2018-2019 influenza season. CDC website. Updated Sept. 5, 2018. Accessed Oct. 7, 2018.
  2. Centers for Disease Control and Prevention. Frequently Asked Flu Questions 2018-2019 Influenza Season. CDC website. Updated Aug. 30, 2018. Accessed Oct. 7, 2018.
  3. Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices – United States, 2018-19 influenza season. CDC website. Updated Aug. 24, 2018. Accessed Oct. 7, 2018.
  4. Pharmacist’s Letter. Flu Vaccines for 2018-2019. Therapeutics Research website. . October 2018.
Posted in: Professional Practice
New Drug Update: Toujeo Max SoloStar®

By Thy Mai, Pharm.D., pharmacy resident, SpartanNash, Grand Rapids


In October 2017, the Food and Drug Administration (FDA) approved Sanofi's Toujeo® (insulin glargine 300 units/mL) Max SoloStar®. This new pen is the highest capacity long-acting insulin pen currently available on the market. This new pen device option is available for patients who require more than 80 units per dose. With the ability to deliver a dose of up to 160 units/mL, the Toujeo Max Solostar® pen may help reduce the number of injections needed to deliver the required dosage for some adults with diabetes. Depicted in the chart below are the differences between the two Toujeo® pen options.

Toujeo Max SoloStar®

Toujeo SoloStar®

Dose adjusted by: 2 units

Dose adjusted by: 1 unit

Max dose: 160 units per injection

Max dose: 80 units per injection

Cartridge: 900 units

Cartridge: 450 units

3 mL and 900 units per pen

1.5 mL and 450 units per pen

1 box contains 2 pens (6 mL and 1800 units total) per box

1 box contains 3 pens (4.5 mL and 1350 units total) per box


The new Toujeo Max SoloStar® pen device still offers the same qualities as the Toujeo® pen such as:

  • Same pen size
  • 5-second hold time
  • 42-day shelf life
  • Lowest injection volume of any basal insulin


1.      Toujeo Max Solostar® [package insert]. Bridgewater, NJ: Sanofi; 2018.

Posted in: Professional Practice
Western Michigan Society of Health-System Pharmacists Update

By Katie Adrian, Pharm.D., BCPS, WMSHP president, clinical pharmacist, Bronson Methodist Hospital, Western Regional Society Representative


The Western Michigan Society of Health-System Pharmacists (WMSHP) took its summer break, with the exception of a summer planning meeting in June. The Board met to begin preparing continuing education (CE) opportunities for the upcoming year and to discuss future directions for our new committees.  We are excited to provide new opportunities for members to get involved in the organization and the community.  The Board also voted to sponsor two members to participate in the Michigan Pharmacy Foundation’s Health Professional Leadership Academy. We are thrilled to be able to provide this opportunity to our membership.


On July 26, more than 40 members and their families enjoyed a baseball game during the WMSHP Summer Outing at Fifth Third Ballpark in Grand Rapids. Although the Whitecaps did not get a win that day, fun was had by all who attended. Thank you to everyone who joined us for the event!


Monthly meetings, with live continuing education for pharmacists and technicians, resumed in September. For more information about WMSHP or our upcoming programs, please visit

Posted in: Member News
The Ideal Resident

By Elizabeth K. Bisaccia, Pharm.D., BCPPS, clinical pharmacy specialist – general pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor


In 2016, a paper by Phillips and colleagues discussed the results of a survey reviewing the factors most associated with a pharmacy student matching with a residency program. The results of this survey found that the number of applications, number of interviews, pharmacy school grade point average and female gender were all significant predictors for matching with a residency.1 In this survey, significantly more females applied to residency programs than males. No differences were noted for activities such as work experience, leadership positions or participation in student organizations. The results of this survey were surprising, given how residency programs often discuss the attributes of an ideal candidate.    


Most preceptors and program directors acknowledge that the characteristics of an ideal resident extend far beyond grade point average. Marta Miyares did an excellent job describing the traits of an ideal resident in her 2013 paper.2 The resident she describes possesses traits that are both intrinsic and teachable. Clinical knowledge is an important backbone for a successful residency, yet clinical skills can be taught and reinforced throughout the residency year. Practical skills, such as time management, are also often considered essential in an ideal resident. Much like clinical skills, these applied skills can be optimized and coached during the course of residency training.  


However, the other traits Miyares references in her paper are tremendously difficult to teach and can be even more challenging to identify: self-awareness, a commitment to continuing improvement, pride in the profession, innovation and a strong understanding of ethically sound decision making.2 These traits are virtually impossible to measure on paper or to assess in interviews. Nevertheless, one can argue that these character traits are vital in a highly successful resident and become even more important once the resident graduates into their practice. Most programs want to foster residents who will make significant contributions to patients and the profession. Therefore, it is important for programs to ask critical questions when considering recruitment. How does a program director successfully screen for these skills? How does a program attract candidates that possess these inherent traits?   


Programs often discuss and debate the ideal characteristics of resident candidates. Similarly, candidates also debate and discuss the characteristics of an ideal program. The resident match is as much about the program as it is the candidate. It is important to remember that the decision to pursue a residency is a private commitment to one’s education, professional development and personal growth. It is a deeply personal decision that students and residents make during the course of their training, usually as a chapter of their lives is coming to a close and an educational milestone is achieved. Candidates select programs with careful consideration. As such, it is important that residency programs strive to provide the ideal program to candidates and remain attractive to the pool of increasingly competitive candidates.


Miyares focuses on the importance of transparency and the decision to respect each learner’s strengths and weaknesses in her analysis of an ideal program.2 Additionally, it is important to understand that programs must remain focused on the clinical progression and professional development of the resident throughout the residency year. As a profession, it is important to continue to provide residency training that is in the best interest of the resident. If a program can continue to make resident education and development the first priority, residency candidates of excellent quality will apply, interview and match.



  1. Phillips JA, McLaughlin MM, Rose C, et al. Student characteristics associated with successful matching to a PGY1 residency program. Am J Pharm Educ 2016;80(5):84.
  2. Miyares MA. The ideal resident: perspective from a residency program director. Hosp Pharm 2013;48(10):825-7.
Posted in: Professional Practice
Demonstrating our Value: “Thank You For All That You Do”

By Kari Vavra Janes, Pharm.D., BCPS, associate professor of pharmacy practice, Ferris State University College of Pharmacy, Grand Rapids


As discussed in the past issues of the MSHP Monitor, the 2018 Michigan Society of Health-System Pharmacists (MSHP) theme is “Demonstrating our Value.”  What better time to do this than right now?  October is officially American Pharmacists Month, and it is the perfect time to bring the 2018 theme to life!  American Pharmacists Month is a time to “celebrate the pharmacy profession, recognize your pharmacy staff and reach out to your patients.”1 The American Pharmacists Association offers an American Pharmacists Month planning guide on their website if you’re in need of ideas.  The guide is available at: Regardless of your practice setting, there are plenty of ideas for every type of pharmacy to “spotlight pharmacists’ contributions toward improving medication use and advancing patient care.”1 There are ideas for technicians and student pharmacists as well.  While the guide offers a more extensive discussion, a few examples include scheduling a health event, visiting your state senator or representative, talking to your administrator(s), connecting with your state pharmacy associations and so much more.1 The guide is just a starting point – be creative!


This month, let’s celebrate pharmacists and the value they provide.  Locally, Michigan Pharmacy week is Oct. 14 – 20, 2018.  Be sure to thank your pharmacists for optimizing medication management and patient health, offering many varied professional services, educating patients and advocating for and advancing our profession.          


This month, let’s celebrate technicians and the value they provide. Tuesday, Oct. 16, 2018 is National Pharmacy Technician Day. Be sure to thank your technicians for supporting distributive and clinical pharmacy functions; they are an essential part of these pharmacy services!


This month, let’s celebrate student pharmacists and the value they provide. Be sure to thank your students for the role they play in extending pharmacy clinical services and improving patient care; they are the future of our profession, and they are ready and willing to be involved! 


Thank you pharmacists, technicians and student pharmacists for “Demonstrating our Value” each and every day!  Enjoy this month dedicated to you!



  1. American Pharmacists Association. American Pharmacists Month. American Pharmacists Association website. Accessed Aug. 28, 2018.


Posted in: Member News
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