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IN THIS ISSUE
• Men Taking Amiodarone At
Increased Risk For Cancer
• Florastor® Updated Advisory
• New Drug Updates
Statins And Cancer Related Mortality
New Hybrid Grapefruit
Avoids Drug
Interactions
Another Step Toward
An Alzheimer’s
Vaccine
Follow ‘Diamond Pharmacy
Services’ on Facebook
VOLUME 10, ISSUE 2, 2013
A Diamond Pharmacy Services Publication
http://www.diamondpharmacy.com
Alternative
Treatment For
Obstructive Sleep
Apnea
In This Issue:
Page 7
Page 8
Editorial Staff
Editor: Eric Pash, R.Ph.
Associate Editors:
Denise Zahorchak, R.Ph.,
Rachael Houllion
Design Staff
Steve Heidenthal
Nick McFerron
Ashley Cheney
Reader Information
If you have any questions or
comments regarding this publication,
please contact our Diamond editors
1.800.882.6337 or via e-mail:
[email protected]
[email protected]
If your company is interested in
advertising your product or service
in this Diamond publication, please
contact our Marketing Department
4
Adverse Drug Watch:
- Azithromycin Associated With Abnormal
Heart Rhythms
- Newer Diabetes Agents And Pancreatic Cancer Risk
5
6
7
Adverse Drug Watch:
Men Taking Amiodarone At Increased Risk For Cancer
Page 13
Page 6
Adverse Drug Watch:
Statins And Cancer - Related Mortality
Regulatory Update:
Legislation To Reschedule Products Containing
Hydrocodone Introduced To Congress
[email protected]
Diamond Pharmacy Services
645 Kolter Drive
Indiana, PA 15701-3570
www.diamondpharmacy.com
1.800.882.6337
Issue 2, 2013
Diamond will not be held responsible for the content within the paid advertisements, nor do we endorse any advertised products or services. Organizations providing financial support do
not participate in the editorial process or otherwise influence editorial decisions. Every effort is made to ensure the accuracy of the information published. Since the standards of care
change rapidly, the authors and editors will not in any way be held liable for the timeliness of information or for errors, omissions, or inaccuracies in this publication. Clinical judgement
must guide each professional. Consult complete prescribing information before administering any medication.
Page 19
8
Keeping It Safe:
New Hybrid Grapefruit Avoids Drug
Interactions
16
In The News:
Another Step Toward An Alzheimer’s
Vaccine
9
10
Keeping It Safe:
Florastor® Updated Advisory
18
Diamond Makes A Difference:
- Diamond Pharmacy Services 1st Annual
Spring Educational Conference
- Diamonds Fundraisers In Support Of
Relay For Life
19
Diamond Makes A Difference:
DEA Take-Back Day A Huge Achievement
12
Med Supply Corner:
Alternative Treatment For Obstructive
Sleep Apnea
New And Noteworthy:
New Drug Updates
• Axona®
• Lumigan® 0.01%
• Abilify MaintenaTM
• InvokanaTM
• TecfideraTM
Azithromycin Associated With
Abnormal Heart Rhythms
Ashley Cheney, Marketing
DIAMOND PHARMACY SERVICES
T
he FDA is warning the public that the antibiotic
azithromycin
(Zithromax®,
Z-pak®)
can
potentially cause fatal heart arrhythmias. Patients
at risk for developing this condition include those
with known risk factors such as existing QT interval
prolongation, low blood levels of potassium or
magnesium, a slower than normal heart rate, use of
certain drugs used to treat abnormal heart rhythms,
and arrhythmias.
Azithromycin is an antibiotic commonly used to
treat infections. The FDA - approved indications for
azithromycin include: acute bacterial exacerbations
of chronic obstructive pulmonary disease, acute
bacterial sinusitis, community-acquired pneumonia,
pharyngitis/tonsillitis, uncomplicated skin and skin
structure infections, urethritis and cervicitis, and
genital ulcer disease.
A study reported an increase in cardiovascular
deaths with patients who were treated with
azithromycin compared to other patients who were
treated with amoxicillin, ciprofloxacin, or no drug.
Healthcare professionals should weigh the risk of
fatal heart arrhythmias and torsades de pointes,
which is an abnormally fast heartbeat, associated
with azithromycin when considering treatment
options for patients who are already at risk for
cardiovascular events. The FDA notes that the
potential risk of QT prolongation with azithromycin
should be placed in appropriate context when
choosing an antibacterial drug. Alternative drugs
in the macrolide class, or non-macrolides such as
the fluoroquinolones, also have the potential for QT
prolongation or other significant side effects, and
this should also be considered when choosing an
antibacterial drug.
References available upon request
Newer Diabetes Agents And
Pancreatic Cancer Risk
Ashley Cheney, Marketing
DIAMOND PHARMACY SERVICES
T
he FDA is looking into evidence that a recently
approved group of diabetes drugs can increase
the chance of pancreatitis and other health issues.
The drugs mimic natural hormones that the body
4
Issue 2, 2013
can usually produce to spur insulin production
following a meal.
the most common form of diabetes. People who
have type 2 diabetes are unable to properly break
down carbohydrates, either because their bodies do
not produce enough insulin or because they have
become resistant to the hormone, which controls
blood sugar levels. These patients are at higher risk
for heart attacks, kidney problems, blindness, and
other serious complications. In recent years, some
of the world’s largest drugmakers have launched
new treatments for diabetes, despite emerging
safety issues.
Scientists performed research on samples of
pancreatic tissue from a small number of patients
having type 2 Diabetes who had died from various
causes and who were taking newer diabetes
medications. The drugs under review were exenatide
(Byetta™, Bydureon™), liraglutide (Victoza™),
sitagliptin (Januvia™, Janumet™, Janumet XR™,
Juvisync™), saxagliptin (Onglyza™, Kombiglyze
XR™), alogliptin (Nesina™, Kazano™, Oseni™),
and linagliptin (Tradjenta™, Jentadueto™).
Analysis of samples of pancreatic tissue taken from
the deceased patients showed inflammation and
cellular changes that occur before cancer.
In 2007 and 2009, the FDA added information to
the product labeling for Byetta™, Januvia™, and
Janumet™ pertaining to cases of pancreatitis, in
some instances fatal. Recent studies of insurance
records found that the use of these medications
could double the risk for developing acute
pancreatitis.
The FDA has not concluded that the drugs could
cause or increase the risk of pancreatic cancer
and agree that patients who are taking these
medications should continue to do so unless
instructed otherwise by a doctor.
References available upon request
Men Taking Amiodarone At
Increased Risk For Cancer
Rachael Houllion, Administration
DIAMOND PHARMACY SERVICES
S
tudies have identified that the antiarrhythmic
drug amiodarone (Cordarone®) might possibly
be linked to a greater risk of cancer in men. These
findings were shown to be more pronounced in
those receiving higher daily doses of amiodarone
within the first year of treatment. The cancer risk
for patients taking amiodarone increased with a
standardized incidence ratio of 1:12. This risk for
developing any type of cancer was found to be
higher for men than women.
“After three years of follow-up, men who received
cumulative defined daily doses in a year, greater
than 180, had a 46% higher risk of cancer”, reported
Vincent Yi-Fong Su, MD Taipei Veterans General
Hospital, Taipei, Taiwan and his colleagues.
There were 6,418 patients in the final cohort,
approximately 57% comprised of men. The median
age of diagnosis was 70 years, and the median for
follow-up was 2.57 years.
During the cohort, patients also developed other
comorbidities, including hypertension (76%),
cardiovascular disease (72%), heart failure (47%),
chronic pulmonary obstructive disorder (44%),
diabetes mellitus (39%), chronic kidney disease
(25%), and cirrhosis (3.2%).
At the endpoint of the study, there were 280
patients diagnosed with cancer - 198 men and 82
women. “An explanation to the difference is that
there is a 37% higher clearance rate of amiodarone
in females than in males, because of differences in
cytochrome P450 3A4 activity and the percentage
of body fat.”
For more information, visit: http://drugtopics.
modernmedicine.com/print/368792
Affecting 25 million Americans, type 2 Diabetes is
5
Statins And CancerRelated Mortality
Rachael Houllion, Administration
DIAMOND PHARMACY SERVICES
S
tatins are a class of medicines that are
frequently used to lower blood cholesterol
levels. They work by blocking the action of HMGCoA reductase, an enzyme found in the liver that
is responsible for cholesterol production. Many
people who begin treatment with a statin to lower
their cholesterol levels lessen it on average by 25
– 30%.
Because cholesterol is necessary for cell growth,
researchers have hypothesized for many years
that reducing the amount of cholesterol in the
body could lead to decreased cell growth and a
positive effect on cancer. A study investigating the
association between statin use and cancer-related
mortality has been conducted in patients over
the age of 40 who were diagnosed with cancer
between 1995 & 2007. This information was taken
from a network of national databases in Denmark.
The retrospective observational cohort study was
done using data from the Danish Civil Registration
System, the Danish Cancer Register, and the
Danish Register of Medicinal Products Statistics
to determine whether the use of statins before and
following a diagnosis of cancer was associated
with reduced cancer-related mortality.
The nationwide study was based on patient records
of 295,925 people aged > 40 years who were
diagnosed with cancer. Regular use of statins
within two years of cancer diagnosis was shown
to significantly reduce death by cancer or all-cause
mortality than in those patients who had never
used statins. Patients diagnosed with cancer at
< 40 years of age were excluded from the study,
as they would have been unlikely to have received
statins. Researchers preformed a nested 1:3
matched study. Each statin user was matched with
three people who had never used statins. Matches
were associated with an increased risk of death
from cancer, including those for sex, age at cancer
diagnosis, year of diagnosis, and cancer type.
Diabetes and cardiovascular disease patients were
excluded from the study to improve the matching of
patient characteristics. Study results showed that
regular statin use was associated with reduced
death from cancer-related causes and all-cause
mortality by approximately 15%.
Eric Jacobs, PhD, American Cancer Society
Strategic Director of Pharmacoepidemiology,
followed the study by the Danish, noting that the
study is exciting, however it does not mean people
with cancer should start using statins in the hopes
of improving their progress. Jacobs also stated
that other factors could account for the lower death
rates. For example, patients taking statins could
have also been taking aspirin, which has been
linked with improved cancer survival in some recent
studies. In addition, randomized trials involving
patients taking statins to prevent heart disease
have not shown a benefit against cancer.
The question remains, can the use of statins help
prevent or improve cancer survival? “Additional
research will be needed to clarify if and how statins
might influence survival in cancer patients,” said
Jacobs.
References available upon request
Legislation To Reschedule
Products Containing Hydrocodone
Introduced To Congress
Rachael Houllion, Administration
DIAMOND PHARMACY SERVICES
O
n March 20, 2012 Senators Joe Manchin
(D-W.Va) and Mark Kirk (R-IL) in coordination
with Representatives Vern Buchanan (R-FL) and
Edward Markey (D-MA) presented their “Safe
Prescribing Act of 2013” to Legislation. This
is an attempt to tighten restrictions on what is
characterized as some of the most powerful,
addictive narcotics on the market.
Legislation intends to reschedule hydrocodone
combination product painkillers, including
Vicodin® and Lortab®, from Schedule III to
Schedule II controlled substances. 44 cosponsors of the bill (29 Republicans, 15
Democrats) were listed in a press release,
claiming that the rescheduling will accurately
reflect the drug’s potentially high percentage
of addiction and abuse. Dr. Andrew Kolodny,
President of Physicians for Responsible Opioid
Prescribing was quoted in the press release
saying “the legislation will correct an error
made over 40 years ago when the Controlled
Substances Act (“CSA”) incorrectly classified
hydrocodone combination products. There is
a clear and convincing medical evidence that
hydrocodone has the same abuse liability as the
schedule II opioids.”
References available upon request
DID YOU KNOW?
Since there is such a wide variety of drugs that contain
hydrocodone, the number of people becoming addicted
increases each year, by an average of 20 percent. Teens
lead the statistics of hyrdocodone addictions, accounting
for 65 percent of addicted individuals.
Sources: www.rehab-international.org/hydrocodone-addiction
6
Issue 2, 2013
7
Florastor® Updated Advisory
Trina Plazio, RN, CRNI
DIAMOND PHARMACY SERVICES
R
New Hybrid Grapefruit Avoids
Drug Interactions
Courtney Adams, Administration
DIAMOND PHARMACY SERVICES
T
hose individuals who love grapefruit, yet
cannot consume it without risking potentially
serious side effects due to the fruit’s chemical
interactions with 40+ drugs, may soon have
reason to rejoice. According to University of
Florida researchers, they believe they have
created a hybrid grapefruit that contains very
low levels of organic chemical furanocoumarins,
which are believed to prohibit enzymes from
breaking down certain medications, resulting in
higher concentrations for those medications in
the bloodstream and thus potentially resulting
in an overdose. Their theory is that this hybrid
is safe to be consumed while taking any
medication.
At this point, tests of the grapefruit juice
in human cells are needed in order to
see if the researchers are correct,
however Fred Gmitter, citrus geneticist and
researcher at the University of Florida, is hopeful.
“Doctors don’t generally tell their patients not to
drink lemonade or not to eat celery. So these
should be as safe as or safer than lemons or
celery.”
References available upon request
ecently, product information for Florastor® was updated to include in its contraindications and warnings
section information pertaining to giving the probiotic to patients with central vascular access devices (CVADcentral lines, PICC lines, and implanted ports). Florastor® was introduced as a dietary supplement and therefore
was not put to the scrutiny of the FDA approval as a drug. The manufacturers and the CDC have both provided
suggestions on how to administer Florastor® to a patient having a CVAD. We encourage you as a facility to
address this situation and create a policy specific to your institutional guidelines. Listed below is the updated
section direct from the manufacturer’s insert, along with guidance from the CDC.
Florastor Website
Healthcare Professional
Contraindications and Warnings
Contraindications
Florastor is contraindicated in patients with a central
line. There are rare reported cases of fungemia due
to accidental manual introduction of Saccharomyces
boulardii lyo cells by individuals into the bloodstream
via a central line. Should a patient develop fungemia,
proper management practices include discontinuation
of Florastor, treatment with appropriate antifungals,
and, when appropriate, removal of the central line.
Central lines include short- and long-term central
venous catheters (CVCs), peripherally inserted central
catheters (PICCs), and totally implantable devices
(e.g., ports).
Warnings
Do not open Florastor capsules or packets in the
vicinity of patients with central lines. Healthcare
workers should follow standard good practices: always
change gloves after handling Florastor as to avoid any
accidental transfer into the central line of any patient.
http://florastor.com/learn-about-probiotics/healthcareprofessionals/contraindications-warnings
Centers for Disease Control and Prevention
Emerging Infectious Disease Journal
Volume 16, Number 11—November 2010
Regulatory Oversight and Safety of Probiotic
Use
Ensuring Patient Safety
Ensuring Patient Safety
Hospitalized patients for whom clinicians may consider
use of a probiotic to manage severe and/or recurrent
CDI often have many of the above risk factors for
development of fungemia, making administration of
S. boulardii less than desirable and its routine use
8
Issue 2, 2013
unsafe. Guideline experts specifically recommend that
administration of S. boulardii be avoided for persons
who are immunocompromised, are critically ill, or have
a central venous catheter. The Florastor package
insert even recommends that patients with a central
venous catheter consult a healthcare professional
before starting therapy and further mentions that “very
rare cases of fungemia have been observed in patients
with a central venous catheter.”
Institutional guidelines are needed to address the
potential safety issues related to S. boulardii use. After
the decision is made to use probiotics on the basis of
careful risk assessment, we suggest that the following
measures be taken: 1) healthcare providers should
wear gloves during the handling of probiotic agents
for administration, then promptly discard the gloves
and properly wash their hands with soap and water,
2) drug capsules should not be opened near patients
with central venous catheters because aerosolized
spores could cross-contaminate sterile sites (i.e., enter
blood through catheter site) of patients receiving the
probiotic as well as other patients nearby, 3) enteral
administration of S. boulardii should be avoided
because of the risk for environmental contamination
and cross-contamination when the seal of the capsule
is opened.
Probiotic products contain different genera, different
species, or even different strains of the same species.
Although the safety concerns noted here for S.
boulardii may not be extrapolated to other probiotics
such as lactobacilli, bifidobacteria, and others, use of
any probiotic dietary supplement as a drug in diseased
or immunocompromised populations requires specific
evaluation of safety in that population.
http://wwwnc.cdc.gov/eid/article/16/11/10-0574_
article.htm#ensuringpatientsafety
9
Snoring and Sleep Apnea
What are the effects?
Cardiac Problems
Alternative Treatment For
Obstructive Sleep Apnea
Depression
Abnormal heart rhythms,
heart attack and heart
failure.
Snoring
Obstructive
Sleep
Apnea
Judy Tomayko, Senior Respiratory Therapist
DIAMOND PHARMACY SERVICES
O
bstructive sleep apnea (OSA) is a serious
health problem that affects approximately
20% of adults, with more than 80% of those being
undiagnosed and untreated.
The prevalence of sleep apnea includes:
• One in five adults has mild OSA
• One in fifteen adults has moderate-to-severe
OSA
• 9% of middle-aged women and 25% of middleaged men suffer from OSA
Treatments for sleep apnea include continuous
positive airway pressure (CPAP) therapy,
uvulopalatopharynogoplasty
(UPPP),
and
mandibular repositioning devices (MRDs).
FIGURE 1:
therapy and are more effective compared to upper
airway surgery. The American Academy of Sleep
Medicine (AASM) indicates the use of MRDs in
patients having mild-to-moderate OSA who prefer
these devices to CPAP therapy or in those who fail
CPAP attempts.
The MRD works on the simple technique of opening
the airway, keeping the palate taught, and helping
air to flow during sleep (FIGURE 2). This device
prevents snoring and treats mild-to-moderate OSA
by advancing the lower mandible forward, opening
the airway for air flow to be successful. By keeping
the airway free and open during sleep, oxygen is
better able to get into the body, allowing for a more
restful and peaceful night’s sleep.
FIGURE 2:
Apnea
airway closed
With Mandibular
Repositioning Device (MRD)
Memory Problems
and inability to
think correctly
Hormone
Disruption
Stroke
On January 3, 2011 Medicare approved oral
appliances for the treatment of OSA. Billing code
E0486 – is defined as an “oral device/appliance
used to reduce upper airway collapsibility,
adjustable or non-adjustable, custom fabricated,
including fitting and adjustment.” Medicare will
approve an oral appliance for the treatment of
OSA for those patients that have had a face – to
– face visit with their physician and a diagnostic
test (PSG) prior to receiving the MRD. Medicare
High Blood
Pressure
Increased insulin
resistance
(Even in non-diabetic
patients)
Death
Increased traffic
and workplace
accidents
will only authorize a licensed dentist to bill for
the MRD. Many other commercial insurance
companies follow Medicare guidelines.
To learn more, contact our respiratory therapist
team at 724-599-2520. To obtain additional
information on OSA, you may also consult your
primary care doctor, refer to a sleep physician, or
visit the American Association of Sleep Medicine.
DID YOU KNOW?
An MRD is a custom-made device used for the
treatment of mild-to-moderate OSA, alleviating
snoring, and for those patients who do not tolerate
CPAP treatment (FIGURE 1). An MRD opens
the upper airway and decreases the collapsibility
of the upper airway. MRDs have been proven to
be equally effective in the treatment of OSA with
greater compliance than conventional CPAP
10
Issue 2, 2013
Clinical benefits of a MRD include:
• High compliance with the device
• Patients having moderate OSA exhibit an
average decrease of 57% in the Apnea/
Hypopnea Index (AHI)
• Noted AHI reductions in severe OSA patients
• Improvement in daytime somnolence
Staying fit and being healthy will help reduce the effects
of sleep apnea. Some of the biggest risk factors for
sleep apnea are related to your health including: being
overweight, consuming alcohol, and smoking. For many
people who suffer from sleep apnea, simply losing only 10
percent of their body weight can help reduce the number
of times they stop breathing at night.
Sources: www.negaoto.com
11
NEW DRUG UPDATES
0.01% has been reported to cause darkening
(pigmentation) of eye color, eyelid skin, and
eyelashes. Pigmentation changes can increase
as long as Lumigan® 0.01% is used. After
stopping Lumigan® 0.01%, darkening of eye
color is likely to be permanent, while darkening
of the eyelid skin and eyelash changes may be
reversible. The effects of increased darkening
beyond five years are not known.
For more information,
lumigan.com/
visit:
https://www.
Rachael Houllion, Administrative Assistant
DIAMOND PHARMACY SERVICES
AXONA
®
(caprylidene)
Axona (caprylidene) is a clinical dietary
management for mild-to-moderate Alzheimer’s
disease. Axona® was found to enhance
memory and cognition in a 90-day, phase llb
clinical trial.
®
Axona® can be used alone or concurrently
with other traditional therapies for Alzheimer’s
disease, such as AChE inhibitors and NMDA
receptor antagonists. It should not be taken
by patients having allergies to milk or soy.
Packaged in convenient individual 40-gram
powder packets, the product comes with easyto-follow instructions in each box.
Axona® is to be given once daily, shortly after
a meal, either at breakfast or lunch, whichever
one is the larger of the two. To reduce chances
of gastrointestinal events, Axona® should be
titrated gradually over seven days before
patients begin to take one 40-gram packet
per day. If side effects are experienced, overthe-counter medications such as simethicone,
antacids, and antidiarrheals may be useful.
In the event Axona® is discontinued until side
effects subside and resolve (typically within
two to three days), patients are encouraged
to restart Axona® at a lower dose and titrate
upward until the full therapeutic dose is reached
(40-grams daily). Should side effects continue
or reappear, patients should be referred to their
medical practitioner.
12
Issue 2, 2013
Ashley Cheney, Marketing
An Axona Discount Program is available for
financial assistance, covering up to 20% of the
cost of each monthly prescription.
®
For more information, visit www.about-axona.
com/ph or call 1-877-649-0004
References available upon request
LUMIGAN® 0.01%
(bimatoprost ophthalmic solution)
Lumigan® (bimatoprost) 0.03% eye drops
were recently removed from the market and
have been replaced with Lumigan® 0.01% eye
drops. Studies have shown that the 0.01%
potency is therapeutically equivalent to the
0.03% concentration.
Lumigan® 0.01% is indicated for the treatment
of increased intraocular pressure (IOP) in
individuals having open-angle glaucoma or
ocular hypertension.
The most common side effects associated with
Lumigan® 0.01% are eye redness, increased
growth of eyelashes, and itchy eyes. Lumigan®
DIAMOND PHARMACY SERVICES
ABILIFY MAINTENATM
(aripiprazole)
Otsuka America Pharmaceutical, Inc. (OAPI)
announced on February 28, 2013 that the FDA
has approved Abilify Maintena™ (aripiprazole)
for extended-release injectable suspension,
an atypical antipsychotic for the treatment
of schizophrenia. Abilify Maintena™ is the
first dopamine D2 partial agonist approved
as a once- monthly injection, offering a new
treatment option to help prevent relapse
and manage symptoms in patients with
schizophrenia.
Schizophrenia is a disease that affects over 24
million people worldwide and is characterized
by a distortion of thought processes and
emotional responsiveness. Common symptoms
include paranoid or bizarre delusions,
hallucinations, and disorganized speech and
thinking, accompanied by significant social or
occupational dysfunction.
Abilify Maintena™, an intramuscular (IM)
depot formulation of aripiprazole, is a sterile
lyophilized powder that, when reconstituted with
sterile water for injection, forms an injectable
suspension that can be administered monthly.
The recommended starting dose of Abilify
Maintena™ is 400 mg given IM once monthly.
If there are adverse reactions experienced with
the 400 mg dose, the dosage may be reduced
to 300 mg per month.
Following the first Abilify Maintena™ injection,
patients are instructed to continue treatment
with oral aripiprazole (10 mg to 20 mg) or other
oral antipsychotic for 14 consecutive days in
order to maintain therapeutic antipsychotic
concentrations during initiation of therapy.
Monthly injections provide patients with
concentrations of the active drug to remain at
a therapeutic range for an extended period of
time.
Potential side effects associated with Abilify
Maintena™ include cerebrovascular adverse
events
(stroke),
neuroleptic
malignant
syndrome (NMS), tardive dyskinesia (TD),
impaired judgment, and body temperature
changes. Metabolic changes such as
hyperglycemia/diabetes mellitus, weight gain,
and dyslipidemia were also noted during
clinical trials.
Abilify Maintena™ should not be used in
patients who are pregnant or consume alcohol.
Caution should be used with patients who have
aspiration pneumonia, seizures/convulsions,
leukopenia, neutropenia, and agranulocytosis,
cardiovascular
disease,
cerebrovascular
disease, or conditions which would predispose
them to hypotension.
For more information, visit www.fda.gov.
References available upon request
INVOKANATM
(canagliflozin)
The FDA has approved a new diabetes
medication from Johnson & Johnson.
Invokana™ (canagliflozin) has shown to be
effective in lowering blood sugar in patients
who have type 2 diabetes. Diabetes affects
the ability for the body to metabolize glucose,
13
Save the
Date
which is needed for energy. Type 2 diabetes is
the most common form of the disease.
Invokana™ is a member of a new class of
approved diabetes treatments called sodiumglucose co-transporter-2 (SGLT2) inhibitors.
Invokana™ is taken orally and has convenient
once-daily dosing. It is available in 100 mg and
300 mg dosages and should be taken prior to
the first meal of the day.
October
3rd, 2013
In addition to improved glycemic control,
significant reductions in weight and systolic
blood pressure-lowering endpoints were also
observed in patient taking Invokana™ during
clinical trials.
An increased risk of cardiovascular disease
and elevations in low-density lipoprotein (LDL)
cholesterol are possible with Invokana™ use.
Other side effects may include dehydration,
hypotension, impairment in renal function,
hyperkalemia, hypoglycemia, genital mycotic
infections, hypersensitivity reactions, and
macrovascular outcomes. Patients who have
severe kidney problems or who are allergic to
canagliflozin should not take Invokana™.
For more information, visit www.fda.gov.
References available upon request
TECFIDERATM
(dimethyl fumarate)
Biogen Idea Inc recently announced that the
FDA has approved Tecfidera™ (dimethyl
fumarate) - the first oral treatment for patients
with relapsing forms of multiple sclerosis.
Tecfidera™ is a nicotinic acid receptor agonist
that activates the nuclear factor-like2 (Nrf2)
pathway, which is involved in the cellular
response to oxidative stress.
Multiple sclerosis symptoms include limb
numbness, which can lead to paralysis and
blindness. The most common form of multiple
sclerosis is relapsing-remitting, characterized
by sporadic neurological attacks followed by
periods of recovery.
Presented By ~
Diamond Pharmacy Services & Medical Supply
Date & Time ~
Tecfidera™ was shown to reduce relapse rates
by 49% whenever the medication was dosed
two to three times a day. Tecfidera™ will be
available in 120mg and 240mg strengths. The
starting dose is 120mg twice daily. After seven
days, the dose should be increased to 240mg
twice daily. The medicine should be swallowed
whole and can be taken with or without food.
Tecfidera™ may cause lymphopenia, flushing
(warmth, redness, itching, and burning
sensations), and gastrointestinal effects
(nausea, vomiting, diarrhea, abdominal pain,
and dyspepsia).
The FDA recommends that a patient’s white
blood cell count be assessed prior to starting
treatment.
References available upon request
Thursday, October 3rd, 2013 from 7:00 am - 4:00 pm
Location ~
Kovalchick Convention & Athletic Complex
711 Pratt Drive Indiana, PA 15701
Continuing Education (CE) Credits For ~
PC / NH Administrators, Social Workers, & RNs
**Agenda to be determined
Cost ~
$30 per Attendee
For more information:
• Visit our website: www.diamondpharmacy.com
~ Click on the resources tab
~ Then click continuing education
• Call: Rachael Houllion at 724-349-1111 ext 2258
• E-mail: [email protected]
(Please Note: if e-mailing for information, e-mail addresses will only be used for educational purposes by the
educational conference committee)
Continue to follow our website over future months for further details
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Issue 2, 2013
645 Kolter Drive, Indiana PA 15701 ~ Phone: 800.882.6337 ~ Fax: 724.349.2982 ~ www.diamondpharmacy.com
Another Step Toward
An Alzheimer’s
Vaccine
Courtney Adams, Administration
DIAMOND PHARMACY SERVICES
A
Swedish investigational agent called CAD106
appears to be an early step on the way
towards an Alzheimer’s vaccine. Researchers
from the Karolinska Institute gave 58 women and
men having mild-to-moderate Alzheimer’s disease
injections of CAD106 or placebo and followed
them for three years. Three-quarters of those who
received CAD106 developed antibodies against
beta amyloid protein, which has been implicated
in Alzheimer’s disease. Almost all participants
reported relatively mild side effects, including
fatigue, headache, muscle pain, and inflammation
of the nose and throat.
“It’s much too early to say whether this particular
vaccine will prove to be a valuable treatment in
Alzheimer’s disease,” stated Dr. Anthony Komaroff,
professor of medicine at Harvard Medical School.
“Nevertheless, in contrast to 25 years ago, today
there is a lot of evidence that beta amyloid is one
important cause of Alzheimer’s disease, and that
targeting beta amyloid with drugs and vaccines
may bring benefits.
Because of biomedical
research, today we have real reason for hope.”
References available upon request
A larger clinical trial needs to take place to further
analyze the effectiveness of slowing the disease
and determine the safety of the vaccine, according
to researchers.
DID YOU KNOW?
In 2012, the direct costs of caring for those with Alzheimer’s
or other dementias to American society totaled an
estimated $203 billion, including $142 billion in costs to
Medicare and Medicaid.
Sources: Alzheimer’s Association - 2013 Alzheimer’s Disease Facts and
Figures
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Issue 2, 2013
17
during the last quarter. The fundraisers included a
Basket Raffle and a T-shirt Sale for the Diamond
Drugs Relay for Life Team.
Diamond Pharmacy Services 1st Annual
Spring Educational Conference
Rachael Houllion, Administrative Assistant
DIAMOND PHARMACY SERVICES
O
n Thursday, March 14, 2013 our Educational
Conference planning committee held a Hawaiian
Luau-themed seminar for attendees at the Best
Western Eden Resort in Lancaster, PA as part of its
1st Annual Spring Educational Conference. Diamond
Pharmacy sponsored a Personal Care (PC) Home
administrator and staff conference in conjunction
with a Skilled Nursing Facility (SNF) staff conference.
Overall, we had 47 attendees at this year’s event: 30
representing PC and 17 SNF participants.
PC administrators were offered six continuing education
(CE) credits. Diamond Consultant Pharmacist Eric
Pash, R.Ph presented on Coronary Heart Disease/
High Cholesterol and COPD. John Avolio, R.Ph, CGP,
head of Diamond’s Education Department, gave a
review on Pain Management. Debbie Yackuboskey,
RN, CRNP, Infection Control Coordinator, spoke on
Commonly Diagnosed Eye Disorders, in addition to
Fall and Accident Prevention. Deborah Milito, Pharm
D, Certified Anticoagulation Specialist, gave an update
on Anticoagulation – What’s Old / What’s New.
SNF staff attendees also had the opportunity to earn
six CE credits. Steve Jablunovsky, RN, CRNI and Trina
Plazio, RN, CRNI taught a four hour class on Advanced
IV Therapy for the RN: A review of the revised INS
Standards for Practice 2011. Steve Jablunovsky, RN,
CRNI also provided a two hour course on Parenteral
Nutrition.
Diamond would like to thank all of our guests and
sponsors who participated; without you the conference
would have not been a success. We hope that you
enjoyed this year’s spring event and that it was
worthwhile. We would also like to thank all the
Diamond employees who worked tirelessly to make
this year’s inaugural spring conference a success. We
look forward to seeing you again next year!
Diamond would like to extend a special thank you to
the participating vendors in attendance:
• Avanir
• Boehringer Ingelheim
• Cubist
• Mobile Xray
• Novartis
• Diamond Medical Supply
• eMAR
• Facility Link
Diamonds Fundraisers In Support
Of Relay For Life
Ashley Cheney, Marketing
DIAMOND PHARMACY SERVICES
E
ach year, more than 4 million people in over 20
countries take part in Relay for Life fundraisers to
raise money and awareness to save lives from cancer.
The American Cancer Society is nationwide, non-profit
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Issue 2, 2013
health organization dedicated to eliminating cancer and
has invested approximately $3.6 billion in research.
Diamond Pharmacy continued to participate in multiple
fundraisers in support of the American Cancer Society
The Relay for Life Basket Raffle was a fundraiser held
by Diamond in April. There were 31 baskets donated
this year by Diamond employees in the basket raffle.
People had a wide variety of baskets to choose from,
such as a Men’s basket, a Summer Fun basket, a
Mother’s Day basket and a Camping Basket. The
basket raffle was a huge success thanks to all of the
participants. From this fundraiser, Diamond collected
$2,880, with all proceeds going to the Diamond Drugs
Relay for Life team.
Diamond wants to thank everyone who has made a
difference and have participated in these fundraisers.
Diamond is currently holding a Marianna’s Pizza and
Sub sale fundraiser. Look for the results of this and
many other fundraisers in the next edition.
The T-Shirt sale was another huge fundraiser for
Diamond. All proceeds benefited the 2013 American
Cancer Society and Diamond Drug Relay for Life
Team.
Employees could choose from short and long sleeve
t-shirts, Nike dry fit golf shirts, hooded sweatshirts,
crewneck sweatshirts and full zip fleece jackets, with
a 2-color Diamond logo embroidered or screenprinted
on the front. Diamond was able to raise $819 from
this fundraiser.
Janet, a Diamond employee for almost ten years, was
the winner of the “Kickin’ Back by the Campfire” basket.
DEA Take-Back Day A Huge Achievement
Ashley Cheney, Marketing
DIAMOND PHARMACY SERVICES
The sixth National Prescription Drug Take-Back Day was
held on April 27th, 2013. This event was sponsored by the
Drug Enforcement Administration (DEA). Take-back days
offer an opportunity for individuals to anonymously bring
in their unused, unwanted, or expired drugs. The DEA
aims to provide a safe, proper, and convenient way of
disposing these drugs, while educating the public about
the potential risks associated with medication abuse.
Last fall, 56.57 pounds of unwanted medication was
collected at our Diamond retail store. This spring,
Diamond helped to collect a total of 84.2 pounds of drugs,
an additional 50% compared to last year! Nationwide, the
DEA collected 742,497 pounds (371 tons) of medications
from more than 5,829 locations across the country,
making the sixth National Prescription Drug Take-Back
Day twice as successful as last year’s event.
Once again, Diamond participated in this event at our retail
pharmacy located on Philadelphia Street in downtown
Indiana, PA, in cooperation with the Armstrong-IndianaClarion Drug and Alcohol Commission, the Indiana
County Sheriff’s Office, and the Indiana County District
Attorney’s Office.
Joan Zilner, R.Ph, President of Diamond Drugs, was very
pleased with the turn out of the DEA Take-Bake Day.
“Diamond’s is happy to participate in this nationwide effort
to keep unwanted medications out of the wrong hands
and out of our environment, where it can potentially harm
animals and humans. Indiana County kept up with the
rest of the nation by collecting 50% more this year than
last. We hope to double that next time.”
Overall, these take-back events combined have removed
more the 2.8 million pounds (1,409 tons) of medications
from circulation.
For more information, visit http://www.deadiversion.usdoj.
gov/drug_disposal/takeback/.
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