Updates in New Treatments for Cancers: Oral Chemotherapy Agents

Speaker: Joanna Schwartz, Pharm.D., BCOP
Albany College of Pharmacy

1. Describe available oral chemotherapy agents available for treatment of cancers, including their dosing, administration, drug interactions, and main adverse effects.
2. Identify safety issues with oral chemotherapy administration including potential for medication errors and safe handling and disposal.
3. Communicate and define various possible safety precaution and patient safety programs that may be instituted in clinics or community pharmacies to enhance and advance the safe and appropriate use of oral chemotherapy agents.

November 5, 2009
Capitol Plaza, Montpelier, Vermont
6:00 PM Registration
6:30 – 7:30 PM Program and dinner
ACPHS # Universal Activity # (UAN) 0045-0000-09-035-L01-P. (1 contact hour–0.1 ceu)

Cost: Pharmacists $30 Technicians / Students $20

Menu Options:

• Slow Roasted Sirloin Steak (10 oz.) with a Caramelized Shallot Bourbon Sauce and Garlic Smashed Potatoes
• Honey Teriyaki Filet of Atlantic Salmon (6 oz.), Jasmine Rice and Asian Vegetables

Albany College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

RSVP to Lisa Jackman, CPhT, by November 2nd at 802-847-9665 or lisa.jackman@vtmednet.org

ASHP Publishes Pharmacy in Public Health: Basics and Beyond

With the flu season and the H1N1 virus looming, pharmacists are increasingly being called on to take a more active role in public health, from immunizations to disaster planning and management. ASHP’s new book, Pharmacy in Public Health: Basics and Beyond, provides pharmacists and other health care practitioners with critical information they’ll need to play a much-needed role in public health, for flu season, emergency preparedness, and chronic disease prevention and management.

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With two years remaining until ozone-depleting nonprescription epinephrine inhalers must come off the market, FDA is seeking an effective way to inform those who purchase the products that they need to find an alternative remedy for asthma symptoms.

The agency held a public meeting September 25 in Rockville, Maryland, to discuss with stakeholders several challenges with the phaseout. These include identifying people who purchase the inhalers, telling them about the deadline, and protecting their health as they transition to new treatments for their asthma, officials said.

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A team of physical therapists, pharmacists, engineers, and nurses are paying visits to the homes of senior citizens in the Dallas-Fort Worth area to inspect the residences' safety. Such inspections are part of a free service to reduce seniors' risk of traumatic injury due to falls. The Centers for Disease Control and Prevention note that falls are the leading cause of accidental death in people 65 years of age and older. In addition, falls are responsible for at least 95 percent of hip fractures in that age group, and 50 percent to 66 percent of falls take place in or around the home. Mary Ann Contreras at Texas Health Harris Methodist Hospital Fort Worth says most falls can be deterred via home safety checks, exercise, and medication reviews.

The FDA has issued a Public Health Alert due to reports received by the agency of errors when dosing instructions for patients taking oseltamivir (Tamiflu) do not match the dosing dispenser. The agency believes these errors are due to the fact that most liquid medications are prescribed using milliliters or teaspoons, while oseltamivir is dosed in milligrams (mg). To prevent these errors, the FDA has asked that pharmacists ensure that the units of measure on prescription instructions for the drug match the dosing device provided. Healthcare providers should also make sure they write all doses in mg if the dosing dispenser for the drug is in mg.

Stanly Community College (SCC) in North Carolina has announced that it will be offering pharmacy technician courses beginning in Spring 2010. Courses are designed to prepare students for certification with the Pharmacy Technician Certification Board. The program includes lecture, lab, and clinical instruction, as well as national certification exam preparation. The pharmacy technician program is a 108-hour course, with 36-hours of coursework in the clinical setting. The new courses are being offered as part of the JobsNOW initiative, which is designed to provide jobs to residents in needed fields. According to the North Carolina Employment Security Commission, the number of pharmacy technician jobs in the state will increase 42 percent in the next 16 years.

The British Columbia government has announced that it will be giving $86 million to the University of British Columbia to construct a new building for the faculty of pharmaceutical science. The new building will allow the department to grow and accept 47 percent more students. It will include research and teaching laboratories, office space, classrooms, and other space that will be leased to drug research and development companies. There is a growing need for pharmacists outside the Vancouver area as the population ages and pharmacists retire. "This is a very exciting development," says Marshall Moleschi, registrar of the BC College of Pharmacists. "It meets a huge need. Our society needs to be able to make sure there are enough pharmacists in this province to be able to meet the needs of the aging population."

The Association for Professionals in Infection Control and Epidemiology (APIC) has called for healthcare facilities to require that all employees with direct patient contact receive annual flu vaccines. Only about 40 percent of healthcare personnel receive yearly flu shots, according to estimates from the Centers for Disease Control and Prevention. APIC also recommends that healthcare facilities obtain informed statements acknowledging the risk to patients from employees who decline the vaccines for non-medical reasons. APIC recommends that all employees with direct patient contact be immunized each year, including physicians, nurses, pharmacists, therapists, dieticians, religious workers, environmental services, and kitchen staff.

Following the 2004 Institute of Medicine report that estimated 98,000 patients die in hospitals annually due to preventable medical errors, hospitals across the country have sought different strategies to reduce such errors. California-based John Muir Health System invested $40 million in a number of technologies, including a medication-dispensing robot. Doctors input medication orders into the computer, and the orders are checked by pharmacists before the robot retrieves the medication. Other technologies are available that use biometric fingerprint scanners to grant nurses access to medication cabinets, and nurses ensure they have the right medication by scanning bar codes. John Muir Health Systems estimates that patient mortality rates have declined 25 percent since the adoption of the new medication administration technologies.

The United States Pharmacopeia (USP) has adopted new manufacturing controls for heparin that will result in a decrease in the potency of heparin used in the United States, according to the FDA. The changes adopted by the USP include a modification of the reference standard for the drug's unit dose so that it now matches the World Health Organization's International Standard unit dose definition, which has been in use in Europe for some time. The revised USP reference is approximately 10 percent less potent than the former USP unit. While these controls officially take effect Oct. 1, the FDA has asked that manufacturers not ship new product until Oct. 8, in order to give healthcare facilities time to make any necessary changes to their pharmacy procedures and dosing practices. These revisions were made, in part, as a response to an incident of heparin contamination involving a manufacturing step in China. The monograph for heparin has now been changed to include a test for the contaminant.

Adding pioglitazone to the combination of metformin and a sulfonylurea or a glinide may help control stubborn type 2 diabetes, researchers suggest. According to a team from Centre Hospitalier Sud Francilien, Corbeil Essonnes, this therapy should be implemented as soon as possible. Their study involved 299 patients with type 2 diabetes who had high hemoglobin A1C (HbA1C) levels despite dual therapy with metformin and a sulfonylurea or a glinide. After adding pioglitazone therapy, 64.8 percent of the treated patients and 9 percent of controls experienced the minimum goal of 0.6 percent HbA1C reduction. After seven months, 39.4 percent of pioglitazone patients and 4.8 percent of placebo patients had HbA1C levels below 7 percent. In the group that received pioglitazone, the homestasis model assessment of insulin resistance, insulin, proinsulin, and C-peptide decreased, and HOMA-B increased. This study is published in the September issue of Diabetes, Obesity and Metabolism.

Although the H1N1 swine flu virus is spreading more quickly and causing more severe disease than seasonal flu, U.S. researchers say that it shows no sign of mixing with other flu strains to create a so-called "reassortant virus." A University of Maryland study conducted on ferrets infected with 2009 H1N1 virus plus either seasonal H1N1 or H3N2 viruses found that both viruses made them sick, but only the H1N1 virus spread to other ferrets. The pandemic H1N1 virus established infections deeper in the respiratory system, while the seasonal flu strains stayed in the nasal passages. Five companies are now making swine flu vaccine for the U.S. market, and tests have begun to determine if people will need one or two doses for protection.