INSIDE FROM THE DESK OF THE PRESIDENT. Volume 23, No. 5 September/October 2013

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1 Editor: Dana Jamero Volume 23, No. 5 September/October 2013 FROM THE DESK OF THE PRESIDENT Dear Members, I am pleased to report that your Executive Committee and Board has been diligently working over the past couple months to move the agenda forward that was set at the Annual Strategic Planning Retreat in August!!! Some of the initiatives that are on the agenda for this year include, but are not limited to: Increasing the membership and involvement of health-care leaders throughout the State Analyzing the current status of residency programs in Louisiana and exploring potential initiatives to expand the number of programs Developing mechanisms to assist hospitals and health-system pharmacies to participate in the ASHP Pharmacy Practice Model Initiative (PPMI) Developing the first-ever REVERSE EXHIBIT format for the 2014 Annual Meeting I would like to personally thank all of the Executive Committee and Board members for their hard work at the State and Regional Chapter levels! In an effort not to steal the thunder of our leaders, I will defer specifics of the aforementioned initiatives to Board member reports. Special Commentary I often share my three keys to success with anyone who will listen and I would like to share them with you as it applies to the current state of health-system pharmacy in Louisiana. Ed Stemley s three keys to success are: Define your goals Know the rules Constantly Play As it relates to defining our goals: What is our practice philosophy for health-systems pharmacy? How much time and energy should we invest to hold onto medication distribution or clinical pharmacy practice or staff development? Like all smart investors, we need to diversify our portfolio. If we focus too much on one particular aspect of health-systems pharmacy, we are sure to lose it all. We must know the rules: Who are the key stakeholders in the quest to actualize our goals? What is our stance with other health care professionals such as physicians and nurses? What do hospital administrators think about the value of our goals? What is on the horizon in the way of pharmacy informatics and medication distribution technology? What health care related legislation is being considered at the national and state level? Management and staff Competency is imperative: Is our leadership competent enough to set new vision for pharmacy in the face of anticipated change? Are our pharmacists and technicians competent enough to perform new roles? Staff buy-in and administrative support for continuous professional development will be critical to establishing the necessary competencies. Continued on page 3 SELSHP Chapter Update LSHP Call for Nominations. Invokana (Canagliflozin).. INSIDE Mid Year Meeting Photos. Upcoming Events

2 Louisiana Society of Health-System Pharmacists Page 2 LOUISIANA SOCIETY OF HEALTH-SYSTEM PHARMACISTS BOARD OF DIRECTORS PRESIDENT Edward Stemley, Pharm.D., M.S. Houston, TX stemleyec@tsu.edu PAST PRESIDENT Roxie Stewart, PharmD. Monroe (318) rstewart@ulm.edu TREASURER Tommy Mannino, RPh Baton Rouge (225) tommann40@aol.com PRESIDENT-ELECT Fancy Manton, RPh, Pharm.D. (225) fancy.manton@womans.org SECRETARY Helen Calmes, PharmD New Orleans (504) hmcalmes@ejgh.org Mark your calendar! 2014 LSHP Annual Meeting MEMBER AT LARGE Brice Mohundro, PharmD Baton Rouge (225) Labruzzo@ulm.edu MEMBER AT LARGE Jessica Brady, PharmD Monroe (318) brady@ulm.edu MEMBER AT LARGE Camtu Ho, PharmD New Orleans (504) cam2ho@gmail.com MEMBER AT LARGE Kristian Fruge, PharmD Baton Rouge (337) frugeks@gmail.com BOARD MEMBER ELECT Frank McCloy, RPh New Orleans (504) mccloym@bellsouth.net BOARD MEMBER ELECT Teresa Nash, PharmD, BCPS New Orleans (504) tnash@ochsner.org HYATT REGENCY 601 LOYOLA AVE, NEW ORLEANS, LA May 22-24, 2014 CENTRAL-LSHP Joseph Gary LeBlanc (318) leblanjg@gmail.com NORTH-LSHP Elizabeth Perry (318) ext. 245 eperr4@lsuhsc.edu NORTHEAST-LSHP Martin Steffenson (318) steffensonm@bellsouth.net SOUTH CENTRAL-LSHP Jennifer Smith (225) smith@ulm.edu SOUTHEAST-LSHP Heather Aaron (504) Heather.Aaron@peopleshealth.com SOUTHWEST-LSHP LSHP Bimonthly Newsletter LA HEALTH-SYSTEM PHARMACISTS Publisher Information The LA Health-System Pharmacist is published 6 times a year by the LSHP, 8550 United Plaza Blvd., Suite 1001, Baton Rouge, LA Subscription to the LA Health-System Pharmacist is a benefit of LSHP membership. All articles published represent the opinions of the authors and do not reflect the policy of the LSHP unless so specified. All student submissions must be reviewed by a pharmacist mentor whose name will be included on the article. Copy, advertising and nonmember subscription inquiries should be directed to the Copy Editor, Heather Gremillion, at (225) Advertising rate sheets and deadlines are available upon request. Please send article submissions to the newsletter editor, Dana Jamero, via at djamero@xula.edu.

3 Louisiana Society of Health-System Pharmacists Page 3 From the desk of the President continued from page 1 The answers to these questions will help to define the rules and put us on a level playing field. As a leader, I find motivating others to comply with the final key to success, Constantly Playing, the most difficult challenge of all. We are faced with the challenges of balancing our personal and professional lives while optimizing our overall quality of life. Constantly Playing does not always fit this mold. One of the most profound statements that I read regarding whether or not to play the game was that we are all playing the game; the only thing that you can control is the role you choose. By not actively engaging and pursuing your goals, you are taking on the role of the victim. Pharmacy is our profession, our livelihood, and our means to improve the lives of the patients we serve. Therefore, we must control our faith and not be victimized by others that will control it for us. Conceptually, Ed s three keys to success are very simple to understand but very difficult to comply with individually. That s why LSHP exists. Collectively, we have a much greater chance to define our goals, determine the rules and provide a constant presence and representation of each and every pharmacy professional s quest to preserve our place in health-systems across the great state of Louisiana. I would like to thank you for entrusting me with the leadership of LSHP for the coming year and for supporting Pharmacy Practice in Louisiana! Gratefully Yours, Edward Stemley, Pharm.D., M.S. LSHP, President The Southeast chapter of LSHP will hold its October meeting on October 24, 2013 at Xavier University of Louisiana. Lori Crawford, PharmD, will be presenting 2013 Immunization Updates for one hour of continuing education credit for pharmacists and pharmacy technicians. Dr. Crawford is a Clinical Assistant Professor at Xavier University College of Pharmacy. She maintains an ambulatory practice site at Daughters of Charity Services of New Orleans. Our November meeting will be on Pediatric Drug Disposition presented by Joseph LaRochelle, PharmD. Dr. LaRochelle is a Clinical Associate Professor at Xavier University College of Pharmacy and Clinical Assistant Professor at LSUHSC School of Medicine. He maintains a clinical practice site at Children s Hospital. SELSHP Chapter Update Heather Aaron, SELSHP Chapter President The SELSHP chapter would like to thank Drs. Crawford and LaRochelle for presenting these continuing education seminars to our members. Past CE presentations from this year included the following presenters and topics: Courtney Harrell, PharmD: Management of Gout Valentina Guzman, PharmD: Drug Resistant Gonorrhea Jessica Johnson, PharmD: Risks Associated with PPI Use

4 Dear Member, Louisiana Society of Health-System Pharmacists Page 4 We would like to offer you the opportunity to get involved with LSHP as a member of the Board of Directors (BOD). We are always looking for volunteers to share their time, talent, and fresh ideas with the Society. Regular meetings for the LSHP Board of Directors are held four (4) times per year. A typical meeting schedule follows: January or February a one day meeting. Usually held by distance connections between Monroe, Baton Rouge, and Shreveport. May A one-day meeting immediately prior to the LSHP Annual Meeting. Usually held in New Orleans. August A two day retreat for Board Members in Woodworth, LA. October A one-day meeting immediately prior to the LSHP Mid-Year Meeting. Usually in Shreveport Your input at Board of Director meetings is valued, therefore attendance is important. Two or more unexcused absences from BOD meetings may result in loss of membership on the Board. We are currently seeking nominations for the following positions. LSHP Call for Nominations President-Elect assists the President in achieving specific Society goals and objectives, and shall perform the duties of the President in the President s absence. The President-Elect assists the Treasurer and Finance Committee in budget preparation. The President-Elect also identifies potential committee chairs and members for the upcoming term of President. Secretary Term of office two (2) years. The Secretary is responsible for maintenance of accurate records of the meetings of the Board of Directors and General Membership Meeting. The Secretary works with the LSHP office staff to maintain and report accurate membership roles. We highly encourage you to consider one of these positions. Serving on the Board of Directors is not extremely time-consuming. All current members of the board work full-time and are able to easily devote time to foster and promote the growth of LSHP and the profession of pharmacy. If you are interested in being nominated for one of these positions, or if you have any further questions, please contact me or the LSHP office (see contact information below). Thank you, Roxie Board Member Elect (2 positions) Term of office two (2) years. The first year is served as a non-voting member while becoming familiar with the governing documents of LSHP. Board Member Elects may serve as chairs or co-chairs of standing committees. Elects may also serve as a proxy for an absent voting member. Members of the BOD foster and promote growth of LSHP and the profession of pharmacy. They represent the membership of the Society, as the official voice of pharmacists in health-system pharmacy. Roxie Stewart, Pharm D Immediate Past-President LSHP Chair, Nominations Committee (318) rstewart@ulm.edu Heather Gremillion Association Coordinator, LSHP (225) office@lshp.org President-Elect Term of office (1) year. This year is served by developing knowledge of the governing documents of LSHP in preparation for succeeding to the office of President the following year. The

5 Louisiana Society of Health-System Pharmacists Page 5 Invokana (Canagliflozin): First Approved Agent in a New Class of Diabetes Medications Chuong Michael Nguyen, Pharm.D. Candidate, Steven Metz, Pharm.D. Candidate, and Kristen Pate, Pharm.D., BCACP Diabetes is a disease that affects 25.8 million Americans, which is 8.3% of the United States population. In particular, type 2 diabetes mellitus (T2DM) accounts for about 90% of those patients diagnosed with diabetes. 1 T2DM results from insulin resistance, along with a progressive insulin secretion deficiency. To be diagnosed with diabetes, patients must meet one of the following diagnostic criteria: hemoglobin A1c (HbA1c) 6.5%, fasting plasma glucose 126 mg/dl, 2-hour plasma glucose (75 g OGTT) 200 mg/dl, or a random plasma glucose 200 mg/dl with symptoms of diabetes. 2 Uncontrolled diabetes can lead to microvascular and macrovascular complications. A HbA1c goal of < 7% is desirable in most patients with T2DM. Treatment of T2DM involves several pharmacologic options, along with lifestyle modifications for all patients. First line medication treatment is metformin unless contraindicated or not tolerated. If HbA1c is not at goal after three to six months, add-on therapy for further A1c reduction can be initiated with a second oral agent, a glucagon-like peptide-1 receptor agonist, or insulin. 2 On March 29, 2013, canagliflozin was approved by the Food and Drug Administration (FDA) and is currently available as the first in a new class of diabetes medications, the sodiumglucose cotransporter 2 (SGLT2) inhibitors. Canagliflozin s novel mechanism works quite differently from other available antihyperglycemic medications. The primary sites for glucose reabsorption are SGLT 1 and 2 in the proximal renal tubules of the kidneys, with approximately 98% of glucose being reabsorbed by SGLT2. Instead of directly dealing with insulin release or sensitivity, canagliflozin inhibits SGLT2. This leads to a reduction in filtered glucose reabsorption and lowering of the renal threshold of glucose which results in an increase in glucose excretion and decrease in plasma glucose concentrations. 3 Canagliflozin is indicated for use as an adjunct to diet and exercise as monotherapy or in combination therapy to improve glycemic control in adults with T2DM. 4 It should not be used in patients with type 1 diabetes, diabetic ketoacidosis, or severe hepatic or renal impairment. It is available as a 100 mg or 300 mg tablet. The recommended initial dose is 100 mg by mouth once daily before the first meal of the day. Patients who need further glycemic control may increase to 300 mg once daily if already tolerant to 100 mg and have an estimated glomerular filtration rate (egfr) of 60 ml/min/1.73m 2. In mild renal impairment, dosing adjustments are not necessary. Dosing in moderate renal impairment, egfr of ml/min/1.73m 2, is limited to 100 mg once daily. In patients with an egfr < 45 ml/ min/1.73m 2, canagliflozin should not be initiated and if already started, should be discontinued. 4 Canagliflozin is metabolized via O-glucuronidation by UGT1A9 and UGT2B4 to two inactive O-glucuronide metabolites. Drug interactions with UGT inducers, such as rifampin or phenytoin, may decrease the efficacy of canagliflozin. Precautions with canagliflozin include: hypersensitivity reactions, hypotension, hyperkalemia, genital mycotic infections, lipid abnormalities, and hypoglycemia when used with insulin or insulin secretagogues. It is contraindicated in patients with a history of serious hypersensitivity reactions to canagliflozin, severe renal impairment (CrCl <30), end stage renal disease or patients on dialysis. Canagliflozin is Pregnancy Category C, and based on studies in animals, may affect maturation and development of the kidney. 4 When dispensing canagliflozin, a medication guide should be provided to the patient. In a 26-week randomized, double blind, placebocontrolled, phase 3 trial, it was found that canagliflozin as monotherapy decreased HbA1c by approximately one percent. Also, canagliflozin showed a small reduction in weight (~2-3%) and systolic blood pressure (~4-5 mmhg) compared to placebo. This trial showed a low risk of hypoglycemia (3.6% for 100 mg and 3.0% for 300 mg). 5 In clinical trials, it has been shown that there is an increased incidence of urinary tract infections, genital mycotic infections, dehydration (due to increased urinary output), and hyperkalemia. 4 As a part of its approval, the FDA is requiring additional post-marketing studies on canagliflozin s long-term safety. With these additional studies, the role of canagliflozin can be further defined. Currently, canagliflozin offers another viable pharmacologic option for the management of patients with T2DM, depending on patient specific factors and goals. References: 1. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. Center for Disease Control and Prevention Web site. Published February Accessed June 25, American Diabetes Association. Standards of medical care in diabetes Diabetes Care. 2013;36 Suppl 1 (Supplement_1):S Devineni D, Curtin CR, Polidori D, et al. Pharmacokinetics and pharmacodynamics of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in subjects with type 2 diabetes mellitus. J Clin Pharmacol. 2013;53(6): Invokana [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; Stenlöf K, Cefalu WT, Kim KA, et al. Efficacy and safety of canagliflozin monotherapy in subjects with type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetes Obes Metab. 2013;15(4): FDA approves Invokana to treat type 2 diabetes. Food and Drug Administration Web site. NewsEvents/Newsroom/PressAnnouncements / ucm htm. Published March 29, Accessed May 24, 2013.

6 Louisiana Society of Health-System Pharmacists Page 6 LSHP 2013 Mid Year Meeting Photos Thanks to everyone who attended the 2013 Mid Year Meeting!! It was a great success!

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8 Upcoming Events October 26: ULM College of Pharmacy will be hosting its Homecoming Tailgate. Party at the ULM Grove Area. Food Service Lines are expected to open at 11:00 am that Saturday morning. Game is to begin at 6:00 PM. November 21: December 8-12: May 22-24, 2014: Dr. Kent Stoneking will be providing a CE activity on diabetes care with 1.5 CEU at 7:00 PM in the West Monroe Convention Center ASHP Midyear Meeting, Orlando, FL LSHP 2014 Mid Year Meeting Hyatt Regency New Orleans